SF-36 Quality Of Life Research Articles

Quantitative evaluation of headache severity before and after endoscopic transsphenoidal surgery for pituitary adenoma.

OBJECT The relationship between headaches, pituitary adenomas, and surgical treatment of pituitary adenomas remains unclear. The authors assessed the severity and predictors of self-reported headaches in patients referred for surgery of pituitary adenomas and evaluated the impact of endoscopic transsphenoidal surgery on headache severity and quality of life (QOL). METHODS In this prospective study, 79 patients with pituitary adenomas underwent endoscopic transsphenoidal resection and completed the Headache Impact Test (HIT-6) and the 36-Item Short Form Health Survey (SF-36) QOL questionnaire preoperatively and at 6 weeks and 6 months postoperatively. RESULTS Preoperatively, 49.4% of patients had mild headache severity, 13.9% had moderate severity, 13.9% had substantial severity, and 22.8% had intense severity. Younger age and hormone-producing tumors predisposed greater headache severity, while tumor volume, suprasellar extension, chiasmal compression, and cavernous sinus invasion of the pituitary tumors did not. Preoperative headache severity was found to be significantly associated with reduced scores across all SF-36 QOL dimensions and most significantly associated with mental health. By 6 months postoperatively, headache severity was reduced in a significant proportion of patients. Of the 40 patients with headaches causing an impact on daily living (moderate, substantial, or intense headache), 70% had improvement of at least 1 category on HIT-6 by 6 months postoperatively, while headache worsened in 7.6% of patients. The best predictors of headache response to surgery included younger age, poor preoperative SF-36 mental health score, and hormone-producing microadenoma. CONCLUSIONS The results of this study confirm that surgery can significantly improve headaches in patients with pituitary adenomas by 6 months postoperatively, particularly in younger patients whose preoperative QOL is impacted. A larger multicenter study is underway to evaluate the long-term effect of surgery on headaches in this patient group.

Preconception and Prenatal Health of Women of Mexican Origin Who Reside in Texas and Mexico

s / Annals of Epidemiology 25 (2015) 702e719 719 Conclusions: Inadequate rate of GWG doubles the odds of stillbirth. Future analyses will use cubic splines to model continuous GWG rate. P70. Preconception and Prenatal Health of Women of Mexican Origin Who Reside in Texas and Mexico Thelma Carrillo MPH, Kyle A. Biggs DO, Roberta J. Ruiz PhD, Lewis P. Rubin MD, Ghulam Murtaza MD, Zuber D. Mulla PhD. Brookdale Hospital and Medical Center Purpose: Acculturation has been associated to favorable and unfavorable health outcomes in the United States. In relation to birth outcomes, studies are finding that less acculturated women have relatively more favorable or as favorable outcomes as populations with greater material resources. We conducted a pilot study in El Paso, Texas, to describe the prenatal health of women of Mexican origin. Methods: A cross-sectional questionnaire was conducted using a simple stratified sampling design among post-partum inpatient women. The three strata consisted of women born in the U.S. and residents of the U.S. (S1), women born in Mexico and residents of the U.S. (S2), and women born in Mexico and residents of Mexico, (S3). The questionnaire included questions from the Quality of Life SF-36, the Medical Outcomes Study Social Support Survey and other validated questions from U.S. national surveys. Results: Preliminary results for some indicators of preconception or prenatal health for 216 women are the following means: pre-pregnancy weight, S1 156.1 (141.6, 170.6), S2 150.2 (142.1, 158.3), S3 146.5 (139.6, 153.5), self-rated health, S1 70.0 (62.3, 77.7), S2 71.7 (66.5, 76.9), S3 72.8 (68.5, 77.0), and emotional well-being, S1 75.6 (70.7, 80.5), S2 78.4 (74.7, 82.2), and S3 78.7 (75.3, 82.0). Conclusions: The preliminary results indicate that a greater proportion of women who were born and resided in Mexico had better health indicators than their more acculturated counterparts. These select and preliminary findings may be worthy of further study to identify the mechanisms through which a culture’s protective factors affect health. P71. High Cost of Pregnancy and Child Birth in India Srinivas Goli PhD. Jawaharlal Nehru University (JNU) Purpose: This paper has twofold objectives: first, to measure the catastrophic payments in the medical care of pregnancy and childbirth. Second is to analyze if the type of hospital, utilization of JSY and family income made a difference in the spending pattern of pregnancy and childbirth. Methods: Our analysis uses unique data from 230 pregnant women that we interviewed in Uttar Pradesh, which is the largest state in India and has among the poorest health outcomes for women and children. In addition to detailed demographic and socioeconomic characteristics of the respondents, we collected information on the type of hospital for ANCs and delivery, pregnancy and childbirth costs, including hospitalization costs, doctor’s fees, medication costs, transportation costs, and access to government programs such as JSY and so on. We have used bivariate and multivariate regression analyses. Results: Our analysis reveals that the percentage share of the total cost of pregnancy and childbirth in annual income of the couples is above 40% for below poverty line families which is a huge catastrophic payment for them. It also shows strong and statistically positive associations between higher levels of education, private hospital and higher costs during pregnancy and childbirth. Conclusions: Although, ANCs and delivery care is highly sponsored in maternal and child health scheme of ongoing National HealthMission (NHM) andmost of the services should be free of cost, but we observed a high cost of pregnancy and child birth even in the government hospitals.

