Quality Of Life In Outpatients Research Articles

Association between isolated or combined malnutrition and sarcopenia and quality of life in heart failure outpatients: A cross-sectional study.

Heart failure (HF) is a chronic condition with symptoms linked to worse quality of life. Malnutrition and sarcopenia are conditions frequently found in patients with HF. This study aims to evaluate the association between isolated or combined malnutrition and sarcopenia and quality of life in outpatients with HF. This is a cross-sectional study with a sample of outpatients with HF aged ≥18 years. Malnutrition was assessed according to the criteria of the Global Leadership Initiative on Malnutrition, and sarcopenia was evaluated by the European Working Group on Sarcopenia in Older People. Quality of life was assessed using the Minnesota Living with HF questionnaire (MLHFQ). Clinical and sociodemographic data were collected. One hundred and fifty-one patients were included in this study, with a median (interquartile range) age of 58 (48-65) years, 58.9% were adults, and 68.9% were male. A total of 29.5% of the patients were malnourished, and 28.5% and 2.6% were identified with probable sarcopenia and sarcopenia, respectively. Of the total, 15.9% of patients were identified with both conditions. Sarcopenia was associated with higher odds of increase in the MLHFQ total score, indicating worse quality of life (odds ratio [OR] = 3.61; 95% CI, 1.65-7.89). The same was found in the presence of two conditions (OR 3.97; 95% CI, 1.32-11.54), whereas isolated malnutrition was not related to life quality (OR = 1.62; 95% CI, 0.73-3.60). The presence of malnutrition and sarcopenia simultaneously were associated with worse quality of life scores when compared with these isolated conditions.

Determinants of Health-Related Quality of Life in Outpatients with Myocardial Infarction.

The health-related quality of life (HRQOL) of patients with myocardial infarction (MI) is suboptimal because of the disease's life-threatening nature, the requirement for long-term lifestyle modifications, and the treatment regimens following MI. This study aimed to evaluate HRQOL and its associated factors in MI patients. This study was conducted on patients with MI who attended the outpatient cardiology clinic at a major teaching hospital in Jordan. The EQ-5D-3L questionnaire was used to assess HRQOL of the study participants. Quantile regression analysis was conducted to identify the variables associated with HRQOL. The study included 333 patients with a history of MI, with a median age of 58 (57-60). The median of the total EQ-5D score was 0.65 (0.216-0.805). Regression results revealed that male patients (Coefficient= 0.110, 95%Cl (0.022-0.197), P=0.014) and not being diagnosed with diabetes (Coefficient= 0.154, 95%Cl (0.042-0.266), P=0.007) were associated with increased HRQOL. On the other hand, low income (Coefficient= -0.115, 95%Cl (-0.203 - -0.026), P=0.011), not receiving DPP-4 (Dipeptidyl Peptidase -4) inhibitors (Coefficient= -0.321 95%Cl (-0.462 - -0.180), P<0.001), and having low (Coefficient= -0.271, 95%Cl (-0.395 - -0.147), P<0.001) or moderate (Coefficient= -0.123, 95%Cl (-0.202 - -0.044), P=0.002) medication adherence was associated with decreased HRQOL. The current study demonstrated diminished HRQOL among patients with MI, highlighting the necessity of tailoring interventions to tackle medication adherence barriers in this population. Personalized interventions such as educational programs, counseling, and reminders that consider each patient's needs and circumstances can greatly enhance medication adherence and, thus, the HRQOL of MI patients. Individuals with lower income levels, female patients, and those with diabetes should be the specific targets of these interventions.

Impact of frailty on cancer-related fatigue and quality of life in outpatients with prostate cancer: a cross-sectional study of patient-reported outcomes.

To investigate the prevalence of frailty and its effects on cancer-related fatigue and quality of life among patients with prostate cancer. In this cross-sectional study, questionnaires were administered to 254 outpatients who visited the Department of Urology at Kagawa University Hospital for prostate cancer; finally, 108 outpatients were analyzed. Frailty, cancer-related fatigue and quality of life were assessed using the G8 screening tool, Japanese version of the Brief Fatigue Inventory and Japanese version of the Short Form 8 Health Survey, respectively. We defined frailty based on a score≤14 points and divided the patients into frailty and no-frailty groups. We also compared the severity of cancer-related fatigue and quality of life between groups. The prevalence of frailty among 108 outpatients was 63%. Older age correlated with frailty severity (P=0.0007) but not cancer-related fatigue severity (P=0.2391). The proportion of patients on treatment or with metastasis was not significantly different between groups. The frailty group had higher cancer-related fatigue severity (P=0.004) and decreased levels of general activity, mood, walking ability, normal work and enjoyment of life, especially on the Brief Fatigue Inventory subscale. The frailty group had lower physical and mental quality of life than the no-frailty group or general population. The frailty rate for these patients increased with age, exceeding 60% regardless of the treatment status, and was associated with worsened cancer-related fatigue severity and reduced quality of life. Our study highlights the importance of assessing frailty when selecting treatment, especially in older patients.

