Patient Duration Research Articles

Effect of Cryotherapy on Pain Intensity for Patients Undergoing Arterial Sheath Removal After Percutaneous Coronary Intervention: A Randomized Controlled Trial

Introduction: Coronary artery disease is the main cause of mortality globally, making up approximately 33% of all deaths Patients with coronary artery disease experience pain and discomfort post-percutaneous coronary intervention after the femoral catheter is removed, which might raise the patient's duration of hospitalisation and the hospital's costs. Aims: The purpose of the study is to evaluate the effect of cryotherapy on the degree of pain that patients who have had their arterial sheath removed after percutaneous coronary intervention felt. Methods: A test-and-retest design in a randomised controlled trial was conducted from January 7, 2024, to February 19, 2024, at Babylon Centre/Imam Al-Sadiq Hospital. A probability (simple random) sampling method was used in a two-group design, with 50 patients in each group as a control and cryotherapy group, and evaluating pain levels utilizing the visual analogue scale. Descriptive and inferential statistics were used in data analysis frequency, percentage, mean, paired sample t-test, standard deviation, and ANOVA. Results: This stated the mean pain level was similar before cryotherapy. However, after cryotherapy, the level of pain in the cryotherapy group was significantly less than that of the control group (2.38± 5.1 vs. 23.34± 11.5), respectively. P = 0.000 (<0.05) demonstrating a statistically significant variation. Conclusions: According to the study, cryotherapy applied to the femoral sheath region assisted the percutaneous coronary intervention patients feel less pain when their femoral catheter was removed. In these situations, a local cold gel bag may be advised as a nursing intervention for pain management.

BURDEN OF FAMILY CAREGIVER IN CARING FOR STROKE PATIENTS: A MIXED METHOD RESEARCH


 
 Background: Stroke is the fifth leading cause of death in the world, stroke does not only have a negative impact on patients but also has an impact on family caregivers. This study aims to describe the burden experienced by family caregivers in caring for stroke patients. 
 Methods: This research uses a mixed method with sequential explanatory approach. The research was conducted from August to October 2019 involved 106 family caregivers using a purposive sampling technique. Burden experienced was measured with the Zarit Burden Interview (ZBI) questionnaire. Quantitative data analysis was performed by SPSS and qualitative data analysis with Opencode.
 Results: Burden experienced was at a mild level, there was a significant relationship to education variables (p = 0.007, r = -0.297), family relationships (p = 0.001, r = 0.001), number of caregivers (p = 0.001, r = 0.364), and the patient's duration of stroke (p = 0.006, r = -0.322). 
 There are three themes in this study, that is difficulties in caring, motivation for caring and sources of support. Conclusion: Although quantitatively the family caregiver experiences a mild burden, qualitatively the family caregiver reports complaints in caring for almost all aspects, so treatment is needed to resolve this burden.

Intermittent versus continuous control of tracheal cuff pressure in patients undergoing mechanical ventilation: Asystematic review and meta-analysis.

To evaluate the effects and safety of intermittent versus continuous control of cuff pressure in patients with mechanical ventilation. Tracheal cuff pressure management is vital to the prognosis of patients with mechanical ventilation. A meta-analysis. This meta-analysis was conducted and reported according to the PRISMA checklist. We searched Pubmed, Embase, The Cochrane Library, BMJ Best Practice, Web of Science, ProQuest Dissertations, as well as the Chinese Biomedical Literature Database, Wanfang, and China national knowledge infrastructure databases up to 5 August 2022 for randomised controlled trials (RCTs) on the intermittent versus continuous control of cuff pressure. Review Manager 5.3 software was used for relevant data analysis. A total of 18 RCTs involving 1998 patients with mechanical ventilation were included. The synthesised outcomes indicated that continuous control of cuff pressure is beneficial to reduce the incidence of ventilator-associated pneumonia (VAP) [RR=0.41, 95%CI (0.35, 0.49)], aspiration [RR=0.36, 95%CI (0.21, 0.63)], duration of mechanical ventilation [MD=-3.23, 95%CI (-4.66, -1.79)], length of ICU stay [MD=-4.12, 95%CI (-5.40, -2.83)], and increase the volume of subglottic drainage [MD=18.54, 95%CI (16.50, 20.58)]. There was no significant difference in the mortality between two groups [RR=1.01, 95%CI (0.84, 1.21)]. Egger regression analyses showed that there were no obvious publication biases in the synthesised results (all p > .05). Existing evidence shows that compared with intermittent monitoring of cuff pressure, continuous monitoring of cuff pressure can reduce the occurrence of aspiration and VAP, shorten the patient's duration of mechanical ventilation and length of ICU stay. Continuous monitoring of cuff pressure is more beneficial and should be promoted in clinical nursing care of patients undergoing mechanical ventilation.

