Improvement In Health-related Quality Of Life Scores Research Articles

Dysphagia Rehabilitation in Dysphagic Patients with Acute or Critical Illness: A Systematic Review and Meta-Analysis.

Dysphagia or swallowing dysfunction is common in patients with acute or critical illness, and diverse methods of dysphagia rehabilitation are provided worldwide. We aimed to examine the efficacy of rehabilitation to treat dysphagia in patients with acute or critical illness. We searched PubMed, ICHUSHI, and Cochrane Central Register of Controlled Trials databases from inception to November 22, 2023 for relevant randomized controlled trials. We focused on dysphagic patients with acute or critical illness who were not orotracheally intubated. Our target intervention included conventional rehabilitation and nerve stimulation/neuromodulation techniques as dysphagia rehabilitation. Comparators were conventional or standard care or no dysphagia interventions. Primary outcomes included mortality, incidence of pneumonia during the study period, and health-related quality of life (HRQoL) scores within 90 days of hospital discharge. We pooled the data using a random-effects model, and classified the certainty of evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation system. Nineteen randomized controlled trials involving 1,096 participants were included. Dysphagia rehabilitation was associated with a reduced incidence of pneumonia (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.54-0.81; moderate certainty), but not with reduced mortality (RR, 0.92; 95% CI, 0.61-1.39; very low certainty) or improved HRQoL scores (mean difference, -0.20; 95% CI, -20.34 to 19.94; very low certainty). Based on the available moderate- or very low- quality evidence, while dysphagia rehabilitation had no impact on mortality or HRQoL, they might reduce the incidence of pneumonia in dysphagic patients with acute or critical illness.

Exercise leads to better sleep in children with inflammatory bowel disease.

The aim of our study was to investigate the effect of an exercise program on health-related quality of life (HRQoL) and sleep quality in children with inflammatory bowel disease (IBD) in remission. A total of 42 pediatric IBD patients in remission were recruited to participate in a 6-month-long home-based exercise program. Their mean age was 15.3 years (with a range of ± 2.08 years) and there were 25 boys. With regard to disease type, 22 had Crohn's disease (CD), 18 had ulcerative colitis (UC), and two had unclassified inflammatory bowel disease (IBD-U). Prior to starting the program, and after its completion, HRQoL was assessed using the IMPACT III questionnaire, and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Patients also wore a triaxial accelerometer for 5 consecutive days before and after the completion of the exercise program to assess physical activity (PA) objectively. Study participants experienced no significant increase in their IMPACT III score (from 147.6 ± 2.7 to 149.6 ± 2.7, p = 0.106) following the completion of the exercise program. The prevalence of impaired sleep quality (PSQI > 5) decreased significantly from 30.9 to 23.8% (p = 0.027). At the baseline, participants' time spent in light PA (LPA) correlated positively with their IMPACT III score (coefficient (coef.) 0.398, p = 0.013). Following the completion of the resistance training program, the changes in the IMPACT III score correlated positively with time spent in moderate-to-vigorous PA (MVPA) (coef. 0.329, p = 0.047) and negatively with changes in PSQI score (coef. -0.493, p = 0.001). The number of children with impaired sleep quality decreased significantly following the completion of a 6-month-long home-based resistance training program but improvements in HRQoL scores did not reach statistical significance.

Gender and Sex Differences in Health-related Quality of Life, Clinical Outcomes and Survival after Treatment of Metastatic Spine Disease.

Retrospective review of prospective, multicenter and international cohort study. To describe the effect of gender on HRQoL, clinical outcomes and survival for patients with spinal metastases treated with either surgery and/or radiation. Gender differences in health-related outcomes are demonstrated in numerous studies, with women experiencing worse outcomes and receiving lower standards of care than men, however, the influence that gender has on low health-related quality of life (HRQoL) and clinical outcomes after spine surgery remains unclear. Patient demographic data, overall survival, treatment details, perioperative complications, and HRQoL measures including EQ-5D, pain NRS, the short form 36 version 2 (SF-36v2) and the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0) were reviewed. Patients were stratified by sex, and a separate sensitivity analysis that excluded gender-specific cancers (i.e., breast, prostate, etc.) was performed. The study cohort included 207 female and 183 male patients, with age, smoking status, and site of primary cancer being significantly different between the two cohorts (P<0.001). Both males and females experienced significantly improved SOSGOQ2.0, EQ-5D, and pain NRS scores at all study time points from baseline (P<0.001). Upon sensitivity analysis, (gender-specific cancers removed from analysis), the significant improvement in SOSGOQ physical, mental, and social subdomains and on SF-36 domains disappeared for females. Males experienced higher rates of postoperative complications. Kaplan-Meier survival analysis of both the overall and sensitivity analysis cohorts showed females lived longer than males after treatment (P=0.001 and 0.043, respectively). Both males and females experienced significantly improved HRQoL scores after treatment, but females demonstrated longer survival and a lower complication rate. This study suggests that gender may be a prognostic factor in survival and clinical outcomes for patients undergoing treatment for spine metastases and should be taken into consideration when counseling patients accordingly.