A structured exercise programme during haemodialysis for patients with chronic kidney disease: clinical benefit and long-term adherence

ObjectiveLong-term studies regarding the effect of a structured physical exercise programme (SPEP) during haemodialysis (HD) assessing compliance and clinical benefit are scarce.Study designA single-centre clinical trial, non-randomised, investigating 46 patients...

Completion pancreatectomy and islet cell autotransplantation as salvage therapy for patients failing previous operative interventions for chronic pancreatitis

Traditional decompressive and/or pancreatic resection procedures have been the cornerstone of operative therapy for refractory abdominal pain secondary to chronic pancreatitis. Management of patients that fail these traditional interventions represents a clinical dilemma. Salvage therapy with completion pancreatectomy and islet cell autotransplantation (CPIAT) is an emerging treatment option for this patient population; however, outcomes after this procedure have not been well-studied. All patients undergoing CPIAT after previous decompressive and/or pancreatic resection for the treatment of chronic pancreatitis at our institution were identified for inclusion in this single-center observational study. Study end points included islet yield, narcotic requirements, glycemic control, and quality of life (QOL). QOL was assessed using the Short Form (SF)-36 health questionnaire. Sixty-four patients underwent CPIAT as salvage therapy. The median age at time of CPIAT was 38 years (interquartile range [IQR], 14.7-65.4). The most common etiology of chronic pancreatitis was idiopathic pancreatitis (66%; n = 42) followed by genetically linked pancreatitis (9%; n = 6) and alcoholic pancreatitis (8%; n = 5). All of these patients had previously undergone prior limited pancreatic resection or decompressive procedure. The majority of patients (50%; n = 32) underwent prior pancreaticoduodenectomy, whereas the remainder had undergone distal pancreatectomy (17%; n = 11), Frey (13%; n = 8), Puestow (13%; n = 8), or Berne (8%; n = 5) procedures. Median time from initial surgical intervention to CPIAT was 28.1 months (IQR, 13.6-43.0). All of these patients underwent a successful CPIAT. Mean operative time was 502.2 minutes with average hospital duration of stay of 13 days. Islet cell isolation was feasible despite previous procedures with a mean islet yield of 331,304 islet cell equivalents, which totaled an islet cell autotransplantation of 4,737 ± 492 IEQ/kg body weight. Median patient follow-up was 21.2 months (IQR, 7.9-36.8). Before CPIAT, all patients required a mean of 120.8 morphine equivalent milligrams per day (MEQ/d), which improved to 48.5 MEQ (P < .001 compared with preoperative requirements) at most recent follow-up. Of these patients, 44% (n = 28) achieved narcotic independence. All patients were able to achieve stable glycemic control with a mean insulin requirement of 16 units per day. Of these patients, 20% (n = 13) were insulin independent after CPIAT. Mean postoperative glycosylated hemoglobin was 7.8% (range, 4.6-12.5). Islet cell viability was confirmed with endocrine testing and mean C-peptide levels 6 months after CPIAT were 0.91 ng/mL (range, 0.1-3.0). The SF-36 QOL survey administered postoperatively demonstrated improvement in all tested modules. This study is the first to examine the results of salvage therapy with CPIAT for patients with refractory chronic pancreatitis. Patients undergoing CPIAT achieved improved postoperative narcotic requirements, stable glycemic control, and improved QOL.

