Related Quality Of Life Scores Research Articles

Out-of-pocket expenses and parent reported quality of life in children with cow's milk protein allergyin Bogotá, Colombia.

To identify the out-of-pocket expenses and parent-reported quality of life (QoL) of children with a diagnosis of cow's milk protein allergy (CMPA)between the ages of 0 and 5 using the Food Allergy Quality of Life Questionnaire - Parent Form. A cross-sectional study was conducted in two tertiary care centers in Bogotá. Demographic, medical information, and QoL scores were collected by parental interview. We carried out a cost-of-illness analysis based on self-reported out-of-pocket expenses attributed to the treatment as a whole and the family's monthly income. Exploratory analyses used the QoL scores and the percentage of out-of-pocket expenses attributable to treatment as outcomes. 122 families were analyzed. Median subject age was 17 months (Q1-Q3: 11-26.75 months) and female subjects made up 71% of the sample. The median QoL score was 3.21 points (Q1-Q3: 2.43-4.34) and only differed by age groups and personal history of other food allergies. The median out-of-pocket treatment related costs was 300,000 Colombian pesos (COP) (Q1-Q3: 280,000-340,000 COP). About 17% of the families had to pay over 15% of their monthly income to purchase food and dietary products. Out-of-pocket treatment related costs differed depending on whether the treatment included formulas (Mann-Whitney test p < 0.001). Out-of-pocket treatment expenses were uncorrelated with the QoL scores. Food allergy related QoL scores were not associated with out-of-pocket expenses as a whole or as a fraction of monthly income but were higher in children with additional food allergies and in older age groups, suggesting a lower QoL.

P619 Sleep disruption is associated with reduced quality of life in inflammatory bowel disease through its interaction with pain

Abstract Background Quality of life is reduced in people with inflammatory bowel disease. Poor sleep is prevalent in people with inflammatory bowel disease. This study aimed to investigate the influence of sleep on quality of life in people with inflammatory bowel disease. Methods An online questionnaire was administered through three tertiary IBD centres, social media and through Crohn’s Colitis Australia. The questionnaire included the EQ-5D-5L measures of health-related quality of including EQ-5D utility score, EQVAS – visual analogue scale from 0-100 of quality of life and domains mobility, selfcare, activities, pain and depression and anxiety. Measures of sleep included the insomnia severity index (ISI), and the Pittsburgh sleep quality index (PSQI). IBD activity was assessed using validated patient reported scores. Demographic data and mental health scores were also obtained. Results Quality of life was lower in people IBD than the general South Australian population (utility score mean (SD) 0.79 (0.15) v 0.91(0.14)). Poor sleep and clinically significant insomnia were associated with lower quality of life (utility score 0.77 (0.15) and 0.71 (0.16) respectively, cohort 0.79 (0.15), p&amp;lt;0.0001). Sleep quality scores moderately correlated with EQ-5D domains pain (Ro=0.35), usual activities (Ro=0.32), and depression-anxiety (Ro=0.37) but not domains self-care or mobility. After adjusting for demographic variables, IBD anxiety, depression, and anxiety the pain domain continued to be influenced by sleep quality, sleep disturbance and sleep duration, and the usual activities domain continued to be influenced by daytime dysfunction (see table 1). Clinically significant insomnia was associated with a reduction of 13.6 (10.42-16.91) (univariate regression) in quality of life measured by EQVAS. Following introduction of demographic and IBD activity the reduction in EQVAS for clinically significant insomnia remained significant (10.11 (6.96-13.27)). Health related quality of life scores (EQVAS) were significantly worse in those with clinically significant insomnia and active IBD than with active IBD alone (see Figure 1). Conclusion Health related quality of life in IBD is influenced by aspects of sleep quality irrespective of IBD activity and mental health conditions. The presence of insomnia is associated with a significant decline health related quality of life. Consideration should be given to sleep targeting interventional studies in an IBD population.

Tourniquet-free minimally invasive total knee arthroplasty is associated with early aseptic loosening

BackgroundWhile tourniquet-free (T-) total knee arthroplasty (TKA) has gained popularity, tourniquet-use during minimally-invasive (MIS)-TKA has not been adequately studied. Traditional techniques employ knee hyper-flexion, compressing vasculature and reducing impact of bleeding, while MIS-TKA embraces the semi-extended knee position, which does not restrict the effects of bleeding on cementation and visualization. We compared the risk of aseptic loosening between patients undergoing T- MIS-TKA compared to T + MIS-TKA. MethodsThis single-surgeon cohort study included 329 consecutive MIS-TKA (226 T+,103 T-) patients with minimum 3-year follow-up. Aseptic loosening, radiolucent lines (RLL), health related quality of life scores, and complications were recorded. T-test and chi-square test were used to compare continuous and categorical variables, and logistic regression included BMI, age, ASA, patellar-resurfacing, and tourniquet-use. ResultsThere were no differences in baseline demographics. One (0.4 %) aseptic loosening occurred with T+, versus 7 (6.8 %) with T- (p = 0.002). No T + and 3 T- patients (2.9 %, p = 0.01) had revision for aseptic loosening. The incidence of RLLs was 16.8 % in T + and 30.1 % in T- (p = 0.008). Logistic regression revealed T + was significantly associated with decreased aseptic loosening and risk of RLL (odds ratio = 16.4, odds ratio = 2.8). ConclusionIn this consecutive series, T- MIS-TKA was associated with increased rates of revision for aseptic loosening as compared to the T + MIS-TKA, even controlling for BMI, age, ASA level, and patellar resurfacing. Radiolucent lines were increased with T- MIS-TKA compared to T + MIS-TKA. Complications, all-cause revision, ROM, and HRQoL scores were similar between tourniquet-use and tourniquet-free cohorts.

