HRQOL Domains Research Articles

MP06-10 WHAT COMBINATION OF URETERAL STENT BIOMATERIAL AND PHARMACOLOGY OPTIMIZES HEALTH-RELATED QUALITY OF LIFE (HRQOL)?: A MULTIPLE-TREATMENTS (NETWORK) META-ANALYSIS

You have accessJournal of UrologyStone Disease: Surgical Therapy I (MP06)1 Sep 2021MP06-10 WHAT COMBINATION OF URETERAL STENT BIOMATERIAL AND PHARMACOLOGY OPTIMIZES HEALTH-RELATED QUALITY OF LIFE (HRQOL)?: A MULTIPLE-TREATMENTS (NETWORK) META-ANALYSIS Scott Brockman, Zev Leopold, and Ephrem Olweny Scott BrockmanScott Brockman More articles by this author , Zev LeopoldZev Leopold More articles by this author , and Ephrem OlwenyEphrem Olweny More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001973.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A majority of stented patients experience negatively impacted HRQoL, modifiable by stent biomaterial, length and/or pharmacologic treatment. However, the optimal combination of stent biomaterial and pharmacologic treatment to improve ureteral stent symptoms has not been reported to date. METHODS: We systematically reviewed randomized controlled trials from January 2005 to October 2020, that reported HRQoL in stented patients using the validated USSQ. Patients received a combination of any of the following ureteral stent biomaterials: silicone (Sili), Percuflex (Pflx), polyurethane (PU), Surgitek, or Applied Medical Vertex (AMVtx), with any of the following pharmacological drugs: alfuzosin (alf), mirabegron (mirabeg), oxybutynin (oxy), pregabalin (Pgaba), solifenacin (soli), tamsulosin (tam), or tolterodine (tolter). The primary outcomes were USSQ urinary, pain and general health (GH) index scores (higher scores=worse HRQoL). Multivariable random effects network meta-analysis was used to compare the different biomaterial / pharmacologic combinations using direct and indirect evidence, ranking the strategies from best to worst using the surface under the cumulative ranking curve (SUCRA) method (higher SUCRA=better treatment). Referent strategy was Pflx without drug treatment. RESULTS: A total of 13 studies with 1606 patients met inclusion criteria. Mean age was 45.7 yr and 59.6% were male. Sili+tam and Pflx+soli+Pgaba were the treatment combinations that best optimized HRQoL in stented patients across all 3 USSQ domains (figure). By SUCRA values, the 3 highest ranking strategies across all HRQoL domains were Sili+tam, Pflx+soli+Pgaba and Pflx+mirabeg (table). CONCLUSIONS: In patients requiring ureteral stents, use of Percuflex stents along with solifenacin + pregabalin, or silicone stents along with tamsulosin, may best mitigate stent-associated discomfort. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e93-e93 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Scott Brockman More articles by this author Zev Leopold More articles by this author Ephrem Olweny More articles by this author Expand All Advertisement Loading ...

MO555ASSESSMENT OF HEALTH-RELATED QUALITY OF LIFE (HRQOL) MEASURES FOR PAEDIATRIC PATIENTS WITH ANAEMIA OF CHRONIC KIDNEY DISEASE (CKD)