Changes in health-related quality of life and associations with improvements in clinical efficacy: a Phase 2 study of mirikizumab in patients with ulcerative colitis

ObjectiveMirikizumab, a monoclonal antibody targeting the interleukin-23 p19 subunit, was effective in a Phase 2 study (NCT02589665) of moderately-to-severely active ulcerative colitis (UC). We studied mirikizumab’s impact on health-related quality...

High-intensity Focused Ultrasound for the Treatment of Fibroids: A Single-center Experience in Singapore.

Uterine fibroids and adenomyosis are common gynecological conditions that often require surgical treatment. Minimally invasive interventions such as ultrasound-guided high-intensity focused ultrasound (USgHIFU) are gaining popularity as they avoid surgical morbidity and conserve the uterus. We present a single-center experience on the use of USgHIFU for the treatment of fibroids and adenomyosis. This was a retrospective study of 167 patients who underwent USgHIFU for uterine fibroids and adenomyosis between July 2018 and December 2020. Relevant demographic data and pre- and post-intervention fibroid volume, symptom severity scores (SSS), and health-related quality of life (QOL) scores were collected and compared. The paired t-test or Wilcoxon signed-rank test was used to compare the difference before and after treatment. P < 0.001 was considered statistically significant. One hundred and sixty-seven patients with fibroids or adenomyosis were included in this study. The mean age of the cohort was 42-year-old. USgHIFU treatment led to a reduction in mean fibroid volume, improvement in SSS, and health-related QOL scores. The average reduction in mean fibroid volume was 68% and 75% at 6 and 12 months, respectively. There was a significant reduction in SSS (46.9 [pre] vs. 15.6 [post], P < 0.001) and improvement in health-related QOL scores at 6 months (58 [pre] vs. 86 [post], P < 0.001). The re-intervention rate following USgHIFU was 7.7% and successful pregnancy post USgHIFU was reported in 6 patients. USgHIFU is safe and effective. In women who desire fertility or are not suitable for surgery, it is a good alternative option. It should be included in the armamentarium for the treatment of uterine fibroids and adenomyosis.

Is quality of life after surgery for adolescent idiopathic scoliosis affected by the presence of a concomitant low-grade isthmic spondylolisthesis non-surgically treated? A retrospective cohort study.

The HRQoL after surgery for adolescent idiopathic scoliosis (AIS) is not affected by the presence of concomitant isthmic spondylolisthesis non-surgically treated. Improvement in QoL after surgery was similar for AIS patients with and without concomitant spondylolisthesis. The purpose is to compare preoperative and postoperative Health-Related Quality of Life (HRQoL) scores in operated AIS patients with and without concomitant isthmic spondylolisthesis. A retrospective study of a prospective cohort of 464 individuals undergoing AIS surgery between 2008 and 2018 was performed. All patients undergoing surgery for AIS with a minimum 2-year follow-up were included. We excluded patients with prior or concomitant surgery for spondylolisthesis. HRQoL scores were measured using the SRS-22 questionnaire. Comparisons were performed between AIS patients with versus without concomitant spondylolisthesis treated non-surgically. AIS surgery was performed for 36 patients (15.2 ± 2.5 y.o) with concomitant isthmic spondylolisthesis, and 428 patients (15.5 ± 2.4 y.o) without concomitant spondylolisthesis. The two groups were similar in terms of age, sex, preoperative and postoperative Cobb angles. Preoperative and postoperative HRQoL scores were similar between the two groups. HRQoL improved significantly for all domains in both groups, except for pain in patients with spondylolisthesis. There was no need for surgical treatment of the spondylolisthesis and no slip progression during the follow-up duration after AIS surgery. Patients undergoing surgical treatment of AIS with non-surgical management of a concomitant isthmic grade I spondylolisthesis can expect improvement in HRQoL scores, similar to that observed in patients without concomitant spondylolisthesis.

Anti-IL-5 therapies for asthma.

Anti-IL-5 therapies for asthma.

