Improvement In QOL Research Articles

The role of inflammation in the development of diabetic polyneuropathy and the possibility of its correction

To study the effect of the combined drug Cytoflavin on the mechanisms of nonspecific inflammation in the treatment of diabetic polyneuropathy (DPN) with an assessment of the dynamics of the TNF-α index. An open comparative prospective observation of patients with a history of DPN for more than 5 years and a high level of TNF-α was carried out. All patients underwent basic oral combined hypoglycemic therapy, the main group used the combined drug Cytoflavin 10 ml (per 200 ml 0.9% NaCl) for 10 days, followed by the transition to the enteral form of the drug, 2 tablets 2 times a day for 1 months The main indication for the appointment of Cytoflavin was the presence of comorbid pathology in the form of cerebrovascular disease in all studied patients. The severity of clinical symptoms of DPN, the quality of life (QOL) of patients, as well as the dynamics of the level of TNF-α as an indicator reflecting the process of inflammation were assessed. As a result of the treatment in the study group, there was an improvement in QoL, a decrease in the severity of sensory complaints and a decrease in the level of TNF-α, which may indicate a possible anti-inflammatory mechanism of the combined drug Cytoflavin. Cytoflavin can inhibit inflammation and reduce the severity of sensitive disorders in patients with DPN.

Особенности вегетативного статуса и качества жизни у пациенток репродуктивного возраста с недифференцированной дисплазией соединительной ткани

The purpose — to study the features of vegetative status and quality of life in female patients of reproductive age with UCTD. Material and methods. We examined 88 female patients (average age 25.0 ± 6.5 years) with UCTD. The control group consisted of 100 practically healthy women without signs of UCTD (average age 26.6 ± 5.4 years). All patients with UCTD had a deficiency of 25(OH)D. In the group of women with UCTD, a significant decrease in the magnesium content in blood serum and oral fluid was diagnosed in comparison with the control group (p = 0.001). The patients were treated with Magnerot (Worwag Pharma, GmbH&Co., KG, Germany) and Fortedetrim (MEDANA PHARMA, SA, Poland) for 8 weeks. After 8 weeks of therapy with Fortedetrim, vitamin D content (25 (OH)D) in blood serum reached reference values and amounted to 36.2 ± 5.2 ng/ml (p = 0.001). After 8 weeks of treatment with Magnerot, the magnesium content in blood serum and oral fluid also reached reference values and amounted to 0.95 ± 0.04 mmol/l and 0.62 ± 0.06 mmol/l, respectively (p = 0.001). Results and discussion. The obtained results testify to a statistically significant decrease in the level of personal anxiety, manifestations of depression, autonomic disorders and improvement in QOL and values of the questionnaire of childbearing role orientations against the background of treatment with Magnerot and Fortedetrim for two months (p < 0.05). Conclusion. The results obtained indicate the need to include magnesium and vitamin D preparations in the program of medical rehabilitation of women of reproductive age with UCTD and its mandatory combination with psychological rehabilitation, taking into account the fact that stressful states and depressive disorders are accompanied by magnesium deficiency. The health protection of such patients becomes especially significant under the catastrophic demographic situation in the Russian Federation («demographic pitfall»).

Comparison of balneotherapy and balneotherapy combined with magnetic-laser therapy at a sanatorium-resort stage of treatment of patients with eczema

