Related Quality Of Life Questionnaire Research Articles

Evaluation of Child Oral Health Related Quality of Life in Bleeding Disorders

Abstract Background Oral bleeding is a common symptom for many inherited and acquired bleeding disorders in children. Understanding oral health and treatment needs of patients with bleeding disorders is necessary for patients' primary oral health prevention. Aim of the Work To evaluate the oral health problems in children with bleeding disorders both clinically and with child oral health related quality of life questionnaire score. To assess the effect of intervention (education and any necessary dental procedure) on the child oral health related quality of life questionnaire score. Patients and Methods This cross-sectional study was conducted on 70 patients aged from (2-18 years), males represent n = 47 (67.1%), females n = 23 (32.9%). Inherited bleeding disorders represent n = 37 (52.9%) and acquired bleeding disorders represent n = 33 (47.1%). ITP n = 33 (47.1%), hemophilia A n = 27 (38.6%), Von Willebrand’s disease n = 7 (10%) and Glanzmann n = 3 (4.3%) and all subjected to full history taking, examination, dental health estimation, oral health education, dental management and replacement therapy as needed at baseline and after 6 months of follow up from October 2021 to April 2022. ITP bleeding score (ISTH SSC bleeding assessment tool) used to assess severity of ITP patients. Child oral health related quality of life and child oral health impact profile questionnaires were filled by patients/parents at base line and after 6 months follow up. Results The current study revealed that (57.1%) of patients have dental caries. Regarding oral hygiene status, (10%) of patients have poor oral hygiene. Regarding gingival health, (50%) of patients have moderate gingivitis and (11.4%) have severe gingivitis. Oral symptomatology, Psychological domain for child, Psychological domain for family, Social domain for child and Total oral health score were significantly affected more with long duration of disease (p-value =0.0005, 0.0015, 0.010, 0.022 and 0.0045 respectively). There was statistically significant improvement in oral health related quality of life questionnaire score after 6 months of follow up with total oral health score (p-value = 0.000). Conclusion Oral health was significantly affected among patients with acquired and inherited bleeding disorders. Oral health education and management had significant impact on oral health related quality of life scores after 6 months of follow up.

Electronic home monitoring of children with cystic fibrosis to detect and treat acute pulmonary exacerbations and its effect on 1-year FEV1

BackgroundWe aimed to investigate the effect of the use of electronic home spirometry in children with cystic fibrosis (CF) on 1-year FEV1 (% predicted, pp) change. MethodsThis is a randomised, one-year prospective study including children with CF between 6 and 18 years of age. Subjects were randomised into home spirometry group (HSG) and usual care group (UCG). Children in HSG performed two pulmonary function tests (PFT) per week. Data regarding acute pulmonary exacerbations (PEx) was obtained from patients’ records. At baseline and 12th month, health related quality of life questionnaire for CF patients (CFQ-R) and lung clearance index (LCI) were performed. ResultsSixty children were recruited with a median (IQR) age of 13.3 (11.4–15.4) years. Absolute change in FEV1pp from baseline to 12th month as median (IQR) was +1% (-6.75–9.75) in HSG and -2.50% (-7.50–3.25) in UCG (p = 0.10). Sensitivity analysis including only adherent children in HSG (n = 22), yielded an increase of 5% (-3.50–12) in HSG and a decrease of 2.50% (-7.50–3.25) in UCG (p = 0.009). A total of 29 (96.7%) subjects in HSG and 23 (76.7%) in UCG had PEx (p = 0.05). Absolute change in median (IQR) LCI2.5 from baseline to the 12th month was -1.6 [-2.9–0] (p<0.001) in HSG and -1.5 [-2.8-(-0.6)] (p<0.001) in UCG (p = 0.94). There was a significant increase in the social domain of the CFQ-R in HSG (from 59.1 to 76.2, p = 0.01). ConclusionsElectronic home monitoring of children with CF by spirometry may result in improvement in lung function.

Relationship between Degrees of Severity Gastroesophageal Reflux Disease (Gerd) with Quality of Life