Abstract Background and Aims Anaemia is a common complication of CKD in children that is associated with adverse clinical outcomes, including poor physical functioning for patients and lower HRQoL for patients and caregivers.1 Given the subjective nature of the disease, instruments that measure patient- and/or observer-reported outcomes (PROs/ObsROs), by collecting information about symptom severity and HRQoL, could be of value to assess treatment benefit. We determined which aspects of anaemia of CKD and its treatments are important for paediatric patients and their caregivers, and examined which PRO/ObsRO instruments comprehensively capture patients’ and caregivers’ experiences. Method A targeted literature review and database search were performed to find a) qualitative and quantitative studies of symptoms and related health outcomes in paediatric patients with anaemia of CKD; b) related clinical practice guidelines; and c) HRQoL information in product labelling. Study outcomes were used to develop a structured representation of health outcomes concepts and issues (‘conceptual model’) capturing the symptoms, perceptions of treatment and impact on HRQoL of anaemia of CKD, from the perspective of both paediatric patients and their caregivers. PRO and ObsRO instruments were identified from published quantitative studies and ongoing clinical trials, and a selection was then critically assessed to determine their content validity and whether their psychometric properties adequately covered the conceptual model domains. Results The conceptual model captured shortness of breath, fatigue and headaches as the most important symptoms experienced by paediatric patients with anaemia of CKD. Concerns regarding disease management included medical interventions, fear associated with interventions and the need for information about the disease. Disease symptoms and their management impacted seven HRQoL domains, namely physical, emotional and social functioning; activities of daily living; and effects on family, work and caregivers (Figure). The quantitative search of published studies identified 20 unique instruments; of these, the most frequently used was Pediatric Quality of Life Inventory™ (PedsQL) Version 4.0. Ongoing clinical trials used 14 unique instruments, of which only EQ-5D-Y was used in more than one study. Two clinical practice guidelines (National Institute for Health and Care Excellence and Kidney Disease: Improving Global Outcomes) supported measurements of HRQoL, symptoms, patient preferences and school attendance/performance, but they did not advocate use of any specific instruments. No HRQoL product labelling information was identified. Based on the conceptual model, the literature review results and age group coverage, five instruments were selected for critical appraisal: PedsQL, PedsQL Infant Scales, PedsQL Multidimensional Fatigue Scale, PedsQL v3.0 End Stage Renal Disease module, and EQ-5D-Y. Between them, these instruments provided complete coverage of the impact of fatigue and headaches, and partial coverage of the effects on physical functioning, activities of daily living, emotional functioning and social functioning. None of these instruments measured the impact of shortness of breath, and there was no coverage of the consequences for work or the family’s/caregivers’ HRQoL. Conclusion Anaemia of CKD affects many HRQoL domains for paediatric patients and their caregivers. While current PRO/ObsRO instruments partially address these impacts, no single instrument in our assessment measured all symptoms and domains of interest to patients and caregivers. Multiple instruments should be included in clinical studies to capture symptoms and HRQoL important to patients, and adequate measurement of the effects of anaemia on work or the family’s/caregivers’ HRQoL might require development of a new instrument.

Patient-reported outcomes in hemodialysis vascular access: A call to action.

While access-related dysfunction is a clear driver of clinical outcomes and costs, the full impact of vascular access dysfunction on patient experience and quality of life is not fully characterized in the literature. One way to more comprehensively characterize the patient experience from the patient perspective is through patient reported outcomes (PROs). However, the limited implementation of PROs in clinical trials, patient registries, quality measurement, and other research settings has significantly constrained the patient voice in evaluation of vascular access outcomes and vascular access decision-making. To address these issues, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and the U.S. Food and Drug Administration, assembled an interdisciplinary workgroup to enhance uptake of access-related PROs with the aims of: (1) reviewing the domains of HRQOL that are affected by vascular access, collect information on existing instruments that measure access-specific HRQOL in hemodialysis, and identify gaps in existing measures; (2) identifying and critically assessing barriers to widespread use of access-specific PRO measures; and (3) defining initiatives to overcome barriers and make recommendations for strategies to improve the use and utility of access-specific PRO measures. A consensus group process identified potential barriers to use of PRO measures in six categories: (1) PRO misperceptions, (2) patient factors, (3) regulators and payers, (4) instrument factors, (5) study design, and (6) physicians. The workgroup provided recommendations for actions to promote the widespread utilization of vascular access-related PRO measures in five categories: (1) development of vascular access-specific PRO measures, (2) ensuring comprehensive assessment when using vascular access PRO measures, (3) ensuring accessibility and applicability of vascular access PRO measures to all end stage kidney disease populations, (4) establishing universal guidelines and accepted vascular access PRO measures, and (5) engaging stakeholders across all facets.

Health-related quality of life and neuropathic pain in sickle cell disease in Jamaica

BackgroundHealth related quality of Life (HRQOL) is an important consideration when managing chronic diseases, like sickle cell disease (SCD). Assessment of neuropathic pain (NP) and its association with HRQOL in SCD are rarely reported. ObjectivesTo examine the prevalence of NP and its association with HRQOL in adult Jamaicans with SCD. MethodsAdult SCD patients were recruited consecutively and data were collected on socio-demographics, NP using Douleur Neuropathique 4 (DN4), and HRQOL using the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me). Means, medians, t-tests, ANOVA tests, Wilcoxon Rank-sum tests, Kruskal-Wallis tests, Pearson’s correlation and multivariate linear regression analyses were performed using STATA 14.2. ResultsThere were 236 respondents, with 56.8% female, mean age 33.2 years (SD: 11.6; range: 18–67 years), and 75% had homozygous SS genotype. NP was likely present in 26.7% of the population. The standardized ASCQ-Me (mean ± SD; ordered from lowest to best HRQOL domain scores) were: emotional impact 53.3 ± 10.1; sleep impact 56.1 ± 9.7; social function 57.7 ± 10.6; pain impact 58.6 ± 7.8; and stiffness impact 61.0 ± 7.3.On multivariate analyses, NP significantly reduced emotional and social functioning and worsened sleep and stiffness. Higher acute pain scores significantly worsened all HRQOL domains, while higher disease severity worsened all except stiffness. Obesity was associated with worse sleep and greater stiffness. Females with leg ulcers reported lower social functioning and unemployed females had greater pain impact. ConclusionsNP is increasingly prevalent in SCD and worsens HRQOL. Gender specific studies are needed to understand the significantly poorer HRQOL in women.