The comparative analysis of influence of different variants of SCL: balneotherapy and balneotherapy combined with magnetic laser therapy on the dermatological status, IL-4 and IL-13 level, psycho-emotional state and QOL evaluation in patients with true eczema. The study involved 112 patients with true eczema undergoing spa treatment (SCR) (54 in the balneotherapy group and 58 in the balneotherapy group combined with magnetic laser therapy. The effectiveness of SCR was assessed using the EASI, HARS and MADRS scales, and the DLQI questionnaire. The dynamics of IL-4 and IL-13 plasma levels were studied. The duration of the study was 6 months and 14 days. After 14 days of SCR, a statistically significant reduction of the EASI index was more pronounced in the balneotherapy group in combination with MLT compared to the balneotherapy group (p=0.041). Balneotherapy combined with MLT contributed to a statistically significant reduction in the HARS and HDRS scores. The decrease in IL-4 and IL-13 levels was statistically more significant in the balneotherapy group in combination with MLT. The combined use of balneotherapy and MLT in comparison with the balneotherapy group was accompanied by a more pronounced improvement in QOL. The combined use of balneotherapy and MLT in the follow-up phase showed a long-term positive effect: 6 months after completing SCR, the number of patients who had clinical remission was statistically significantly higher than that of the balneotherapy group (87.4% vs 22.5%). The combined use of balneotherapy and MLT compared with balneotherapy in patients with true eczema on SCR was shown to be advantageous. The complex application of balneotherapy and MLT decreases inflammatory biomarker scores, improves dermatological and psychoemotional status, QOL parameters and is well tolerated.

Long-term effects of deep-learning digital therapeutics on pain, movement control, and preliminary cost-effectiveness in low back pain: A randomized controlled trial.

The present study aimed to compare the effects of a deep learning-based digital application with digital application physical therapy (DPT) and those of conventional physical therapy (CPT) on back pain intensity, limited functional ability, lower extremity weakness, radicular symptoms, limited range of motion (ROM), functional movement, quality of life, cost-effectiveness, and postintervention questionnaires for perceived transmission risk of COVID-19 and satisfaction results in 100 participants with low back pain (LBP). One hundred participants with LBP were randomized into either DPT or CPT groups, three times per week over four weeks. Outcome measures included the (1) Oswestry Disability Index, (2) Quebec Back Pain Disability Scale, (3) Roland-Morris Disability Questionnaire (RMDQ), (4) Numeric Pain Rating Scale, (5) functional movement screen (FMS), (6) short form-12, (7) lower extremity strength, (8) ROM of trunk flexion, extension, and bilateral side bending, (9) questionnaires for perceived transmission risk of COVID-19, (10) preliminary cost-effectiveness, and (11) postintervention satisfaction questionnaire results. The analysis of variance was conducted at p < 0.05. Analysis of variance showed that DPT showed superior effects, compared to CPT on RMDQ, hip extensor strength, transmission risk of COVID-19, as well as satisfaction. Both groups showed significant improvement pre- and postintervention, suggesting that DPT is as effective as CPT, and was superior in preliminary cost-effectiveness and transmission risk of COVID-19. Our results provide novel, promising clinical evidence that DPT was as effective as CPT in improving structural and functional impairment, activity limitation, and participation restriction. Our results highlight the successful incorporation of DPT intervention for clinical outcome measures, lower extremity strength, trunk mobility, ADL improvement, QOL improvement, and FMS in LBP.

Laparoscopic Simple Prostatectomy: A Single Center Experience with A Long-Term Follow Up.

The aim of this retrospective study is to assess the long-term outcomes and safety of laparoscopic simple prostatectomy. Between 2012 and 2019 80 patients with prostates volumes ≥ 80 mL were treated with laparoscopic simple prostatectomy at our department. Uroflowmetry, post void residual volume and standardized questionnaires were assessed pre- and postoperatively. Perioperative complications were categorized using the Clavien-Dindo classification. The mean specimen weight was 83 grams, and the mean operation time was 156 minutes. At a mean follow-up time of 40 months patients showed a significant improvement of Qmax (P = .002), IPSS (P < .001) and QoL (P < .001). Post void residual volumes decreased significantly. Complications occurred in 11 patients (13.8%), nine had mild (grade 1 - 2) and two had severe (grade 3b - 4a) complications. One conversion to open surgery due to massive prostatic adherence from previous abscess formation was recorded and one patient needed blood transfusion intraoperatively. laparoscopic simple prostatectomy is an effective and safe procedure for large volume prostate glands with a significant and stable long term symptoms improvement.