Impact of early tumor shrinkage on quality of life in patients treated with first-line cetuximab plus chemotherapy for unresectable metastatic colorectal cancer: results of Phase II QUACK trial

PurposeAlthough early tumor shrinkage (ETS) is a predictor of improved overall survival (OS), the association between ETS and health-related quality of life (HRQOL) remains unclear for patients with metastatic colorectal cancer (mCRC) treated with first-line cetuximab plus chemotherapy.MethodsThe data were collected from a prospective trial that assessed HRQOL using the EORTC QLQ-C30. The impact of ETS on HRQOL was estimated using a linear mixed-effects model for repeated measures.ResultsETS was achieved in 82 (64.1%) of 128 mCRC patients treated with first-line cetuximab plus chemotherapy, and these patients had a significantly longer OS than those without ETS (HR, 0.38; 95% CI, 0.20–0.72; P = .002). Asymptomatic patients with ETS had a favorable OS, while symptomatic patients without ETS had a worse OS (2-year OS rates, 77.8% vs. 42.5%). Symptomatic patients with ETS had similar outcomes as asymptomatic patients without ETS (2-year OS rates, 64.1% vs. 67.0%). For symptomatic patients, ETS was associated with improved HRQOL scores between baseline and 8 weeks: the mean changes for patients with and without ETS were 5.86 and -4.94 for global health status (GHS)/QOL, 26.73 and 3.79 for physical functioning, and 13.58 and -3.10 for social functioning, respectively. The improved HRQOL was comparable to that of asymptomatic patients without ETS. For asymptomatic patients, ETS showed a decreased deterioration in HRQOL.ConclusionOur findings highlight the importance of ETS for HRQOL and prognostic estimates, and assessing ETS may provide clinically useful information for physicians and patients to make more informed decisions.

P1740: HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH RELAPSED/REFRACTORY MULTIPLE MYELOMA (RRMM) TREATED WITH IDECABTAGENE VICLEUCEL VS BELANTAMAB MAFODOTIN: A MATCHING-ADJUSTED INDIRECT COMPARISON STUDY

Background: Patients (pts) with RRMM who are triple-class exposed (TCE; to an immunomodulatory imide drug [IMiD® agent], proteasome inhibitor [PI], and anti-CD38 monoclonal antibody [mAb]) have poor clinical outcomes and poor health-related quality of life (HRQoL). The B-cell maturation antigen (BCMA)-directed CAR T cell therapy idecabtagene vicleucel (ide-cel, bb2121) received regulatory approval in the US for pts with RRMM with ≥4 prior lines of therapy (LOT), including an IMiD agent, PI, and anti-CD38 mAb, and in Europe and Japan for pts with RRMM with ≥3 prior LOTs including an IMiD agent, PI, and anti-CD38 mAb. Ide-cel showed frequent, deep, and durable responses in TCE pts with RRMM in KarMMa, a phase 2, single-arm trial (NCT03361748). Clinically meaningful improvements in HRQoL outcomes vs baseline were observed. The BCMA-targeted antibody-drug conjugate belantamab mafodotin (BM) was approved in the US and Europe for pts with RRMM with ≥4 prior LOTs including an IMiD agent, PI and anti-CD38 mAb, based on data from the phase 2, single-arm DREAMM-2 trial (NCT03525678). There is a paucity of evidence comparing HRQoL for different treatment options approved in RRMM. Aims: To compare HRQoL outcomes for TCE pts with RRMM treated with ide-cel vs BM. Methods: Data were analyzed using unanchored matching-adjusted indirect comparisons. Between-study differences in pt characteristics were adjusted using individual-level pt data from KarMMa to align with summary-level pt characteristics from DREAMM-2. The ide-cel-treated population (N=128; median follow-up 15.4 months) from KarMMa (of whom, 54 pts received the target dose of 450×106 CAR+ T cells) and the intention-to-treat population (N=97; median follow-up 13.0 months) from DREAMM-2 who received the 2.5 mg/kg dose of BM (Popat et al. HemaSphere 2020;4:S1. EP1746) were analyzed. Predefined outcomes of interest were differences in mean change from baseline scores for the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30) pain, fatigue, and global health/QoL domains, and the QLQ-Multiple Myeloma (MY20) pain domain. Analyses were performed at 2, 3, 4, 6, 9, and 12 months of follow-up. Given differences in time points of evaluation between KarMMa and DREAMM-2, the nearest neighbor approach was used. Pt characteristics included as covariates in the propensity model included: age, sex, race, years from initial diagnosis, disease stage, and number of prior treatments. Sensitivity analyses included additional covariates: high-risk cytogenetics and extramedullary disease. Results: Ide-cel was associated with improved HRQoL vs BM at all evaluated time points for the QLQ-C30 global health status/QoL domain (Table). Improved HRQoL scores were statistically significant for ide-cel vs BM at 6 and 9 months for the QLQ-C30 fatigue domain (HRQoL scores were numerically better for ide-cel vs BM at all other time points). Similarly, HRQoL scores favored ide-cel vs BM at all evaluated time points for the QLQ-C30 pain and QLQ-MY20 pain domains, with statistically significant findings at 4, 6, and 9 months for QLQ-C30 and 3, 4, and 6 months for QLQ-MY20. Sensitivity analyses were consistent with the base case analyses. Image:Summary/Conclusion: While this analysis was limited by the availability of aggregate data from DREAMM-2, which may influence the outcomes of interest, results suggest that one-time treatment with ide-cel offers improved HRQoL vs BM across the QLQ-C30 pain, fatigue, and global health status/QoL domains, as well as the QLQ-MY20 pain domain.

