Overall Improvement In Health-related Quality Research Articles

Influence of Insurance Status on Curve Magnitude in Adolescent Idiopathic Scoliosis in Mainland China.

Study Design:Retrospective cohort study.Objectives:To determine whether there is an association between insurance status and curve magnitude in idiopathic scoliosis pediatric patients in mainland China.Methods:Medical records of patients with adolescent idiopathic scoliosis in 4 tertiary spine centers across China from January 2013 to December 2017 were analyzed. Data was extracted on insurance status, curve magnitude, recommended treatment at presentation, source of referral, and treatment initiated. Additional information was collected for patients requiring corrective surgery, including time from recommendation for surgery to surgery and clinically relevant parameters such as, postoperative complications, and pre-/postoperative Scoliosis Research Society–22 scores were also collected for patients requiring corrective surgery.Results:Of the 1785 patients included, 1032 were Urban Resident Basic Medical Insurance Scheme (URBMS) insured and 753 were New Rural Cooperative Medical Scheme (NRCMS) insured. NRCMS patients presented with a larger major curve than URBMS patients (32.9° ± 15.1° vs 29.3° ± 12.6°, P = .028). For patients having surgery recommended, NRCMS patients presented with a larger mean Cobb angle at the first presentation (57.7° vs 50.9°, P < .0001) and at time of surgery (61.3° vs 52.2°, P < .0001), and experienced a significantly longer time from surgery recommendation to decision for surgery. Complication rates were comparable between the 2 groups, except for pulmonary complications (NRCMS 7.3% vs URBMS 2.8%, P = .04). Postoperatively, patients covered by NRCMS insurance experienced greater overall improvement in health-related quality of life and were less satisfied with the treatments.Conclusions:This study shows that health insurance may influence the severity of scoliosis on presentation, with implications on early diagnosis and surgery time.

Patient-reported outcomes of adalimumab, phototherapy, and placebo in the Vascular Inflammation in Psoriasis Trial: A randomized controlled study

Thereare limited data about the impact of narrowband ultraviolet B phototherapy on patient-reported measures of health-related quality of life. To evaluate the impact of adalimumab and phototherapy on health-related quality of life. We examined patient-reported outcomes from a multicenter, randomized, placebo-controlled trial (ClinicalTrials.gov no. NCT01553058). The Dermatology Life Quality Index and EQ-5D-3L were evaluated every 4weeks. We enrolled 97 patients: 30.9% were female, mean age was 43.5years (standard deviation, 14.0), and median Psoriasis Area and Severity Index score was 16.7 (interquartile range, 13.9-21.6). At week 12, patients being treated with adalimumab (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.02-8.17) and phototherapy (OR, 8.83; 95% CI, 2.47-31.57) were more likely to achieve the minimal clinically important difference in the Dermatology Life Quality Index compared with those receiving placebo. There were higher odds of achieving the minimal clinically important difference for the EQ-5D-3L Index score when comparing phototherapy versus placebo (OR, 9.78; 95% CI, 2.99-31.95) and phototherapy versus adalimumab (OR, 4.07; 95% CI, 1.42-11.70). Small sample size, secondary analysis, generalizability. Phototherapy and adalimumab both improve skin-related quality of life and overall health-related quality of life compared with placebo in patients with psoriasis; however, patients treated with phototherapy achieved more improvement in overall health-related quality of life compared with patients treated with adalimumab.

Expert opinion on managing chronic HCV in patients with neuropsychiatric manifestations.

Neurological manifestations of HCV infection appear to be under-recognized in clinical practice despite the majority of HCV-infected patients experiencing symptoms such as fatigue, depression and cognitive dysfunction. There is also growing evidence for a link between HCV infection and an increased risk of Parkinson's disease. The mechanism underpinning the association between HCV and these neuropsychiatric syndromes still requires further investigation. Here we review the pre-clinical and clinical evidence for a link between HCV and effects on the central nervous system leading to neuropsychiatric syndromes. Lastly, we describe how improvements in neuropsychiatric manifestations of HCV following treatment have been observed, which is subsequently reflected in an overall improvement in health-related quality of life.

Effective dosing strategies for therapeutic immunoglobulin: managing wear-off effects in antibody replacement to immunomodulation.