Prevazilaženje izazova - model metodologije nadzora infekcija povezanih sa zdravstvenom zaštitom

Healthcare-associated infections are infections people get while they are receiving health care for another condition and they can happen in any health care facility. In the U.S.A. alone the annual number of these infections has been estimated to 1.7 million by the Centers for Disease Control and Prevention. Also, it is estimated that they contribute to around 99,000 deaths per year. The focus on preventive strategies is only possible if reliable data on infection rates per ward are available. For this purpose, a frequent broad-based healthcare-associated infections surveillance is necessary. The aim of this article is to present a specific type of epidemiological surveillance system called Integrated Disease Management Corporation Surveillance. Future research has a great challenge to see how to successfully implement Integrated Disease Management Corporation Surveillance into different types of health care system facilities. The emphasis in the future process of such implementation should consider the definition of quantitative share or qualitative indicator that would be able to present how much an Integrated Disease Management Corporation Surveillance, incorporated in a medical facility would be capable to result in improvement in HAI specific QoL, activities of daily living capacity, hospital admissions, and hospital days per person. Future research should evaluate which combination of Integrated Disease Management Corporation Surveillance components and which intervention duration are most effective for Integrated Disease Management Corporation Surveillance programs, and should consider contextual determinants of implementation and treatment effect, including process related outcomes, long term follow up, and cost effectiveness analyses. All of this should be tailor targeted for specific medical facility that is about to start using the Integrated Disease Management Corporation Surveillance.

Efficacy of Kinematic Therapy on Mood Disorders, Functional Independence Recovery and Quality of Life of Stroke Survivors

Background and Aims: Mood disorders impact negatively on rehabilitation process and outcomes in stroke survivors (SSv). This study determined efficacy of Kinematic Therapy (KT) on depression, anxiety, functional independence (FI) and QoL of SSv. Methodology: Study involved 940 ambulant SSv recruited from eight health institutions in Lagos, Nigeria and were assessed for depression, anxiety, QoL and FI using Becks Depression Inventory, Becks Anxiety Inventory, Stroke-Specific-QoL questionnaire and FI Measure respectively. They were randomised into KT and Common Physiotherapy (CP) groups. The KT received 25minutes of kinematic therapy while the CP received usual physiotherapy, twice weekly for 6weeks. Results: Six hundred and seventy-four (343males) of the 940 SSv were diagnosed of depression and/or anxiety and participated in this study; 341(50.59%) were in KT while 333 were in SP. More (81.23%) of KT had mild mood disturbance before intervention while 92.36% of them had normal mood after. More (83.18%) of SP had borderline mood disorder before intervention while 84.69% had normal mood after. There was significant (p&lt;0.05) improvement in depression, anxiety, QoL and FI except in language, personality, family role, self care, social role, thinking and upper-limb function in SP. The KT had significantly better improvement all the outcomes than SP. There was negative significant relationship (p&lt;0.05) between depression and anxiety, and FI and QoL. There was positive significant relationship (p&lt;0.05) between FI and QoL except in vision domain. Conclusion: Mood disorders is common in stroke survivors. Kinematic Therapy is more effective in managing depression and anxiety symptoms and improving functional independent recovery and quality of life than conventional physiotherapy in stroke survivors.

JS-CME-2: REDUCTION IN CARDIOVASCULAR MORBIDITY AND MORTALITY BY CARDIAC REHABILITATION: WHAT'S THE EVIDENCE?

