Improvements In Quality Of Life Measures Research Articles

Abstract TP52: Post-acute Transition Of Care In Stroke Patients: A Systematic Review

Background: Post-acute transition of care (TOC) in stroke patients is a multifactorial process. Different TOC interventions have been tested, with inconsistent benefits. Objective: Our aim is to evaluate the effect of post-acute TOC interventions on various stroke patients’ outcomes. Methods: All published interventional studies evaluating the impacts of TOC models for stroke survivors, during their post-acute care disposition, were included. We excluded studies tackling only patients with intracerebral hemorrhage (ICH) or transient ischemic attacks, those with purely rehabilitative interventions, case reports and case studies, as well as systematic reviews and meta-analyses. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) through July 2022. Results: We included 38 studies involving 82,416 patients. TOC services were heterogeneous, commonly including scheduled home visits, telephone calls and office visits, in the setting of a multidisciplinary approach. Outcome measurement time varied between 1 month and 5 years. Activities of daily living (ADLs)-related outcomes, functionality, quality of life (QOL)-related outcomes, readmission rates, mental health-related outcomes, and mortality were reported in 20, 11, 10, 10, 7, and 6 studies, respectively. Only 4 studies looked at rates of medication adherence and 2 studies at control of vascular risk factors. In 6 out of 10 studies, improvements in QOL measurements and patient-reported health surveys were reported, whereas no study reported improvement in mortality rates. Three studies showed improvement for each of the following outcomes: ADLs, functionality, and readmission rates. Only 2 studies noted decrease in mental health problems with the intervention, and 2 noted better control of vascular risk factors. Both studies with medication adherence outcomes showed that the intervention increases rates of compliance to prescribed drugs. Conclusion: Post-acute TOC interventions seem to have a positive effect on stroke survivors’ quality of life and self-perceived health, as well as on rates of medication adherence, but bear no effect on mortality.

Dry eye-related quality of life among type 2 diabetes patients: a hospital-based cross-sectional study

ABSTRACT Background To investigate the impact of dry eye syndrome (DES) on dry eye-related quality of life (QoL) in patients with type 2 diabetes. Research design and methods Evaluation of DES included assessment of meibomian gland function, tear breakup time (TBUT), Schirmer test, fluorescein ocular surface staining, and Ocular Surface Disease Index (OSDI) scores. DES diagnosis was based on OSDI score ≥13, TBUT < 10s, and fluorescein staining. Results After adjusting for age, duration of diabetes, drug usage, and comorbidities, severity of DES symptomatology and signs resulted in poorer QoL of patients when comparing cases and controls. TBUT, meibum quality, and ocular surface staining were the objective clinical tests that significantly correlated with QoL. Poor QoL was also associated with the presence of eyelash and eyelid anomalies (eyelash: aOR = 2.58, CI = 1.49–4.47, p = 0.001; eyelids: aOR = 1.66, CI = 1.01–2.71, p = 0.04). Patients who had been previously diagnosed and treated for DES registered improved QoL measures. Conclusions Symptoms or clinical signs of DES resulted in poorer QoL in a clinical sample of type 2 diabetes patients, stressing the need for clinicians to evaluate such signs and symptoms in order to improve QoL.

Impact of apremilast on quality of life in Behçet’s syndrome: analysis of the phase 3 RELIEF study

ObjectiveTo assess apremilast’s impact on patient quality of life (QoL) in active Behçet’s syndrome and correlations between improvement in patients’ QoL and efficacy measures in the phase 3 RELIEF study.MethodsQoL...

Does urinary urgency drive urinary frequency in overactive bladder?