Medial Patellofemoral Ligament Reconstruction: A Longitudinal Study Comparison of 2 Techniques with 2 and 5-Years Follow-Up.

Background : The purpose of this study was to compare the results of two popular surgical techniques for medial patellofemoral ligament MPFL reconstruction with a minimum of two-year follow-up.Methods : Fifty-eight patients with traumatic tear of the medial patellofemoral ligament were included in one of the two surgical groups. Group 1 MPFLs were reconstructed through graft endobutton fixation and Group 2 through graft anchor fixation into the patella. After two to five-year follow-up, patients were asked to answer knee function questionnaires (Fulkerson and Kujala) as well as the SF-36 life quality score.Results : There were no statistical difference among postoperative Kujala, Fulkerson, and SF-36 questionnaires scores between Groups 1 and 2. There were statistical significant differences favorable to patients in Group 1 with a shorter follow-up length (2-5 years) compared to those with a longer period of 5-10 years for both Kujala and Fulkerson scores and no difference for group 2.Conclusion : Both medial patellofemoral ligament reconstruction techniques had similar results in a two to ten-year follow-up according to functions and life quality questionnaires. Furthermore, endobutton fixation for the patellar edge of the graft had better results in patients with 2 years of follow-up than those with 5 years. Gender was not significant for surgical results. Moreover, group 1 patients had higher number of complications.

PTH-263 Analysing short-term outcomes and patient satisfaction with laparoscopic ventral mesh rectopexy

Introduction Laparoscopic ventral mesh rectopexy (LVMR) has been used to treat rectal prolapse and obstructive defaecation syndrome (ODS). However, limited outcome data have been reported. The purpose of this study was to evaluate the indications and outcomes of LVMR by comparing pre-and postoperative function and quality of life. Method A Prospective database identified all patients undergoing from November 2011 to July 2014. Cleveland clinic constipation score (CCCS), St Mark’s incontinence score (SMIS), Quality of life SF12 (QOL) and Cleveland surgery satisfaction questionnaire were used to evaluate surgical outcomes and patient satisfaction retrospectively. Results 28 LVMRs (26 women, mean age +/− SD, 69 +/− 29 years, median 65 years), were performed during the study period. 25 patients were followed up (median 71 days, range 39 to 197 days). 78% of patients responded to the questionnaire with 15 patients suffered from rectal prolapse and 7 patients ODS). Eight patients underwent LVMR following perineal repair, of these 1 reported recurrence of prolapse and faecal leakage. The mean score for CCCS and SMIS were compared pre and post-operatively. Both showed a reduction in symptoms, scoring 11.0 vs. 7.0 (P Changes in physical component and mental component summary were observed using QOL SF-12 with no statistically significance and a mean difference of 4.02 and 5.68. 82% of patients completing the Cleveland surgery satisfaction questionnaire would recommend LVMR with a mean score of 4.3 out of 5. Conclusion LVMR is associated with low recurrence and a significant improvement in symptoms of pelvic floor dysfunction. Improvement in QOL was observed with the majority of patients recommending this procedure. Disclosure of interest None Declared.

Quality of life evaluation of patients with neurogenic bladder submitted to reconstructive urological surgeries preserving the bladder.

ABSTRACTTreatment of neurogenic bladder (BN) aims to upper urinary tract protection. When the conservative clinical measures are insufficient, surgical treatment is indicated. Though admittedly important, the quality of life (QoL) has been little studied in these patients, there are even contradictory results. The aim of this study was to evaluate QoL before and after bladder augmentation in patients with BN refractory to medical treatment. We analyzed, prospectively, the data of 67 patients who underwent surgical treatment for BN by questionnaire SF-36® and Qualiveen® QoL before and after six months of operation. Comparisons using paired t-tests and Wilcoxon and the assumption of normality was assessed using the Shapiro-Wilk test were made. According to the analysis of the SF-36® questionnaire, the patients had higher QoL indices in the postoperative period in the areas functional capacity, general state of health, vitality, social aspects, emotional aspects and mental health (n = 67; p <0.05). The questionnaire also revealed Qualiveen® best result in quality of life index in the postoperative period, and show lower specific negative impact by urinary problems (n = 36; p <0.05). The results show that, despite not being the main objective, the bladder augmentation results in significant improvement in QoL, probably related to the perception of better health and the resolution of urinary incontinence. Thus, the bladder augmentation associated with other urologic reconstruction techniques allows the upper urinary tract protection, and contribute to a better quality of life of patients with BN.