Background. Gastroesophageal reflux disease (GERD) is a pathological condition caused by the reflux of gastric contents into the esophagus, with symptoms that appear inside and outside the esophagus which can reduce the patient's quality of life. The aim study is to analyze the relationship between the severity of GERD and the quality of life of students Faculty of Medicine at Universitas Sumatera Utara (USU) in 2019 and 2020. Method. Cross-sectional research with a sampling technique in the form of total sampling. Data collection was carried out using an online questionnaire in the form of a Google form with an assessment using the GERD Questionnaire (GerdQ), Frequency scale for the symptoms of GERD (FSSG), Gastroesophageal reflux disease-health related quality of life questionnaire (GERD-HRQL), and the 20-item self-reporting questionnaire (SRQ-20). After that, the data that has been collected will be tabulated. This study used bivariate analysis, with the Chi-square test and the Fisher Exact Test. Results. The total number of samples that met the inclusion and exclusion criteria of the study was 225 people with 41 people with GERD (18.2%) suffering from GERD. Of the 41 Students of the Faculty of Medicine from USU in 2019 and 2020 with GERD, 29 people (70.7%) had a good quality of life, and the remaining 12 people (29.3%) had a bad quality of life. There is a relationship between GERD and gender and psychological stress. In addition, there is a relationship between quality of life and the severity of GERD, psychological stress, and drinking alcohol, but there is no relationship between quality of life and gender, smoking habits, and BMI. Conclusion. Most Medical School Students have a good quality of life, and there is a significant relationship between the severity of GERD and the quality of life.

Health Related Quality of Life among Reproductive Age Women Having Polycystic Ovarian Syndrome

INTRODUCTION: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder commonly seen in young reproductive age women and is manifested by polycystic appearing ovaries on ultrasonography along with oligomenorrhoea or amenorrhoea, hirsutism, obesity and emotional disturbances further leading to infertility and metabolic disturbances as well as chronic illness. These symptoms, however, are frequently linked to decline woman's self-esteem and self-image, and may have an impact on her health-related quality of life (HRQoL). MATERIALS AND METHODS: Descriptive, web based-cross sectional study was conducted among 686 reproductive age women of Facebook page named PCOS WARRIOR Nepali woman selected conveniently. Structured and standardized health related quality of life questionnaire (German PCOS Questionnaire -g) was used to collect data by posting google form on Facebook page. Obtained data were analysed in Statistical Package for Social Science (SPSS) version 20, descriptive statistics and inferential statistics. RESULTS: More than half (50.9%) of the respondents were found to have good quality of life. The most common health related concern was for Infertility (28.57%) and least was for Acne (71.43%). There was statistically significance between Health-related quality of life and Body Mass Index (BMI) (p=&lt;0.001), menstruation Pattern (p=0.013), duration of medication (p=0.002) and presence of co-morbidities (p=0.010) respectively. CONCLUSIONS: It is concluded that more than half of the respondents have good quality of life. Various programmes should be conducted regarding infertility and assisted reproductive technologies giving special attention to the women having PCOS. Management of PCOS should be directed to improve quality of life of PCOS patients.

Comorbidity in multiple sclerosis: Emphasis on patient-reported outcomes

BackgroundAim of our study was to estimate the prevalence of comorbid conditions and adverse health behaviors in relapsing-remitting multiple sclerosis (RRMS) patients and evaluate association between comorbidity and MS outcomes (relapse rate, fatigue and quality of life) in Lithuanian setting. MethodsA prospective cohort study was carried out in the MS center of Lithuanian University of Health Sciences Hospital Kaunas clinics from November 2016 to March 2021. People with MS filled a self-report comorbidity and adverse health behavior questionnaire, visual analogue fatigue scale (VAFS), a Short Form 36 (SF-36) v2 health related quality of life questionnaire (QoL). Information about disability and relapses was acquired from medical documentation and Lithuanian MS registry at baseline and after 24-month observational period. Chi square, t-test, ANOVA, Mann-Whitney U were used for basic statistical evaluation. Multivariable logistic regression models were used to prognose MS outcomes in association to comorbidity and adverse health behaviors, adjusting for age and baseline disability. ResultsOf 230 RRMS patients, 167 (72.6%) were women, average age was 42 years. 207 persons were followed through the observational period and included into relapse analysis. 112 (48.7%) of participants reported having at least one comorbidity, the most prevalent were arterial hypertension (19.1%) depression (16.5%) and anxiety (14.8%). People with comorbidities had higher fatigue (6.6 vs. 5.3, p < 0.001) and lower quality of life (overall SF-36 46.3 vs 59.1, p < 0.001). People consuming alcohol had fewer relapses per 24 months (0.56 vs. 0.82, p = 0.01), lower fatigue (5.7 vs. 6.4, p = 0.03), better quality of life (overall SF-36: 56.8 vs. 45.6, p < 0.001), compared to abstinents.In regression models, comorbidities were associated with severe (>7 VAFS) fatigue (Exp(B)=1.98, 95% CI [1.02, 3.86], p = 0.043), diminished (<50 SF-36) QoL (Exp(B)=3.50, 95% CI [1.72, 7.09], p = 0.001). Depression was independently associated with lower QoL (Exp(B)= 2.86, 95% CI [1.04, 7.88], p = 0.042) and severe fatigue (Exp(B)=4.65, 95% CI [2.39, 9.01], p < 0.001); anxiety with diminished QoL (Exp(B)= 4.99, 95%CI [1.67, 14.92], p = 0.002). Light alcohol consumption (compared to abstinents) was associated with decreased risk for: relapse during 24 months (Exp(B)=0.44, 95% CI[0.24, 0.77], p = 0.005), severe fatigue (Exp(B)=0.48, 95% CI [0.24, 0.98], p = 0.042) and lower QoL (Exp(B)= 0.32, 95% CI [0.16, 0.65], p = 0.002). ConclusionComorbidity is a relevant issue in multiple sclerosis as half of people with MS report concomitant conditions. Hypertension, depression, and anxiety are especially prevalent in MS. In our study, comorbidity is associated with quality of life and fatigue, but not relapse rate. Depression and anxiety are independently associated with lower quality of life and higher fatigue. Light alcohol consumption is associated with reduced relapse risk, less fatigue and better quality of life. Overweight and tobacco smoking do not seem to have negative impact on MS outcomes in our sample.

Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants.

Adults with spinal deformity (ASD) are known to have postural malalignment affecting their quality of life. Classical evaluation and follow-up are usually based on full-body static radiographs and health related quality of life questionnaires. Despite being an essential daily life activity, formal gait assessment lacks in clinical practice. What are the main alterations in gait kinematics of ASD and their radiological determinants? 52 ASD and 63 control subjects underwent full-body 3D gait analysis with calculation of joint kinematics and full-body biplanar X-rays with calculation of 3D postural parameters. Kinematics and postural parameters were compared between groups. Determinants of gait alterations among postural radiographic parameters were explored. ASD had increased sagittal vertical axis (SVA:34 ± 59 vs -5 ± 20 mm), pelvic tilt (PT:19 ± 13 vs 11 ± 6°) and frontal Cobb (25 ± 21 vs 4 ± 6°) compared to controls (all p < 0.001). ASD displayed decrease walking speed (0.9 ± 0.3 vs 1.2 ± 0.2 m/s), step length (0.58 ± 0.11 vs 0.64 ± 0.07 m) and increased single support (0.45 ± 0.05 vs 0.42 ± 0.04 s). ASD walked with decreased hip extension in stance (-3 ± 10 vs -7 ± 8°), increased knee flexion at initial contact and in stance (10 ± 11 vs 5 ± 10° and 19 ± 7 vs 16 ± 8° respectively), and decreased knee flexion/extension ROM (55 ± 9 vs 59 ± 7°). ASD had increased trunk flexion (12 ± 12 vs 6 ± 11°) and reduced dynamic lumbar lordosis (-11 ± 12 vs -15 ± 7°, all p < 0.001). Sagittal knee ROM, walking speed and step length were negatively determined by SVA; lack of lumbar lordosis during gait was negatively determined by radiological lumbar lordosis. Static compensations in ASD persist during gait, where they exhibit a flexed attitude at the trunk, hips and knees, reduced hip and knee mobility and loss of dynamic lordosis. ASD walked at a slower pace with increased single and double support times that might contribute to their gait stability. These dynamic discrepancies were strongly related to static sagittal malalignment.

Quality of life of patients with leukemia undergoing chemotherapy

Abstract: Leukemia is a stem cell disorder characterized by a malignant neoplastic proliferation and accumulation of immature hematopoietic cells in the bone marrow.Aim of the study: assessquality of life of patients with leukemia undergoing chemotherapy. Subjects & Method: A descriptive design was conducted at the Oncology Department and Hematology Unit at Alexandria Main University Hospital, Egypt. Subjects: a convenient sample of 150 adult patients diagnosed with leukemia who had received at least 2 cycles of chemotherapy. Tools: Tool I: Leukemic Patient's Structured Interview Schedule: It was included two parts: Part (I) Socio-demographic Data. Part (II) Clinical Data. Tool II: Leukemic patients' Health related Quality of Life Questionnaire: It was consisted of 8 domains & included 36 statements. Results: 51.3% have poor general health; there was no correlation between the QOL and socio-demographic variables, while there was no statistical significant relation between other clinical data of the studied patients and overall QOL percent score. Conclusion: more than half patients with leukemia who received chemotherapy had poor QOL which have negative impact on patient's physical, psychological, social life, and spiritual life. Recommendation: Pre and in-services training programs need to be developed for Chemotherapeutic Patients and nurses working with leukemia patients receiving chemotherapy.