Factors associated with quality of life among patients with a newly diagnosed oral cavity and oropharyngeal cancer

PurposeThe objectives of this report were 1) to examine the quality of life (QOL) of patients with a newly diagnosed oral cavity or oropharyngeal (OCOP) cancer; and 2) to examine factors contributing to QOL before cancer treatment. MethodsThe sample included 115 participants with a new diagnosis of OCOP cancer. Participants completed the demographic form, oral cancer disease and treatment form, Hospital Anxiety and Depression Scale (HADS), Brief Health Literacy Screen (BHLS), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Pearson correlations and linear regressions were used for data analysis. ResultsParticipants had a median global health related QOL score of 66.7 (interquartile range, IQR = 50.0, 83.4) with median scores for the subdomains being generally high (all >80 of possible 100). Anxiety and depression were significantly inversely correlated with all areas of EORTC QOL (r = - 0.48 to −0.78, all p < .001). Multivariable associations were strongest with the physical functioning domain (R = 0.56, p < .001), with younger age, higher income, Stage I/II cancer (compared to Stage III/IV) significant contributors to the multiple correlation (beta > ± 0.20, p < .05). ConclusionsHealth care providers should be attentive to OCOP cancer patients with older age, lower household income, advanced cancer stage, and presence of anxious and/or depressive symptoms for indicators of poor QOL. Clinicians should consider the benefit ofinitiating supportive interventions before cancer treatment among OCOP cancer patients with poor QOL.

Management of Perianal Crohn's Disease - AJG.

Perianal Crohn's disease affects 25-35% of Crohn's disease patients and has proven to be one of the most difficult complications of the disease to treat. Patients with perianal Crohn's disease have lower health related quality of life scores typically related to pain and fecal incontinence. Additionally, perianal Crohn's patients have higher rates of hospitalizations, surgeries and overall healthcare costs. A multidisciplinary approach is necessary for the successful management of Crohn's disease with perianal fistula. Medical management is required to treat the underlying immune dysregulation to heal the luminal inflammation as well as the inflammation within the fistula tracts. Current options for medical therapy include biologics, dual therapy with thiopurines, therapeutic drug monitoring and close follow-up. Surgical management is critical to drain abscesses prior to immunosuppressive therapy and place setons when appropriate. Once the patient's inflammatory burden is well managed, definitive surgical therapies including fistulotomies, advancement flaps and ligation of intersphincteric fistula tract procedures can be considered. Most recently, the use of stem cell therapy in the treatment of perianal fistula has given new hope to the cure of perianal fistula in Crohn's disease. This review will outline the most current data in the medical and surgical management of perianal Crohn's disease.

Clinical influence of conversion of laparoscopic sleeve gastrectomy to one anastomosis gastric bypass on gastroesophageal reflux disease

Assess the subjective impact of gastro-esophageal reflux disease (GERD) symptoms on patients undergoing revision from laparoscopic sleeve gastrectomy (LSG) to one-anastomosis gastric bypass (OAGB) using the Reflux Disease Questionnaire for GERD (RDQ) and the GERD-health related quality of life score (GERD-HRQL), prior to- and following conversion. Patients undergoing revision from LSG to OAGB were prospectively followed between May 2015 and December 2020. Data retrieved included demographics, anthropometrics, previous bariatric history, time interval between LSG and OAGB, weight loss, and co-morbidities. Pre- and post-OAGB RDQ and GERD-HRQL questionnaires were obtained. In the case of sleeve dilatation, sleeve resizing was performed. During the study period, 37 patients underwent revision from LSG to OAGB. Mean ages at LSG and pre-OAGB were 38 ± 11.74 and 46 ± 12.75, respectively. Median follow-up time was 21.5months (range 3-65). All patients underwent sleeve resizing. RDQ and GERD-HRQL scores were obtained at a median of 14months (range 3-51) between pre- and post-OAGB. Median RDQ score pre-OAGB vs post-OAGB was significantly reduced (30 (range 12-72) vs 14 (range 12-60), p = 0.007). All 3 parts of the GERD- HRQL questionnaires were significantly reduced between pre-OAGB and post-OAGB: Symptoms (20; 62.5% vs 10; 31.3%, p = 0.012), overall score (15 (0-39) vs 7 (0-28), p = 0.04) and subjective improvement (10; 31% vs 20; 62.5%, p = 0.025). Conversion of LSG to OAGB showed subjective improvement of GERD symptoms both in RDQ and in GERD-HRQL.