Nurse and Social Worker Palliative Telecare Team and Quality of Life in Patients With COPD, Heart Failure, or Interstitial Lung Disease

Many patients with chronic obstructive pulmonary disease (COPD), heart failure (HF), and interstitial lung disease (ILD) endure poor quality of life despite conventional therapy. Palliative care approaches may benefit this population prior to end of life. Determine the effect of a nurse and social worker palliative telecare team on quality of life in outpatients with COPD, HF, or ILD compared with usual care. Single-blind, 2-group, multisite randomized clinical trial with accrual between October 27, 2016, and April 2, 2020, in 2 Veterans Administration health care systems (Colorado and Washington), and including community-based outpatient clinics. Outpatients with COPD, HF, or ILD at high risk of hospitalization or death who reported poor quality of life participated. The intervention involved 6 phone calls with a nurse to help with symptom management and 6 phone calls with a social worker to provide psychosocial care. The nurse and social worker met weekly with a study primary care and palliative care physician and as needed, a pulmonologist, and cardiologist. Usual care included an educational handout developed for the study that outlined self-care for COPD, ILD, or HF. Patients in both groups received care at the discretion of their clinicians, which could include care from nurses and social workers, and specialists in cardiology, pulmonology, palliative care, and mental health. The primary outcome was difference in change in quality of life from baseline to 6 months between the intervention and usual care groups (FACT-G score range, 0-100, with higher scores indicating better quality of life, clinically meaningful change ≥4 points). Secondary quality-of-life outcomes at 6 months included disease-specific health status (Clinical COPD Questionnaire; Kansas City Cardiomyopathy Questionnaire-12), depression (Patient Health Questionnaire-8) and anxiety (Generalized Anxiety Disorder-7) symptoms. Among 306 randomized patients (mean [SD] age, 68.9 [7.7] years; 276 male [90.2%], 30 female [9.8%]; 245 White [80.1%]), 177 (57.8%) had COPD, 67 (21.9%) HF, 49 (16%) both COPD and HF, and 13 (4.2%) ILD. Baseline FACT-G scores were similar (intervention, 52.9; usual care, 52.7). FACT-G completion was 76% (intervention, 117 of 154; usual care, 116 of 152) at 6 months for both groups. Mean (SD) length of intervention was 115.1 (33.4) days and included a mean of 10.4 (3.3) intervention calls per patient. In the intervention group, 112 of 154 (73%) patients received the intervention as randomized. At 6 months, mean FACT-G score improved 6.0 points in the intervention group and 1.4 points in the usual care group (difference, 4.6 points [95% CI, 1.8-7.4]; P = .001; standardized mean difference, 0.41). The intervention also improved COPD health status (standardized mean difference, 0.44; P = .04), HF health status (standardized mean difference, 0.41; P = .01), depression (standardized mean difference, -0.50; P < .001), and anxiety (standardized mean difference, -0.51; P < .001) at 6 months. For adults with COPD, HF, or ILD who were at high risk of death and had poor quality of life, a nurse and social worker palliative telecare team produced clinically meaningful improvements in quality of life at 6 months compared with usual care. ClinicalTrials.gov Identifier: NCT02713347.

Predictors of health-related quality of life in outpatients with coronary heart disease.

Health-related quality of life (HRQoL) is an important treatment target in patients with coronary heart disease (CHD) and is associated with poor outcomes. Therefore, it is of clinical importance to identify the key determinants of HRQoL among these patients. There is, however, limited knowledge of how a comprehensive set of psychosocial factors influence HRQoL. We aimed to determine the relative associations of clinical and psychosocial factors with mental and physical components of HRQoL in a sample of CHD outpatients. This cross-sectional study included 1,042 patients 2-36 (mean 16) months after a CHD event recruited from two general Norwegian hospitals with a combined catchment area making up 7% of the Norwegian population, representative with regards to demographic and clinical factors. We collected data on HRQoL, demographics, comorbidities, coronary risk factors, and psychosocial factors. HRQoL was assessed using the Short Form 12 (SF12), which comprises a Mental Component Scale (MCS), and the Physical Component Scale (PCS). Crude and multi-adjusted linear regression analyses were used to investigate the association between covariates and MCS and PCS. Mean age was 61 [standard deviation (SD) 10] years, 20% were females, 18% had type D personality, 20% significant depression symptoms, 14% significant symptoms of anxiety whereas 45% reported insomnia. The presence of type D personality (β: -0.19), significant symptoms of depression (β: -0.15), and the presence of insomnia (β: -0.13) were negatively associated with MCS, but not PCS in multi-adjusted analyses. The presence of chronic kidney disease (β: -0.11) was associated with reduced MCS, whereas the presence of chronic obstructive pulmonary disease (β: -0.08) and low physical activity (β: -0.14) were negatively associated with PCS. Younger age was associated with lower MCS, whereas older age was associated with lower PCS. We conclude that Type D personality, depressive symptoms, insomnia, and chronic kidney disease were the strongest determinants of the mental component of HRQoL. Assessing and managing these psychological factors among CHD outpatients may improve their mental HRQoL.