COPD-Lower Respiratory Tract Infection Visual Analogue Score (c-LRTI-VAS) validation in stable and exacerbated patients with COPD

BackgroundWe developed the chronic obstructive pulmonary disease (COPD)-Lower Respiratory Tract Infection-Visual Analogue Score (c-LRTI-VAS) in order to easily quantify symptoms during exacerbations in patients with COPD. This study aimed to...

Roflumilast (Daliresp®) to reduce acute pulmonary events in fibrotic sarcoidosis: a multi-center, double blind, placebo controlled, randomized clinical trial.

Background:Fibrotic sarcoidosis patients often have acute events of increased cough and sputum production. We evaluated the impact of roflumilast in fibrotic sarcoidosis patients with repeated episodes of increased cough and sputum.Methods:Sarcoidosis patients with pulmonary fibrosis and at least two acute episodes in the previous year were randomized to receive either roflumilast (ROF) or placebo (PLA) in a double blind, placebo controlled multi-center trial. Subjects were assessed initially and every three months for 12 months. At each visit, spirometry and health related quality of life questionnaires were completed. For each subject, the best forced expiratory volume at 1 second (FEV-1) was noted.Results:Of the 38 subjects who enrolled in the study, 28 subjects (14 in each group) received at least three months of treatment and 10 in each arm completing all 12 months of study. During the treatment, patients treated with ROF were less likely to have visits in which the FEV-1 was less than 90% of the best FEV-1 (Odds ratio=0.34 (0.16 to 0.76 95% confidence interval, p=0.0073). At the end of treatment with ROF, patients had a significant improvement in their KSQ LUNG (Initial visit: 45.3 ± 6.89 (Mean ± S.D.); Last visit: 52.6± 7.91, p<0.05) with no change for PLA treated patients.Conclusion:Patients treated with at least three months of roflumilast had fewer follow-up visits with an FEV-1 of less than 90% of best value. At the end of treatment, ROF treated patients had a better quality of life as assessed by KSQ LUNG.Clinical Trial Registration:NCT01830959

386 LAPAROSCOPIC HELLERS MYOTOMY AND ANGLE OF HIS ACCENTUATION FOR ACHALASIA CARDIA: 10 YEARS EXPERIENCE FROM A SINGLE SURGICAL CENTRE.

Abstract Achalasia is a rare disease with Laparoscopic Hellers cardio-myotomy (LHCM) being the gold standard surgical modality. An antireflux procedure is required along with myotomy to decrease the chances of reflux postoperatively. We have performed Angle of His Accentuation (AOH) as an anti-reflux procedure in 126 patients who underwent LHCM since 2010. This study presents the symptomatic and objective outcomes of LHCM with AOH. Methods Review of prospectively collected data of patients with Achalasia cardia undergoing LHCM with AOH from 2010–2019. Subjective symptoms were scored for dysphagia, heartburn, regurgitation and quality of life using scoring systems mentioned in table 1 and Achalasia specific health related Quality of life questionnaire (ASHRQoL). Objective tests included Timed Barium swallow, Endoscopy and high-resolution manometry. Patients were evaluated in pre and postoperative period at regular intervals. Success was defined as follows: Eckardt score of ≤3, Dysphagia score of 0/1, Regurgitation and heartburn score of 0, &amp;gt;50% clearance on timed barium swallow, IRP &amp;lt;15 and absence of esophagitis. Results 126 patients were operated during the study period with no mortality or conversion. Mean age was 33.5(years), symptom duration 49.8(months), 31 had preoperative dilatation. The mean operative time was 131 (minutes). Subjective outcome was available in all patients &amp; objective data in 66. At median follow of 31 months (IQR 15–59) outcomes significantly improved (Table 1) with 93% having dysphagia relief. 14 (11%) had new onset heartburn; 6(4.7%) needed regular proton pump inhibitors. ASHRQoL improved significantly (59.51 to 19.57). Pre&amp;post-operative IRP, Timed Barium and endoscopy available in 66,39 and 62 patients improved significantly. 6(9.6%) patients had endoscopic evidence of esophagitis (LA-A 3, B/C 3). Conclusion Laparoscopic Heller myotomy with Angle of His accentuation is safe simple and effective procedure for Achalasia cardia. It provides significant relief of symptoms, improvement in quality of life and improvement in objective parameters. Post- operative heartburn and esophagitis is acceptable. We recommend Angle of His accentuation as an adjunct to Laparoscopic Heller myotomy.