PULP Score vs AAST EGS Grading System in Prediction of Outcome of Perforated Peptic Ulcer Disease: A Retrospective Study

Introduction: Peptic Ulcer Disease (PUD) is the most common diagnosis for upper abdomen pain, and it includes ulcerations and erosion in the Stomach and Duodenum. Complication such as Perforated PUD (PPUD) is only second to bleeding and remains a life-threatening emergency. Aim: To compare the American Association for the Surgery of Trauma– Emergency General Surgery (AAST EGS) scoring system with a widely accepted Peptic Ulcer Perforation (PULP) scoring system for PULP to determine the discriminative capacity and pairwise comparison of both scoring systems. Materials and Methods: This was a retrospective study conducted from September 2018 to August 2020 at Department of General Surgery, PES institute of Medical Science, Kuppam, Andhra Pradesh, India. All the adults diagnosed with perforated PUD were included. Preoperative, Intraoperative, and postoperative data were collected. The scores were generated for PULP and AAST EGS grades and analysed using Statistical Package for Social Sciences (SPSS) version 17.0. Spearman’s rho test evaluated a comparison of each variable with the AAST EGS grade. The pairwise comparison was performed for complication development, patient duration of stay, mortality and described using the Area Under the Receiver Operating Characteristic (AUROC) with 95% confidence intervals. Results: This study included 165 patients in this 87% male with a mean age of 56.89±16.79 years. All the total patients were divided into those <=50 years (n=56,mean age:36.8±9.04 years) and >50 years (n=109,mean age: 67.2±8.4 years) and comparative analysis was performed accordingly. Overall, the patients were categorised into the following AAST EGS grade I (9, 5.5%), grade II (99, 60%), grade III (42, 25.45%), grade IV (15, 9%), there were no patients with grade 5 AAST EGS. The AAST EGS grade was comparatively better them PULP score for postoperative complications, but there is not much difference between the PULP score and AAST EGS score for the patient's duration of stay. AAST EGS grade and the PULP discriminated, patient 30-day mortality similarly, but if Area Under Curve (AUC) >0.8, it is a good predictor. Conclusion: The AAST EGS scoring system and the PULP scoring system do similarly predict mortality and complication. But the presence of many variables with points and tabulation which requires laboratory investigation makes PULP scoring system inconvieninent at bedside.

CLINICAL ORAL ABSTRACTS: Safety and efficacy of no-test medication abortion: A retrospective multi-site study