Correlation Between Online Gaming Duration and Dry Eyes Complaints and Quality of Life Using DEQS Questionnaire

Introduction: Dry eye is a component of computer vision syndrome (CVS) which is affected by the duration of using a visual display terminal (VDT), such as playing online games. Purpose: To analyze the correlation between the duration spent playing online games and the degree of dry eye complaints and quality of life. Methods: This research is cross-sectional research conducted on students of the General Practitioner Study Program, Faculty of Medicine, Universitas Nusa Cendana, Kupang, Indonesia, who play online games through Zoom meetings and Whatsapp with a total sampling method on 47 respondents. Data was acquired through online game playing duration questionnaire and dry eye related quality of life score (DEQS) questionnaire. The inclusion criteria in this research was an active medical student of the Universitas Nusa Cendana, Kupang, Indonesia, who had a habit of playing online games and had good literacy skills. This research used eta square statistical analysis. Results: From the 47 acquired samples, the most prominent acquired sample was male (70.2%). DEQS score that was acquired was vary. The lowest score 0-10 is was present on 25.53% of samples, score 11-74 was present on 72.34% of samples and the highest score (75) is present on 2.1% of samples. Impaired quality of life score was found on dry eye range (31-75). There was no significant correlation between the duration spent online playing games and the degree of dry eye complaints (p = 0.693). There was significant correlation between degree of dry eye complaint and quality of life (p = 0.000). Conclusions: The duration of spent online playing games has no effect on the degree of dry eye complaints. The degree of dry eye complaints can affect the quality of life.

Safety, Feasibility, and Efficacy of Upfront Daratumumab-Based Therapy in Blacks with Dysproteinemia

Background: Black patients (pts) with dysproteinemia are underrepresented in clinical trials included in new drug applications and biological license application submissions. Even after approval, access to novel therapies remains a challenge. Daratumumab (dara) is an anti-CD38 monoclonal antibody, which has revolutionized the care of patients with both multiple myeloma (MM) and light chain (AL) amyloidosis. The underrepresentation of black pts in clinical trials of dara in newly diagnosed patients with dysproteinemia raises concerns regarding the safety, tolerability and efficacy of dara in this population. We report the results from a cohort of pts treated with dara in the management of newly diagnosed MM (NDMM) and AL amyloidosis. Methods: The Cancer and Aging Resilience Evaluation in Hematologic Malignancies (CARE-Heme) registry is an ongoing prospective registry enrolling pts ≥50 years of age with a diagnosis of hematologic malignancy undergoing treatment at a single institution. For this analysis, we included pts with NDMM and AL amyloidosis treated with dara-based combination therapy between January 2020 and January 2022. We obtained baseline disease- and patient-related characteristics. Toxicity was evaluated by chart review up to the first 6 cycles and adverse events (AEs) were graded using Common Terminology Criteria for Adverse Events (CTCAE v5.0). For patients receiving >1 cycle, response assessment was ascertained using International Myeloma Working Group (IMWG) uniform response criteria. All patients were followed until progression, death or last follow up and progression-free survival (PFS) and overall survival (OS) were measured using Kaplan Meier methods. Health-related quality of life (HRQoL) was measured using Patient-Reported Outcomes Measurement Information System (PROMIS) global 10 and quantified using physical health (PH) and mental health (MH) t-scores at baseline and 3 month follow up. Variables were compared in each race by using independent and paired sample t-tests as appropriate. Results: Over the study period, 36 black pts (NDMM=32; AL=4) and 50 white pts (NDMM=44; AL=6) received upfront dara-based combination therapy. There were no differences in age or sex, IGH translocations, but there was a higher incidence of cytogenetic high-risk disease among the black pts in our cohort (p=0.02). Black pts presented with more advanced disease at the time of presentation - hypercalcemia 33% vs. 14%, p=0.04; renal dysfunction 56% vs. 28%, p=0.01; anemia 67% vs. 38%, p=0.01). Incidence of bone disease was similar between the groups (p=0.69) (Table 1) Among blacks, the most utilized regimen was DaraVRd (56%), DaraRd (17%), DaraKRd (11%) and DaraVCd (11%). While for the white pts, it was DaraVRd (52%), DaraRd (12%), DaraKRd (8%) and DaraVCd (22%). Blacks had a similar incidence of ≥grade 3 non-hematologic AEs (p=0.21), with fatigue, diarrhea and leg edema being the most common. There is a trend towards higher ≥grade 3 hematologic AEs which did not reach statistical significance (p=0.05). After 6 cycles of therapy, overall response rate was comparable (100% vs. 94%, p=0.81) among the two groups (≥VGPR 47% vs. 62%, p=0.36). With 18 month median follow up, there was no difference in median PFS and OS, both not reached (Figure 1). Complete quality of life (QoL) t-scores were available at baseline for 55 pts (20 blacks and 35 whites). The baseline PH and MH related QoL scores were comparable between whites and blacks (p= 0.51; p=0.58, respectively). From baseline to 3 months follow up, PH t-scores improved in both whites as well as blacks although the difference was not statistically significant. Meanwhile, MH t-scores remained largely unchanged from baseline to follow up in both groups. Conclusions: We report the largest cohort to date of black pts with dysproteinemia systematically treated with frontline dara. Our data shows the feasibility of this strategy in a single institution setting with comparable safety, efficacy and HRQoL with the use of upfront dara-based combinations in black and white pts. Our data supports comparable clinical outcomes among black pts when treated with novel therapeutic combinations despite a higher proportion of high risk cytogenetic abnormalities in our cohort without an increase in AEs. Minority representation in cancer clinical trials as well as access to approved novel therapies can significantly help mitigate disparities in outcomes. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Health Related Quality of Life of Adult Client Living with Sickle Cell Disease in a Hospital at Banke District, Nepal