To determine if reduction in urgency in patients with refractory overactive bladder syndrome (rOAB) is correlated with a reduction in voiding frequency and symptom bother. Data from a prospective series of women with rOAB undergoing radiofrequency ablation of the subtrigonal tissue, termed selective bladder denervation (SBD), was analyzed. Main outcome measures included urgency voids, nonurgency voids, and urgency urinary incontinence (UUI) epidsodes from a 3-day voiding diary and quality of life (QoL) measures (Overactive Bladder Questionnaire Short Form [OAB-q SF]). The dataset comprised 62 completer subjects at 6 months. Compared to baseline, UUI and urgency voids were lower (P < .001), but nonurgency voids were increased (P < .001) and QoL measures were improved (P < .001), but functional bladder capacity did not increase. At baseline and 6 months post treatment, symptom bother was correlated with urgency voids (P < .05) but inversely correlated with nonurgency voids (P < .001). Urgency and nonurgency voids were inversely related at baseline and at 6 months (P < .0001). Following treatment, urgency voids decreased by 41% and nonurgency voids increased by 33%. As with other interventions for OAB, SBD resulted in a reduction in OAB symptoms and an improvement in QoL measures. However, the decrease in urgency voids was offset by an increase in nonurgency voids, suggesting that habit or defensive voiding is a significant driver of urinary frequency. It is not certain if this is a unique finding of the SBD effect, but these data do suggest that analyses of outcomes of other OAB interventions are warranted to gain a better understanding of the genesis of OAB symptoms.

Examining spoken words and acoustic features of therapy sessions to understand family caregivers’ anxiety and quality of life

BackgroundSpeech and language cues are considered significant data sources that can reveal insights into one’s behavior and well-being. The goal of this study is to evaluate how different machine learning (ML) classifiers trained both on the spoken word and acoustic features during live conversations between family caregivers and a therapist, correlate to anxiety and quality of life (QoL) as assessed by validated instruments. MethodsThe dataset comprised of 124 audio-recorded and professionally transcribed discussions between family caregivers of hospice patients and a therapist, of challenges they faced in their caregiving role, and standardized assessments of self-reported QoL and anxiety. We custom-built and trained an Automated Speech Recognition (ASR) system on older adult voices and created a logistic regression-based classifier that incorporated audio-based features. The classification process automated the QoL scoring and display of the score in real time, replacing hand-coding for self-reported assessments with a machine learning identified classifier. FindingsOf the 124 audio files and their transcripts, 87 of these transcripts (70%) were selected to serve as the training set, holding the remaining 30% of the data for evaluation. For anxiety, the results of adding the dimension of sound and an automated speech-to-text transcription outperformed the prior classifier trained only on human-rendered transcriptions. Specifically, precision improved from 86% to 92%, accuracy from 81% to 89%, and recall from 78% to 88%. InterpretationClassifiers can be developed through ML techniques which can indicate improvements in QoL measures with a reasonable degree of accuracy. Examining the content, sound of the voice and context of the conversation provides insights into additional factors affecting anxiety and QoL that could be addressed in tailored therapy and the design of conversational agents serving as therapy chatbots.

Abstract 11751: Long Term Quality of Life Improvement After Peripheral Vascular Intervention- Insights From the Liberty 360 Study

Background: Improving patients’ quality of life (QoL) is a primary indication for peripheral endovascular intervention (PVI) for peripheral arterial disease (PAD). Little is known about the long-term improvement in QoL following PVI or predictors of those who may experience the greatest benefit. Methods: We studied 1204 patients enrolled in LIBERTY 360 Study, a prospective, multicenter study that evaluated clinical outcomes in symptomatic PAD patients undergoing lower extremity PVI. Patient reported QoL measures were assessed at 30 days, 12 months and 36 months using EuroQol and VascuQol-25. Multivariable regression was used to identify significant predictors of improved quality of life at 12 months. Results: For claudication patients (Rutherford 2-3), the baseline VascuQol total score was 4.3±1.3 and EuroQol composite score indicated that 21.5% had no/slight functional problems (NSFP). Health status significantly improved by 30 days, with VascuQol score 5.4±1.3 and 48.2% with NSFP), and persisted through 3 years (1 year: VascuQol score 5.3±1.3, 46.3% with NSFP; 3 years: VascuQol score 5.3±1.4, 46.9% with NSFP). For patients with critical limb ischemia (CLI; Rutherford 4-6), baseline VascuQol total score was 3.8±1.4 and 16.6% had NSFP. Health status significantly improved by 30 days, with VascuQol score 4.7±1.4 and 29.9% with NSFP, and persisted through 3 years (1 year: VascuQol score 5.0±1.4, 35.0% with NSFP; 3 years: VascuQol score 5.0±1.4, 38.0% with NSFP). In multivariable regression, baseline symptom severity, disease severity, BMI, gender, history of PVI, target lesion residual stenosis and renal disease were significant predictors of QoL improvement post-intervention (Figure 1). Conclusions: Endovascular intervention is associated with significant, long-term improvement in QoL measures across different disease severity. Baseline symptom severity and comorbidities were strong predictors of QoL improvement 1 year after intervention.