The relationship between health-related quality of life (HRQoL) and clinical outcomes in patients with advanced renal cell carcinoma (aRCC) in CheckMate (CM) 214.

4502 Background: In CM 214, when compared to sunitinib (S), nivolumab plus ipilimumab (N+I) was associated with both clinical benefit and improved HRQoL as first-line treatment for intermediate/poor (I/P)-risk patients (pts). This analysis investigates the direct association between HRQoL and clinical outcomes in aRCC pts. Methods: I/P-risk population included 425 and 422 pts in the N+I and S arms, respectively. HRQoL was assessed using the FKSI-19 (Total Score and Disease Related Symptoms [DRS]). Three separate analyses (A, B, and C) were conducted. A: Changes in individual item scores from baseline to last assessment prior to progression were descriptively assessed. B: For each FKSI-19 score, multivariable Cox regression, adjusted for treatment and stratification factors, was used to evaluate the prognostic significance of baseline and time-dependent HRQoL scores in separate models. Hazard ratios (HR) were calculated based on the risk of death per improvement in HRQoL scores, defined using the clinically meaningful change threshold (5 points for FKSI-19 Total and 3 points for DRS). Pts with overall survival (OS) events were censored if their survival event was not within 12 weeks of the last available HRQoL assessment. C: The association between HRQoL change status (ie, improvement or maintenance vs. worsening from baseline in the FKSI-19 Total Score), irrespective of treatment arm, and OS was further assessed using a landmark analysis at the month 6 (mo-6) landmark. Additional landmark time points were explored in sensitivity analysis. Results: Items related to fatigue and perceived bother of the side-effects of treatment had the largest percentage of pts worsening prior to progression. In both baseline and time-dependent HRQoL analyses, OS was independently associated with both HRQoL measures. Higher (better) baseline scores were associated with significantly reduced risk of death (HR [95% CI] for FKSI-19 Total Score and DRS was 0.83 [0.80-0.87] and 0.80 [0.76-0.84], respectively). Every 5-point increase (improvement) in FKSI-19 Total Score and 3-point increase in DRS was associated with a 31% decreased risk of death ( P &lt; 0.01). At mo-6, 301 pts showed improvement or maintenance in HRQoL. Pts with improved/stable HRQoL had a 52% reduction in risk of death compared to pts who had worsened (HR 0.48 [95% CI: 0.39-0.59]). Conclusions: Results demonstrate there is an association between HRQoL and clinical outcomes in CM 214. Baseline HRQoL scores are a potential predictor for survival in aRCC, and HRQoL changes are informative for pts’ expected survival. HRQoL change status at mo-6 was significantly and positively associated with subsequent survival. Thus, patient-reported outcomes may be useful for both describing pt experience in clinical trials and providing valuable clinical insights during routine practice. Clinical trial information: NCT02231749.