Background: Sickle-cell disease is characterized by a modification in the shape of the red blood cell from a smooth shape into a crescent shape. The misshapen cells lack plasticity and can block small blood vessels, impairing blood flow. The purpose of the study was to find out the quality of life of client living with sickle cell disease.&#x0D; Method: A descriptive cross sectional quantitative study design was used. Non probability convenient sampling technique was used for the selection of respondents after conforming hemoglobin electrophoresis report attending out-patient department of Bheri Hospital.&#x0D; Results: A total 143 participants were studied who were at age range of 19 to 40 years with mean age of 30.26±8.42. Almost 81.8% perceived their health was only fair in comparison to past year. In comparison to other people 60.1% participants believe they get sick little easier. The overall quality of life was good in 56% participants. The health related quality of life scores for eight domains are as follows-physical functioning (77.25±18.22), social functioning (58.39±16.77), role limitation due to emotional problem (57.23±33.99), pain (56.43±22.84), role limitation due to physical problem (49.56±29.76), emotional wellbeing (49.59±14.5), Vitality (36.62±16.85) and general health (36.78±19.99).&#x0D; Conclusion: Quality of life of adults with sickle cell disease is better in the domain of physical function in comparison to other domains. The aspect of energy scale indicates poor quality of life. Female and uneducated clients should be focused for improvement in all domains.

Resistance Training in Patients With Coronary Artery Disease, Heart Failure, and Valvular Heart Disease: A REVIEW WITH SPECIAL EMPHASIS ON OLD AGE, FRAILTY, AND PHYSICAL LIMITATIONS.

Current guidelines recommend individually adapted resistance training (RT) as a part of the exercise regime in patients with cardiovascular diseases. The aim of this review was to provide insights into current knowledge and understanding of how useful, feasible, safe, and effective RT is in patients with coronary artery disease (CAD), heart failure (HF), and valvular heart disease (VHD), with particular emphasis on the role of RT in elderly and/or frail patients. A review based on an intensive literature search: systematic reviews and meta-analyses published in 2010 or later; recent studies not integrated into meta-analyses or systematic reviews; additional manual searches. The results highlight the evaluation of effects and safety of RT in patients with CAD and HF with reduced ejection fraction (HFrEF) in numerous meta-analyses. In contrast, few studies have focused on RT in patients with HF with preserved ejection fraction (HFpEF) or VHD. Furthermore, few studies have addressed the feasibility and impact of RT in elderly cardiac patients, and data on the efficacy and safety of RT in frail elderly patients are limited. The review results underscore the high prevalence of age-related sarcopenia, disease-related skeletal muscle deconditioning, physical limitations, and frailty in older patients with cardiovascular diseases (CVD). They underline the need for individually tailored exercise concepts, including RT, aimed at improving functional status, mobility, physical performance and muscle strength in older patients. Furthermore, the importance of the use of assessment tools to diagnose frailty, mobility/functional capacity, and physical performance in the elderly admitted to cardiac rehabilitation is emphasized.

A Study on Oral Health-Related Quality of Life and Its Influencing Factors in Elderly Diabetic Patients

Objective: To investigate the oral health related quality of life in elderly diabetic patients and analyze its influencing factors. Methods: Convenience sampling was used to select 190 elderly patients with diabetes under the Department of Endocrinology and Department of Integrated Traditional Chinese and Western Medicine in the Affiliated Hospital of Hebei University as the research subjects. The Chinese version of the Oral Health Influence Scale (OHIP-14) was used to conduct a questionnaire survey, and univariate analysis and multiple stepwise regression analysis were used to analyze the influencing factors of oral health related quality of life in elderly diabetic patients. Results: The elderly diabetic patients’ oral health related quality of life score was 34.48 ± 3.23, which is in the middle-lower range. The findings of multivariate stepwise regression analysis revealed that the course of disease, regular visits to the dentist, sleep quality, oral health knowledge, and oral health attitude together explained 58.9% of the total variance in elderly diabetic patients in terms of their oral health related quality of life (p &lt; 0.05). Conclusion: The oral health related quality of life of elderly diabetic patients is generally low, and is affected by the duration of diabetes, sleep quality, and oral health knowledge, attitude, and behavior (regular visits to the dentist). Improving patients’ attention to oral health problems by improving sleep as well as their own oral health knowledge, attitude, and behavior is an effective way to enhance oral health related quality of life.

Preliminary Results of a Prospective Clinical and Radiological Study with Roentgen Stereophotogrammetric Analysis (RSA) after Implantation of a Posterior Dynamic Stabilization Device in the Lumbar Spine