HEALTH-RELATED QUALITY OF LIFE AND DEPRESSION AMONG PATIENTS OF LIVER CIRRHOSIS IN PAKISTAN

Objective: The present study was designed to assess HRQoL and depression among patients of liver cirrhosis in Pakistan.
 Methods: A descriptive cross-sectional study design was used to assess health-related quality of life and depression among liver cirrhosis patients in Pakistan. Two pre-validated questionnaires i.e. SF 36 and HADS were self-administered to a sample of 382 cirrhotic patient’s selected using convenience sampling technique for measuring HRQoL and depression, respectively. After data collection, data was cleaned, coded and analyzed using in SPSS version 21.
 Results: The results highlighted that lowest scores for HRQoL were observed in the domain of role physical (40.02,±24.01) followed by role emotional (41.93,±26.99) whereas the highest scores were observed in the domain of physical functioning (51.87,±15.22).
 Conclusion: The results of the present study concluded that liver cirrhosis patients in Pakistan had poor HRQoL across all domains along with mild to moderate depression. While all domains were affected, the greatest impact was on role limitation due to physical as well as emotional problems. The most affected group among patients were females and patients having age greater than 60 y. Besides this severity and advanced stage of cirrhosis had a negative effect on all domains of HRQoL. Presence of complications further reduced HRQoL and increased depressive symptoms among liver cirrhosis patients.

An exploratory study of discrepancies between objective and subjective measurement of the physical activity level in female patients with chronic fatigue syndrome

ObjectiveTo explore the ability of a self-report activity diary to measure the physical activity level (PAL) in female patients with chronic fatigue syndrome (CFS) and whether illness-related complaints, health-related quality of life domains (HRQOL) or demographic factors are associated with discrepancies between self-reported and objectively measured PAL. MethodsSixty-six patients with CFS, recruited from the chronic fatigue clinic of a university hospital, and twenty matched healthy controls wore an accelerometer (Actical) for six consecutive days and registered their activities in an activity diary in the same period. Participants' demographic data was collected and all subjects completed the CFS Symptom List (illness-related complaints) daily and Short-Form-36 (HRQOL domains) during the first and second appointment. ResultsA significant, but weak association between the activity diary and Actical was present in patients with CFS (rs = 0.376 and rs = 0.352; p < 0.001) and a moderately strong association in healthy controls (rs = 0.605; and rs = 0.644; p < 0.001) between week and weekend days, respectively. A linear mixed model identified a negative association between age and the discrepancy between the self-reported and objective measure of PA in both patients with CFS and healthy controls. ConclusionThe activity diary showed limited ability to register the PAL in female patients with CFS. The discrepancy between measures was not explained by illness-related complaints, HRQOL domains or demographic factors. The activity diary cannot replace objective activity monitoring measured with an accelerometer, but may provide additional information about the perceived activity.

The Association of COVID-19 Pandemic Stress With Health-Related Quality of Life in the Kingdom of Saudi Arabia: A Cross-Sectional Analytical Study.