The Effects of Exercise Prescription on Aerobic Performance and Quality of Life During the Course of Lymphoma Chemotherapy: Results of a Prospective Controlled Study

Background and Aim: This study is designed to investigate the physical, psychological and quality of life (QoL) effects of a 16 week supervised and structured intensive aerobic and strength training during the first line chemotherapy of lymphomas. Patients and MethodsThis pre-post study with two groups enrolled ≥18 years of age lymphoma patients scheduled for the first line chemotherapy. Eligible patients were assigned upon patients’ preference either to control group (Group C) involving simple counselling, or intervention group (Group I) involving supervised intensive training. Baseline, interim and final evaluations were performed per protocol. Repeated measures analysis of variance was used to investigate the effect of intervention. ResultsThe mean age of 47 enrolled patients was 44 [standard deviation (SD) ± 17] and 27 (57.4%) of them were male. Patients in Group C (n = 19) and Group I (n = 28) had similar baseline characteristics. Tmax was significantly higher in Group I (P = .03) without a significant change during the study course (P = .98). Significant increases were observed in the power of some muscle groups, irrespective of the intervention type. The mean adherence rates were 83.0% (SD ± 22.0) and 54.0% (SD ± 23.0); the discontinuation rates were 10.7% (n = 3) and 42.9% (n = 12), at interim and final evaluations, respectively. ConclusionBoth supervised and structured schemes and simple counselling, prevent further muscle wasting and lead to modest improvements in aerobic performance and muscle strength during lymphoma chemotherapy. These results do not translate into a significant improvement in QoL measures. Non-adherence and discontinuation are important issues to be solved.

The impact of cognitive rehabilitation on quality of life in multiple sclerosis: A pilot study.

BackgroundCognitive impairment in people with multiple sclerosis (pwMS) negatively impacts daily function and quality of life (QoL). Prior studies of cognitive rehabilitation in pwMS have shown limited benefit but many focused on cognitive function scores rather than QoL measures. Studies using QoL metrics primarily evaluated group cognitive rehabilitation, which may be less appropriate due to variable cognitive profiles in pwMS. This study assesses the impact of an individualized cognitive rehabilitation approach on QoL in MS.MethodsWe performed a retrospective chart review of NeuroQoL assessments done by pwMS (n = 12, mean age 47.9 ± 4.0 years, 75% female, 100% White, 75% RRMS) before and after participation in an individualized compensatory cognitive program. We used a comparison group of pwMS who were candidates for the program but did not participate (n = 9, mean age 48.9 ± 4.4 years, 88.9% female, 100% White, 66.7% RRMS)ResultsPwMS who participated in the rehabilitation program saw improvements in Sleep Disturbance (50.5 from 55.5, p = 0.005), Fatigue (52.5 from 57.0, p = 0.024), Anxiety (49.8 from 55.4, p = 0.011), and Cognitive Function (39.3 from 36.7, p = 0.049).ConclusionsIndividualized compensatory cognitive rehabilitation appears effective for improving QoL measures in pwMS with cognitive complaints, supporting the need for further randomized controlled prospective analysis of this intervention.