Health-related quality of life in outpatients with coronary heart disease: impact of type D personality, depression, anxiety and insomnia

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Drammen hospital, Vestre Viken trust. Background Health-related quality of life (HRQoL) is an important treatment target in patients with coronary heart disease (CHD) and associated with impaired prognosis. Therefore, knowledge about correlates of HRQoL may be of clinical importance. However, there is limited knowledge about how a comprehensive set of psychosocial factors, including type D personality, depression, anxiety, and insomnia influence HRQoL in CHD outpatients. Purpose To determine the relative associations of clinical and psychosocial factors with mental and physical HRQoL in a sample of Norwegian CHD outpatients. Methods This cross-sectional study included 1017 patients 2-36 (mean 16) months after hospitalisation for a coronary heart disease event (80% myocardial infarction). Data on HRQoL, psychosocial factors, coronary risk factors, comorbidity, and demographics were collected from self-report questionnaires, clinical examination with blood samples and hospital medical records. HRQoL was assessed using the Short Form 12 (SF12), which is a 12-item questionnaire comprising two subscales: Mental Component Scale (MCS) and Physical Component Scale (PCS). Type D personality, depression and anxiety, and insomnia were measured using the type D Scale 14 (DS14), Hospital Anxiety and Depression Scale (HADS), and the Bergen Insomnia Scale (BIS), respectively. Crude and multi-adjusted linear regression analyses were used to investigate the association between covariates and MCS and PCS, respectively. Results Mean age was 61 (SD 10) years, 20% were females, 18% had type D personality, 20% depression, 14% anxiety and 45% insomnia. Mean scores for SF12 subscales were 47.1 (6.0) for MCS and 38.5 (4.8) for PCS. Type D personality, symptoms of depression, and insomnia, but not anxiety, were negatively associated with MCS, but not PCS in multi-adjusted analyses. (Table). Chronic kidney disease was associated with reduced MCS, whereas chronic obstructive pulmonary disease and low physical activity were all negatively associated with PCS. Younger age was associated with poor MCS, whereas older age was associated with poor PCS. Conclusions This study found that HRQoL was low among Norwegian CHD outpatients. Type D personality, depressive symptoms, insomnia, and chronic kidney disease were the strongest correlates of the mental component of HRQoL. However, these variables were not significantly associated with the physical subscale of the SF12. Assessing and managing type D personality, depression, and insomnia among these group of CHD outpatients may improve HRQoL.

From the Editor’s Desk...

From the Editor’s Desk...

Construction of an Explanatory Model for Quality of Life in Outpatients with Ulcerative Colitis

Introduction: To date, no studies have reported explanatory models of health-related quality of life (HRQoL) in patients with ulcerative colitis. Therefore, this study aimed to examine HRQoL and its related factors in outpatients with ulcerative colitis to construct an explanatory model. Methods: We conducted a cross-sectional survey at a clinic in Japan. The HRQoL was evaluated using the 32-item Inflammatory Bowel Disease Questionnaire. We extracted explanatory variables of HRQoL from demographic, physical, psychological, and social factors reported in previous studies and created a predictive explanatory model. The relationship between explanatory variables and the questionnaire total score was examined using Spearman’s rank correlation coefficient, the Mann-Whitney test, or the Kruskal-Wallis test. We conducted multiple regression and path analyses to examine the effect of explanatory variables on the total score. Results: We included 203 patients. Variables that were associated with the total score were the partial Mayo score (r = −0.451), treatment side effects (p = 0.004), the Hospital Anxiety and Depression Scale-Anxiety score (r = −0.678), the Hospital Anxiety and Depression Scale-Depression score (r = −0.528), and the availability of an advisor during difficult times (p = 0.001). The model included the partial Mayo score, treatment side effects, the Hospital Anxiety and Depression Scale-Anxiety score, and the availability of an advisor during difficult times as explanatory variables of the total score that showed the best goodness-of-fit (adjusted R² = 0.597). The anxiety score exerted the greatest negative effect on the questionnaire total score (β = −0.586), followed by the partial Mayo score (β = −0.373), treatment side effects (β = 0.121), and availability of an advisor during difficult times (β = −0.101). Conclusion: Psychological symptoms exerted the strongest direct effect on HRQoL in outpatients with ulcerative colitis and mediated the relationship between social support and HRQoL. Nurses should listen carefully to the concerns and anxieties of patients to ensure that a social support system is provided by leveraging multidisciplinary collaborations.