<h3>Introduction</h3> The COVID-19 pandemic brought new attention to medication abortion because it does not require direct physical contact between patient and clinical staff. No-test approaches for medication abortion preserve the usual standard of care, except that they replace the in-person ultrasound or physical exam before the abortion with other evidence-based methods to assess the patient's duration of pregnancy and screen for ectopic pregnancy. Early in the pandemic, a no-test sample protocol was published to offer guidance for clinical practice. However, little has been published on the safety and efficacy outcomes of no-test approaches. <h3>Method</h3> Through webinars and personal contacts, we invited US-based clinics that had adopted the no-test medication abortion protocol to join the study. A no-test medication abortion was defined as not having a preabortion ultrasound or physical exam. Participating clinics abstracted data from medical records of all patients who received a no-test medication abortion and entered them into a REDCap database. We conducted descriptive analyses of the clinic protocols and the patient sample. We also developed a multilevel, multivariable model that accounted for clustering at the clinic-level to estimate the adjusted odds of medication abortion failure and adverse events. <h3>Results</h3> We included 11 clinics, 4 of which contributed some data from the TelAbortion Study. Clinics shared data on 791 patients served from Jan. 1 to Dec. 31, 2020. Among all patients, 58.1% received mifepristone in person and 41.9% received it by mail. At mifepristone provision, patients' pregnancy durations ranged from 27 to 74 days; 36.4% were <=42 days, 45.3% were 43 to 56 days, 16.4% were 57 to 70 days, and 1.9% were >71 days. We received at least some follow-up data for 626 patients (79.1%) and excluded 14 patients who did not take mifepristone. Of the remaining 612 patients, 5 (0.8%) experienced serious adverse events defined as hospital admission, abdominal surgery and blood transfusion. One patient had a confirmed ectopic pregnancy and was admitted to a hospital for salpingectomy 9 days after provision of mifepristone (included as a serious adverse event). Abortion outcome data were available for 394 patients (64.4%). Overall, 94.7% (95% CI: 92.0% to 96.7%) of patients had a complete abortion with <1600 mcg of misoprostol, without an aspiration, procedure, or more mifepristone and misoprostol. 2 patients had suspected or confirmed ongoing pregnancies. Outcomes were similar for those who received medications in-person and those who received them by mail. <h3>Conclusions</h3> No-test medication abortion with either in-person pick up or mailing of medications is effective and safe, with outcomes similar to rates found in the published literature. Moreover, omitting tests reduce COVID-19 risk and conform with FDA REMS requirements when combined with in-person pick up. Follow up rates (64.4%) with the NTMA approach were similar to other medication abortion protocols. Combining no-test medication abortion protocols with mailing of medications to patients would support public health efforts for those who want to avoid a clinic visit.

Safety and Effectiveness of Longer‐Term Phentermine Use: Clinical Outcomes from an Electronic Health Record Cohort

The aim of this work was to study weight loss and risk of cardiovascular disease (CVD) or death associated with longer-term phentermine use. Using electronic health record data, 13,972 adults were identified with a first phentermine fill in 2010 to 2015, creating exposure categories according to a patient's duration of use (referent: ≤ 3months). Multivariable linear models were used to compare percent weight loss across categories at 6, 12, and 24months, and Cox proportional hazards models were used to compare risk of composite CVD or death, up to 3years after starting phentermine. The cohort was 84% female and 45% white, with a mean (SD) baseline age 43.5 (10.7)years and BMI of 37.8 (7.2)kg/m2 . In multivariable models, longer-term users of phentermine experienced more weight loss; patients using continuously for > 12months lost 7.4% more than the referent group at 24months (P<0.001). The composite CVD or death outcome was rare (0.3%, 41 events), with no significant difference in hazard ratios between groups. Greater weight loss without increased risk of incident CVD or death was observed in patients using phentermine monotherapy for longer than 3months. Despite the limitations of the observational design, this study supports the effectiveness and safety of longer-term phentermine use for low-risk individuals.

79-Year-Old Man With Shortness of Breath and Fevers

79-Year-Old Man With Shortness of Breath and Fevers

Comparison of video-assisted thoracoscopic surgery and thoracotomy in the treatment of mediastinal cysts.