Preliminary results of Chinese magnetic sphincter augmentation in treating gastroesophageal reflux disease

Objective: To examine the preliminary clinical efficacy of Chinese magnetic sphincter augmentation (MSA) in the treatment of gastroesophageal reflux disease (GERD). Methods: According to the enrollment criteria for the MSA developed by ShengJieKang Co. and Shanghai Chest Hospital (SS-MSA) clinical trial, a total of 19 GERD patients were treated with SS-MSA from August 2018 to January 2020 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University. The majority of registered cases were male patients with age of (32.2±7.3) years (range: 22 to 50 years), height of (170.7±6.2) cm (range: 160 to 179 cm) and weight of (65.2±10.3) kg (range: 47.5 to 90.0 kg). SS-MSA was implanted via laparoscopy. The major evaluation indexs of postoperative efficacy were the total time of acid exposure within 24 hours and the total number of reflux. Secondary efficacy indicators included: (1) evaluation of the average daily dose of proton pump inhibitor medications; (2) the score of GERD health related quality of life questionnaire (GERD-Q) before and after MSA implantation. Paired design t-test was used to evaluate the efficacy of the SS-MSA. Results: A total of 19 patients underwent SS-MSA surgery successfully. The history of the GERD were 19 (54) months (M(Q(R))). The operation time was 63 (22) minutes and the in-hospital stay was 3 (2) days. No obvious surgical complications occurred. Postoperative adverse events included 14 cases with mild to moderate dysphagia exited after surgery, gradually eased within 1 to 3 months, 1 case with the removal of the device after 1 month of severe swallowing difficulties, 1 case of diarrhea. No corrosion, perforation, displacement occurred. The GERD-Q score (11.0(4.5) vs. 6(1.0), t=4.274, P=0.013), 24-hour acid exposure time (6.2(4.8)% vs. 0.1(0.9)%, t=5.814, P=0.004), and Demeester score (23.72(16.20) vs. 0.96(3.10), t=6.678, P=0.003) were significantly decreased 1 year after surgery(n=5). Proton pump inhibitor reuse rates were 6/18, 5/15, 3/10, and 1/5 in 1, 3, 6 and 12 months after the operation, respectively. Conclusions: SS-MSA implantation is feasible and safe with short hospital stay and rare perioperative complications. The preliminary results is good after 1 year follow-up. It could be expected to be an ideal substitutive for future GERD treatment.

P16. Spinopelvic deformities and postural malalignment affect gait patterns in ASD patients

BACKGROUND CONTEXT Adults with spinal deformity (ASD) are known to have postural malalignment affecting their quality of life. Classical evaluation and follow-up are usually based on full-body static radiographs and health related quality of life questionnaires. Despite being an essential daily life activity, a formal gait assessment is lacking in clinical practice. Moreover, gait alterations and their relationships with static deformities in ASD still remain to be elucidated PURPOSE To investigate gait alterations in subjects with ASD and their static radiographic determinants. STUDY DESIGN/SETTING Prospective Single Center. PATIENT SAMPLE A total of 52 Adult Spinal Deformity patients, and 63 control subjects. OUTCOME MEASURES Full body image, 3D gait analysis. METHODS A total of 52 Adult Spinal Deformity (ASD) patients age and weight-matched to 63 controls underwent full-body 3D gait analysis with extraction of 3D lower limb and trunk kinematics. All subjects underwent full-body biplanar X-rays with subsequent calculation of classical 3D postural parameters. Kinematics and postural parameters were compared between ASD and controls. Determinants of gait alterations among postural radiographic parameters were explored in ASD. RESULTS ASD subjects had significantly increased SVA (33.6±59 vs -4.6±20mm), CAM-HA (12±62 vs -21±26mm), PT (19±13 vs 11±6°), frontal Cobb (25±21 vs 4±6°) compared to controls (all p CONCLUSIONS Subjects with ASD are known to have spinal malalignment causing postural alterations such as forward bending of the trunk; they also recruit compensatory mechanisms in the pelvis and lower limbs by increasing radiographic pelvic tilt and knee flexion. This study showed that static compensations in the lower limbs persist during gait where ASD patient exhibit a flexed attitude at the trunk, hips and knees, a reduced hip mobility and loss of lordosis. ASD walked at a slower pace with an elevation of their single support time that might contribute to their stability while walking. These dynamic discrepancies were shown to be strongly related to skeletal radiological alterations, specifically the increased forward shift of the head and trunk, the pelvic retroversion and the lack of lumbar lordosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Transcultural adaptation and validation of a Korean version of the Oxford Ankle Foot Questionnaire for children