MP21-06 IMPACT OF SEXUAL DYSFUNCTION ON QUALITY OF LIFE IN WOMEN AFTER PELVIC FRACTURE

You have accessJournal of UrologyCME1 May 2022MP21-06 IMPACT OF SEXUAL DYSFUNCTION ON QUALITY OF LIFE IN WOMEN AFTER PELVIC FRACTURE Helen Gambrah, and Niels Vass Johnsen Helen GambrahHelen Gambrah More articles by this author , and Niels Vass JohnsenNiels Vass Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002554.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic neurovascular damage accounts for the well-known association between pelvic fracture and sexual dysfunction. The impact of sexual dysfunction on quality of life has been well-documented but has historically focused on patients with lower urinary tract injuries. These injuries have been shown to be associated with higher rates of SD and therefore are more likely to influence patient-reported quality of life. We hypothesized that the presence of SD following pelvic fracture negatively impacts health-related quality of life (HrQOL) even for patients with no lower urinary tract injuries. METHODS: Women treated for pelvic fracture at a level 1 trauma center between 2012 and 2017 were invited to complete an online survey. Patients with spinal cord injuries, associated lower urinary tract injuries, and isolated acetabular fractures were excluded. Sexual function was assessed using the Female Sexual Function Index (FSFI). HrQOL was evaluated using the visual analog scale (VAS) component of the EuroQol 5 Dimensions Questionnaire (EQ-5D). Inverse probability weighting was utilized to adjust for subject nonresponse. Multivariate regression was performed to evaluate the impact of sexual function on HrQOL. RESULTS: 98 of the 780 potential subjects completed the survey (12.6%). Responders had a mean age at time of injury of 42.2 years (SD 22.4) and median time since injury of 45 months (IQR 30.0, 57.4). After weighting, median FSFI score was 19.1 (IQR 5.5, 27.7), and median EQ-5D VAS score was 71 (IQR 60, 85). Bivariate linear analysis showed that FSFI scores and time since injury were significantly associated with patient-reported HrQOL. A decrease in FSFI scores correlated to a decline in EQ-5D VAS score (β = 0.62, 95% CI 0.30–0.95, p <0.001). Additionally, after adjustment for potential confounders, FSFI, time from injury, and age were all independently associated with HrQOL, with FSFI having the largest effect size (Table 1). CONCLUSIONS: Younger age, increased time since injury, and higher FSFI scores were all independently associated with improved HrQOL scores among women with a history of traumatic pelvic fracture, with FSFI scores as the strongest independent predictor for decreased HrQOL in this patient population. These data highlight the importance of addressing sexual health issues in female pelvic trauma survivors in the post-injury setting. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e329 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Helen Gambrah More articles by this author Niels Vass Johnsen More articles by this author Expand All Advertisement PDF DownloadLoading ...

Laboratory Value-Based Innovation in Heart Failure Improves Patient Health-Related Outcomes.

NT-proBNP is emerging as a novel tool for improving management of patients with heart failure (HF). The concept of health-related outcomes as the primary endpoint for therapeutic intervention in chronic disease, such as HF, should be the focal point going forward. We conducted a prospective real-world study in heart failure with reduced ejection fraction (HFrEF) patients. The main target was to evaluate the impact on patient's health-related outcomes of a personalized medical follow-up procedure, based on a laboratory model of risk stratification supported by NT-proBNP. One hundred and five consecutive patients admitted to the Hospital Heart-Failure unit were stratified into three groups (low, medium, and high risk) and prospective follow-ups during the 12 months post discharge. It was found that patients under this new approach experienced early and robust improvements in patient health-related outcomes with consistency in most domains which persisted beyond 12 months post follow-up. Improvements in health related quality of life score (HRQLS) was observed over the time of the study. After 6 months we found a significant improvement in HRQLS of 18.2% (from 76.5 ± 22.4 to 95.0 ± 15.7) and 14.4% (from 76.5 ± 22.4 to 96.3 ± 15.9) after 12 months of follow-up (p < 0.001). The highest improvements were found in the symptom severity domain where patients reported an improvement of 22.6% after 6 months and 18.9% after 12 months (p < 0.001). The lowest scores were reported in the physical domain with increase of 11.0% and 4.3% after 6 months and 12 months (p = 0.089). Psychosocial domain and the ability to carry out the activities of normal life showed improvement as well. Our strategy based on NT-proBNP optimizes HFrEF management and represents a major new approach for clinical laboratories to improve patient health-related outcomes in HFrEF.

Changes in Quality-of-Life Parameters in Patients Receiving Therapeutic Interventions for Cancer-Associated Anemia: A Systematic Review