Medication Adherence, Attitude Towards Medication, and Quality of Life in Outpatients With Neurotic Disorders in Tehran, Iran: A Six-Month Follow-up Study

Objectives This study aims to investigate the attitude towards medication, medication adherence, and quality of life (QoL) in outpatients with neurotic disorders referred for the first time to the psychiatric clinic of Tehran Psychiatric Institute in Iran. Methods In this study, participants were adult outpatients with neurotic disorders referred to the psychiatric clinic of Tehran Psychiatric Institute for the first time, who had met the inclusion criteria (age 18-60 years, having a neurotic disorder diagnosed by the psychiatrist, and consent to participate in the study). At baseline and in one and six months after the first visit, they completed a demographic form, the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and the drug attitude inventory (DAI-10). Their medication adherence was assessed using the medication possession ratio. Results Of 100 participants, 76 were females and had a mean age of 35.9 years. Favorable medication adherence significantly increased in the sixth month compared to the first month, and the number of patients with favorable medication adherence increased from 38 to 63. In comparing the overall score of QoL, a significant improvement was observed in the 1st and 6th months compared to baseline and in the sixth month compared to the first month (P&lt;0.001). Regarding the domains of the QoL, mental health and general health in the first and sixth months were significantly increased compared to the baseline (P&lt;0.001). Physical health domain was significantly increased in the sixth month compared to the first month (P&lt;0.001). Social relationships domain was significantly increased in the first month compared to the baseline (P= 0.001). Environmental health domain was significantly increased in the first month compared to the baseline (P=0.019). Comparison of the QoL score between patients with favorable and unfavorable medication adherence showed no significant difference (P=0.6). Attitude towards medication was significantly improved from baseline to the sixth month (P&lt;0.001). Conclusion The QoL and its some domains as well as medication adherence and attitude towards medication in outpatients with neurotic disorders seem to be improved after six months of follow-up. There is no significant difference in QoL between outpatients with favorable and unfavorable medication adherence.

Fluid REStriction in Heart Failure vs Liberal Fluid UPtake: Rationale and Design of the Randomized FRESH-UP Study

It is common practice for clinicians to advise fluid restriction in patients with heart failure (HF), but data from clinical trials are lacking. Moreover, fluid restriction is associated with thirst distress and may adversely impact quality of life (QoL). To address this gap in evidence, the Fluid REStriction in Heart failure vs liberal fluid UPtake (FRESH-UP) study was initiated. The FRESH-UP study is a randomized, controlled, open-label, multicenter trial to investigate the effects of a 3-month period of liberal fluid intake vs fluid restriction (1500 mL/day) on QoL in outpatients with chronic HF (New York Heart Association Classes II--III). The primary aim is to assess the effect on QoL after 3 months using the Overall Summary Score of the Kansas City Cardiomyopathy Questionnaire (KCCQ). Thirst distress, as assessed by the Thirst Distress Scale for patients with HF, KCCQ Clinical Summary Score, each of the KCCQ domains and clinically meaningful changes in these scores, the EQ-5D-5L, patient-reported fluid intake and safety (ie, death, HF hospitalizations) are secondary outcomes. The FRESH-UP study is registered at ClinicalTrials.gov (NCT04551729). The results of the FRESH-UP study will add substantially to the level of evidence concerning fluid management in chronic HF and may impact the QoL of these patients.

Community pharmacists' measurement of health-related quality of life in outpatients taking high-risk drugs.