The Japanese Society of Cardiac Rehabilitation defines cardiac rehabilitation (CR) as follows. Cardiac rehabilitation refers to a long-term, multifaceted, comprehensive program designed to optimize a cardiac patients physical, psychological, social, and vocational status, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic or heart failure processes, thereby reducing recurrence, rehospitalization and mortality and enabling patients to live comfortably and actively. CR programs include medical assessment, prescribed exercise training, coronary risk factor modification, patient education, counseling and optimal medical therapy for individual patients, which are provided by a multi-disciplinary team in a coordinated manner. Comprehensive CR consists of continuous multidisciplinary team medical care centered on exercise therapy and disease management. Comprehensive CR improves exercise tolerance and physical function in most heart diseases. Improvements in subjective symptoms and QOL are also observed in many heart diseases. Concerning long-term prognostic improvement effect, it is observed in coronary artery disease and heart failure. Reduced readmissions are also observed in heart failure patients. Mechanisms for improving the long-term prognosis of patients with coronary artery disease and heart failure include: 1) improvement of coronary risk factors, 2) improvement of vascular endothelial function and systemic anti-arteriosclerosis/anti-inflammatory effects via suppression of oxidative stress, 3) improvement of autonomic nerve function, 4) increase in skeletal muscle mass and associated various myokine actions. Based on the above-mentioned evidence, all clinical guidelines of the Japanese Circulation Society, AHA, and ESC strongly recommend participation in CR as class I (evidence and/or general agreement that a given procedure or treatment is effective and useful) for patients after acute myocardial infarction. In post-CABG patients, American and European guidelines recommend CR as Class I. As for chronic heart failure, exercise therapy is strongly recommended as class I in all heart failure clinical guidelines in Japan, Europe, and the United States. However, a clinical problem is the low rate of CR participation in patients with heart disease. This tendency is particularly conspicuous in Japan. Furthermore, an increase in the number of elderly heart failure patients with frailty is also a major issue. There is a need to create a system that supports patients through a community network throughout the acute, recovery, and maintenance phases.

Physiotherapy rehabilitation in chronic kidney disease along with cardiovascular complications– case study in ICU settings

Chronic kidney disease or kidney damage leads to decline in glomerular filtration rate (GFR) that lasts for three months or more. Chronic kidney disease (CKD) and heart failure (HF) coexist, and it's thought that roughly 50% of HF patients also have CKD. The following case study is done to interpret the effects of physiotherapy on CKD patient in ICU setting. The goal of the treatment was to decrease shortness of breathing, to maintain the patency of the lungs, to remove the secretions, to maintain the secondary complications and to do early mobilization to make patient independent in ADLs. Outcome measures used were The Timed Up and Go (TUG), Borg rating of perceived exertion (RPE) and SF-36. Along with the improvement of QOL, patient reported Lower levels of discomfort and improved rest and sleep patterns after physiotherapy interventions. Keywords: Chronic kidney disease, physiotherapy in ICU, chest physiotherapy

Determinants of quality of life improvements in anxiety and depressive disorders-A longitudinal study of inpatient psychotherapy.

Quality of life (QoL) is substantially impaired in patients with anxiety disorders (AD) and depressive disorders (DD) and improvements in symptom burden after psychotherapy are not always paralleled by similar improvements in QoL. So far, little is known about treatment outcome in terms of QoL and predictors of QoL improvements following inpatient psychotherapy with a focus on cognitive behavior therapy (CBT). The current study aimed at investigating the relationship between changes in symptoms and QoL across different life domains. Additionally, predictors of a positive treatment outcome were evaluated. 122 patients with AD and/or DD undergoing an 8-weeks inpatient CBT program completed self-report measures of psychopathological symptoms and QoL at pre- and post-treatment. Mixed effects models were used to investigate changes, a confirmatory factor analysis was applied to analyze the latent factor structure of the anxiety sensitivity index and binary logistic regression analyses were performed for predictors of QoL improvements. Patients showed moderate to strong decreases in anxious and depressive symptoms and moderate to strong improvements in general QoL, particularly in the psychological and physical QoL subdomains. Changes in symptom burden correlated most strongly with psychological and physical QoL. In addition, poor QoL before treatment and low levels of specific anxiety sensitivity symptoms (items 1 and 5) significantly predicted improvement in QoL. Patients with poor QoL who are not as inhibited to openly express their anxious feelings particularly benefit from inpatient psychotherapy (individual and group) to improve their QoL. In contrast, our research suggests that patients who are too anxious to openly express their nervousness should receive additional social skills training, more focused treatment to build sufficient self-confidence to better engage in the treatment program.