Introduction: Cancer-associated anemia (CAA) is multifactorial in etiology and can occur due to the malignancy itself or as a side effect of the treatment. The prevalence of CAA can exceed 90%. Several studies have reported positive correlations between increased hemoglobin (Hb) and improved health-related quality of life (HR-QoL) measures including fatigue scores and scores for physical, mental and social well-being. However, Hb increases and extent of improvement in HR-QoL measures varied by therapeutic interventions (Oral/intravenous iron, erythropoietin stimulating agents (ESAs), transfusions, and/or others), as did HR-QoL tools used in these studies. We conducted a systematic review to identify final target Hb levels as well as changes in Hb from baseline that resulted in significant improvement in HR-QoL parameters following interventions for CAA. We also sought to identify HR-QoL tools that effectively and comprehensively captured symptomatic improvement following Hb increases in patients with CAA.Methods: Randomized Controlled Trials (RCTs) and prospective studies which evaluated HR-QoL changes following drug interventions for CAA were identified through searches of the CINAHL Plus, Embase, PubMed, and Web of Science for articles in English from 1997-2021. Inclusion criteria were: RCT or prospective study; patients with CAA; a HR-QoL was used. Two reviewers independently screened abstracts. A third reviewer resolved disagreements. Bias assessment was performed using Joanna Briggs checklist.Results: Of the 8243 studies identified of which 1718 were duplicates and 6525 records were screened at the title and abstract level. Of the 59 full text articles reviewed, 38 articles met our eligibility criteria (Figure 1). A total of 19 RCTs and 19 prospective studies were identified. On average, studies were conducted over 14.2 ± 5.5 weeks, with a mean of 546 ± 693 study participants in each study. 23 studies provided information on the number of enrolled participants completing study. Mean study completion rates among participants was 70 ± 1 (%). A summary of HR-QoL measures utilized in the various studies is presented in Table 1.Hb changes and HR-QoL score changes were reported consistently in 30 studies and are presented in Table 2. Therapeutic interventions for CAA included ESAs (n=19; 65.5%), Oral/IV iron (n=1; 3.4%); transfusions (n=2; 6.9%), other agents used in specific conditions (luspatercept (MDS)) n=1; 3.3%, or combinations of these (n=7; 24.1%). Overall, 78% of studies that reported an Hb increase following drug interventions for CAA also reported an improvement in HR-QoL measures. Mean Hb increases was 1.9 g/dL. Median change in the most frequently used HR-QoL (FACT-An, FACT-F) was +3 points (Range: 0-4).Studies utilizing transfusions as the intervention for CAA reported the lowest final Hb (8.8 gm/dL) as well as the lowest change in Hb (Δ Hb= 1gm/dL) levels from study onset to completion. These studies also reported the least improvements in HR-QoL scores. HR-QoL tools used in transfusion-based studies were variable. With regard to other outcomes measured in the various studies, raising Hb levels by various interventions did not significantly impact bleeding scores, infections, hospitalizations, or mortality.Conclusions: Our data suggest the need to identify optimum Hb thresholds (final target Hb levels as well as changes in Hb levels from baseline) that result in meaningful improvements in HR-QoL parameters following the use of any therapeutic intervention for CAA. Specifically, studies utilizing transfusions alone as intervention for CAA may not reach the optimum threshold (>11gm/dL or a Δ Hb of greater than 2 gm/dL) to result in meaningful improvements in HR-QoL measures as has been shown in studies utilizing ESAs or iron or a combination of these agents. Further, it is imperative for studies in transfusion medicine to identify appropriate HR-QoL tool/s that comprehensively capture all aspects of well-being related to CAA. As such, studies may need to utilize more than one HR-QoL tool that gathers information on physical, social and emotional well-being before and after transfusions, while balancing the risk of questionnaire fatigue. A meta-analysis of our systematic review is ongoing and will provide additional information on data gathered thus far. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Enhancing care transitions intervention with peer support to improve outcomes among older adults with co-occurring clinical depression: a pilot study

ABSTRACT The Care Transitions Intervention (CTI) is an evidence-based intervention aimed at supporting the transition from hospital back to the community for patients to ultimately reduce preventable re-hospitalization. In a pilot randomized controlled trial, we examined the preliminary effectiveness of an Enhanced Care Transitions Intervention (ECTI), CTI with the addition of peer support, for a racially/ethnically diverse sample of older adults (age 60+) with co-morbid major depression. We observed a significant decline in health-related quality of life (HRQOL) after being discharged from the hospital among those who received CTI. Additionally, those who received ECTI either maintained HRQOL scores, or, saw improvement in HRQOL scores. Findings suggest the Enhanced Care Transitions Intervention can maintain or improve HRQOL and reduce disparities for older participants from diverse racial/ethnic backgrounds with clinical depression.

B-PO05-200 EJECTION FRACTION IMPROVEMENT DOES NOT REFLECT CHANGES IN HEALTH-RELATED QUALITY OF LIFE FOLLOWING CARDIAC RESYNCHRONIZATION THERAPY