BackgroundThe purpose of this study was to translate and transculturally adapt the original English version of the Oxford Ankle Foot Questionnaire (OAFQ) into a Korean version, and to evaluate its psychometric properties.MethodsA Korean OAFQ for children was developed according to established guidelines. To test validity, 169 consecutive patients with foot and ankle problems and their caregivers each completed the OAFQ. The children also completed a Korean version of the KIDSCREEN-52 health related quality of life questionnaire (KIDSCREEN-52 HRQOL). To validate the Korean version of the OAFQ, reliability (child–parent agreement and internal consistency), feasibility (floor and ceiling effects), and construct validity were evaluated, and factor analysis was performed.ResultsIn terms of reliability, Cronbach’s α values were > 0.7 in all subscales of the OAFQ (0.765 to 0.901). Child–parent agreement was confirmed by high intraclass correlation coefficients for all subscales (0.791 to 0.863). In terms of construct validity, there were moderate correlations between the subscales of the OAFQ and the subscales of the KIDSCREEN-52 HRQOL. Factor analysis revealed a three-component solution for both the child/adolescent and parent-proxy version, by combining the school and play, and footwear items into one subscale. In terms of feasibility, no floor effects were found for all subscales. However, ceiling effects were observed for the school and play, and emotional subscales for child/adolescent and parent-proxy versions.ConclusionsThe OAFQ was successfully translated and transculturally adapted into the Korean language; the Korean version of the OAFQ represents a reliable and valid instrument for evaluating children’s foot or ankle problems. However, factor analysis suggested the use of a three-subscale questionnaire.

“Does cost of care influence the glycemic control, psychosocial illness and quality of care among adolescents with type 1 diabetes?: A hospital based cross section study in Mysuru, Karnataka

ContextType-1 Diabetes Mellitus, “a poor cousin of Type-2 Diabetes”, is the third commonest pediatric endocrine disease. On an average three new cases of T1DM/100,000 adolescents of 0–14 years are reported from India annually.Objective.To find out the relationship between cost of care and glycemic control, psychosocial illness and quality of life among adolescent with type -1 diabetes. MethodsThis cross sectional study was conducted in a tertiary care hospital in Mysore for a period of 6 months. Adolescents in the age group of 11–19 years with T1DM who were on treatment for at least one year were included. Direct and indirect cost incurred in diabetes management was collected from receipts. Glycemic control was assessed with fasting, postprandial blood sugar and HbA1C levels in last 3 investigations. Psycho social illness was assessed by DSM-5 (Diagnostic and Statistical Measure −5) criteria and quality of life was assessed using Health related quality of life questionnaire for Diabetics. ResultsAmong 50 subjects of type-1 diabetes included in the study, median annual cost of care for was 25,758/- and of this 90.9% direct and 9.1% was indirect cost. There was a negative correlation between cost of care and glycemic control. The spending on diabetes care was lower among the subjects with psychosocial illnesses. The quality of life was poor among subjects who spend less on diabetes care. ConclusionThere was a negative correlation between cost of care and glycemic control. Lower cost of care was associated with high burden of psychosocial illness and poor quality of life.

The quality of life of the cluster headache patients during the active phase of the headache

Cluster headache (CH), which affects 0.1% of the population, is one of the most painful human conditions: despite adequate treatment, the frequent and severe headaches cause a significant burden to the patients. According to a small number of previous studies, CH has a serious negative effect on the sufferers' quality of life (QOL). In the current study, we set out to examine the quality of life of the CH patients attending our outpatient service between 2013 and 2016, using generic and headache-specific QOL instruments. A total of 42 CH patients (16 females and 26 males; mean age: 39.1±13.5 years) completed the SF-36 generic QOL questionnaire and the headache- specific CHQQ questionnaire (Comprehensive Headache- related Quality of life Questionnaire), during the active phase of their headache. Their data were compared to those of patients suffering from chronic tension-type headache (CTH) and to data obtained from controls not suffering from significant forms of headache, using Kruskal-Wallis tests. During the active phase of the CH, the patients' generic QOL was significantly worse than that of normal controls in four of the 8 domains of the SF-36 instrument. Apart from a significantly worse result in the 'Bodily pain' SF-36 domain, there were no significant differences between the CH patients' and the CTH patients' results. All the dimensions and the total score of the headache-specific CHQQ instrument showed significantly worse QOL in the CH group than in the CTH group or in the control group. Cluster headache has a significant negative effect on the quality of life. The decrease of QOL experienced by the patients was better reflected by the headache-specific CHQQ instrument than by the generic SF-36 instrument.