Background: There is a global disaster since WHO declared Covid-19 as a pandemic. With the increase in cases & mortality rate, various health issues viz., stress, mental disorders and altered health-related quality of life have been noted as a result of pandemic and lockdowns. This study aimed to assess the association of COVID-19 pandemic stress with health-related quality of life in the Kingdom of Saudi Arabia.Methodology: It was a cross-sectional analytical study. Subjects included 878 citizens and residents of Saudi Arabia aged 18 years and above. Convenience, non-probability sampling technique was used. A web-based, self-administered, electronic questionnaire in Arabic language having three sections; Sociodemographic & clinical profile, Standard PSS-10, and Standard SF-12 was used as the study tool and distributed through various social media means. The study period was of 2 months. Data were analyzed using SPS version 25. Descriptive statistics, Pearson's correlation coefficient, independent sample t-test and the one-way analysis of variance (ANOVA) were employed for suitable statistical analysis.Results: Almost two-thirds of the subjects were between the age of 18 to < 40 and majority (74.1%) being females. Majority (83.0%) reported as having no chronic diseases, and 69.5% had no contact history with COVID-19 cases. The mean of MCS & PCS was (32.34 ± 25.30) & (41.65 ± 11.82), respectively. Majority (67.6%) had a moderate level of COVID-19 stress. A significant negative relationship between total stress scores and HRQOL domains was observed.Conclusion: Majority subjects had a moderate level of stress related to COVID-19 lockdown. Stress during COVID-19 has a significant negative association with both physical and mental HRQOL in which MCS was significantly lower than PCS. It is recommended to evaluate the effectiveness of stress management program and follow a holistic approach.

Telerehabilitation Programme as a Maintenance Strategy for COPD Patients: A 12-Month Randomized Clinical Trial

BackgroundThere is uncertainty regarding efficacy of telehealth-based approaches in COPD patients for sustaining benefits achieved with intensive pulmonary rehabilitation (PR). Research questionTo determine whether a maintenance pulmonary telerehabilitation (TelePR) programme, after intensive initial PR, is superior to usual care in sustaining over time benefits achieved by intensive PR. Study design and methodsA multicentre open-label pragmatic parallel-group randomized clinical trial was conducted. Two groups were created at completion of an 8-week intensive outpatient hospital PR programme. Intervention group (IG) patients were given appropriate training equipment and instructed to perform three weekly training sessions and send performance data through an app to a web-based platform. Patients in the control group (CG) were advised to exercise regularly (usual care). ResultsNinety-four patients (46 IG, 48 CG) were randomized. The analysis of covariance showed non-significant improvements in 6-min walk distance [19.9m (95% CI ∧4.1/+43.8)] and Chronic Respiratory Disease Questionnaire • Emotion score [0.4 points (0•0.8)] in the IG. Secondary linear mixed models showed improvements in the IG in Short Form-36 mental component summary [9.7, (4.0•15.4)] and Chronic Respiratory Disease Questionnaire • Emotion [0.5, (0.2•0.9)] scores, but there was no association between compliance and outcomes. Acute exacerbations were associated with a marginally significant decrease in 6-minute walk distance of 15.8m (∧32.3/0.8) in linear models. ConclusionsThe TelePR maintenance strategy was both feasible and safe but failed to show superiority over usual care, despite improvements in some HRQoL domains. Acute exacerbations may have an important negative influence on long-term physical function. ClinicalTrials.gov identifierNCT03247933.

Health-related quality of life of people living with HIV/AIDS: the role of social inequalities and disease-related factors

BackgroundHealth-related quality of life (HRQoL) serves as a direct measure of individuals’ health, life expectancy and the impact that the utilization of health care has on quality of life. The purpose of this study is to assess the HRQoL of people living with HIV (PLHIV), and to ascertain its association with the social inequalities and clinical determinants among people living with HIV in Benishangul Gumuz Regional State, Ethiopia.MethodsA cross-sectional study was conducted between December 2016 and February 2017; 390 people at two referral hospitals and three health centers participated in the study. The Patient-Reported Outcomes Measurement Information System Global Health Scale (PROMIS Global 10) was used to measure key HRQoL domains. Global Physical Health (GPH) and Global Mental Health (GPH) summary scores were employed. GPH and GMH summary scores below 50 (the standardized mean score) were determined as poor HRQoL. Bivariate and multivariate logistic regression analyses were used to identify factors associated with GPH and GMH summary scores.ResultsThis study included 259 (66.4%) females and 131 (33.6%) males. The GPH summary scores ranged from 16.2 to 67.7 with a mean of 48.8 (SD = 8.9). Almost 44.6% of the study population has a GPH summary score of below 50; the GMH summary scores ranged from 28.4 to 67.6 with a mean of 50.8 (SD = 8.1). About 41.8% of the study population has a GMH summary score of below 50. Unemployment, household food insecurity and comorbidities with HIV were associated with both poor GPH and poor GMH summary scores. Age below 25 years and being a member of Christian fellowship were inversely associated with poor GPH. The least wealth index score and CD4 count below 350 cells/mL were also associated with poor GMH.ConclusionOverall, socioeconomic inequalities and HIV-related clinical factors play an important role in improving the HRQoL of PLHIV. Many of these determinants are alterable risk factors. Appropriate strategies can improve the holistic management of chronic HIV care and maximize PLHIVs’ HRQoL. Such strategies require the adoption of comprehensive interventions, including policies and programmes that would improve the health, wellbeing and livelihood of PLHIV.