Abstract P1-09-14: Improved outcome of breast cancer survivors participating in a multidisciplinary cancer survivorship program at Texas Tech University Health Sciences in El Paso, TX

Abstract Introduction: Breast Cancer (BC) survivors in El Paso, TX include a majority of Hispanics. We have previously reported that these survivors have decreased mental and physical health related Quality of Life (QOL). We sought to determine whether BC survivors would benefit from participating in a comprehensive multidisciplinary BC Survivorship Program at the Garbar Breast Care Center (GBCC), as determined by improvement of performance on the following validated questionnaires: 1) Patient Health Questionnaire 9(PHQ9), 2) General Anxiety Disorder 7 (GAD 7), and SF36 QOL questionnaires. Methods: After IRB approval, we recruited consecutive patients at our institution over 6 months starting October, 2013, and who are within the first 5 years post-diagnosis with Stages I-III BC and have completed surgery, chemotherapy and/or radiation therapy. Survivors were enrolled in the survivorship program staffed by an oncologist, a nurse practitioner, a nutritionist and a clinical psychologist. They participate in individual as well as group sessions. Survivors are initially screened for depression and generalized anxiety disorder using PHQ9 and GAD 7, in addition to assessing the patient’s QOL at baseline, and every 3 months. Survivors are provided with a personalized summary of all received treatment and follow up care plans; dietary counselling and individual meal plans, in addition to in-depth psychological assessment and an intervention using Mindfulness Based Stress Reduction. Results: 47 patients have been recruited so far and all but one completed baseline questionnaires;17 and 7 respectively had 3 and 6 months follow up visits. 94% were Hispanics. Mean age 54 years. 38% of participants were younger than 50 years of age; Stage 1 BC (36%), Stage 2 (36%), and stage 3 (28%) . 80% received chemotherapy ; and 68% had hormone receptor positive BC and received endocrine therapy. The scores at baseline were : PCS representing the mean for the SF-36 QOL Physical Health was 46.0, and the MCS for Mental Health was 44.0, both below the population norm (50.0). Mean scores for GAD 7 was 7.54 and for PHQ 9 7.33, both abnormal (&amp;lt;5 on PHQ9 and GAD 7 are considered normal scores). At 3 months the scores were as follows: PCS 49.71, MCS 45.34, both improved (the higher the better); GAD7 5.18; and PHQ9 6.82 (both improved, the lower the better). At 6 months, same favorable trend continues: PCS 50.07 [SD 5.54, 44.29-53.35]; MCS 49.66 [SD 7.73, 38.93-62.41]; GAD7 5.00 (SD 3.70); and PHQ9 4.57 (SD 3.64). Conclusion: BC survivors are benefiting from participating in the new BC Survivorship Program launched at Texas Tech in El Paso, TX. They have experienced improved mental and physical health related QOL, improved anxiety and depression by GAD7, and PHQ9, with scores reaching near normal values at 6 months into the program which continues to enroll BC survivors. This program represents a culturally appropriate model for Hispanic BC survivors. It is expected to continue to improve the quality of life of these patients, empower them in their transition from cancer treatment to survivorship and lead to improved psychosocial adjustment and normal social functioning with significant implication not only on survivors, but also on their families and the community. Citation Format: Zeina Nahleh, Rebecca Pasillas, Alok Dwivedi, Azadeh Nasrazadani, Rosalinda Heydarian, Luis Sanchez, Indika Mallawaarachchi, Cecilia Ochoa, Edward Saltzstein. Improved outcome of breast cancer survivors participating in a multidisciplinary cancer survivorship program at Texas Tech University Health Sciences in El Paso, TX [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-14.