Patients experiencing severe side effects when taking high-risk drugs may have a significantly reduced health-related quality of life (QOL); therefore, it is important to identify changes in the health-related QOL in these patients. This study aimed to determine the health-related QOL in community pharmacy outpatients taking high-risk drugs. This prospective observational study was conducted in 29 community pharmacies with 71 pharmacists in 12 regions and cities in Japan from October to December 2020 and 760 patients were enrolled. Using descriptive questionnaires of EuroQOL-5-dimensions-5-levels (EQ-5D-5L), community pharmacists obtained health-related QOL data from outpatients taking high-risk drugs. The mean health-related QOL of all outpatients was 0.869. The health-related QOL decreased with increasing age. The outpatient health-related QOL was 0.700, 0.763, 0.785, and 0.817 when taking antiepileptic, antidepressant, digitalis, and antiarrhythmic drugs, respectively, which was lower than the average health-related QOL of all outpatients. Mobility and pain/ discomfort accounted for a large proportion of the decline in the health-related QOL with increasing age. There were no significant differences in personal care with increasing age; however, the number of outpatients with mobility, normal activity, and pain challenges decreased with age. In contrast, outpatients aged <65 years with anxiety/depression showed a lower than overall average health-related QOL. To the best of our knowledge, this is the first study in Japan to report an investigation by community pharmacists regarding health-related QOL assessment in outpatients taking high-risk drugs.

The Impact of Pharmacist Intervention on Clinical Outcome, Adherence, and Quality of Life of Patients with Type 2 Diabetes Mellitus

Diabetes Mellitus (DM) is a chronic disease that occurs when the body cannot produce enough insulin or cannot use insulin (insulin resistance) and diagnosed by measuring blood glucose level (BGL). BGLs of DM patients should always be controlled to prevent complications. The purpose of this analytical cohort study was to analyze the effect of pharmacy intervention (PI) on BGL, adherence, and quality of life (QOL) of DM Type 2 (T2DM) patients (n=48) admitted to Dr. Tengku Mansyur hospital in Tanjung Balai period December 2020 to May 2021. The BGL, adherence, and QOL of the patients were compared before and after PIs. The patients’ BGLs were recruited from their medical records, their adherence to medication was analyzed using MMAS-8 questionnaire, and the patients QOLs were analyzed using the EQ-5D-3L questionnaire and the scores were categorized into 3 categories (&lt; 0.60 = bad, 0.6 - &lt;0.80 = moderate, ≥0.80 = good). The obtained data were analyzed using descriptive and Wilcoxon Signed-Rank tests in the SPSS Program.&#x0D; Mean age of the patients was 59.20 ± 8.20 (years). Most (58.3%) of them were females. The mean BGLs (mg/dL) of the patients: before PI 1, 262.02±5.91; before PI 2, 259.39±5.53; after PI, 202.35±4.80; and follow up after PI, 168.60±3.07. The mean adherence scores: before PI 1, 4.833 ± 0.08; before PI 2 4.70±0.07; after PI 6.833±0.09; follow up after PI 7.793±0.05. The mean QOLs of the patients: before PI 1, 0.719±0.005; before PI 2, 0.719±0.001; after PI, 0.801±0.009; follow up after PI 0.977 ± 0.009. There were significant differences among BGLs, patients’ adherence, and their QOLs before and after PI. p=0.000&#x0D; The present study proved that PI improved medication adherence, BGLs, and QOLs of outpatients with T2DM.

Health-related quality of life in outpatients with substance use disorder: evolution over time and associated factors

BackgroundHealth-related quality of life (HRQoL) is an important element of patient care and clinical research. The aim of this study was to describe HRQoL changes and identify associated factors during a 6-month follow-up of outpatients starting care for alcohol or opioid dependence.MethodsHRQoL was measured at baseline and 3 and 6 months later using the SF-12. Data on the patients’ sociodemographics, clinical characteristics and levels of anxiety and depression were collected using the Hospital Anxiety and Depression Scale (HADS). Repeated-measures analyses were performed to assess factors associated with global HRQoL differences and the evolution of HRQoL indicated by both physical and mental scores (PCS and MCS, respectively).ResultsThe mean PCS and MCS scores were initially low at 45.4 (SD = 8.6) and 36.0 (SD = 10.9), respectively. The improvement in HRQoL was rapid in the first 3-month period and then slowed and remained stable over the subsequent 3-month period. Being employed (p = 0.012), having no comorbidities (p = 0.014) and having no depression (p = 0.004) were associated with significant differences in the average PCS scores at the 3 time points. Patients who had lower overall HRQoL MCS scores on average were those for whom a medication was initiated (p = 0.009), as was the case for patients with anxiety (p < 0.001) and depression (p < 0.001). Patients with depression at baseline were also those for whom a significantly greater increase in MCS score during the 6 months of follow-up was observed.ConclusionOur findings highlight the importance of screening early psychological distress and considering other factors associated with HRQoL changes in outpatients after the first 3-month period of treatment for substance use disorder.