Effects of a resistance training community programme in older adults

AbstractAgeing is associated with reduced muscle mass, strength, flexibility and balance, resulting in a poor quality of life (QOL). Past studies have occurred in highly controlled laboratory settings which provide strong support to determine whether similar gains can be made in community programmes. Twenty participants were enrolled in an eight-week community-based resistance training programme (mean age = 61.3 (standard error (SE) = 0.9) years); Body Mass Index = 32.0 (SE = 1.3) kg/m2). All participants completed surveys to assess outcomes associated with QOL. Given the relationship between muscle function and nerve health, nerve conduction studies (NCS) were also conducted in a separate group of participants (mean age = 64.9 (SE = 2.0) years; Body Mass Index = 32.6 (SE = 1.9) kg/m2). This community-based training programme significantly improved QOL measures in older adults (p &lt; 0.001). Although weight loss was not the primary outcome of the study, participants reduced their body weights (p &lt; 0.001), by primarily reducing fat mass (p = 0.007) while maintaining muscle mass. Significant improvements were observed in muscle strength (2.2%), flexibility and balance (3.2–464.2%, p ⩽ 0.05 for all). Improvements were also observed in plasma glucose (p = 0.05), haemoglobin A1C (p = 0.06) and aldolase enzyme levels (p &lt; 0.001). Scores for surveys on memory and sleep improved (p &lt; 0.05). Improved QOL was associated with increased lean mass (r = −0.714, p = 0.002), decreased fat mass (r = −0.702, p = 0.003) and improved flexibility and balance (r = −0.627, p = 0.008). An eight-week, community-based resistance training programme significantly improved QOL in older adults. Influence on the lipid profile and NCS still needs further investigation.

Early Changes in Physical Activity and Quality of Life With Thoracic Radiation Therapy in Breast Cancer, Lung Cancer, and Lymphoma

The effects of thoracic radiation therapy (RT) on physical functioning and quality of life (QoL) are incompletely defined. We determined the associations between thoracic RT dose volume metrics, physical activity, and QoL in patients with cancer. Participants with breast cancer, lung cancer, or mediastinal lymphoma treated with radiation with or without chemotherapy were enrolled in a prospective, longitudinal cohort study. Data were collected pre-RT, immediately post-RT, and 5 to 9 months post-RT. At each timepoint, self-reported physical activity was assessed via the Godin-Shephard Leisure-Time Physical Activity Questionnaire, and QoL metrics were assessed via Functional Assessment of Chronic Illness Therapy Fatigue and Dyspnea Scales. Multivariable adjusted linear regression models were stratified by breast cancer alone and lung cancer and lymphoma combined. One hundred thirty participants were included in the study. In breast cancer (n = 80), each 1-Gy increase in mean heart dose was associated with worse Functional Assessment of Chronic Illness Therapy Fatigue scores (-1.0; 95% confidence interval [CI], -1.9 to -0.2; P = .021); similar associations were observed between V5 and fatigue (-2.5; 95% CI, -4.4 to -0.6; P = .010 for each 10% increase in V5). In lung cancer and lymphoma (n = 50), each 10% increase in V5 was associated with decreased physical activity (Godin-Shephard Leisure-Time Physical Activity Questionnaire score -2.3; 95% CI, -4.3 to -0.4; P = .017). Although the associations between baseline levels of physical activity and fatigue and dyspnea were of borderline significance in breast cancer alone (P < .10), increased physical activity over time was associated with improvements in fatigue and dyspnea across all cancer types (P < .05 for all). Higher cardiac RT dose was associated with worse fatigue and physical activity across breast cancer, lung cancer, and mediastinal lymphoma. Longitudinal increases in physical activity were associated with concurrent improvements in QoL measures. Strategies to increase physical activity and decrease cardiac RT dose may improve physical functioning and QoL for patients with cancer.

Quality of life outcomes from a randomized controlled trial of patient navigation in Latina breast cancer survivors.