Cardiac resynchronization therapy (CRT) can improve left ventricular ejection fraction (EF) and health-related quality of life (HRQoL) in patients with heart failure with reduced EF (HFrEF). It is unknown if improvements in HRQoL reflect EF response to CRT. To determine if EF response after CRT correlates with improved HRQoL. We included HFrEF patients who underwent CRT and had EF and HRQoL data available at baseline and within one year. EF response was categorized as absent (0% change or decrease), modest (0-19% increase), or significant (>20% increase). HRQoL response was categorized as improved (by >5 points), unchanged (<5 points), or worsened (by >5 points). We examined the associations between EF response and generic (PROMIS tools) and HF-specific (KCCQ-12) HRQoL. The group included 84 patients with mean age of 66 years and baseline EF of 32%; 44% were female (n=37). Nineteen percent (n=16) had significant EF response and 60% (n=50) had a modest response. AF burden (p=0.2) and mitral regurgitation severity (p=0.1) were similar across EF groups. General Health score was significantly associated with EF response (Figure, p=0.036). However, PROMIS Physical Function (p=0.5), PROMIS Depression (p=0.8), and KCCQ-12 (p=1.0) were not. A significant proportion of patients without EF improvement had improved HRQoL scores after CRT implant. In this cohort, CRT was associated with a modest to significant EF response in the majority. However, EF response did not strongly correlate with generic or HF-specific HRQoL tools. These results warrant further investigation into the determinants of improved HRQoL in HFrEF.

The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery

Study DesignRetrospective cohort.PurposeThis study aims to evaluate the impact of anemia on functional outcomes, health-related quality of life (HRQoL), and early hospital readmission (EHR) rates after adult spinal deformity (ASD) surgery at the time of discharge from the hospital.Overview of LiteratureConcerns with risks of transfusion, insufficient evidence for its benefits, and the possibility of associated adverse outcomes have led to restrictive transfusion practices. Therefore, patients are discharged according to patient blood management programs that are implemented in hospitals nationwide to reduce unnecessary blood transfusions. However, not many comprehensive kinds of studies exist on the effect of postoperative anemia on functional life and complications.MethodsAnemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre- and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter.ResultsThis study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild [11, 64.7%]; moderate [5, 29.4%]; severe [1, 5.9%]) were readmitted within 30 days. The mean hemoglobin values were higher in readmitted patients (p=0.071). Infection was the leading cause of readmission (n=12), but a low hemoglobin level was not observed in any of these patients at the time of discharge. Except for Scoliosis Research Society-22 questionnaire, HRQoL improvements did not reach statistical significance in early readmitted patients in the first year after surgery.ConclusionsThe results of this study demonstrated that the occurrence and the severity of postoperative anemia are not associated with EHR in surgically treated patients with ASD. The findings of the current research suggested that clinical awareness of the parameters other than postoperative anemia may be crucial. Thus, improvements in HRQoL scores were poor in early readmitted patients 1 year after surgery.

Lowest Instrumented Vertebra Selection to S1 or Ilium Versus L4 or L5 in Adult Spinal Deformity: Factors for Consideration in 349 Patients With a Mean 46-Month Follow-Up.

Retrospective cohort study. To compare the outcomes of patients with adult spinal deformity (ASD) following spinal fusion with the lowest instrumented vertebra (LIV) at L4/L5 versus S1/ilium. A multicenter ASD database was evaluated. Patients were categorized into 2 groups based on LIV levels-groups L (fusion to L4/L5) and S (fusion to S1/ilium). Both groups were propensity matched by age and preoperative radiographic alignments. Patient demographics, operative details, radiographic parameters, revision rates, and health-related quality of life (HRQOL) scores were compared. Overall, 349 patients had complete data, with a mean follow-up of 46 months. Patients in group S (n = 311) were older and had larger sagittal and coronal plane deformities than those in group L (n = 38). After matching, 28 patients were allocated to each group with similar demographic, radiographic, and clinical parameters. Sagittal alignment restoration at postoperative week 6 was significantly better in group S than in group L, but it was similar in both groups at the 2-year follow-up. Fusion to S1/ilium involved a longer operating time, higher PJK rates, and greater PJK angles than that to L4/L5. There were no significant differences in the complication and revision rates between the groups. Both groups showed significant improvements in HRQOL scores. Fusion to S1/ilium had better sagittal alignment restoration at postoperative week 6 and involved higher PJK rates and greater PJK angles than that to L4/L5. The clinical outcomes and rates of revision surgery and complications were similar between the groups.