Impact of Functional Constipation on Quality of Life in Children

Background Pediatric functional constipation (FC) is a common disease and may impair behavioral and psychological functioning and ultimately quality of life (QoL) in children. The aim of this study was to compare four aspects of emotional, social, physical and educational functioning of constipated children with their healthy peers by means of pediatrics health related quality of life questionnaires. Materials and Methods A total of 184 Iranian children aged 7-12 years, 92 with FC defined as ROME IV criteria referred to pediatric gastroenterology clinic of Rasoul-e-Akram Medical Center in Tehran, Iran, during Apr. 2016 to Dec. 2017 and 92 healthy children as control group, were enrolled in this case-control study. QoL in four aspects of physical, emotional, social and school functioning were assessed and compared in two groups of children with and without constipation. Results Mean age of children with and without functional constipation was 9.49 ± 1.76 and 9.49 ± 1.43 years, respectively. 61% (66.3) of constipated children, and 40% (43.5) of healthy ones were male (P=0.002). There were statistically significant differences in mean QoL scores, as well as all four detailed aspects of QoL between children with and without FC (P < 0.001). Conclusion FC in children aged 7-12 years may impair all four aspects of QoL, so early diagnosis and adequate medical treatment alongside behavioral therapy are necessary for successful outcome and promoting QoL in these patients.

EDITORIAL COMMENT

A cancer diagnosis comes with profound effects on the patient's mental psyche. However, bladder cancer carries additional ramifications like potential of living with an ostomy bag, loss of sexual function, and repeat operations throughout a lifetime. Previous studies have created health related quality of life questionnaires like the Bladder Utility Symptom Scaled, 1 Perlis N. Krahn M.D. Boehme K.E. et al. The bladder utility symptom scale: a novel patient reported outcome instrument for bladder cancer. J Urol. 2018; 200: 283-291https://doi.org/10.1016/j.juro.2018.03.006 Crossref PubMed Scopus (21) Google Scholar and Bladder Cancer Index 2 Gilbert S.M. Dunn R.L. Hollenbeck B.K. et al. Development and Validation of the Bladder Cancer Index: a comprehensive, disease specific measure of health related quality of life in patients with localized bladder cancer. J Urol. 2010; 183: 1764-1770https://doi.org/10.1016/j.juro.2010.01.013 Crossref PubMed Scopus (103) Google Scholar aimed at better understanding the disease burden on various facets of function. This study used the Edmonton Symptom Assessment System-revised 3 Johnstone P.A.S. Lee J. Zhou J.M. et al. A modified Edmonton Symptom Assessment Scale for symptom clusters in radiation oncology patients. Cancer Med. 2017; 6: 2034-2041https://doi.org/10.1002/cam4.1125 Crossref PubMed Scopus (16) Google Scholar to evaluate patients over 65 and under 65 at different time points in treatment of bladder cancer. It fills an important gap in the literature by suggesting that age plays a vital role in the needs of the patient. It brings to light the concerns with bladder cancer in that younger patients might suffer more psychologically from the diagnosis and treatment of bladder cancer. This information can better guide urologists in managing expectations with this population of patients.

Case Study of Korean Medicine Treatment of Diffuse Esophageal Spasm

Objective This case study reports on the result of Korean medicine treatment of diffuse esophageal spasm. Methods A 46-year-old female Korean patient with diffuse esophageal spasm received electroacupuncture, herbal medicine, and moxibustion treatment for 2 weeks in hospital. Results Decreases in the visual analog scale (VAS) (from 8.7 to 7.0), numeric rating scale (NRS) (from 7.0 to 5.5), gastrointestinal symptom rating scale (GSRS) (from 9 to 6), and gastroesophageal reflux disease-health related quality of life questionnaire (GERD-HRQL) (from 46 to 38) scores were observed after the treatment. Conclusion Evaluation of Korean medicine treatment is worthwhile for rare diseases like diffuse esophageal spasm. Keywords: diffuse esophageal spasm, herbal medicine, electroacupuncture, Korean medical treatment

1797P - Patterns of care for patients with metastatic bone disease in solid tumors: A cross-sectional study (SAKK 95/16)