ASSOCIATION OF CLINICAL MANIFESTATIONS AND COMORBIDITIES WITH QUALITY-OF-LIFE MEASURES IN PATIENTS WITH GOUT

Objective: to identify factors associated with low quality of life (QL) in patients with gout. Subjects and methods. The investigation enrolled 175 patients (153 men and 22 women) with a definite diagnosis of gout. Their mean age was 48.0±12.3 years; median disease duration – 5.7 [3.0; 12.3] years; the annual number of arthritis attacks – 3 [1; 5]; and the mean serum level of uric acid (UA) – 510±120 μmol/l. 31.4% of the patients received allopurinol; 40.5% had chronic arthritis; 36.5% – subcutaneous tophi, 23% – coronary heart disease (CHD); 76% – hypertension; 15.4% – type 2 diabetes mellitus (DM); 10.2% – chronic kidney disease (CKD) at a glomerular filtration rate of <60 ml/min; 56% – obesity; 5.1% – chronic heart failure (СHF); 9.1% – history of vascular catastrophes. Pearson’s and Spearman’s correlation analyses were made to reveal correlations between QL measures according to the EQ-5D and SF-36v1 questionnaires, HAQ functional status (FS), and the clinical characteristics of the disease, as well as comorbidities. Multiple regression analysis was used to identify factors worsening QL. Results and discussion. Negative correlations were found between SF-36 QL measures and age, disease duration, serum UA level, presence of chronic arthritis and tophi, use of allopurinol, diuretics, alcohol, as well as hypertension, CHD, obesity, vascular catastrophes, CKD, and CHF. The multiple regression analysis established a direct association between HAQ FS worsening and female gender, elderly age, number of inflamed joints and frequency of arthritis attacks; the coefficient of multiple determination (R 2 ) was 0.41. EQ QL correlated inversely with age, number of inflamed joints, frequency of arthritis attacks, intake of diuretics and obesity (R 2 = 0.33). The reduction in the SF-36 physical health component correlated with increases in age, number of inflamed joints, and frequency of arthritis attacks, presence of CKD (R 2 = 0.3); a weak association was noted between worsening mental health component and female gender, increased number of inflamed joints, and vascular catastrophes (R 2 = 0.1). Conclusion. Decreased QL in gout is independently associated with higher number of inflamed joints, frequency of arthritis attacks, elderly age, female gender, and comorbidities (CKD, obesity, vascular catastrophes).

Impact of osteopathic manipulative therapy on quality of life of patients with deep infiltrating endometriosis with colorectal involvement: results of a pilot study

ObjectiveA prospective pilot study to evaluate the potential role of osteopathic manipulative therapy (OMT) on quality of life (QOL) of patients with Deep Infiltrating Endometriosis (DIE) and colorectal involvement. Study designTwenty patients with DIE and colorectal infiltration completed the SF-36 QOL questionnaire before and after undergoing OMT. ResultsThe median age (range) of the patients was 30.4 years (22–39). Thirty-five percent of the patients had undergone previous surgery for endometriosis and 70% were on medical treatment. Fifteen of the 20 patients (75%) completed the protocol. There was no difference in the epidemiological characteristics or in the pre-OMT Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36 questionnaire between patients who completed the protocol or not. After a mean period of 24 days (15–53), a significant improvement in PCS (p=0.03) and MCS (p=0.0009) compared to pre-OMT values was observed giving a success rate of 80% and 60% in intention-to-treat, respectively. ConclusionOur results support that OMT can improve QOL of patients with DIE and colorectal involvement. Moreover, this pilot study can serve to determine power calculations for future randomized trials.

Assessment of Quality of Life and Family Life Support Reference Relatives of Patients with Schizophrenia

The aim of our study was to investigate the characteristics of quality of life referent relatives of patients with schizophrenia and their family characteristics of resource support. It examined 168 referent relatives (RR) of patients with paranoid schizophrenia. Among the patients were 47 wives, 51 husbands, 70 – one of the parents. Examined were in the age range of 29 to 76 years (mean age: “wife» 44,7 ± 0,9 years, “husband» 53,3 ± 0,5 and “one parent» 62,8 ± 2,2 years). In order to assess quality of life and social functioning, reference relatives of schizophrenic patients were divided into 3 groups. Accordingly, the duration of the disease in patients 4 years -1 group (n = 57), 4-8 years – 2 (n = 58) group and 8 years – 3 (n = 53) group. In group 1 patients was 16 wives, 14 husbands and 27 people (a parent); 2 and 3 groups, respectively, 18.17, 23, 13, 12 and 28 people. The control group were 55 mentally healthy individuals, in families that do not live mentally ill person. Methods Psychosocial and psychological characteristics relative reference identified by means of psychodiagnostic method using a methodology for assessing the quality of life SF-36. Research resource family support was carried out by questionnaire assessment of family resources Conclusion In all groups surveyed in the dynamics of the disease there is a deterioration of social functioning and quality of life. The peculiarities suggest that with the development of schizophrenia in a family member (RR) offset empatio-affiliative tendencies and desires in interpersonal interactions with patients.

Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients

Background:The Nintendo® Wii is a simple and affordable virtual therapy alternative. It may be used at home, and it is a motivating recreational activity that provides continuous feedback. However, studies comparing the use of the Nintendo® Wii to conventional physical therapy are needed.Objective:To compare the effect of a rehabilitation treatment using the Nintendo® Wii (NW) with conventional physical therapy (CPT) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients.Methods:The present study applied a randomized, blind, and controlled clinical trial. In total, 30 patients with post-stroke hemiparesis were evaluated. A total of 15 patients were randomly assigned to each group. The SF-36 quality of life and Fugl–Meyer scales were used to evaluate the patients.Results:After treatment, the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy. A significant difference was observed between both groups before and after treatment in terms of the following Fugl–Meyer scale items: passive movement and pain, motor function of the upper limbs (ULs), and balance. The CPT group also showed a significant difference with regard to their UL and lower limb (LL) coordination. The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains: physical functioning, role limitation due to physical aspects, vitality, and role limitation due to emotional aspects. The NW group also exhibited a significant difference in the mental health domain. The results indicate that both approaches improved the patients' performance in a similar manner.Conclusion:Virtual rehabilitation using the Nintendo Wii® and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores, motor function of the upper limb, balance, physical functioning, vitality, and the physical and emotional aspects of role functioning.

Impact of the clinical Pilates exercises and verbal education on exercise beliefs and psychosocial factors in healthy women.

[Purpose] Exercise is one of the most important components of a healthy life. The purpose of this study was to analyze exercise beliefs and psychosocial factors in sedentary and active healthy women and observe the changes in these parameters resulting from clinical Pilates exercises and verbal education in healthy women. [Subjects and Methods] Sixty-six healthy women were included in the study. Participants were divided into clinical Pilates (n=21), verbal education (n=25), and control groups (n=20). Prior to and at the end of the study, demographic information, body mass index, waist-hip circumference, exercise beliefs, physical activity index, and psychosocial factors (Rosenberg self-esteem scale, Body Cathexis Index, SF-36 quality of life, Beck Depression Scale, visual analog scale for tiredness) of the subjects were recorded. [Results] Meaningful changes for all the parameters took place in the clinical Pilates and verbal education groups. Our analyses indicated that the changes in the clinical Pilates group were more meaningful than those in the verbal education group. When the data of the study groups were compared with those of the control group, the clinical Pilates group showed meaningful differences. [Conclusion] The result of this study indicate that both clinical Pilates and verbal education are effective in changing exercise beliefs and physical and psychosocial parameters.

Change in quality of life after transcatheter aortic valve implantation and aortic valve replacement surgery in Australian patients aged ≥ 75 years: the effects of EuroSCORE and patient operability.

ObjectiveTo determine the extent to which differences in generic quality of life (QOL) between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) patients explained by EuroSCORE and heart-team operability assessment.MethodsA total of 146 high-risk patients with EuroSCORE > 6 and aged ≥ 75 years underwent TAVI (n = 80) or aortic valve replacement (n = 66) between February 2010 and July 2013. A total of 75 patients also completed preoperative and six month SF-12 QOL measures. Analyses examined incident major morbidity, compared six month QOL between groups adjusted for EuroSCORE and operability, and quantified rates of clinically significant QOL improvement and deterioration.ResultsThe AVR group required longer ventilation (> 24 h) (TAVI 5.0% vs. AVR 20.6%, P = 0.004) and more units of red blood cells [TAVI 0 (0–1) vs. AVR 2 (0–3), P = 0.01]. New renal failure was higher in TAVI (TAVI 5.0% vs. AVR 0%, P = 0.06). TAVI patients reported significantly lower vitality (P = 0.01) by comparison to AVR patients, however these findings were no longer significant after adjustment for operability. In both procedures, clinically significant QOL improvement was common [range 25.0% (general health) – 62.9% (physical role)] whereas deterioration in QOL occurred less frequently [range 9.3% (physical role) – 33.3% (mental health)].ConclusionsClinically significant improvement and deterioration in QOL was evident at six months in high risk elderly aortic valve replacement patients. Overall QOL did not differ between TAVI and AVR once operability was taken into consideration.