The hypospadias-specific health-related quality of life conceptual framework: a scoping review of the literature.

Health-related quality of life (HRQoL) is an important yet understudied construct for individuals with hypospadias (HS). An important barrier towards understanding HRQoL and integrating it into research and clinical care for people with HS is the absence of an underlying conceptual framework to illustrate this construct. We propose a conceptual framework for HS-specific HRQoL based upon a scoping review of the HS literature. We conducted a literature review of articles published between 1989 and 2019. Our search in Embase and Pubmed used the keyword "hypospadias" in combination with "quality of life" and "patient-reported outcomes." We used thematic analysis of the resulting publications to identify core HRQOL domains. From these results and review of HRQoL literature in other pediatric populations, we developed a conceptual framework representing HS-specific HRQoL. We identified five domains of HRQOL previously studied in research with youth and adults with HS: penile appearance, voiding, social interaction, sexual health, and psychological or behavioral function. We propose a model of HS-specific HRQoL comprised of these domains and their areas of overlap, based upon the findings and conceptual mapping of our literature review. This novel conceptual framework provides a foundation for understanding disease-specific HRQoL in individuals with HS and may serve as a guide for the conduct of future qualitative studies of the HS population. The overlapping biopsychosocial domains illustrate the possible effects of HS on day-to-day life. This framework may guide future surgical, clinical, and behavioral interventions that aim to improve medical care and quality of life outcomes for HS patients.

Associations between domains of health-related quality of life and co-occurring emotional and behavioral problems in youth with autism spectrum disorder

BackgroundHealth-related quality of life (HRQoL) can be used as a measure of the impact of a particular disorder on one’s daily functioning. Previous studies have found that comorbid psychiatric disorders in children and adolescents with autism spectrum disorder (ASD) are associated with poorer HRQoL than ASD alone. Less is known about potential associations between specific symptoms of co-occurring psychopathology (i.e., emotional and behavioral problems) and domains of functioning or HRQoL in youth with ASD. MethodParticipants were 470 children with ASD 2–14 years old recruited from one of three sites. Hierarchical multiple regressions were conducted with Pediatric Quality of Life Inventory 4.0 (PedsQL; Varni, Seid, & Kurtin, 2001) HRQoL domains of physical functioning, emotional functioning, school functioning, and social functioning as the dependent variables. Covariates were entered at step 1, followed by the independent variables of interest at step 2: irritability, social withdrawal, stereotypic behavior, hyperactivity/noncompliance, and inappropriate speech. ResultsThe study found that increased irritability was associated with poorer emotional and physical functioning and that greater social withdrawal was associated with worse social functioning. Furthermore, findings showed that more hyperactivity/noncompliance was associated with worse school functioning. ConclusionsResults demonstrated that certain emotional and behavioral symptoms are differentially associated with domains of HRQoL. This indicates that emotional and behavioral problems should be considered when measuring HRQoL in children with ASD. It also suggests that treating co-occurring emotional/behavioral problems could improve HRQoL and functioning in certain domains for this population.

The need for supportive mental wellbeing interventions in bladder cancer patients: A systematic review of the literature.

ObjectivesThere is an increased awareness of the effect of a bladder cancer diagnosis and its treatments on the mental wellbeing of patients. However, few studies have evaluated the efficacy, feasibility and acceptability of interventions to improve this mental wellbeing. This systematic review is the first phase of the Medical Research Council Framework for developing complex interventions and provides an overview of the published mental wellbeing interventions that could be used to design an intervention specific for BC patients.MethodsThis review was conducted in accordance with the PRISMA guidelines in January 2019 and studies were identified by conducting searches for Medline, the Cochrane Central Register of Controlled Trials and Ovid Gateway. All included studies met the following criteria: mental wellbeing interventions of adults with medically confirmed diagnosis of any type of urological cancer, reported outcomes for specific HRQoL domains including psychological factors. The quality of evidence was assessed according to Down and Black 27-item checklist.ResultsA total of 15,094 records were collected from the literature search and 10 studies matched the inclusion and exclusion criteria. Of these, nine interventions were for patients with prostate cancer and one for patients with kidney cancer. No studies were found for other urological cancers. Depression was the most commonly reported endpoint measured. Of the included studies with positive efficacy, three were group interventions and two were couple interventions. In the group interventions, all showed a reduction in depressive symptoms and in the couple interventions, there was a reduction in depressive symptoms and a favourable relationship cohesion. The couple interventions were the most feasible and acceptable, but further research was required for most of the studies.ConclusionWhile awareness of the importance of mental wellbeing in bladder cancer patients is growing, this systematic literature review highlights the gap of feasible and acceptable interventions for this patient population.