Determining optimal dosing strategies for therapeutic immunoglobulin (Ig) to minimize ‘wear-off’ effects (defined here as end-of-cycle loss of efficacy, although wear-off may also refer to secondary end-points such as fatigue) is particularly challenging in the face of limited data. Loss of efficacy of Ig therapy is linked to waning bioavailability and may be explained on the basis of Ig pharmacokinetics and catabolism. It is predominantly a problem with intravenous immunoglobulin (IVIg) as replacement therapy or as an immunomodulator. However, there are no systematic data on the scale of the problem.

Changes in the Oswestry Disability Index that predict improvement after lumbar fusion

Clinical studies use both disease-specific and generic health outcomes measures. Disease-specific measures focus on health domains most relevant to the clinical population, while generic measures assess overall health-related quality of life. There is little information about which domains of the Oswestry Disability Index (ODI) are most important in determining improvement in overall health-related quality of life, as measured by the 36-Item Short Form Health Survey (SF-36), after lumbar spinal fusion. The objective of the study is to determine which clinical elements assessed by the ODI most influence improvement of overall health-related quality of life. A single tertiary spine center database was used to identify patients undergoing lumbar fusion for standard degenerative indications. Patients with complete preoperative and 2-year outcomes measures were included. Pearson correlation was used to assess the relationship between improvement in each item of the ODI with improvement in the SF-36 physical component summary (PCS) score, as well as achievement of the SF-36 PCS minimum clinically important difference (MCID). Multivariate regression modeling was used to examine which items of the ODI best predicted achievement for the SF-36 PCS MCID. The effect size and standardized response mean were calculated for each of the items of the ODI. A total of 1104 patients met inclusion criteria (674 female and 430 male patients). The mean age at surgery was 57 years. All items of the ODI showed significant correlations with the change in SF-36 PCS score and achievement of MCID for the SF-36 PCS, but only pain intensity, walking, and social life had r values > 0.4 reflecting moderate correlation. These 3 variables were also the dimensions that were independent predictors of the SF-36 PCS, and they were the only dimensions that had effect sizes and standardized response means that were moderate to large. Of the health dimensions measured by the ODI, pain intensity, walking, and social life best predicted improvement in overall health-related quality of life, as measured using the SF-36 PCS.

Translation and cultural adaptation of health utilities index with application to pediatric oncology patients during neutropenia and recovery in Turkey

This is a report on the translation and cultural adaptation from English to Turkish languages of a standard HEALTH UTILITIES INDEX® (HUI®) questionnaire for interviewer-administration and proxy assessment of patients' health status, and its use for assessing 50 consecutive pediatric oncology patients during periods of and subsequent recovery from neutropenia. Preparation of the Turkish-language questionnaire was a collaborative effort by physician-researchers in Turkey, senior Health Utilities, Inc. staff with extensive experience in the development and translation of HUI questionnaires, and Turkish-born residents of Canada. Standard HUI questionnaires cover both HUI Mark 2 (HUI2) and HUI Mark 3 (HUI3). The mean improvement in overall health-related quality of life (HRQL) scores between neutropenic and non-neutropenic phases was clinically important according to both HUI2 and HUI3 instruments. Single-attribute utility scores showed clinically important size improvements between phases for HUI2 mobility, emotion, and HUI2 self-care. Significant reductions in disability rates between phases were also detected for pain (HUI2 and HUI3 rate decreases of 30%, P < 0.001) and HUI3 ambulation (rate decline of 14%, P = 0.020). The study results provide evidence that the Turkish-language questionnaire is acceptable, valid and useful for collecting parental assessments of health-status among young cancer patients in Turkey. Neutropenia was associated with important deficits in overall HRQL and disabilities in ambulation/mobility, emotion, self-care, and pain. Treatment plans should include strategies for addressing emotion and pain problems to improve the HRQL of neutropenic patients.

The levonorgestrel intrauterine system as an alternative to hysterectomy for the treatment of idiopathic menorrhagia