Symptom control in asthma, relationship with life quality and the effect of patient training on the control of symptoms

Methods Data were gathered through the questionnaire. Asthma Control Test(ACT) and SF-36 life quality questionnaire (SF-36 LQQ) were applied to the patients. Respiratory functions were measured. Treatments of the patients were given according to GINA guideline. Trainings of patients were offered. Approximately one month later; ACT and SF-36LQQ were repeated. Data were analyzed through SPSS10.0, and the relationship between ACT and SF-36LQQ was investigated by correlation analysis.

Prognostic Criteria in Traumatic Knee Dislocations: A Retrospective Study of 42 Cases

Objectives:Traumatic knee dislocation (TKD) is an orthopaedic emergency, which may include not only knee joint’s structures, but also neurovascular tissues. While such a major trauma can easily be expected to cause significant impairment in knee joint’s functions in long term, individual impact of these injured structures on the outcome needs to be clarified. This study questions the effect of injury type and the effect of the presence of neurovascular injuries on the functional outcome after TKD treatment in a level 3 trauma center.Methods:Between 1997 and 2013, 42 knee joints of 42 patients (mean age 34; range 18 – 80) were diagnosed with TKD and treated accordingly. Patients were reviewed after a mean period of 116 months (range 12 – 204), retrospectively. The type of knee injury was classified according to Schenck’s criteria, accompanying injuries and emergency and elective surgical interventions were recorded. Patients were evaluated radiographically and clinically on the follow-up examination. Clinical outcome parameters were KSS, Lysholm-Tegner, IKDC and SF-36 scores, grouping patients as either “good or excellent” or “poor or fair”. Cut-off values for this stratification was 70 points or higher for KSS, 80 or higher for Tegner-Lysholm and 70 for IKDC score. Effect of injury patterns on the clinical outcome was investigated using frequency tables and Chi-Square test for categorical data and Anova one-way analysis or Kruskal-Wallis test for numerical results.Results:According to Schenck’s classification, 6 knee joints (13.9%) were classified as KDI, 3 joints (6.9%) as KDII, 10 joints (23.2%) as KDIII, 19 joints (44.1%) as KDIV and 3 (6.9%) as KDV. An arterial injury was diagnosed in 11 cases (25.5%), fibular nerve injury in 12 cases (27.9%) and tibial nerve injury in 2 cases (4.6%). An external fixator was placed in 20 patients (46.5%) in the emergency setting. Vascular repair was performed in 6 patients, of which four (9.3%) also received a fasciatomy with a diagnosis of compartment syndrome. Fibular nerve was repaired in 9 joints. ACL reconstruction was performed in 22 joints, PCL in 10, MCL repair in 26, LCL repair or reconstruction in 35 and PLC repair or reconstruction in 10. In the final follow-up examination, mean ROM was calculated as 116 degrees, mean KSS-1 score as 79, mean KSS-2 score as 78; mean Tegner-Lysholm score as 80, mean IKDC score as 72, mean SF-36 MCS as 50 and mean SF-36 PCS as 48. Both arterial and fibular nerve injuries were associated with a poor outcome using the IKDC, KSS 1-2 and Tegner-Lysholm scores (p<0.01). A vascular injury was related to a significantly lower ROM degree (p<0.05) in the final follow-up, as well as the fibular nerve damage (p<0.05). The severity of knee injury (Schenck’s grade) was inversely correlated with ROM degrees (P<0.05). SF-36 life quality scores were significantly better in KDI group when compared to the remaining four groups (p=0.02), while no difference was observed between groups KDII - KDV. Incidence of neurovascular damage was not increased with the severity of the Schenck’s grade.Conclusion:A Schenck’s grade of KDII or higher and presence of arterial or nerve injury is correlated with poor outcome in traumatic knee dislocation. The incidence of neurovascular injury was not significantly related Schenck’s grade.

Exercise training for pulmonary hypertension: A systematic review and meta-analysis

Exercise training for pulmonary hypertension: A systematic review and meta-analysis

Relationship of physical function and quality of life among persons aging with HIV infection.