Assessment of Health Related Quality of Life among Chronic Kidney Disease Patients: Challenges for Nephrologists in Pakistan

Introduction: During the past few decades, health related quality of life has been considered as an important predictor for positive health outcomes. Health-related quality of life assessment helps in determining the impact of disease on the everyday life of patients. Chronic kidney disease severely affects health related quality of life of patient.&#x0D; Objective: The objective of this study was to assess health related quality of life among patients with chronic kidney diseases in Pakistan.&#x0D; Methodology: A descriptive cross-sectional study design was used. Study respondents included CKD pre-dialysis and dialysis patients with or without comorbidities visiting tertiary care facilities located in twin cities of Pakistan. Sample size was calculated to be 386 pharmacists to achieve 95% confidence level with 5% margin of error. Convenient sampling technique was used to select respondents. A pre- validated questionnaire Kidney Disease Quality of Life questionnaire (KDQoL-36) was used. Data was coded and analyzed using SPSS 21 after collection. Mann-Whitney and Kruskal-Wallis (p ≥ 0.05) tests were according to different demographic variables.&#x0D; Results: The results of the current study showed lowest scores for HRQoL in domain of physical health composite (30.77±11.16) followed by domain of symptoms and problems associated with CKD whereas daily life had the highest scores. The results highlighted that females had better HRQoL in all domains mental health (46.30, ± 8.73), burden of kidney disease (69.47, ± 32.35), symptoms (29.79, ± 31.22) and effect of disease on daily activities (40.96, ± 32.11) while lowest score for physical health (30.90, ± 10.34). Married respondents had better HRQoL among all domains than unmarried patients except for physical health (32.26, ± 10.7). A significant difference (p ≥ 0.05) was observed among different domains of HRQoL of CKD patients with respect to different genders, marital status, age groups and qualification levels. Males had relatively better physical health scores but their daily activities were also affected more by their disease. Married respondents had relatively better HRQoL among all domains than unmarried patients except for physical health. No significant difference (p ≥ 0.05) was observed for different stages of disease.&#x0D; Conclusion: The present study concluded that patients with CKD had poor HRQoL regardless of novel treatments availability. A negative impact was observed across all domains of health related quality of life among chronic kidney disease patients. Necessary programs focusing on health education for patients with low literacy levels should be initiated to increase health awareness and improve mental health among CKD patients.

Quality of Life and Complications in the Morbidly Obese Patient following Post-Bariatric Body Contouring.

With a growing obesity epidemic, an increasing number of patients are seeking body contouring procedures (BCP). The aim of this study was to assess the association of morbid obesity (BMI > 40kg/m2) with both clinical and health-related quality of life (H-RQOL) outcomes following BCP. Patients evaluated for post-bariatric BCP at a large academic hospital by one surgeon were retrospectively identified. Patients were surveyed using the BODY-Q© during initial and postoperative visits. Demographic, clinical, operative characteristics, and surgical outcomes data were extracted. BODY-Q domain scores were compared between morbidly obese (MO) and non-morbidly obese (NMO). The absolute change in HR-QOL scores for MO and NMO was also compared. Overall, 59 patients were included (MO 72.9% vs. NMO 27.1%). The median age was 50 years old (Interquartile range [IQR] ± 17); the majority were non-Hispanic (89.8%), non-diabetic (81.4%), non-smokers (67.8%). Assessment of surgical site occurrences, reoperations, and the complication composite outcome revealed no statistical differences between groups (p >0.05). MO patients showed lower net improvement in three HR-QOL domains: satisfaction with body (median 30 [IQR ± 53] vs. 65 [IQR ± 54]; p = 0.036), body image (median 39 [IQR ± 55] vs. 52 [IQR ± 44]; p = 0.025), and social function (median 12 [IQR ± 18] vs. 19 [IQR ± 35]; p = 0.015). Post-bariatric BCP can be safely performed in the MO patient without increased risk of complication. However, the benefit of truncal BCP is less in MO as it pertains to specific QOL domains: satisfaction with body, body image, and social function. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Quality of Life in Women with Heavy Menstrual Bleeding Associated with Uterine Fibroids: Baseline Disease Burden from Elaris UF-1 and UF-2