Introduction: Posterior dynamic stabilization (PDS) can be based on interspinous distraction devices (IDD). The goals of these implants are maintaining or restoring intervertebral range of motion (ROM) in a controlled fashion and avoiding a complete restriction of mobility. Clinical and radiological data with the Wallis® spacer as one type of IDD have been rarely reported. The goal of this study was to present clinical and radiological data including roentgen stereophotogrammetric analysis (RSA) after a short- to mid-term follow-up period.&#x0D; Patients and Methods: 10 patients were included in this prospective monocentric study and had PDS of the lumbar spine with an IDD (Wallis® spacer). Before and soon after operation and 3, 6, and 12 months later clinical and radiological evaluations were performed. Pain and disability were analyzed by use of visual analog scale for back and leg pain, Oswestry Disability Index, Roland-Morris Disability Questionnaire and Short-Form-36 Health Survey. The ROM of the operated levels and the total lumbar spine was determined by use of lateral functional x-ray images with calculation of the differences of the segmental and total lumbar spine angles in flexion and extension. Furthermore, RSA was used to measure the segmental ROM.&#x0D; Results: After a follow-up of 12 months, the results of the pain intensity and the disability and health related quality of life scores showed statistical significant improvement. The segmental angles of the operated levels demonstrated statistical significant reduction in ROM during the different follow-up examinations. The discrepancy of the conventionally determined segmental angles and the data measured by RSA were low with a mean of 1.77°. The mean total lumbar spine angles did not change statistically significantly during the postoperative controls.&#x0D; Conclusions: According to the radiological results of this study, the used implant leads to a posterior dynamic stabilization. The clinical findings are promising, but they are to be interpreted with caution because of the small number of patients and the lack of a control group.

Oral Health-Related Quality of Life of Children and Adolescents with Hemophilia

Background: The problems arising from the teeth and the surrounding tissues in patients with hemophilia have an important role in the treatment planning of bleeding disorder. The aim of this study is to evaluate the oral health related quality of life of children and adolescents with hemophilia. Methods: POQL (pediatric oral health related quality of life) Instrument was used in this cross sectional study for quality of life measurement. The instrument was applied to children and adolescents with (n=64) or without (n=196) hemophilia. The data collected were consist of demographic data, POQL and screening part. SPSS 23.0 was used to analyze the data. Results: DMFT and decay (D) scores of patients with hemophilia were higher than the control group: mean values of hemophilia group are 7 and 4.1 vs. control group 4.7 and 2.3 are respectively (p=0.0001 and p=0.011). Among 8-14 age group and teen age group oral health related quality of life scores were significantly higher among hemophilia group, scores were 34.0 and 17.4 in 8-14 group (p=0.0001) and 37.1 and 26.0 in teen group (p=0.043), respectively. Conclusions: DMFT scores and POQL scores have shown that oral health related quality of life of children with hemophilia is worse than healthy controls.

Effectiveness of Comprehensive Nursing Intervention Programme on Symptom Experience and Health Related Quality of Life among Post Menopausal Women

Background: Overall health of middle-aged women have become a major public health concern, there is therefore a need to evaluate the effectiveness of comprehensive nursing intervention program with the intention of reducing their symptom experience and increasing their health-related quality of life. Aims: The aim of the study was to assess the effectiveness of comprehensive nursing intervention program on reducing the symptom experience and increasing their health related quality of life. Methodology: Menopausal Rating Scale (MRS) was used for assessing postmenopausal symptoms and WHOQOL-BREF quality of life scale was used for assessing quality of life of postmenopausal women. 60 post menopausal women attending at B.V.V.Sangha’s Akkanabalaga Bagalkot were selected for the study using Simple random technique with Lottery method and then 30 post menopausal women were randomly assigned to experimental and control group respectively using computer generated random sequence. Data were analyzed using SPSS 25v. Findings: Findings related to significance of difference between post-test symptom experience and health related quality of life scores of experimental group and control group postmenopausal women revealed that, there was a significant difference between the post test symptom experience scores of experimental group and post test symptom experience scores of control group [t=26.052, p=0.000]. Similarly, there was significant difference between post test health related quality of life scores of experimental group and post test health related quality of life scores of control group [t= 23.117,p=0.000]. Conclusion: The study concluded that the comprehensive nursing intervention was highly effective in reducing the symptom experience and health related quality of life scores of post menopausal women. Keywords: Symptom Experience, Quality of Life, Postmenopausal Women, Comprehensive Nursing Interventions.

Laboratory Value-Based Innovation in Heart Failure Improves Patient Health-Related Outcomes.

NT-proBNP is emerging as a novel tool for improving management of patients with heart failure (HF). The concept of health-related outcomes as the primary endpoint for therapeutic intervention in chronic disease, such as HF, should be the focal point going forward. We conducted a prospective real-world study in heart failure with reduced ejection fraction (HFrEF) patients. The main target was to evaluate the impact on patient's health-related outcomes of a personalized medical follow-up procedure, based on a laboratory model of risk stratification supported by NT-proBNP. One hundred and five consecutive patients admitted to the Hospital Heart-Failure unit were stratified into three groups (low, medium, and high risk) and prospective follow-ups during the 12 months post discharge. It was found that patients under this new approach experienced early and robust improvements in patient health-related outcomes with consistency in most domains which persisted beyond 12 months post follow-up. Improvements in health related quality of life score (HRQLS) was observed over the time of the study. After 6 months we found a significant improvement in HRQLS of 18.2% (from 76.5 ± 22.4 to 95.0 ± 15.7) and 14.4% (from 76.5 ± 22.4 to 96.3 ± 15.9) after 12 months of follow-up (p < 0.001). The highest improvements were found in the symptom severity domain where patients reported an improvement of 22.6% after 6 months and 18.9% after 12 months (p < 0.001). The lowest scores were reported in the physical domain with increase of 11.0% and 4.3% after 6 months and 12 months (p = 0.089). Psychosocial domain and the ability to carry out the activities of normal life showed improvement as well. Our strategy based on NT-proBNP optimizes HFrEF management and represents a major new approach for clinical laboratories to improve patient health-related outcomes in HFrEF.