This study aims to compare the results of videoassisted thoracoscopic surgery and thoracotomy in the treatment of mediastinal cystic lesions. Sixty patients (28 males, 32 females; mean age 36.1±19.4 years; range, 2 days to 82 years) who were performed thoracotomy or video-assisted thoracoscopic surgery for mediastinal cyst treatment in our clinic between January 1997 and December 2016 were retrospectively evaluated. Chest radiography and thorax computed tomography were used in all participants for diagnosis. Magnetic resonance imaging was used additionally in 23 participants. Of the patients, mediastinal cysts were localized in anteriorsuperior mediastinum in 19 (31.7%), middle mediastinum in 19 (31.7%) and posterior mediastinum in 22 (36.6%). Histopathologically, 17 bronchogenic cysts, 15 hydatid cysts, 10 pericardial cysts, seven cystic teratomas, four enteric cysts, four thymic cysts, two lymphangiomas and one thoracic duct cyst were identified. While thoracotomy was performed in 34 patients (56.7%), video-assisted thoracoscopic surgery was performed in 26 patients (43.3%). Mean duration of thoracotomies and video-assisted thoracoscopic surgeries was 123.6±24.7 minutes and 87.4±17.6 minutes, respectively (p<0.01). Mean duration of hospital stay was 8.2±4.3 days after thoracotomy and 4.3±1.2 days after video-assisted thoracoscopic surgery (p<0.01). While postoperative complications developed in four patients (two pneumothoraxes, one pleural effusion, one chylothorax), no mortality was observed in any of them. Main treatment method for mediastinal cysts is surgery. Thoracoscopic approach significantly reduces patient's duration of surgical procedure and postoperative duration of hospital stay. We believe that minimally invasive approaches will be administered more frequently compared to open surgeries for mediastinal cysts in the near future.

Duration of Agitation, Fluctuations of Consciousness, and Associations with Outcome in Patients with Subarachnoid Hemorrhage.

Agitation is common after subarachnoid hemorrhage (SAH) and may be independently associated with outcomes. We sought to determine whether the duration of agitation and fluctuating consciousness were also associated with outcomes in patients with SAH. We identified all patients with positive Richmond Agitation Sedation Scale (RASS) scores from a prospective observational cohort of patients with SAH from 2011 to 2015. Total duration of agitation was extrapolated for each patient using available RASS scores, and 24-h mean and standard deviation (SD) of RASS scores were calculated for each patient. We also calculated each patient's duration of substantial fluctuation of consciousness, defined as the number of days with 24-h RASS SD>1. Patients were stratified by 3-month outcome using the modified Rankin scale, and associations with outcome were assessed via logistic regression. There were 98 patients with at least one positive RASS score, with median total duration of agitation 8h (interquartile range [IQR] 4-18), and median duration of substantially fluctuating consciousness 2days (IQR 1-3). Unfavorable 3-month outcome was significantly associated with a longer duration of fluctuating consciousness (odds ratio [OR] per day, 1.51; 95% confidence interval [CI], 1.04-2.20; p=0.031), but a briefer duration of agitation (OR per hour, 0.94; 95% CI, 0.89-0.99; p=0.031). Though a longer duration of fluctuating consciousness was associated with worse outcomes in our cohort, total duration of agitation was not, and may have had the opposite effect. Our findings should therefore challenge the intensity with which agitation is often treated in SAH patients.

Unpacking the therapist effect: Impact of treatment length differs for high- and low-performing therapists

Objective: Differences between therapists in their average outcomes (i.e., therapist effects) have become a topic of increasing interest in psychotherapy research in the past decade. Relatively little work, however, has moved beyond identifying the presence of significant between-therapist variability in patient outcomes. The current study sought to examine the ways in which therapist effects emerge over the course of time in psychotherapy. Method: We used a large psychotherapy data set (n = 5828 patients seen by n = 158 therapists for 50,048 sessions of psychotherapy) and examined whether outcomes diverge for high-performing (HP) and low-performing (LP) therapists as treatment duration increases. Results: Therapists accounted for a small but significant proportion of variance in patient outcomes that was not explained by differences between therapists' caseload characteristics. The discrepancy in outcomes between HP and LP therapists increased as treatment duration increased (interaction coefficient = 0.071, p < .001). In addition, patients' trajectories of change were a function of their therapist's average outcome as well as the patient's duration of treatment (interaction coefficient = 0.060, p = .040). Conclusions: Indeed, patterns of change previously described ignoring between-therapist differences (e.g., dose-effect, good-enough level model) may vary systematically when disaggregated by therapist effect.