Evaluating health related quality of life in outpatients receiving anti-cancer treatment: results from an observational, cross-sectional study

BackgroundThe aim of the study was to assess health-related quality of life (HRQOL) in outpatients receiving anti-cancer treatment.MethodsObservational, cross-sectional, single-center study that assessed HRQOL in cancer patients receiving antineoplastic treatment.ResultsA total of 184 patients were included in the study; the median total FACT-G score was 66 ± 12.9; the scores for the physical well-being, social/family well-being, emotional well-being and functional well-being domains were 17.8 + 4.8, 19.1 ± 4.4, 14.8 ± 3.8 and 14.3 ± 4.7 respectively. Patients with adverse events had poorer HRQOL compared to those without them (FACT-G score 62.2 vs. 67.3; p < 0.05). In the multivariate analysis the variables associated with poorer HRQOL in the form of a gradient were tumor stage and performance status (ECOG); female sex was also associated with poorer HRQOL.ConclusionIn our study, the neoplastic disease and anti-cancer treatment toxicities had an impact on HRQOL. Patients had poorer scores in the functional well-being domain and higher ones in the social/family well-being domain. Variables associated with worse HRQOL were tumor stage, performance status (ECOG) and female sex.

Health-related quality of life in outpatients with chronic liver disease: a cross-sectional study

BackgroundThe symptoms and complications related to chronic liver disease (CLD) have been shown to affect patient well-being. Currently there is limited research data on how CLD severity may affect both health-related quality of life (HRQOL) and the development of depressive symptoms in CLD patients. Moreover, the ongoing advances in CLD treatment, and its effect on HRQOL, highlight the need for further studies. Therefore, the aim of the present study was to evaluate if the CLD severity may affect the HRQOL and the development of depressive symptoms.MethodsA cross-sectional study was conducted. Patients with CLDs were identified at their regular visits to the outpatient clinic of the Sant’Orsola-Malpighi Hospital in Bologna, between September 2016 and July 2017. HRQOL was measured with Short Form 12 (SF-12) and Nottingham Health Profile (NHP) questionnaires; depressive symptoms were measured with Beck Depression Inventory-II (BDI). CLD severity was measured using the MELD score and the sample was stratified into five classes according to it. Group comparisons were conducted using the Kruskal–Wallis test.ResultsTwo hundred and fifty-four patients were included. Mean age was 62.84 years (SD 11.75) and 57.9% were male. Most participants were affected by compensated cirrhosis (140.2%) and chronic hepatitis (40.2%), with a disease duration ≥ 5 years (69.3%). Regarding the MELD score, 67.7% of patients belonged to Class I, 29.9% to Class II, and 2.4% to Class III. There were not patients belonging to the Classes IV and V.No statistically significant differences were found in all SF-12 and NHP domains between the MELD classes, except for CLD impact on sexual life and holidays (p = 0.037 and p = 0.032, respectively). A prevalence rate of 26% of depressive symptoms was reported, no statistically significant differences were found in BDI-II total scores between the three MELD classes.ConclusionsAll domains of HRQOL and depression were altered in CLDs patients, nevertheless CLD severity was not confirmed as an affecting factor for HRQOL.

Physical activity, physical fitness and quality of life in outpatients with major depressive disorder versus matched healthy controls: Data from a low-income country

BackgroundThere is an urgent need to increase awareness that people with major depressive disorder (MDD) in low-income countries do also have a compromised physical health. We compared physical fitness and physical activity levels in outpatients with MDD with healthy matched controls in Uganda and explored whether the variance in quality of life (QoL) can be explained by the variance in physical fitness and physical activity levels. MethodsFifty outpatients (35 men, median age = 29 years, interquartile range = 14 years) and 50 age, gender and body mass index matched controls performed a 6-minute walk test (6MWT), the World Health Organization Quality of Life short-version (WHOQoLBref), Simple Physical Activity Questionnaire (SIMPAQ), and Brief Symptoms Inventory-18 (BSI-18). Differences between groups were assessed with a Mann Whitney U test and backward stepwise multivariable regression analysis was performed to evaluate independent variables explaining the variance in WHOQoLBref scores. ResultsOutpatients with MDD have significantly lower 6MWT, SIMPAQ walking, SIMPAQ incidental physical activity, physical and psychological WHOQoLBref scores, and significantly higher BSI-18 depression and anxiety scores. BSI-18 depression was the only significant independent predictor of the WHQoLBref physical score explaining 39.7% of the variance, while the 6MWT score remained the only significant independent predictor of the WHQoLBref psychological score explaining 31.7% of the variance. ConclusionsOur data demonstrate that outpatients with MDD in a low-income country are significantly less physically fit and less physically active than the general population. Lower physical fitness levels are also associated with lower QoL levels.

The evidence for pharmacist care in outpatients with heart failure: a systematic review and meta-analysis.