Voice outcomes and its impact on quality of life after open airway surgery in children

IntroductionOpen airway surgery is used to treat severe grades of laryngotracheal stenosis in children. Scarring of the airway following these procedures may lead to voice impairment and impact quality of life. This study was designed to characterize vocal outcome in children submitted reconstructive airway surgery and verify how this correlates to voice related quality of life in this population. Material and methodsChildren submitted to open airway surgery that had been decannulated for a minimum of 30 days and had functional speech were invited to participate. Pediatric Voice-Related Quality-of-Life survey (PVRQoL) was applied, consensus auditory perceptive of voice (CAPE-V) protocol was used for perceptual voice evaluation and acoustic analysis was performed using Praat software. ResultsTwenty children were enrolled in the study with an average age of 4 years and 8 months. Averages for PVRQoL exceeded normative values in 80% of the children. Half of the children had normal voice or mild dysphonia and half had moderate dysphonia, according to perceptual evaluation. Measures of F0, jitter and particularly shimmer were abnormal in most of the children. ConclusionVoice quality varies from normal to moderately impaired in children following reconstructive airway surgery. Voice quality impacts quality of life in the majority of cases and the degree of dysphonia does not always correlate with voice related quality of life scores.

This Month in Adult Urology

You have accessJournal of UrologyThis Month in Adult Urology1 Nov 2021This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002138AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Time to Conversion from Prostate Cancer Active Surveillance to Treatment Putting together a multicenter study across the world requires a tremendous amount of effort and coordination. The multi-institutional study by Cooley et al (page 1147) in this issue is a tour de force in this regard as it includes 7,239 patients on active surveillance for prostate cancer.1 A third progressed to treatment after a median of 6.7 years. As expected, higher grade, increased prostate specific antigen, higher stage and increased number of positive biopsy cores predicted earlier abandonment of surveillance. The large patient numbers provide robust data although there isn’t and, really, can’t be uniformity in criteria for when it was decided a patient should move on to treatment. The immensity of the data source did provide opportunity for some new observations. Higher volume grade group I cancers progressed sooner than patients with low volume disease. This has direct clinical implications. The study also provided useful perspective on the influence of race as there was no identifiable difference based on race. One anticipates many important future publications based on this data set. Urinary Microbiome in Postmenopausal Women with Recurrent UTIs There is increasing interest in the urinary microbiome and its role in urinary tract infections (UTIs). Also, the microbiome may change with menopause in women and be affected by chronic antibiotic use. This multicenter study by Vaughan et al (page 1222) evaluated postmenopausal women, all of whom had a history of recurrent UTI and were using topical vaginal estrogens.2 No difference in expanded quantitative urine culture was noted whether the patient was taking antibiotic prophylaxis or not. Some differences were observed in anaerobic taxa associated with phenotypic group. Despite some interesting associations, the authors concluded that additional work is needed to better understand the microbiome in postmenopausal women. Systematic Control Biopsies following Partial Prostate Gland Ablation with High-Intensity Focused Ultrasound Many reports of the results of partial gland ablation using high intensity focused ultrasound rely upon prostate specific antigen (PSA) kinetics and only a for cause biopsy strategy. This may significantly underestimate the presence of residual cancer. Rompré-Brodeur et al (page 1157) from Canada performed routine control biopsies at 12 months in patients in this single institution study. Clinically significant cancer was found overall in 31% and cancer was in the treated lobe in 27%.3 Neither PSA kinetics nor magnetic resonance imaging findings predicted the probability of finding clinically significant cancer. In concordance with guideline recommendations, routine biopsy was recommended for adequate assessment of oncologic results. Timing of Radiotherapy after Radical Prostatectomy It is generally accepted that salvage or adjuvant radiation after radical prostatectomy should be delayed for a period of time to permit adequate surgical healing. How long that time should be and how much difference a delay actually makes are uncertain. This study by Westhofen et al (page 1192) from Germany evaluated timing of postoperative radiation in 4,511 men and used propensity matching to compare those receiving radiation less than or longer than 6 months after surgery.4 Health related quality of life scores were better at 12 and 24 months for those in the delayed radiation group. Both urinary and sexual function were better in the delayed group. The findings support withholding radiation for at least 6 months even if there are low detectable prostate specific antigen levels postoperatively. Progression of Disease after Bacillus Calmette-Guérin Therapy Patients who progressed to muscle invasive bladder cancer while on bacillus Calmette-Guérin (BCG) therapy have historically had a worse prognosis than those who present with de novo invasive cancer and go straight to cystectomy. Hensley et al (page 1258) from Houston, Texas explored in a comparative study whether neoadjuvant chemotherapy (NAC) impacts these findings.5 In a study of 801 patients, the authors again found that progression on BCG portended a worse prognosis than cystectomy in de novo patients in the absence of NAC. In the subgroup of patients with progression who were treated with NAC, the adverse implications were abrogated. These findings should encourage the use of NAC, especially in patients who progress to muscle invasion on BCG. Standard versus Expanded Cultures to Diagnose Urinary Tract Infections in Women Barnes et al (page 1212) from Maywood, Illinois studied whether the use of expanded quantitative urine culture (EQUC) better predicted response to antibiotics in women with urinary tract infection compared to standard urine culture (SUC).6 Of the women 64% and 69% reported resolution of symptoms for SUC and EQUC, respectively. For the overall population, there was no difference in symptom resolution for infections caused by Escherichia coli vs non-E. coli bacteria. T-Tilt Position for Retrograde Intrarenal Surgery In a prospective randomized trial, Liaw et al (page 1232) from New York, New York assessed table position during retrograde intrarenal surgery for stone disease.7 Standard positioning vs a T-Tilt (15° Trendelenberg and 15° airplane away from the surgical side kidney) was used. Over two-thirds of patients in both groups had lower pole stones. Stone-free rate was 76% with the standard position vs 92% for T-Tilt (p=0.015) and for lower pole stones specifically (68% vs 95%, respectively). Preoperative Immunonutrition and Perioperative Cystectomy Outcomes Radical cystectomy remains a morbid procedure and many patients have compromised nutritional status preoperatively. In this retrospective study by Khaleel et al (page 1132) from Minneapolis, Minnesota patients who received an oral L-arginine immune-nutritional supplement (pre-INS) were compared to a control group.8 Those who had pre-INS were less likely to require postoperative total parenteral nutritional support. Importantly, they also had a lower rate of infection complications (25% vs 45%, p=0.003). Other complications were not affected, but infectious problems are one of the most frequent causes of morbidity after this procedure. Comparative Outcomes of Salvage Retzius-Sparing versus Standard Robotic Prostatectomy Various technical maneuvers are used in an attempt to improve functional results after robotic prostatectomy (RALP). This is even more meaningful with salvage surgery as morbidity can be substantial. Kowalczyk et al (page 1184) analyzed the impact of Retzius sparing in a multicenter retrospective analysis of patients having salvage RALP.9 Complication rates and oncologic results were similar compared to a group without Retzius sparing. However, continence was better in the Retzius sparing group (78% vs 43% for 0–1 pad, 54% vs 6% for no pads). Return to continence was shorter in the Retzius sparing patients (47 vs 180 days). These results mirror those of some studies of Retzius sparing in the treatment naïve RALP population but may have more importance in the salvage setting. Risk of Prostate Cancer Progression in Active Surveillance Patients with Bilateral Disease Williams et al (page 1157) from Bethesda, Maryland retrospectively studied prediction of progression in patients on active surveillance and evaluated the impact of bilateral disease.10 All patients had grade group I cancer on initial biopsy, and 41% with unilateral disease progressed on followup biopsy compared to 61% with bilateral disease. Progression was detected in 16% of patients with bilateral cancer using combined targeted plus systematic biopsies compared to targeted alone.