Aim of the study. Prospective, observational study to determine the percentage of hysterectomies cancelled after a year of treatment with levonorgestrel intrauterine system (LNG-IUS) among women diagnosed with idiopathic menorrhagia.Main findings. Eighty-two women with a mean age of 44.3 ± 4.9 were enrolled. Throughout 1-year follow-up, progressive and significant reduction was observed in number of days of bleeding (8.9 ± 4.0 vs. 5.0 ± 5.4), number of sanitary measures (29.3 ± 19.4 vs. 8.1 ± 10.8) and percentage of patients having intense/very intense bleeding (98.8%vs. 6.4%). Duration of menstrual cycle significantly increased from 26.9 ± 5.5 to 52.6 ± 33.6 days. Significant improvement in overall health-related quality of life was achieved. Patient satisfaction was good/very good in 70.7%. Considering only women who attended 12-month visit satisfaction reached 91.2%. 75.6% of scheduled hysterectomies were cancelled. Adverse effects were recorded in less than 40% of patients with no significant differences between visits. Adverse effects led to premature discontinuation of treatment in seven cases. No serious adverse effects were encountered.Interpretation of results. LNG-IUS meets the effectiveness and tolerability criteria for being considered as a first choice treatment option for women with idiopathic menorrhagia. Its use may contribute to decrease the large number of hysterectomies scheduled in Spain.

Robotic-assisted laparoscopic surgery in urology:a historical perspective

Significant improvements in the surgical approaches and management of disease have been made since the advent of antiseptic surgical technique and the widespread use of antibiotics. During the last quarter century, especially in the last decade, however, there has been an indisputable paradigm shift toward the use of minimally invasive surgery for treatment of a variety of diseases. This has benefited the patient in terms of lower morbidity and mortality through less violation of the body's natural protective boundaries. The morbidity in terms of pain, discomfort, and disability often associated with open surgery is due to the process of gaining access to the specific organ or region of interest as opposed to the actual procedure itself. Put another way, the move toward minimally invasive approaches for surgical disease has resulted in superior outcomes, fewer complications, and an overall improvement in health-related quality of life (HRQOL).

A randomized trial among women with heavy menstruation – impact of a decision aid on treatment outcomes and costs

To evaluate the effects of a decision aid for menorrhagia on treatment outcomes and costs over a 12-month follow-up. Randomized trial and pre-trial prospective cohort study. Gynaecology outpatient clinics in 14 Finnish hospitals, 363 (randomized trial) plus 206 (cohort study) patients with menorrhagia. A decision aid booklet explaining menorrhagia and treatment options, mailed to patients before their first clinic appointment. Health related quality of life, psychological well-being, menstrual symptoms, satisfaction with treatment outcome, use and cost of health care services. All study groups experienced overall improvement in health-related quality of life, anxiety, and psychosomatic and menstrual symptoms, but not in sexual life. Treatment in the intervention group was more active than in the control group, with more frequent course of medication and less undecided treatments. However, there were no marked disparities in health outcomes, satisfaction with treatment outcome and costs. Total costs (including productivity loss) per woman because of menorrhagia over the 12-month follow-up were 2760 and 3094 in the intervention and control group, respectively (P = 0.1). The pre-trial group also had a significantly lower rate of uterus saving surgery compared with the control group, but no difference in costs because of menorrhagia treatment. Despite some differences in treatment courses, a decision aid for menorrhagia in booklet form did not increase the use of health services or treatment costs, nor had it impact on health outcomes or satisfaction with outcome of treatment.