AimsPatients with heart failure (HF) have poor outcomes, including poor quality of life, and high morbidity and mortality. In addition, they have a high medication burden due to the multiple drug therapies now recommended by guidelines. Previous reviews, including studies in hospital settings, provided evidence that pharmacist care improves outcomes in patients with HF. Because most HF is managed outside of hospitals, we aimed to synthesize the evidence for pharmacist care in outpatients with HF.Methods and resultsWe conducted a systematic literature search in PubMed of randomized controlled trials (RCTs) and integrated the evidence on patient outcomes in a meta‐analysis. We found 24 RCTs performed in 10 countries, including 8029 patients. The data revealed consistent improvements in medication adherence (independent of the measuring instrument) and knowledge, physical function, and disease and medication management. Sixteen RCTs were included in meta‐analyses. Differences in all‐cause mortality (odds ratio (OR) = 0.97 [95% CI, 0.84–1.12], Q‐statistic, P = 0.49, I 2 = 0%), all‐cause hospitalizations (OR = 0.86 [0.73–1.03], Q‐statistic, P = 0.01, I 2 = 45.5%), and HF hospitalizations (OR = 0.89 [0.77–1.02], Q‐statistic, P = 0.11, I 2 = 0%) were not statistically significant. We also observed an improvement in the standardized mean difference for generic quality of life of 0.75 ([0.49–1.01], P < 0.01), with no indication of heterogeneity (Q‐statistic, P = 0.64; I 2 = 0%).ConclusionsResults indicate that pharmacist care improves medication adherence and knowledge, symptom control, and some measures of quality of life in outpatients with HF. Given the increasing complexity of guideline‐directed medical therapy, pharmacists' unique focus on medication management, titration, adherence, and patient teaching should be considered part of the management strategy for these vulnerable patients.

Quality of Life and Its Associations with Religiosity and Religious Coping among Outpatients with Psychosis in Singapore.

This cross-sectional study investigated the relationship of religiosity, the use of positive and negative religious coping methods, and quality of life (QOL) among 364 outpatients with psychosis in Singapore. Positive religious coping was significantly associated with better scores on physical (β = 0.51, p = 0.02) and psychological (β = 0.64, p = 0.01) QOL domains in the regression model. Negative religious coping was related to worse QOL in all four domains: physical (β = −0.44, p = 0.03), psychological (β = −0.76, p < 0.01), social (β = −0.54, p = 0.03), and environment (β = −0.65, p < 0.01). Increased participation in organizational religious activities was positively associated with higher QOL for psychological (β = 2.47, p < 0.01), social relationships (β = 2.66, p = 0.01), and environment (β = 2.09, p = 0.01) domains. Interestingly, those with no religious affiliation were found with higher scores in the QOL domain for social relationships (β = 4.59, p = 0.02). Religious coping plays an important role for the QOL of outpatients with psychosis. Greater awareness of the importance of religion in this population may improve cultural competence in treatment. Individuals with psychosis may benefit from greater community support and collaboration between clinical and religious community-based organizations to improve social integration and QOL.

Effect of RBC Transfusion on Six Minute Walk Test Performance and Quality of Life in Outpatients