BackgroundThe best use of bone targeted agents (BTAs), i.e. how patients (pts) profit most from treatment, optimal timing of treatment start and frequency of administration as well as duration of treatment is unclear to date. MethodsPhysicians were asked to indicate the criteria they use for the indication and administration of BTAs in pts with bone metastases from solid tumors in Switzerland (physician-related outcomes, PO) during a period of 3 months. Patterns of care (POC) was assessed by questions about reasons for BTA administration, treatment pattern, patient characteristics, and actual treatment. Pts completed a pain and bone-pain related quality of life questionnaire. ResultsPO: Most of the physicians reported to start treatment with BTAs according to current guidelines (70.9%, 61/86). A smaller proportion would first assess the risk (high vs low) for developing skeletal-related events (SREs) to decide about treatment initiation (24.4%, 21/86). Factors contributing to define high risk were former SREs (89.5%, 77/86), lytic bone metastases (87.2%, 75/86), and high burden of disease (67.4%, 58/86), respectively. POC: The majority of the pts have been treated with BTAs immediately after the diagnosis of bone metastases (73.6%, 307/417). The main reasons for treatment with BTAs were high risk of bone complications (43%, 132/307), bone pain (21.8%, 67/307), and location of bone metastases (10.1%, 31/307), respectively. Denosumab was the most frequently used BTA (78.5%; 241/307), and a 3-4 week interval was most common (88.9%; 273/307). SREs were reported in 8.5% of treated vs 7.3% of non-treated pts, and were similar in pts rated as low or as high risk (about 8%). ConclusionsThe majority of the pts was treated according to current guideline recommendations with regard to start and interval of BTA treatment. The number of SREs was low irrespective of BTA treatment or risk classification for SREs, which may reflect a high impact of systemic cancer treatment on SRE reduction, or a selection of the pts according to risk factors not defined as the ones in the literature. Legal entity responsible for the studySAKK. FundingAmgen. DisclosureM.T. Mark: Advisory / Consultancy: Roche; Advisory / Consultancy: MSD; Advisory / Consultancy: Böhringer Ingelheim; Advisory / Consultancy: Takeda; Advisory / Consultancy: BMS. B.J.K. Thuerlimann: Advisory / Consultancy, Travel / Accommodation / Expenses, Shareholder / Stockholder / Stock options: Roche; Shareholder / Stockholder / Stock options: Novartis; Advisory / Consultancy: Lilly; Advisory / Consultancy: Amgen; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Pfizer. R. von Moos: Advisory / Consultancy: amgen; Advisory / Consultancy: BMS; Advisory / Consultancy, Research grant / Funding (institution): Merck; Advisory / Consultancy: Novartis; Honoraria (self), Advisory / Consultancy: Roche; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Bayer; Advisory / Consultancy: Pfizer. All other authors have declared no conflicts of interest.

Effect of "Tongdu Tiaoshen" needling combined with swallowing training on dysphagia, cerebral blood flow and serum BDNF and NGF levels in ischemic stroke patients

To observe the efficacy of Tongdu Tiaoshen (dredging Governor Vessel and regulating mind) needling combined with swallowing training in the treatment of ischemic stroke (IS) with dysphagia, and to investigate its effect on cerebral blood flow and serum levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF). A total of 100 IS inpatients with dysphagia were enrolled in the present study, and randomly and equally divided into control group and treatment group by using a random number table. The patients of the control group received routine swallowing training including tongue extending and retracting, cheek-muscle training, breathing exercise, and laryngopharyngeal exercise, beginning from the 2nd day after hospitalization. The patients of the treatment group received manual acupuncture stimulation of Dazhui (GV14), Fengfu (GV16), Shenting (GV24), Shendao (GV11), Baihui (GV20), Shuigou (GV26), etc., on the basic treatment as those mentioned in the control group. The treatment was conducted once daily, 5 times per week and for 4 successive weeks. The swallowing ability was tested by using video fluoroscopic swallowing study (VFSS), Kubota water swallowing test, and the standard swallowing function assessment (SSA) scale, separately, and patients' daily life quality was assessed by using swallowing related quality of life questionnaire (SWAL-QOL). The cerebral hemodynamics including mean blood flow velocity (Vm), maximum peak flow speed (Vs), and vascular resistance index (RI) of the bilateral cerebral arteries was detected by transcranial color Doppler ultrasound tests, and serum BDNF and NGF contents were assayed by enzyme linked immunosorbent assay. The therapeutic effect of swallowing ability was evaluated after the treatment. After 4 weeks' treatment, the scores of Kubata water swallowing test, SSA, and SWAL-QOL and RI were considerably decreased (P<0.01), and the VFSS scores, Vs and Vm levels as well as serum BDNF and NGF contents were significantly increased (P<0.01) in both groups compared with their own pre-treatment. Of the 48 and 49 cases in the control and treatment groups, 4 (8.33%) and 8(16.33%) were cured, 26 (54.17%) and 33 (67.35%) effective, 18 (37.50%) and 8 (16.33%) failed, with the effective rate being 62.50% and 83.67%, respectively. The therapeutic effect of the treatment group was significantly superior to that of the control group in the effective rate (P<0.05), and in lowering the scores of Kubota water swallowing test, SWAL-QOL, SSA, RI, and in up-regulating the scores of VFSS, Vs and Vm, and serum BDNF and NGF levels (P<0.01). Tongdu Tiaoshen needling combined with swallowing training is effective in improving swallowing ability, promoting cerebral blood flow and in up-regulating serum neurotrophic factor levels in patients with dysphagia after ischemic stroke.