OP18 Clinical Effectiveness And Safety Of Implantable Bulking Agents For Fecal Incontinence: A Systematic Review

IntroductionThe purpose of this systematic review is to evaluate whether implantable versus injectable bulking agents (second-line therapies) are equal/superior in terms of effectiveness (severity, quality of life [QoL], sustainability) and safety (adverse events) for fecal incontinence (FI).MethodsA systematic review was conducted and five databases were searched (Medline via Ovid, Embase, Cochrane Library, University of York Centre for Reviews and Dissemination, and International Network of Agencies for Health Technology Assessment database). In-/exclusion criteria were predefined according to the PICOS scheme. The Institute of Health Economics risk of bias (RoB) tool assessed studies’ internal validity. According to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the strength of evidence for safety outcomes was rated. A qualitative synthesis of the evidence was used to analyse the data.ResultsSix prospective uncontrolled trials (143 patients) were included. The evidence consists of six prospective single-arm, before-after studies fulfilling the inclusion criteria for assessing clinical effectiveness and safety for implantable bulking agents. FI severity (Cleveland Clinic FI Score) statistically significantly improved to three months (p&lt;0.01) and six months (p&lt;0.05) follow-up (five studies). Improvements in severity sustainability were reported after 12, 14 (p&lt;0.01), and 36 (p&lt;0.0001) months postoperatively. Improved disease-related QoL (FI QoL Score) was found (p&lt;0.05) 12 months after surgery, and statistically significant improvements in QoL’s sustainability after 12 months (one study).Procedure-related adverse events (n=3) occurred, where prostheses extruded during surgery, and anal discomfort/pain was felt (n=11). Device-related adverse events, i.e., prostheses’ dislodgement (n=31) and removed/extruded prostheses (n=3), occurred. Studies were judged with moderate/high RoB. The strength of evidence for safety was judged to be very low.ConclusionsImplantable bulking agents might be an effective and safe minimally invasive option in FI treatment if conservative therapies fail. FI severity significantly improved, but not QoL, which needs to be explored in further studies. Due to the uncontrolled nature of the case series, comparative studies need to be awaited.

Early feasibility testing of a web-based mind-body resiliency program for adults with neurofibromatosis: The NF-Web study.

We aimed to test early feasibility, acceptability, and signals of improvement after the 8-week individually delivered asynchronous, web-based mind-body program (NF-Web) modeled after the synchronous group-based live video program (Relaxation Response Resiliency Program for NF; 3RP-NF). Two cohorts (cohort 1 n = 14, cohort 2 n = 14) completed baseline and posttest (feasibility markers, t-tests). Enrolled participants (N = 28; 80% of those eligible) completed baseline (N = 28; 100% of sample) and posttests (N = 25; 89.3%). Video lesson (58.0%) and homework (70.9%) completion were fair to good. Satisfaction (M = 8.85/10; SD = 2.35), credibility (M = 7.07/10; SD = 1.44), and expectancy (M = 6.68/10; SD = 2.10) were good to excellent. Participation was associated with statistically significant pre-to-post positive changes in quality of life (QoL; Physical, Psychological, Social, and Environmental,; p < 0.05) and emotional distress (depression, anxiety, and stress; p < 0.05). Pain intensity and interference did not improve significantly (p > 0.05) after participation. NF-Web demonstrates initial feasibility, acceptability, and signals of improvement. Results support future trials to ascertain efficacy. Web-based programs may be valuable for individuals with rare illness who prefer to learn skills on their own timeline, have barriers to live video participation, and who also have apprehensions about interacting with others during treatment.

The outcomes of surgical management options for adult acquired buried penis.

Functional and surgical outcomes after surgical correction of adult acquired buried penis (AABP) are limited in the current literature. We retrospectively recruited patients underwent surgical treatment of AABP in a single institution from 2017 to 2021. Surgical repair was classified according to surgical complexity following Pariser-Santucci's classification. The primary endpoint of the study was the recurrence-free rate survival. The secondary endpoints were surgical, functional and patients' reported outcomes. Overall 28 patients were included in the study. Median follow-up was 27.5 (18.5-34.5). The most common complaints at presentation were sexual (53.6%) and voiding (39.3%) dysfunction. Surgical management steps ranged from circumcision to more complex procedures, such as suprapubic fat pad excision, abdominoplasty and/or penile shaft skin grafting. Overall postoperative complications were recorded in 32.1%. High-grade complications (Clavien≥3) occurred in 7.1%. One-year recurrence-free survival was 88.7%. Postoperatively IPSS and IIEF-15 questionnaires showed a significant improvement in urinary 8 (0-12) vs 2 (0-3), p = 0.03 and sexual function 37 (23-68) vs 68 (45-72), p = 0.001 respectively. Overall, patients reported functional improvement and 93.8% experienced a positive impact of QoL. AABP surgical repair, despite the high incidence of complications, seems to allow satisfactory outcomes and a significant improvement in patients' QoL.