IntroductionBreast cancer survivorship is a life‐long process involving challenges to health‐care communities and individuals, especially Latinas. Patient Navigation has shown some success in meeting these challenges. The purpose of this study was to compare the effects of an enhanced Patient Navigation program (Intervention; PN+) vs Control (PN) over time on general cancer and breast cancer‐specific quality of life (QoL) in Latina breast cancer survivors (BCS).MethodsWe conducted a 2‐year, two‐arm randomized controlled trial of the “Staying Healthy” program among Latina BCS. The design compared PN+ vs PN over time. We recruited 60 patients into each study arm and randomized them by sequential numerical assignment. PN+ participants received culturally tailored educational materials and active, personalized Patient Navigation services, including phone calls, transportation, and care coordination. PN participants were navigated only upon request. Primary outcomes included general cancer (Functional Assessments of Cancer Therapy [FACTS]‐G) and breast cancer‐specific (FACT‐B) QoL.ResultsPN+ participants had significantly improved QoL measures compared to PN at 6‐month follow‐up on all subscales (P‐values .007‐.04) except physical well‐being (PWB; P = .11). Intervention effect size coefficient (standard error) for FACT‐G overall was 7.9 (3.1); P = .01. For FACT‐B, it was 10.9 (3.9); P = .006. Again, all subscales showed significant effects [range 1.7‐3.1 (0.8‐1.2); P‐values .006‐.04], except for PWB [1.5 (1.0); P = .16] and social/family well‐being (SWB) [2.1 (1.1); P = .06]. There were no differences between groups at baseline.DiscussionMultiple cultural, psychosocial, and socioeconomic variables contributing to these intervention effects will be addressed in future studies. As the national BCS population continues to increase, more Patient Navigation‐focused partnerships among patients, health‐care professionals, research groups, and community organizations are needed to improve BCS experiences. The Staying Healthy program has the potential to serve as a national survivorship care model for improving Latina BCS QoL.

Adult Attention-Deficit/Hyperactivity Disorder and Quality of Life in High-Dose Benzodiazepine and Related Z-Drug Users

Background: Problematic high-dose benzodiazepine (BZD) and related Z-drug use for a long period is a substance use disorder previously found to be associated with adult attention-deficit/hyperactivity disorder (ADHD) and worse quality of life (QoL). Whether adult ADHD impacts QoL in high-dose BZD/Z-drug users has not been explored. Aim: The aim of the study was to explore the impact of adult ADHD on QoL in high-dose BZD and related Z-drug users. Methods: We recruited 393 patients (205 men and 188 women) consecutively admitted to the Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Italy, from July 2016 to July 2019 for detoxification from high-dose BZD or Z-drug dependence. Demographic and clinical variables and QoL measures were recorded. The World Health Organization ADHD Self-Report Scale version 1.1 Symptom Checklist Part A was used to detect adult ADHD. Results: In our sample, 39.4% of patients were positive to adult ADHD testing (ADHD+), with some clinical features differing in comparison to patients negative to ADHD testing (ADHD−). QoL was worse in high-dose BZD/Z-drug users than the general population. The ADHD+ group showed significantly worse QoL measures than the ADHD− group. Multivariate analysis, including potential covariates showed adult ADHD and age to have the most robust and consistent positive effect for age (i.e., higher QoL) and negative effect for ADHD (i.e., lower QoL) on QoL measures. Conclusions: Adult ADHD is associated with worse QoL measures in high-dose BZD/Z-drug users. Future studies should explore whether appropriate BZD/Z-drug detoxification might improve QoL measures and whether the most appropriate detoxification protocol differs in ADHD+ versus ADHD− populations.

Efficacy of antireflux surgery in children with or without neurological impairment: a systematic review.

Antireflux surgery is commonly performed in children, yet evidence for its efficacy is limited. The aim of this review was to determine the effect of antireflux surgery with regard to objective measures of quality of life (QoL) and value of upper gastrointestinal investigations in neurologically normal (NN) and neurologically impaired (NI) children. A systematic review was conducted of articles reporting children undergoing antireflux surgery in whom preoperative and postoperative objective testing was performed. Primarily, Embase, CINAHL, MEDLINE and PubMed were searched from inception to April 2019. Methodological Index for Non-randomized Studies (MINORS) criteria were used to assess article quality. Of 789 articles, 14 met the eligibility criteria, 12 prospective observational and 2 retrospective studies. The median MINORS score was 59·4 (i.q.r. 39 to 62·5) per cent. Seven studies reported assessment of validated QoL measures before and after antireflux surgery in 148 children. Follow-up ranged from 1 to 180 months. All studies confirmed significant improvements in QoL measures among NN and NI children at all follow-up points. Eleven studies reported on preoperative and postoperative investigations in between 416 and 440 children children. Follow-up ranged from 0·5 to 180 months. Nine studies confirmed improvements in gastro-oesophageal reflux using 24-h oesophageal pH monitoring with or without manometry, but conflicting results were identified for four studies reporting gastric emptying. No studies reported fluoroscopy or endoscopy adequately. Based on the results of studies of low-to-moderate quality, antireflux surgery improved QoL and reduced oesophageal acid exposure in NN and NI children in the short and medium term. Although antireflux surgery is a common elective operation, the lack of rigorous preoperative and postoperative evaluation(s) in the majority of patient-reported studies is striking.