Psychiatric Care Lowers IBS Treatment Costs

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessPsychiatric Care Lowers IBS Treatment CostsMark MoranMark MoranSearch for more papers by this authorPublished Online:21 Mar 2003https://doi.org/10.1176/pn.38.6.0029Both psychotherapy and paroxetine appear to improve health-related quality of life for patients with irritable bowel syndrome (IBS), and at no additional cost.“Improvement in overall health-related quality of life is possible even if the pain does not greatly improve,” said Francis Creed, M.D., a professor of psychological medicine at the university department of psychiatry at Manchester Royal Infirmary in Manchester, England.“If patients with severe IBS do not respond to usual treatment, an SSRI antidepressant or referral to psychotherapy is worth trying,” Creed told Psychiatric News. “Exploration of psychological problems, even if they are not very severe, may well lead to improvement in health-related quality of life.”Creed and colleagues published results comparing psychotherapy and paroxetine for IBS in the February issue of Gastroenterology.In the study, 257 subjects treated at seven British hospitals for IBS were randomized to receive either psychotherapy, 20 mg of paroxetine for a period of three months, or treatment as usual—defined as whatever treatment was deemed appropriate by the patient’s treating physician.Psychotherapy consisted of one two-hour and seven 45-minute sessions of “psychodynamic interpersonal therapy” delivered over three months.Creed and colleagues found at one-year follow-up that abdominal pain was similar in all three groups. But both psychotherapy and paroxetine were superior to treatment as usual in improving the physical aspects of health-related quality of life, as measured by the SF36 Health Survey.Importantly, psychotherapy—but not paroxetine—was associated with a significant reduction of health care costs compared with treatment as usual. Psychotherapy was associated with a total cost of $976 (U.S. dollars) compared with paroxetine at a cost of $1,252.Treatment as usual was associated with a cost of $1,663, according to the study.Creed says that many patients with irritable bowel syndrome typically don’t seek treatment at all or use over-the-counter products that may not be helpful. Most patients who do seek help from a gastroenterologist achieve some success with dietary modifications and antispasmodic or other medical therapies.Yet a sizable cohort remains that is not helped, Creed says. And it is among this treatment-refractory group that the highest prevalence of psychiatric illness is found.Mind-Body InteractionCreed and others say IBS is a condition that highlights the mental and emotional component of much medical illness, refuting the traditional dichotomy of mind and body. Among clinic patients with IBS, approximately 50 percent have significant anxiety and depression, Creed said.“For some patients there is primarily an infective, dietary, or other cause,” she told Psychiatric News. “For a small number of people it is primarily anxiety and depression. For the majority, however, there is a physical component together with a psychological component.”Constantine Lyketsos, M.D., a professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, called the study “extremely important,” noting that there have been few controlled cost-effectiveness studies of the best way to treat IBS.Study Proves Treatment Value“This study is showing not only that treatment works and which treatments work, but also the effect on cost,” Lyketsos told Psychiatric News. “In this particular case, it appears that it actually reduces health care costs to treat IBS in a particular way.”Lyketsos, who is chair of APA’s Committee on Consultation-Liaison Psychiatry and Primary Care Education, emphasized that the study demonstrates the value of psychiatric treatment of a condition typically thought of as medical illness. “Those of us in psychosomatic medicine have known this, and this study provides controlled-trial evidence to drive it home,” he said.Lyketsos said that while in most cases there is no known organic cause for the condition, the suffering and distress experienced by patients are real. “The issue is the functioning of the gut, which is affected by the patient’s perceptions,” he said. “The problem isn’t in the gut necessarily, but how the brain interacts with the gut.”At press time, Lyketsos said that the American Board of Medical Specialties is expected to endorse psychosomatic medicine as a new psychiatric subspecialty (Psychiatric News, September 6, 2002).“This study is an example of what this new field is going to do for psychiatry,” he said. “There is going to be more of this kind of work at the research and clinical levels to show how psychiatric care of medically ill patients makes a difference.”An abstract of the study, “The Cost-Effectiveness of Psychotherapy and Paroxetine for Severe Irritable Bowel Syndrome,” is posted on the Web at www2.gastrojournal.org under the February issue. ▪ ISSUES NewArchived

The effects of Panax ginseng on quality of life.

Panax ginseng is marketed and used to maintain natural energy, increase mental and physical abilities, improve mood and promote general health and well-being. Panax ginseng has been studied in a number of randomized clinical trials investigating its effect on physical and psychomotor performance, cognitive function, immunomodulation, diabetes mellitus and herpes simplex type-II infections. Equivocal results have been demonstrated for many of these indications. P. ginseng is also commonly used to promote quality of life (QoL). As a result, ginseng's effect on QoL has become an increasingly important endpoint in clinical trials. We reviewed all studies (n = 9) that determined the effect of P. ginseng on QoL. P. ginseng's has been evaluated at dosages of 80-400 mg. Study duration has spanned from 2 to 9 months. Several QoL measures have been used, ranging from widely accepted core instruments to unpublished investigator-derived questionnaires. In addition, many of the investigators utilized ginseng extracts that were supplemented with vitamins and minerals while others used only standardized ginseng extract. Populations evaluated also differed in terms of underlying morbidity. Nearly every study evaluated (n = 8) demonstrated some degree of QoL improvement. Beneficial effects were evident within instrument summary component scores but improvement in overall composite scores of QoL was rarely seen. However, findings were equivocal. While populations evaluated varied in terms of underlying morbidity, there did not appear to be a substantial difference in their response to ginseng with respect to QoL. Despite some positive results, improvement in overall health-related quality of life cannot, given the current research, be attributed to P. ginseng. However, the possibility that various facets of QoL may have improved and the potential of early transient effects cannot be discounted.