Mortality Risk of Hypnotics: Strengths and Limits of Evidence.

Sleeping pills, more formally defined as hypnotics, are sedatives used to induce and maintain sleep. In a review of publications for the past 30 years, descriptive epidemiologic studies were identified that examined the mortality risk of hypnotics and related sedative-anxiolytics. Of the 34 studies estimating risk ratios, odds ratios, or hazard ratios, excess mortality associated with hypnotics was significant (p < 0.05) in 24 studies including all 14 of the largest, contrasted with no studies at all suggesting that hypnotics ever prolong life. The studies had many limitations: possibly tending to overestimate risk, such as possible confounding by indication with other risk factors; confusing hypnotics with drugs having other indications; possible genetic confounders; and too much heterogeneity of studies for meta-analyses. There were balancing limitations possibly tending towards underestimates of risk such as limited power, excessive follow-up intervals with possible follow-up mixing of participants taking hypnotics with controls, missing dosage data for most studies, and over-adjustment of confounders. Epidemiologic association in itself is not adequate proof of causality, but there is proof that hypnotics cause death in overdoses; there is thorough understanding of how hypnotics euthanize animals and execute humans; and there is proof that hypnotics cause potentially lethal morbidities such as depression, infection, poor driving, suppressed respiration, and possibly cancer. Combining these proofs with consistent evidence of association, the great weight of evidence is that hypnotics cause huge risks of decreasing a patient's duration of survival.

A CASE SERIES OF A PAV+ WEANING PROTOCOL IN AN ACUTE CARE ENVIRONMENT DEMONSTRATING AN ABSENCE OF WEANING FAILURE

Most patients undergoing mechanical ventilation (MV) in critical care units are liberated from the ventilator within a median of 7 days. Unfortunately, some patients experience difficulty in liberation from MV during their ICU stays and require extended time on MV. It has been estimated that 40% of the patient's duration on the ventilator is spent weaning.[1] Moreover, although patients requiring prolonged mechanical ventilation represent approximately 6% of all ventilated patients, they consume 37% of intensive care unit resources.[2] Therefore, accelerating the liberation of prolonged weaning patients from MV improves patient care and could yield significant economic benefits.

OC-073 Calculating the cost-effectiveness of a nutrition support team at a busy district general hospital

IntroductionNICE Nutrition Support In Adults (2006) recommends that all Trusts should have a multidisciplinary Nutrition Support Team (NST). Austin & Stroud (2007) suggest its implementation can improve parenteral nutrition (PN)...

Association Between Plantar Fasciitis and Isolated Contracture of the Gastrocnemius

Current evidence suggests that limited ankle dorsiflexion is an etiologic factor for plantar fasciitis. This limitation can arise from either an isolated contracture of the gastrocnemius or from a contracture of the gastrocnemius-soleus complex. This study's aim was to determine the proportion of patients with plantar fasciitis that have an associated isolated gastrocnemius contracture. This investigation was a prospective evaluation of patients with either acute or chronic plantar fasciitis. Two hundred fifty-four patients with plantar fasciitis were included. Patients were assessed for the existence of limited ankle dorsiflexion which was further characterized by noting the presence of an isolated gastrocnemius contracture or contracture of the gastrocnemius-soleus complex. The patient's duration of symptoms, type of occupation, and body mass index were also documented. Patients with acute plantar fasciitis were defined as having symptom duration of 9 months or less while those with chronic plantar fasciitis were those with over 9 months of symptoms. The Wilcoxon rank sum and chi square tests were used to compare characteristics between the acute and chronic populations. Eighty-three percent (211 of 254 patients) had limited ankle dorsiflexion. Fifty-seven percent (145 of 254) had an isolated contracture of the gastrocnemius, 26% (66 of 254) had a contracture of the gastrocnemius-soleus complex, and 17% (43 of 254) did not have a dorsiflexion limitation. Patients were further stratified into acute versus chronic symptom duration at the time of presentation. Equinus contracture was noted in 83% (129 of 155) of acute cases, and 82% (82 of 99) of chronic cases. An isolated contracture of the gastrocnemius was found in 60% (93 of 155) of acute, and 52% (52 of 99) of chronic cases. A gastrocnemius-soleus complex contracture was noted in 23% (36 of 155) of acute cases, and 30% (30 of 99) of chronic cases. Patients with chronic plantar fasciitis had a significantly higher number (p<0.05) of medical comorbidities than those with acute plantar fasciitis. Limited ankle dorsiflexion is commonly associated with plantar fasciitis and more than half of these patients had evidence of an isolated gastrocnemius contracture. These findings can be utilized to develop and further refine non-operative and operative treatment strategies for those with recalcitrant plantar fasciitis.