Utilization of 3D imaging reconstructions and assessment of symptom-free survival after microvascular decompression of the facial nerve in hemifacial spasm.

Hemifacial spasm (HFS), largely caused by neurovascular compression (NVC) of the facial nerve, is a rare condition characterized by paroxysmal, unilateral, involuntary contraction of facial muscles. It has long been suggested that these symptoms are due to compression at the transition zone of the facial nerve. The aim of this study was to examine symptom-free survival and long-term quality of life (QOL) in HFS patients who underwent microvascular decompression (MVD). A secondary aim was to examine the benefit of utilizing fused MRI and MRA post hoc 3D reconstructions to better characterize compression location at the facial nerve root exit zone (fREZ). The authors retrospectively analyzed patients with HFS who underwent MVD at a single institution, combined with a modified HFS-7 telephone questionnaire. Kaplan-Meier analysis was used to determine event-free survival, and the Wilcoxon signed-rank test was used to compare pre- and postoperative HFS-7 scores. Thirty-five patients underwent MVD for HFS between 2002 and 2018 with subsequent 3D reconstructions of preoperative images. The telephone questionnaire response rate was 71% (25/35). If patients could not be reached by telephone, then the last clinic follow-up date was recorded and any recurrence noted. Twenty-four patients (69%) were symptom free at longest follow-up. The mean length of follow-up was 2.4 years (1 month to 8 years). The mean symptom-free survival time was 44.9 ± 5.8 months, and the average symptom-control survival was 69.1 ± 4.9 months. Four patients (11%) experienced full recurrence. Median HFS-7 scores were reduced by 18 points after surgery (Z = -4.013, p < 0.0001). Three-dimensional reconstructed images demonstrated that NVC most commonly occurred at the attached segment (74%, 26/35) of the facial nerve within the fREZ and least commonly occurred at the traditionally implicated transition zone (6%, 2/35). MVD is a safe and effective treatment that significantly improves QOL measures for patients with HFS. The vast majority of patients (31/35, 89%) were symptom free or reported only mild symptoms at longest follow-up. Symptom recurrence, if it occurred, was within the first 2 years of surgery, which has important implications for patient expectations and informed consent. Three-dimensional image reconstruction analysis determined that culprit compression most commonly occurs proximally along the brainstem at the attached segment. The success of this procedure is dependent on recognizing this pattern and decompressing appropriately. Three-dimensional reconstructions were found to provide much clearer characterization of this area than traditional preoperative imaging. Therefore, the authors suggest that use of these reconstructions in the preoperative setting has the potential to help identify appropriate surgical candidates, guide operative planning, and thus improve outcome in patients with HFS.

The effect of scalp cooling on CIA-related quality of life in breast cancer patients: a systematic review.

Chemotherapy-induced alopecia (CIA) remains a distressing adverse event of cancer treatment but may be prevented by scalp cooling. The effectiveness of scalp cooling, however, is dependent on the chemotherapy regimen with successful hair preservation (i.e., < 50% hair loss) in 41-59% of women on taxane-based therapies in comparison to 16-36% on anthracycline-based therapies. Despite the potential utility, use of scalp cooling has shown a more equivocal impact on quality of life (QoL). In this review, we aim to evaluate the use of scalp cooling for CIA and quantitative QoL measures. A systematic review of PubMed, Embase, Web of Science, and Cochrane databases for clinical studies on scalp cooling to prevent CIA published before October 29, 2018 was performed. Clinical studies with 5 or more patients that reported on a quantitative QoL measure were included and graded according to a modified five-point scale from the Oxford Centre for Evidence-Based Medicine. Studies meeting inclusion criteria included 4 randomized clinical trials (RCT), 8 cohort studies, and 1 cross-sectional study with 1282 unique patients. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30: 46%) and Breast Cancer Module (QLQ-BR23: 46%) represented the most commonly used QoL assessments. Overall, 4 (31%) of the 13 studies concluded that scalp cooling was associated with significant improvements in QoL measures; 8 (62%) determined that there was either non-significant or no improvements; and 1 (7.7%) provided a mixed conclusion. Although 2 (50%) RCT demonstrated that scalp cooling can effectively prevent CIA depending on the chemotherapy regimen, these studies did not show that successful hair preservation was associated with improved QoL measures. This review demonstrates that scalp cooling is not consistently associated with significant QoL improvements as assessed by EORTC QLQ-C30 and -BR23. Representing a critical limitation, more than one-third of the studies did not subcategorize QoL outcomes for successfully or unsuccessfully scalp-cooled patients but rather reported on QoL measures for all scalp-cooled patients in general. Failure to prevent hair loss in patients undergoing an expensive and potentially uncomfortable treatment likely contributes to decreased well-being, impacting the overall distribution of QoL measures in scalp cooling patients compared to controls. Future studies should incorporate validated QoL instruments specific to hair disease and classify QoL outcomes for scalp-cooled patients based on the degree of hair preservation.