Study ObjectiveReport baseline Uterine Fibroid Symptoms Quality of Life Questionnaire (UFS-QoL) data from Elaris UF-1 and UF-2 to characterize disease burden from heavy menstrual bleeding (HMB) associated with uterine fibroids (UF).DesignElaris UF-1 (NCT02654054) and UF-2 (NCT02691494) were identical, phase 3, double-blind, randomized, placebo-controlled studies investigating safety and efficacy of elagolix alone or combined with hormonal add-back therapy for HMB associated with UF.SettingOutpatient in clinic/office.Patients or ParticipantsPremenopausal women (n=790) aged 18–51 years with diagnosed UF and HMB (menstrual blood loss [MBL] >80 mL/cycle for ≥2 menses).InterventionsN/AMeasurements and Main ResultsA modified UFS-QoL (4-week recall) was conducted before study drug administration. UFS-QoL is a self-administered, 37-item, disease-specific questionnaire that measures symptom severity and health-related QoL (HRQoL; calculated from 6 subscales and scored 0–100). Lower HRQoL scores indicate worse QoL. At baseline, mean (standard deviation [SD]) age was 42.4 (5.4) years, and MBL was 239.7 (158.7) mL. Baseline total HRQoL score was low, reflecting low QoL (mean [SD], 42.9 [23.2]). Mean (SD) scores were generally low across HRQoL domains (concern, 28.1 [24.6]; activities, 40.9 [27.0]; energy/mood, 47.4 [25.3]; control, 54.2 [28.3]; self-consciousness, 39.9 [30.7]; sexual function, 47.5 [35.4]). In each HRQoL domain, the questions most frequently answered ‘most’ or ‘all’ of the time were how often symptoms made patients: feel concerned about soiling underclothes (80%; concern), decrease the amount of time on exercise or other physical activities (59%; activities), feel tired or worn out (68%; energy/mood), feel less productive (50%; control), feel conscious about the size and appearance of their stomach (57%; self-consciousness), and avoid sexual relations (46%; sexual function).ConclusionThere was considerable baseline disease burden. Patients reported the greatest impacts to concern and self-consciousness. Common issues included concerns about soiling underclothes and feeling tired or worn out.

Health-Related Quality of Life Among Healthcare Providers in Pakistan.

ABSTRACTEvaluation of health-related quality of life (HRQOL) in healthcare professionals (HP) is a crucial measure for improving their healthcare interventions and pharmaceutical care planning which they provide to their patients for prevention and better treatment of diseases. Studies have shown that poor health status among HPs is a greater risk factor in achieving desired outcomes in their patients. This study assessed the current level of HRQoL among HPs and evaluated various factors influencing their HRQoL. A cross-sectional study was conducted among HPs using the self-administered research tool “WHOQOL-BREF”. Descriptive, comparative, and inferential statistics were performed using SPSS ver. 24. The study results reported a total of 336 participants, with more males than females (n=268, 79.8%, and n=68, 20.2% respectively). The mean scores for the physical, psychological, social relationships and environmental domains were 65.18±13.01, 68.92±15.53, 70.30±15.90, and 65.10±15.17, respectively. This study confirmed that HPs in Pakistan were more satisfied with their HRQoL in social domain and relatively less satisfied in physical and environment domains of HRQoL.

A systematic review of the association between dietary patterns and health-related quality of life