Physical function impairments are seen among aging, HIV-infected persons on effective antiretroviral therapy (ART). The impact of physical function impairments on health-related quality of life (QoL) during ART is unknown. This was a cross-sectional study including 359 HIV-infected patients, aged 45-65 years, on ART for more than 6 months. Patients completed the SF-36 QoL questionnaire, 400-m walk, 5-time chair rise, and grip strength. HIV-associated mortality risk was calculated using the Veterans Aging Cohort Study (VACS) Index. Physical function, physical activity (> 500 versus ≤ 500 kcal/week), and VACS scores were used to estimate QoL in multivariable linear regression. For every 1 m/s increase in gait speed, we saw an estimated 11.8 [95% confidence interval (CI) 8.4, 15.2] point increase in the physical function scale with smaller differences across all subscales. For every 1 rise/s faster chair rise pace, we saw an estimated 16.0 (95% CI 9.1, 22.9) point increase in the physical function scale with smaller differences across all subscales. SF-36 scores were between 2.8 and 5.7 points higher among more physically active compared to less active patients. A 1 kg increase in grip strength was associated with a 0.2 (95% CI 0.01, 0.3) higher mental health score, but there were no differences in other subscales. VACS scores did not improve the model. Faster gait speed and chair rise time, and greater physical activity were associated with greater QoL, independent of HIV-related mortality risk. Targeted exercise programs to increase physical activity and improve speed and power should be evaluated as interventions to improve QoL during ART.

Collaborative care for schizophrenic patients in primary care: A double blind, randomized clinical trial of efficacy and safety

Background: Schizophrenia is one of the most severe psychiatric illnesses, with a prevalence of approximately 1% in the population. Pharmacists cooperate with the patient and other professionals in designing, implementing and monitoring a therapeutic plan and pharmacotherapy recommendations that will produce specific therapeutic outcomes for such patients. The objective of this study was to assess the role of clinical pharmacists’ involvement in Psychiatry ward for the treatment of schizophrenic patients. Methods: A double blind randomized control study was carried out in Psychiatry ward for a period of one year and three months at Lady Reading hospital, Khyber Pakhtunkhwa, Peshawar, Pakistan. Clinical response was determined in schizophrenic patients i.e. first episode psychosis, with objective rating scales, length of stay, adverse events, and patient compliance with the first clinic visit scheduled after discharge, and patient satisfaction on likert scale. Different scales were used to check the severity of positive, negative and general symptoms of the disorder, adherence to the medication and quality of life. Diary cards were given to the patients’ attendant so that they may remind their patient of their medication. Results: A total of 96 patients were enrolled in which 46 in control 50 in intervention groups. 3 patients in intervention group and 2 patients in control were under-diagnosed. We compared the outcomes of subjects treated in this collaborative care model, 46 in intervention group with 46 controlled group subjects receiving usual hospital care. After 6 months, the intervention group showed a significantly higher drug adherence rate than that of the control group. Morisky medication adherence scale (MMAS) and medication adherence report scale (MARS) showed p-value 0.006 and 0.001, respectively. The positive and negative syndrome scale (PANSS) showed p-value of 0.01 with change scores of -4.8 for intervention group. The SF-12 for quality of life (QOL) questionnaire showed p-value 0.002 in physical component summary (PCS), 0.001 in both mental component summary (MCS) and general health respectively. Patient satisfaction on likert scale showed a mean of 4.45 (SD=0.52) in the intervention group. Conclusion: Medication adherence and the quality of life of the schizophrenic patients were improved. Patients with co-morbidity were identified. Patient education and counseling regarding indication and medication adherence was helpful. Clinical improvement was noted in both groups, but the difference in intervened group was significant.

Life events and quality of life in female patients with dermatitis artefacta: a comparative study with siblings and controls

BackgroundIf the severity of dermatitis artefacta (DA) is accepted by most authors, few published studies have sought to clarify its etiology and impact. It is in this context that this work aimed to compare Life Events (LE) and quality of life (QoL) scores in patients with DA, in their siblings and in control patients with other chronic dermatological diseases. MethodsThis is a descriptive and comparative cross-sectional study carried out in the dermatology department of Farhat Hached hospital in Sousse, Tunisia. Thirty female patients diagnosed with DA according to DSM-IV criteria were retrospectively recruited. For each patient with DA, one of her sisters, the closest in age, was enrolled in the siblings group. The control group consisted of thirty female patients with other chronic dermatological diseases, matched with DA patients for age and duration of disease progression. Assessment was based on Paykel inventory for LE and on SF-36 for QoL. ResultsCompared to both control groups, DA patients reported more LE with more objective negative impact of these events and had a lower score and more often impaired mean global score of QoL. ConclusionsLE would have a role in the pathogenesis of DA which seems to alter the QoL of patients. These results could help to improve the understanding of DA and incite clinicians to focus not only on the diagnosis and treatment of DA but also on the impact of this disease.