When Should Pediatric Septoplasty Be Performed for Nasal Airway Obstruction?

When Should Pediatric Septoplasty Be Performed for Nasal Airway Obstruction?

Destination Therapy: Standardizing the Role of Palliative Medicine and Delineating the DT-LVAD Journey

ContextDestination therapy (DT) patients face significant challenges as they transition from chronic left ventricular assist device (LVAD) support to comfort-oriented care. Integration of palliative medicine (PM) into the multidisciplinary team is important to facilitate advanced care planning (ACP) and improve quality of life (QoL). ObjectivesWe evaluated the impact of a structured programmatic approach to the end-of-life (EOL) process in DT patients as measured by QoL surveys and the utilization of ACP. MethodsWe instituted a four prong intervention approach: 1) delineated the path from implant to EOL by defining specific stages, including a transitional phase where care limits were agreed upon, 2) standardized the role of PM, 3) held transitional care meetings to support shared decision-making, and 4) held multidisciplinary team debriefings to facilitate communication. Preintervention and postintervention outcomes were measured for patients/caregivers by using the QUAL-E/QUAL-E (family) QoL instrument. Wilcoxon signed-ranks test compared nonparametric variables. ResultsAll patients (n = 41)/caregivers (n = 28) reported improved QoL measures (patient P = 0.035/caregiver P = 0.046). Preparedness plans increased from 52% to 73% after implementation and advance directives increased from 71% to 83%. Fifty-nine percent of the patients completed an outpatient PM clinic visit; 51% completed/scheduled a second visit. Clinician outcomes improved including satisfaction with multidisciplinary team communication/expectations, ACP processes, and EOL management. ConclusionA programmatic approach that standardizes the role of PM and delineates the patient's path from implant to EOL improved quality outcomes and increased implementation of ACP. A defined communication process allowed the multidisciplinary team to have a clear patient management approach.

The Effect of Telehealth Interventions on Quality of Life of Cancer Patients: A Systematic Review and Meta-Analysis.

In 2016, ∼1.7 million new cases of cancer were diagnosed. Cancer patients can have physical, functional, and psychosocial issues when dealing with cancer treatment. Telehealth has been effectively introduced to help deliver treatment to patients suffering from chronic disease; however, there is little consensus on its effectiveness in administering sociobehavioral cancer treatments. Thus, this study determines the benefits of telehealth-based interventions providing emotional and symptom support in improving quality of life (QOL) among cancer patients. Two researchers conducted comprehensive searches on PubMed, SCOPUS, Medline, PsycINFO, ERIC, Psychology and Behavioral Collection, and Medline Complete. Key search terms included telehealth or telemedicine and QOL and cancer. Articles were included if they assessed a telehealth-delivered intervention for adult cancer patients and provided a QOL assessment. Data were extracted to calculate mean effect sizes for QOL measures on the effectiveness of telehealth relative to usual care (UC) for cancer treatments. Out of 414 articles identified in our initial search, nine articles fit our inclusion criteria. Both telehealth (Hedges g = 0.211, p = 0.016) and standard of care (Hedges g = 0.217, p < 0.001) cancer treatment delivery methods demonstrated small, but statistically significant improvements in QOL measures. However, there were no statistically significant differences in effectiveness between the telehealth interventions and UC (p = 0.76). The results indicate that telehealth interventions are as effective at improving QOL scores in patients undergoing cancer treatment as in-person UC. Further studies should be undertaken on different modalities of telehealth to determine its appropriate and effective use in interventions to improve the QOL for cancer patients undergoing treatment.