Successful Treatment of An Elderly Patient with Refractory Chronic Immune Thrombocytopenic Purpura with Combination Therapy of Rituximab and Corticosteroids: A Case Report

AbstractAbstract 4686Immune thrombocytopenic purpura (ITP) is an autoimmune disorder. A corticosteroid, usually prednisone is often the first line treatment for ITP. However, the problem is that about 70 percent of adult patients experience a relapse after discontinuation of corticosteroids. And approximately 20–30% of patients with chronic ITP do not respond to corticosteroids therapy. Rituximab has been proven effective in refractory chronic ITP, but the timing of response is slower than expected, at least three months might be necessary to observe an effect. And the response duration to rituximab remains relatively short in some patients. So, sometimes it is necessary to use combination therapy including rituximab, according to different patient conditions. Here, we report an 82-year-old man with chronic ITP who had thrombocytopenia (platelet count <10 × 109/L) for more than 6 months and relapsed on a prednisone taper. He presented sustaining blood-tinged sputum, bleeding in skin and steroid-induced diabetes, the result of short-term prednisone. He didn't want splenectomy and other immune suppressive drugs. His blood glucose got control after insulin therapy. We gave the patient intravenous infusions of rituximab 375 mg/m2 weekly for 4 weeks combined with dexamethasone (10 mg intravenously weekly for 4 weeks). After first dose of dexamethasone followed by rituximab, within 24 hours his platelet count had increased to 65 × 109/L and bleeding symptoms were significantly improved. During the next 3-week period of treatment, his platelet counts fluctuated between 30 × 109/L and 60 × 109/L. And then the platelet count dropped back to a minimum of 19 × 109/L. Consider the slow responses to rituximab and prevention of bleeding, we still gave the patient maintenance therapy with 15mg prednisone daily and he had been no bleeding. Two months after starting rituximab and dexamethasone, his platelet counts began to gradually recover to normal. Although we need to further observe the patients's duration of response, this case suggests that combination therapy of rituximab and corticosteroids may be a promising treatment for refractory chronic ITP. Disclosures:No relevant conflicts of interest to declare.

Algorithms for the Treatment of Patients With Metastatic Breast Cancer and Prior Exposure to Taxanes and Anthracyclines

At present, metastatic breast cancer (MBC) remains an incurable disease, with the goals of care aimed at maximizing the patient's duration and quality of life. Treatment options for a patient with MBC have become more efficacious and numerous. In addition to endocrine and chemotherapy agents, a number of targeted agents, including trastuzumab and bevacizumab, are available. The option to use novel agents combined with a multitude of standard chemotherapies has further enhanced the landscape of therapeutic options. As such, specific regimens must be evaluated within the framework of the individual patient, answering such questions as whether to treat with sequential single agents or combination regimens as well as which agents to use and in what sequence. The concept of personalized care is even more apparent in the setting of MBC, where the goal of palliation is intrinsically more nuanced than that of curative intent. This review will broadly assess the evidence for current treatment options with attention to varying clinical scenarios. Ultimately, delivering quality of care necessitates balancing an understanding of evidence-based data with sensitive attention to quality-of-life goals.