Latent profile analysis for quality of life in older patients

BackgroundQuality of life (QOL) is a complex concept known for being influenced by socio-demographic characteristics, individual needs, perceptions and expectations. The study investigates influences of such heterogeneous variables and aims to identify and describe subgroups of older patients who share similar response patterns for the four domains (physical health, psychological health, social relationships and environment) of World Health Organization Quality of Life instrument, Short Form (WHOQOL-BREF).MethodsThe sample used included older Romanian patients (N = 60; equal numbers of men and women; mean age was 71.95, SD = 5.98). Latent Profile Analysis (LPA) was conducted to explore quality of life profiles with the four WHOQOL-BREF domains as input variables. Differences between profiles were analysed by MANOVA and ANOVAs as a follow-up.ResultsThe LPA results showed that the three-profile model was the most suitable and supported the existence of three distinct QOL profiles: low and very low (28.3%), moderate (63.3%) and high (8.4%). The relative entropy value was high (0.86), results pointed to a good profile solution and the three profiles differed significantly from one another.ConclusionOur results reveal heterogeneity within the older adult sample and provide meaningful information to better tailor QOL improvement programs to the needs of older patient groups, especially those designed for patients of profiles related to poorer QOL in different domains.

Patient-reported outcomes from the randomized phase 3 CROWN study of first-line lorlatinib versus crizotinib in advanced ALK-positive non-small cell lung cancer

ObjectivesQuality of life (QoL) for patients with non-small cell lung cancer (NSCLC) is negatively impacted by their disease and treatment side effects. We present detailed patient-reported outcome (PRO) data from the phase 3 CROWN study, which compared lorlatinib with crizotinib in patients with previously untreated ALK-positive advanced NSCLC. Materials and methodsPROs were assessed using the European Organisation for Research and Treatment of Cancer QoL Questionnaire with Lung Cancer module. A longitudinal, random-intercept, random-slope, mixed-effect model assessed score changes from baseline up to (not including) end of treatment. Mean changes of absolute scores from baseline at each cycle were calculated and presented up to cycle 18 (≥ 10-point change considered clinically meaningful). ResultsIn both lorlatinib (n = 148) and crizotinib (n = 140) arms, there were longitudinal improvements across multiple functioning and symptom scores during treatment compared with pre-treatment. Numerical improvements for most longitudinal functioning scores (physical, role, emotional, social) favored lorlatinib; cognitive functioning favored crizotinib. Numerical improvements favored lorlatinib for several symptoms (fatigue, nausea and vomiting, insomnia, appetite loss, constipation, diarrhea [clinically meaningful improvement], and cough); peripheral neuropathy favored crizotinib. Subgroup analyses showed PROs did not differ by presence/absence of baseline brain metastases. ConclusionsPatients receiving first-line lorlatinib or crizotinib showed improvements and delayed deterioration in QoL, functioning, and several symptoms. Alongside the previously reported significantly longer progression-free survival and higher intracranial response rates for lorlatinib versus crizotinib, these data further support the use of lorlatinib over crizotinib in patients with advanced ALK-positive NSCLC with/without baseline brain metastases and provide evidence of several QoL improvements with lorlatinib when used in the first-line setting.