Health Related Quality of Life after Hysterectomy Performed for Benign Conditions in Tertiary Hospitals, Rwanda

Objective: Hysterectomy is the most common major surgical procedure performed by gynaecologists. Most studies reporting on surgical procedures emphasize surgical outcomes such as operation time, surgical complications and hospital stay. Most women undergo hysterectomy to relieve symptoms and improve their Health-Related Quality of Life (HRQoL). It is an important outcome variable in clinical research for benign gynaecological conditions. The objective of this study was to assess the HRQoL in women after hysterectomy performed for benign gynaecological conditions in Rwanda. Objective: Hysterectomy is the most common major surgical procedure performed by gynaecologists. Most studies reporting on surgical procedures emphasize surgical outcomes such as operation time, surgical complications and hospital stay. Most women undergo hysterectomy to relieve symptoms and improve their Health-Related Quality of Life (HRQoL). It is an important outcome variable in clinical research for benign gynaecological conditions. The objective of this study was to assess the HRQoL in women after hysterectomy performed for benign gynaecological conditions in Rwanda. Results: The mean age of patients was 51 ± 9 years. Most of the women were premenopausal (64.1%). The most common indications for hysterectomy were fibroids (52.2%) and uterine prolapse (22.8%). Most of the hysterectomies (76.1%) were performed transabdominally. The average length of hospital stay was 6 ± 4 days. All domains showed significant improvement in HRQoL scores after hysterectomy (p<0.001). The physical health component summary improved from 28.8 to 61.3(p<0.001) and the mental health component summary improved from 35.8 to 67.0 (p<0.001). Conclusions: Health related quality of life significantly improve after hysterectomy performed for benign gynaecological conditions in Rwanda. These findings are vital and may be useful to patients and health care providers in counselling women before hysterectomy.

Quality of Life Outcomes in Treatments for Symptomatic Uterine Fibroids: A Systematic Literature Review

Study Objective To conduct systematic literature review (SLR) on quality of life (QoL) outcomes of treatments for symptomatic uterine fibroids (UF). Design A systematic review was conducted using MEDLINE, Embase, PubMed and Google Scholar to identify studies published since database inception and May 1, 2020. Prospective and retrospective studies with at least ten patients were considered eligible if they included treatment of symptomatic UF patients and reported QoL measures using the uterine fibroid symptom quality of life (UFS-QoL) questionnaire. The baseline, post baseline and change from baseline (CFB) UFS-QoL scores for overall and subscales were extracted for each time point reported in the study. Setting N/A Patients or Participants N/A Interventions N/A Measurements and Main Results Of 746 search results, 64 references for 60 studies were included: 42 prospective studies, 9 retrospective studies, 3 post hoc analyses and 6 other studies. A total of 8,047 patients were included, with a median study size of 66 patients. The baseline and post-baseline median health-related quality of life (HRQoL) scores were 46.6 and 82.0, respectively (Mean scores were 49.8 and 82.4 respectively). The median improvement in HRQoL score was 34.2 (Mean 31.8, N=7,261 pts). The baseline and post-baseline median symptom severity scores (SSS) were 55.9 and 22.3, respectively (Mean scores were 54.0 and 21.3 respectively). The median improvement in SSS was -32.6 (Mean -31.7, N=7,380 patients). Similar range of improvements were observed for other subscales of UFS-QoL. Conclusion To our knowledge, this study is one of the first and the most comprehensive systematic review on quality of life outcomes of treatments for symptomatic UF patients. An on-going meta-analysis is warranted to provide a more quantitative overview of QoL outcomes.

Improvements of health-related quality of life 5 years after gastric bypass. What is important besides weight loss? A study from Scandinavian Obesity Surgery Register.

Obesity continues to increase in the world. It is strongly associated with morbidity, mortality, and decrease of health-related quality of life (HRQoL). Surgery is the most effective treatment for obesity, resulting in sustained weight loss and improvements of HRQoL. The aim of this study was to examine whether other factors, apart from weight loss, are associated with improvement in HRQoL scores between the preoperative visit and the 5-year follow-up. To examine whether there are factors besides weight loss that affect the improvement of HRQoL from before to 5 years after gastric bypass surgery. Large, nationwide, observational study with national quality and research registry. Patients operated with a primary gastric bypass in Sweden between January 2008 and December 2012 were identified in the Scandinavian Obesity Surgery Register. Patients with HRQoL data available at both baseline and 5 years after surgery were included. Two HRQoL instruments, the RAND Short form-36 and the obesity-related problems scale, were used in the study. The study sample comprised 6998 patients (21% men). Differences in HRQoL change according to sex were minor. Younger patients showed greater improvements in physical health scales. In general linear regression model analyses, age and weight loss correlated significantly with improvement in HRQoL after 5 years. Patients treated medically for depression preoperatively (13%) experienced less improvement in HRQoL than patients without such treatment. Patients with postoperative complications (26%) had significantly less improvements in all aspects of HRQoL compared with those without any form of postoperative complication. The study confirmed the importance of weight loss for improvement in HRQoL after bariatric surgery. Preoperative medication for depression and suffering a complication during the 5-year follow-up period were associated with less improvement in HRQoL.