Determining Quality of Life and Sleep in Hemodialysis Patients

AbstractBACKGROUNDHemodialysis causes major changes in patients' lifestyles that affect their quality of life (QoL) and sleep quality. The purpose of this study was to determine the quality of life and sleep of hemodialysis patients.METHODS AND MATERIALSThe study sample was 138 patients receiving dialysis in a university hospital dialysis unit. Data were collected with a personal information form (PIF), Medical Outcomes Study 36‐item Short Form (SF‐36) questionnaire, and the Pittsburg Sleep Quality Index (PSQI).RESULTSAll of the hemodialysis patients had low quality of life. There was a significant correlation between QoL and sleep quality (p &lt; .001); as QoL decreased sleep quality also decreased. As patients' age increased their QoL and sleep decreased. Women, housewives, those with no formal education, and patients living in extended families had lower QoL. Patients aged 51 years and older had low QoL and sleep. No significant difference was found in QoL and sleep according to the patient's duration of hemodialysis (p &gt; .05).CONCLUSIONHemodialysis patients have a low QoL and there is a close correlation between QoL and sleep quality. Interventions to help dialysis patients maintain their QoL and sleep are as important as extending their lives.

What CATIE Found: Results From the Schizophrenia Trial

What CATIE Found: Results From the Schizophrenia Trial

Retrospective 5‐year review of 131 patients with mycosis fungoides and Sézary syndrome seen at the National Skin Centre, Singapore

A total of 131 new cases of mycosis fungoides and Sézary syndrome were diagnosed clinically and histopathologically at our centre over a 5-year period. There were 87 males and 44 females with a mean age of 36.3 years (range 3-87 years) and no racial predilection. Of the 62 patients (47.3%) with classical mycosis fungoides, the majority were male (male : female = 4.2:1). There was one patient with Sézary syndrome. Patients aged older than 50 years were more likely to present with a longer duration of symptoms and advanced disease. In contrast to classical mycosis fungoides, the 47 patients diagnosed with hypopigmented mycosis fungoides had early stage disease, were younger, and no gender predilection was noted. The mean duration of follow up was 19.7 months (range 0.2-54.8 months). Complete remission was achieved in 24.7% and 53.8% of patients followed up at 1 and 3 years, respectively, using skin-directed and systemic treatment modalities appropriate for the stage of disease. There were five patients with progressive disease and three patients with advanced disease who died from disease-related complications. The most significant prognostic factors for 1-year and 3-year outcomes were the patient's duration of symptoms and stage of disease at presentation.

Health-Related Quality of Life and Caregiver Burden among Peritoneal Dialysis Patients and Their Family Caregivers in Japan

Recent studies have found that patients with chronic renal failure suffer from depression and other symptoms of decreased mental health. However, little is know about caregiver burden and mental health among patients' families. In the present study, we examined the relationship in Japan between peritoneal dialysis (PD) patients and caregivers with regard to health-related quality of life (HRQOL) and caregiver burden. In March of 2002, we recruited 60 subjects--26 patients on continuous ambulatory peritoneal dialysis (CAPD), and 34 caregivers--from a PD patient support group in southern Japan. We used the Kidney Disease Quality of Life Short Form (KDQOL-SF) and the Medical Outcomes Study Short Form 36 (SF-36) to measure HRQOL. We used the Zarit Burden Interview (ZBI) to measure caregiver burden. Data was also collected on each patient's duration of illness, treatment modality, age, sex, and medical history. All data were collected by mail surveys. Mean age of the PD patients was 48.2; mean age of the caregivers was 46.6. Mean caregiver burden on the ZBI was 14.1, which is considerably lower than that reported among caregivers for patients with dementia or stroke. Caregivers and patients both rated their general health and vitality among the lowest of the eight dimensions on the KDQOL-SF. In addition, patients scored lower than a normative population in all dimensions and significantly lower than caregivers in the dimensions of role physical functioning, role emotional functioning, and social functioning. Compared to national normative data for their age group, caregivers scored substantially lower in general health, vitality, and mental health. Patients on CAPD are at risk for social role dysfunction, and their caregivers are at risk for decreased mental health. Further research is needed to identify interventions that can improve the HRQOL of CAPD patients and their family caregivers.