A Prospective Study of Mucosal Sparing Radiation Therapy in Resected Oropharyngeal Cancer Patients

Our objective was to report the prospective results of mucosal sparing radiation therapy in human papillomavirus-related oropharyngeal squamous cell carcinoma. From March 2016 through May 2019, patients were enrolled in this institutional review board-approved prospective cohort study at a multisite institution. Inclusion criteria included p16+ American Joint Committee on Cancer seventh edition pathologic T1 or T2, N1 to N3, and M0 oropharyngeal cancers. Proton therapy (PT) was delivered to at-risk nodal regions, excluding the primary mucosal site. Secondary to insurance denial for PT, intensity modulated radiation therapy (IMRT) was allowed. European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module and Patient-Reported Outcomes Measurement Information System surveys (quality of life [QOL]) and modified barium swallowing impairment profiles (MBSImP) were obtained at baseline before radiation therapy, then 3 and 12 months after radiation therapy. Kaplan-Meier estimates were calculated for time-to-event clinical outcomes, and repeated measures mixed models were used to explore changes in QOL over time. A comparison of QOL and swallowing outcomes with standard-of-care treatment was analyzed. There were 61 evaluable patients with a median follow-up of 38 months (range, 10-64); 44 (72%) were treated with PT and 17 (28%) were treated with IMRT. The 2-year local control, locoregional control, distant metastasis-free survival, and overall survival were 98%, 97%, 98%, and 100%, respectively. There were 6 grade ≥3 events related to treatment. Two IMRT patients required percutaneous endoscopic gastrostomy tube placement during treatment secondary to significant nausea due to dysgeusia. Patients noted significant QOL improvement over time in the pain, swallowing, speech, social eating, social contact, mouth opening, and use of pain medication domains (all P < .02). The MBSImP overall severity score as well as oral and pharyngeal impairment scores showed stability with no significant change over time. For the 44 patients treated with PT, the mean D95 to the primary target was 10.7 Gy (standard deviation=12.5 Gy). Mucosal sparing radiation is well tolerated in select resected human papillomavirus-related oropharyngeal squamous cell carcinoma with a low risk of recurrence at the mucosal primary site, a low rate of percutaneous endoscopic gastrostomy tube placement, and few radiation-related grade ≥3 adverse events.

Quality of Life, Depressive Symptoms, and Personality Traits in Syrian Refugee Adolescents.

PurposeRefugee adolescents’ quality of life (Qol) was not investigated during the Covid-19 pandemic which have a potential impact on refugee adolescents’ Qol. In this study, it is planned to investigate refugee adolescents’ Qol and its association with depression and quality of life.Methods301 refugee adolescents aged between 14 and 18 who immigrated from Syria was included in the study. Personality Inventory for DSM-5 Brief Form (PID-5 BF), Beck Depression Scale, and Life Quality Scale was used as assessment tools. The data were tested using structural equation modeling.ResultsBoth depressive symptoms and personality traits are associated with low Qol. Also, depression mediated the relationship between personality disorder and Qol.ConclusionThis is the first study that investigates Qol in Syrian refugee adolescents during the pandemic. This study draws attention to the importance of depressive symptoms and personality traits management for improvement of Qol in Syrian refugee adolescent population.Highlights• Depressive symptoms are associated with low Qol in refugee adolescents.• Personality traits are associated with low Qol in refugee adolescents.• Depressive symptoms have a mediator role between personality traits and Qol.

Baroreflex activation therapy in advanced heart failure therapy: insights from a real-world scenario.

Baroreflex activation therapy (BAT) is an innovative treatment option for advanced heart failure (HFrEF). We analysed patients' BAT acceptance and the outcome of BAT patients compared with HFrEF patients solely treated with a guideline-directed medical therapy (GDMT) and studied effects of sacubitril/valsartan (ARNI). In this prospective study, 40 HFrEF patients (71±3years, 20% female) answered a questionnaire on the acceptance of BAT. Follow-up visits were performed after 3, 6, and 12months. Primary efficacy endpoints included an improvement in QoL, NYHA class, LVEF, HF hospitalization, NT-proBNP levels, and 6MHWD. Twenty-nine patients (73%) showed interest in BAT. Ten patients (25%) opted for implantation. BAT and BAT+ARNI patients developed an increase in LVEF (BAT +10%, P-value (P)=0.005*; BAT+ARNI +9%, P=0.049*), an improved NYHA class (BAT -88%, P=0.014*, BAT+ARNI -90%, P=0.037*), QoL (BAT +21%, P=0.020*, BAT+ARNI +22%, P=0.012*), and reduced NT-proBNP levels (BAT -24%, P=0.297, BAT+ARNI -37%, P=0.297). BAT HF hospitalization rates were lower (50%) compared with control group patients (83%) (P=0.020*). Although BAT has generated considerable interest, acceptance appears to be ambivalent. BAT improves outcome with regard to LVEF, NYHA class, QoL, NT-proBNP levels, and HF hospitalization rates. BAT+ARNI resulted in more pronounced effects than ARNI alone.