BackgroundHealth related quality of life (HRQOL) is a potent indicator of individual’s happiness and life satisfaction. The way in which the HRQOL is affected by the diet is a topic of constant interest and debate among researchers. Evaluating the association between single nutrients or foods and HRQOL fails to take into consideration the complex interactions between nutrients. Also, the findings from previous investigations on the relationship between dietary patterns and HRQOL have been inconsistent. Therefore, our aim was to assess the existing evidence regarding the relationship between the dietary patterns and HRQOL by conducting a systematic review.MethodsA literature search was conducted in PubMed, Scopus, Web of Sciences and Google scholar databases from inception to March 2020, to identify studies that investigated associations between the dietary patterns (regardless of methods used to define dietary patterns) and HRQOL domains. Two researchers independently checked titles and abstracts, evaluated full-text studies, extracted data, and appraised their quality using the Newcastle–Ottawa Scale (NOS).ResultsThirteen studies (four longitudinal, and nine cross-sectional studies), with a total of 43,445 subjects, were included. Of the studies included in this review, eight studies evaluated the association between "Mediterranean" dietary patterns (MDP) and HRQOL, while five studies examined the association between different dietary patterns ("Healthy", "Unhealthy", "Western", "Fruit and vegetable", "Bread and butter" and etc.) and HRQOL. Excluding three studies which showed no significant association, healthy dietary patterns such as MDP, "Healthy" and "Fruit and vegetable" dietary patterns were associated with better HRQOL in physical and mental components scores. The quality assessment of included studies according to NOS criteria were ranged between medium to high quality.ConclusionAccording to the current evidence, "Healthy" dietary patterns and “Mediterranean” dietary patterns are associated with better dimension scores of HRQOL in both physical and mental summaries. While, unhealthy dietary patterns and "Western" dietary patterns are associated with lower scores of HRQOL. Further longitudinal studies are required to clarify the association between dietary patterns and HRQOL

Assessment of Health-Related Quality of Life in Children with Rheumatic Heart Disease at Upper Egypt

Background: Many published literatures suggested that RHD can cause stress and anxiety in patients, with increased risks of evolving physical and psychosocial impairments. These include not only pain and fatigue but also difficulties with activities of daily living. Objective: The study aimed to evaluate the HRQOL in children with RHD and delineate the HRQOL domains in various clinical subtypes of RHD. Patients and methods: The present study was a cross-sectional, comparative, study that was conducted on 120 RHD patients who were recruited from Upper Egypt University Hospitals (Aswan, Assiut, and Qena hospitals) for six months. Also, 120 age and sex-matched healthy volunteers were included as the control group. Results: In our cohort, the most common presentation of the included patients was pancarditis with arthritis (33.3%), followed by polyarthritis (31.7%), and fever with pan carditis (20%). One-third of the patients had a history of one hospital admission, and 26.7% had a history of two or more admission. Besides, 65% had swollen, redness, hotness, limitation of movement in the lower limb. All patients were on long-acting penicillin and 10.8% had a history of cardiac surgery. In the present study, the mean serum CRP level was notably high in patients with RHD (mean 114.63 ±113.5mg/dL). Conclusion: Rheumatic heart disease imposed a considerable burden on the quality of life of the Egyptian pediatric population. In our study, we found that Egyptian patients with rheumatic heart disease had significant impairments on the physical, emotional, social, and school functioning, as compared to their counterpart healthy population.

Model Theory of Planned Behavior to Improve Adherence to Treatment and the Quality of Life in Tuberculosis Patients

Introduction: Tuberculosis (TB) is a global public health problem and a leading cause of death from infectious diseases. The research objective was to determine the relationship between the theory of planned behavior, adherence and quality of life using the path model.Methods: This study employed a cross-sectional design with 154 tuberculosis patients. The research was conducted in all community health centers in the Buleleng, Bali. Data on subjective norms, attitudes, perceived behavior control, intention, physical and mental HRQoL domains and medical adherence were collected. Data were analyzed using a descriptive and structural equation model feature using structural equation model.Results: Most respondents have attitudes in the positive category and subjective norms in the good category. Perceived behavior is control in the good category, intentions in the good category and physical health in the good category. Almost all respondents have mental health in the good category and are married. All respondents in this study had adherence to treatment. The influence of subjective norms on intentions (p = &lt;0.01), the influence of intentions on adherence (p = &lt;0.01) and the effect of adherence on quality of life (p = &lt;0.01) were found.Conclusion:Subjective norms are the most important part to influence intention. Adequate TB treatment causes HRQoL to improve.

Feasibility of Utilizing EPIC-CP to Guide Symptom Management for Clinically Localized Prostate Cancer Patients Undergoing Hypofractionated Radiotherapy

Utilization of patient-reported outcome measures (PROMs) to guide symptom management during radiation therapy has shown to be more sensitive to changes in health status and might detect the exact onset of the toxic effects of radiotherapy more accurately than clinician-reported outcomes. The Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) is a validated 16-item, diseasespecific PROM that targets the unique needs of men with prostate cancer (PCa) and evaluates the five HRQOL domains of urinary incontinence, urinary irritation/obstruction, bowel related symptoms, sexual dysfunction and hormonal symptoms.