Repair of Large Hiatal Hernias With the Use of Mesh and Autologous Platelet-Rich Plasma.

According to recent studies, large hiatal hernias (HH) can be associated with a lower content of type-I and type-III collagen in the phrenoesophageal ligament (POL). We therefore hypothesize that the use of a mesh implant with autologous platelet-rich plasma (PRP) for repair of large HH would have a positive effect on long-term outcome.The purpose of our study was to determine the level of type-I and type-III collagens in the POL of patients with large HH with the aim of improving the technique of HH repair. During the first phase of the study, the collagen content within the POL was assessed in 18 patients with HH and 14 cadaveric specimens without HH. During the second phase, 54 patients with large HH (defined as 10 to 20 cm2), that required surgery were recruited. Laparoscopic repair involved use of a nonabsorbable self-fixating ProGrip mesh infiltrated with 2 to 4 mL of autologous PRP was used for reinforcement of crural repair. Results were assessed using endoscopy, barium swallow, 24-hour impedance-pH monitoring and a quality of life gastroesophageal reflux disease-health related quality of life questionnaire. The content of collagen within POL in patients with HH was significantly lower than in the cadaveric specimens without HH. Of the 54 patients undergoing HH repair, all procedures were performed laparoscopically and there were no mortalities in this group. At 48 months, only 2 HH recurrences (3.7%) were detected. During this period, the mean gastroesophageal reflux disease-health related quality of life score decreased from 15.7±5.5 to 5.9±0.6 (P<0.05). Our study has shown that the collagen content is reduced in patients with large HH; thus, it is advisable to use mesh for HH repair in such patients. Use of mesh infiltrated in PRP is safe and can have positive impact on results of HH repair.

251. Recovery kinetics and final outcomes for 1-2 level anterior cervical surgery is not impacted by anxiety and/or depression