Mid-term results of water vapor thermal therapy in patients with lower urinary tract symptoms related to benign prostatic hyperplasia

ObjectiveIn this study, we evaluate the short- and mid-term results of water vapor thermal therapy (WVTT) for LUTS (lower urinary tract symptoms) due to benign prostatic hyperplasia (BPH).MethodsPatients with LUTS due to BPH who underwent WVTT from September 2019 to April 2022 were included in this prospective, single-center study. Data regarding functional and sexual outcomes were evaluated by validated questionnaires as well as uroflowmetry, urinalysis and cultures, digital rectal examination, serum prostate-specific antigen, and transrectal ultrasound. The patients were followed-up with 3, 6, 12, and 18 months after the procedure.ResultsEighty-four men were treated. Mean ± SD prostate volume, operative time, and hospital stay were 76.9 ± 26.3 ml, 14 ± 18.5 min, and 0.9 ± 0.7 days, respectively. The catheter was removed after 7 ± 4.4 days. A significant (p &amp;lt; 0.05) improvement in Qmax, IPSS, QoL, OAB-q SF, ICIQ-SF, and IIEF- 5 from the baseline at the last follow-up (18 months) was recorded. Seventy-six (90%) patients reported a significant improvement in ejaculatory function (de novo dry ejaculation in 4 patients). Early (≤30 days) postoperative complications were reported in 70% of patients, all grade 1 according to Clavien–Dindo. No late (&amp;gt;30 days) Clavien–Dindo &amp;gt;1 procedure-related complications occurred. Three patients required reoperation (6–12 months after surgery).ConclusionWVTT is an effective and safe treatment for the management of LUTS due to BPH in the short- and mid-term follow-up, and it provides negligible sequelae with respect to ejaculation.

Quality of life reporting in the management of posterior fossa tumours: A systematic review.

IntroductionSurvival amongst posterior fossa tumour (PFT) patients is improving. Clinical endpoints such as overall survival fail to depict QoL. There is yet to be a review of current QoL instruments used for adult PFTs. Aim of this review is to outline the QoL reporting in the management of PFTs and measure participation level.MethodsThis systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A search strategy to identify adult patients with PFTs who took part in QoL metrics was conducted. Observational and experimental studies published from 1990 to date were included. Studies with a sample size less than 10 and performance measures such as Karnofsky Performance Status were not considered.ResultsA total of 116 studies were included in the final analysis. Vestibular schwannomas were the most common tumour pathology (n = 23,886, 92.6%) followed by pilocytic astrocytomas (n = 657, 2.5%) and meningiomas (n = 437, 1.7%) Twenty-five different QoL measures were used in the study pool. SF-36 was the most common (n = 55, 17 47.4%) QoL metric in the whole study pool, followed by the Penn Acoustic Neuroma QoL scale (n = 24, 20.7%) and Dizziness Handicap Inventory (n = 16, 13.8%). Seventy-two studies reported less-than 100% participation in QoL evaluation. The commonest reason for non-participation was a lack of response (n = 1,718, 60.8%), incomplete questionnaires (n = 268, 9.4%) and cognitive dysfunction (n = 258, 9.1%).ConclusionInformed clinical decision-making in PFT patients requires the development of specific QoL outcomes. Core outcome sets, and minimal clinically important differences (MCID) are essential for these metrics to show clinically significant improvements in patient QoL.