Patients with cancer or other diagnoses associated with chronic anemia often receive red blood cell (RBC) transfusion as outpatients for symptoms including fatigue. To determine the effect of RBC transfusion on functional status and quality of life (QoL), we measured 6-minute walk test distance and fatigue-related QoL scores before and after RBC transfusion in outpatients.MethodsThe Red Cells in Outpatients Transfusion Outcomes (RETRO) study was a prospective, observational study of subjects before and after RBC transfusion. Patients were recruited through hospital outpatient infusion units at 4 sites. To account for potential confounding effects of chemotherapy, patients were classified into 2 groups based on cancer treatment (CT) within 4 weeks before or after the study transfusion (CT group) or not (No CT group). Inclusion criteria were age ≥ 50, ambulatory, and chronic anemia with at least one prior RBC within 6 months. Exclusion criteria included active bleed and recent myocardial infarction. Walk test distance, QoL (FACIT-Fatigue Scale), and hemoglobin (Hgb) were measured before and at 5-10 days post-transfusion. Extra RBC transfusions given as part of clinical care and interim Emergency Department (ED) or hospital admissions during the study were recorded. Unadjusted results are expressed as median, interquartile range (IQR) and p values assigned using signed rank test. Regression analyses of change in walk test distance and change in QoL score were performed using backwards elimination to identify significant clinical variables. Minimum clinically important change in walk test distance was 20 meters (m) and in QoL score was 3 points based on literature review.ResultsA total of 221 patients with at least one benign or malignant hematology/oncology diagnosis enrolled and 200 (138 CT, 62 No CT) completed both pre- and post-transfusion walk tests. Mean subject age was 66 and 1 RBC (73%) or 2 RBC (27%) were transfused during the study transfusion episode; 18% received 1-3 additional RBC between walk tests. On average, walk test distance and QoL scores were higher after transfusion. In the No CT group, unadjusted median change in walk test distance was 30 m (IQR 0 to 50; p<0.001). In the CT group, median change in walk test was 16 m (IQR -11 to 45; p<0.001). Median change in QoL score pre- to post-transfusion in the no CT group was 4.0 points (IQR 0 to 11; p<0.001) and 2.5 points (IQR -3 to 7.5; p<0.003) in the CT group.In the regression model of change in walk test distance with RBC, no recent cancer treatment, absence of interim ED visits or hospitalizations, post-transfusion Hgb ≥8 g/dL, and total RBC dose predicted larger increases in walk distance (p<0.05) (Table). Patients with no recent CT had an estimated adjusted change in walk test distance of 24.2 m greater on average than CT patients. Grouped by post-transfusion Hgb, the mean change in walk test distance between patients with post-transfusion Hgb ≥8 and <8 g/dL was 31 m. The total number of RBC transfused between walk tests also predicted greater improvement in walk performance (estimated adjusted mean difference in walk test distance 17.9 m per RBC unit).In the regression model of QoL, baseline Hgb, and Karnofsky score were associated with change in fatigue-related QoL in addition to no CT and lack of interim events (p<0.05). Patients with higher baseline Hgb had larger increase in QoL score (adjusted mean difference 3.8 scale points per g/dL Hgb).The following variables were not significantly associated with change in either primary outcome with transfusion: age, sex, body mass index, number of previous RBC transfusions, and change in Hgb at 1 week.ConclusionsRBC transfusion in outpatients improves walk test performance and fatigue-related QoL. Patients who maintained Hgb 8 g/dL or greater at one week post RBC showed clinically important (>20 m) increases in mean walk test distance. Patients with higher baseline Hgb levels showed relatively larger improvement in QoL scores. For both outcomes, improvement with RBC was most apparent in clinically stable patients not on chemotherapy. The finding that increased RBC dose between walk tests predicted greater increase in walk distance suggests that more RBC transfusion may further improve functional status in some patients. Studies that measure patient-related outcomes, including functional status and QoL, are essential in deciding which oncology patients will benefit the most from RBC transfusion. [Display omitted] DisclosuresCarson:Terumo: Research Funding.

N08 Construction of an explanatory model for quality of life in outpatients with ulcerative colitis

Abstract Background Previous studies have reported explanatory models of health-related quality of life (HRQoL) in patients with Crohn disease or inflammatory bowel disease. However, no model for HRQoL has been developed that is specialised for patients with ulcerative colitis (UC). In this study, we aimed to develop and evaluate a predictive explanatory model for HRQoL among outpatients with UC in Japan. Methods We conducted a cross-sectional survey between December 2019 and July 2020 at a clinic in Japan. HRQoL was evaluated using the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ-32). We extracted explanatory variables of HRQoL, including disease activity, psychological symptoms, and social support, from previous studies and created an explanatory model based on the conceptual model of Wilson &amp; Cleary (1995). The relationship between explanatory variables and the IBDQ-32 total score was examined using the Spearman’s rank correlation coefficient, Mann–Whitney test, or Kruskal–Wallis test. We conducted multiple regression analysis and path analysis to examine the effect of explanatory variables on IBDQ-32 total score. Results We included a total of 203 patients with UC. Variables that were significantly associated with the IBDQ-32 total score were partial Mayo Score, presence or absence of treatment side effects, Hospital Anxiety and Depression Scale (HADS) score, and having/not having an adviser when patients were severely ill-conditioned. HADS had the largest negative effect on IBDQ-32 total score (β = −0.474), followed by partial Mayo Score (β = −0.408), presence/absence of treatment side effects (β = −0.116), having/not having an adviser when patients were ill-conditioned (β = 0.081). Having an adviser or not when ill-conditioned had an indirect effect on patients’ IBDQ-32 total score via HADS (β = −0.111). We verified the final model, which included IBDQ-32 total score and the above four explanatory variables (adjusted R² = 0.501, GFI = 0.996, AGFI = 0.970, CFI = 1.000, RMSEA = 0.010, AIC = 28.043). Conclusion Psychological symptoms had the most direct effect on HRQoL in patients with UC and acted as a mediator in the relationship between social support and HRQoL. Nursing interventions to improve HRQoL in patients with UC should consider the effect of psychological symptoms and support when patients are severely ill-conditioned.