<h3>BACKGROUND CONTEXT</h3> The postoperative recovery for anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) may be impacted by affective disorders, especially depression/anxiety. The authors hypothesized that depression/anxiety may slow recovery after anterior cervical surgery (ACDF or CDR) for cervical radiculopathy/myelopathy. <h3>PURPOSE</h3> To evaluate the effect of anxiety and depression on recovery speed after ACDF or CDR. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospectively collected data. <h3>PATIENT SAMPLE</h3> Patients who underwent 1-2 level ACDF or CDR for cervical radiculopathy/myelopathy and had at least 1-year follow-up and complete radiographic measurements and health related quality of life scores (HRQOLs) at 6 weeks, 3 months, 6 months and 1 year postoperatively. <h3>OUTCOME MEASURES</h3> Patient-reported outcome measures (PROMs) - HRQOLs including neck disability index (NDI), short-form 12 physical component score (SF-12 PCS), short-form 12 mental component score (SF-12 MCS), PROMIS score, visual analog scale arm (VAS-arm) and neck (VAS-neck) pain scores were follow. <h3>METHODS</h3> Radiographic measurements of C2-C7 Cobb angle, cervical sagittal vertical axis (cSVA) and T1-slope were assessed preoperatively to ensure that the cohorts were similar in terms of alignment. Patients were stratified based on whether they had been diagnosed with anxiety/depression (A/D cohort) or not (non-A/D cohort). We compared recovery kinetics between the A/D versus non-A/D cohort. This was done by normalizing all HRQOLs at each interval time point. The area under the curve (AUC) was then calculated for a plot of the normalized score versus follow-up time point as has been done in previous studies (IHS, Integrated Health State). We used a student's t-test to compare demographic information, radiographic parameters and HRQOLs between the A/D versus non-A/D cohort. <h3>RESULTS</h3> Forty-eight patients with a mean age of 50.0±11.8 years and comprising 22 females were included. All patients had minimum of 1-year follow-up. There were 10 patients in the A/D cohort. There were no significant differences in age (p = 0.18), baseline radiographic parameters (all p>0.10) or preop HRQOLs (all p>0.30) between the A/D versus non-A/D. After normalization there was no significant difference in terms of IHS for A/D versus non-A/D for NDI (0.66±0.38 vs 0.59±0.35, p=0.65), VAS-arm (0.55±0.40 vs 0.36±0.33, p=0.23), VAS-neck (0.55±0.28 vs 0.43±0.27, p=0.24), PROMIS (1.2±0.32 vs 1.3±0.37, p=0.48), SF-12 PCS (1.2±0.26 vs 1.2±0.28, p=0.79) or SF-12 MCS (1.1±0.17 vs 1.1±0.17, p=0.23). Final follow-up outcome scores were also similar for A/D vs non-A/D cohorts for all HRQOLs (all p>0.16). <h3>CONCLUSIONS</h3> We found no negative influence of anxiety/depression on either final-outcome scores or recovery kinetics after 1-2 level ACDF/CDR. Our analysis of IHS shows that the recovery speed after ACDF/CDR were not be impacted by a patient's comorbid anxiety/depression. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P66. The impact of anxiety/depression on outcomes following 1-2 level anterior cervical surgery

<h3>BACKGROUND CONTEXT</h3> Outcomes after anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) are likely impacted by the mental state of a patient during recovery. Psychologic factors such as anxiety/depression might negatively impact outcomes for a subset of patients. <h3>PURPOSE</h3> To elucidate whether anxiety/depression affect outcomes following 1-2 level anterior cervical surgery (ACDF or CDR) at short-term and final follow-up. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospectively collected data. <h3>PATIENT SAMPLE</h3> Patients who underwent 1-2 level ACDF/CDR for cervical radiculopathy/myelopathy and had health related quality of life scores (HRQOLs) at 6 weeks, 3 months and 6 months out from surgery. <h3>OUTCOME MEASURES</h3> Patient-reported outcome measures (PROMs) - Neck disability index (NDI), short-form 12 physical component score (SF-12 PCS), short-form 12 mental component score (SF-12 MCS), PROMIS score, visual analog scale arm (VAS-arm) and neck (VAS-neck) pain scores. <h3>METHODS</h3> Duration of symptoms prior to surgery was recorded. HRQOLs, including NDI, SF-12 and VAS arm and neck were followed. Classic radiographic measurements of C2-C7 cob angle, cervical sagittal vertical axis (cSVA), and T1-Slope were assessed preoperatively to ensure that the cohorts were similar in terms of alignment. Patients were stratified whether they were diagnosed with anxiety/depression (A/D cohort) or not (non-A/D cohort). We compared outcome scores at each time point to determine if there was a difference in time to recovery for A/D patients.We tested normality of data using a Kolmogrov-Smirnov test. Student's t-test or Mann-Whitney test were used to compare normally and non-normally distributed HRQOLs respectively at each time point between the two cohorts. <h3>RESULTS</h3> There were 82 patients with at least 6-month follow-up (mean age 51.4±11.1 years old, 40 female). There were 16 patients in the A/D cohort. There were no significant differences in age (p=0.14), baseline radiographic parameters (all p>0.05), duration of symptoms (p=0.63) or preop HRQOLs (all p>0.77) between the A/D versus non-A/D. At 2 weeks, VAS-neck (p=0.04) and SF-12 MCS (p < 0.001) were worse for the A/D cohort. At 6 weeks, SF-12 MCS (p < 0.03) was less for the A/D cohort. At 3 months, SF-12 MCS (p<0.001) was worse for the A/D cohort. At final follow-up the only HRQOL that was statistically significant different between the cohorts was SF-12 MCS (54.5±8.4 vs 43.4±10.3, p<0.001) which was worse for the A/D cohort. <h3>CONCLUSIONS</h3> The impact of anxiety/depression on outcomes after 1-2 level ACDF/CDR is minimal. Specific HRQOL measures for mental health like SF-12 MCS will likely be lower in this population as we found within our dataset. Overall outcomes for patients with anxiety/depression mirror positive outcomes for those without these comorbid conditions after 1-2 level ACDF/CDR. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.