Percutaneous Subtrochanteric Osteotomy for Painful Dislocated Hips in Patients With Cerebral Palsy.

Treatment of a painful, chronically dislocated hip in nonambulatory children with cerebral palsy (CP) is challenging and controversial. Although many surgical options have been described, there is limited information, including patient-centered outcomes, following treatment. The purpose of our study was to evaluate the effect of a percutaneous subtrochanteric valgus osteotomy (SVO) using external fixation (EF) on hip abduction, radiographic parameters, and quality of life (QOL) measures in such patients. Fifteen nonambulatory patients (8 male, 7 female) with CP with 19 chronically dislocated hips underwent SVO using EF and adductor tenotomy at an average age of 14.3 years (range, 10.7 to 26.8 y). Changes in hip abduction and radiographic angular correction following surgery were assessed. Caregivers completed 2 surveys detailing differences in the patient's QOL measures, including severity and duration of pain and ease of nursing care, and the modified Child Health Index of Life with Disabilities (CPCHILD). Caregivers of 11 patients completed both surveys at an average follow-up of 50 months (range, 17 to 119 mo) after fixator removal. There was improvement in pain, sitting tolerance, ease of transfers, and perineal care in the majority (9/11) of patients. The modified CPCHILD (possible score, 10 to 50) improved from 27.2 to 16.23 (P=0.05). Hip abduction improved from -7 degrees (range, -32 to 5 degrees) to 24 degrees (range, 0 to 40 degrees) (P<0.0001). The average valgus osteotomy correction was 48.2 degrees (range, 2.2 to 93.2 degrees). The pelvic femoral shaft angle improved from -15.2 degrees (range, -47.7 to 7.4 degrees) to 15.4 degrees (-44.3 to 44.6 degrees). There was some correlation of both, change in hip abduction (R=0.55) and osteotomy angle (R=0.60), with improvement in QOL measures. There were 3 major complications (20%) in 15 patients. On the basis of preliminary results, percutaneous SVO stabilized with EF improves QOL in the majority of nonambulatory CP patients despite untoward events and is a viable alternative to open osteotomy with internal fixation. More robust comparative studies are needed to further assess the optimal salvage technique in this patient population. Level IV.

Preoperative Belladonna and Opium Suppository for Ureteral Stent Pain: A Randomized, Double-blinded, Placebo-controlled Study

To investigate whether the use of a belladonna and opium (B&O) rectal suppository administered immediately before ureteroscopy (URS) and stent placement could reduce stent-related discomfort. A randomized, double-blinded, placebo-controlled study was performed from August 2013 to December 2014. Seventy-one subjects were enrolled and randomized to receive a B&O (15 mg/30 mg) or a placebo suppository after induction of general anesthesia immediately before URS and stent placement. Baseline urinary symptoms were assessed using the American Urological Association Symptom Score (AUASS). The Ureteral Stent Symptom Questionnaire and AUASS were completed on postoperative days (POD) 1, 3, and after stent removal. Analgesic use intraoperatively, in the recovery unit, and at home was recorded. Of the 71 subjects, 65 had treatment for ureteral (41%) and renal (61%) calculi, 4 for renal urothelial carcinoma, and 2 were excluded for no stent placed. By POD3, the B&O group reported a higher mean global quality of life (QOL) score (P = .04), a better mean quality of work score (P = .05), and less pain with urination (P = .03). The B&O group reported an improved AUASS QOL when comparing POD1 with post-stent removal (P = .04). There was no difference in analgesic use among groups (P = .67). There were no episodes of urinary retention. Age was associated with unplanned emergency visits (P <.00) and "high-pain" measure (P = .02) CONCLUSION: B&O suppository administered preoperatively improved QOL measures and reduced urinary-related pain after URS with stent. Younger age was associated with severe stent pain and unplanned hospital visits.