Sickness Impact Profile Scores Research Articles

Family functioning and health-related quality of life of inpatients with coronary heart disease: a cross-sectional study in Lanzhou city, China

BackgroundA key outcome in coronary heart disease (CHD) is Health Related Quality of Life (HRQoL), and family functioning is important in the management of CHD. But few studies have examined both together, and little is known about them among inpatients with CHD in less developed areas of China. Therefore, this study aimed to assess the HRQoL and family functioning status of inpatients with CHD in Lanzhou from Northwest China, and identify the factors that affect their HRQoL.MethodsA cross‑sectional study was conducted in 224 CHD inpatients at one major hospital. Sociodemographic data and disease information of CHD inpatients were collected by face-to-face using a structured questionnaire and data were also obtained from patient medical records. HRQoL was measured using the Sickness Impact Profile (SIP). Family functioning was measured using the family APGAR index. Multiple binary logistic regression analysis (MBLRA) was used to explore potential risk factors associated with HRQoL, and Pearson’s correlations were used to assess the relationship between family functioning and HRQoL.ResultsThe overall, physical and psychosocial SIP scores were 25.03 ± 8.52, 18.61 ± 9.90 and 28.08 ± 9.64, respectively. The total family APGAR score was 6.11 ± 2.45. MBLRA found older age, poorer cardiac function and more severe disease were associated with poorer HRQoL, while better family functioning, higher monthly income, and urban living were associated with better HRQoL. Family functioning was weakly to moderately correlated with total and psychosocial HRQoL.ConclusionsOlder and less affluent inpatients with lower educational level, less family support and more severe CHD have poorest quality of life, and health care providers should consider interventions to support them.

Effects of Low-dose and High-dose Rifaximin in the Treatment of Covert Hepatic Encephalopathy.

Rifaximin is effective in preventing and treating hepatic encephalopathy (HE). This study aimed to investigate the efficacy and safety of different dosages of rifaximin in the treatment of cirrhotic patients with covert HE (CHE). In this single-center, randomized, controlled, open-label study, CHE was diagnosed using a combination of the psychometric HE score and the EncephalApp Stroop test. Cirrhotic patients with CHE were recruited and randomly assigned to low-dose rifaximin 800 mg/day, high-dose rifaximin (1,200 mg/day), and control groups, and were treated for 8 weeks. The sickness impact profile (SIP) scale was used to evaluate the health-related quality of life (HRQOL) of patients. Forty patients were included in the study, 12 were assigned to the low-dose group, 14 to the high-dose group, and 14 patients to the control group. The percentage of patients with CHE reversal was significantly higher in both the low-dose (41.67%, 5/12) and high-dose (57.14%, 8/14) groups than in the control group (7.14%, 1/14) at 8 weeks (p=0.037 and p=0.005, respectively). In addition, both doses of rifaximin resulted in significant improvement of the total SIP score compared with the control group. There were no significant differences in the CHE reversal rate, total SIP score improvement, and incidence of adverse event between the low-dose and high-dose groups (p>0.05). Low-dose rifaximin reverses CHE and improves HRQOL in cirrhotic patients with comparable effects and safety to high-dose rifaximin.

Incidence and Bedside Predictors of the First Episode of Overt Hepatic Encephalopathy in Patients With Cirrhosis.

Hepatic encephalopathy (HE) is associated with marked increases in morbidity and mortality for patients with cirrhosis. We aimed to determine the risk of and predictors for HE in contemporary patients. We prospectively enrolled 294 subjects with Child A-B (70% Child A) cirrhosis and portal hypertension without previous HE from July 2016 to August 2018. The primary outcome was the development of overt HE (grade >2). We assessed the predictive power of model for end-stage liver disease-sodium (MELD-Na) score, the Inhibitory Control Test, the Sickness Impact Profile score, and the Bilirubin-Albumin-Beta-Blocker-Statin score. We also derived a novel predictive model incorporating MELD-Na score, impact of cirrhosis on daily activity (Likert 1-9), frailty (chair-stands per 30 seconds), and health-related quality of life (Short-Form 8, 0-100). The cohort's median age was 60 years, 56% were men, and the median MELD-Na score was 9. During a follow-up of 548 ± 281 days, 62 (21%) had incident overt HE with 1-year probability of 14% ± 2%, 10% ± 2%, and 25% ± 5% for Child A and B. The best model for predicting the risk of overt HE included MELD-Na, Short-Form 8, impact on activity rating, and chair-stands within 30 seconds. This model-MELDNa-Actvity-Chairstands-Quality of Life Hepatic Encephalopathy Score-offered an area under the receiver operating curve (AUROC) for HE development at 12 months of 0.82 compared with 0.55, 0.61, 0.70, and 0.72 for the Inhibitory Control Test, Sickness Impact Profile, Bilirubin-Albumin-Beta-Blocker-Statin, and MELD-Na, respectively. The AUROC for HE-related hospitalization was 0.92. This study provides the incidence of HE in a well-characterized cohort of contemporary patients. Bedside measures such as activity, quality of life, and physical function accurately stratified the patient's risk for overt HE.

Liver Transplant Is Associated with Sustained Improvement in Tandem Gait and Risk of Falls.

Cirrhosis is associated with poor health-related quality of life (HRQOL), cognitive dysfunction (CD), and lack of coordination leading to falls. Tandem gait (TG; heel-toe) can be used to assess coordination. The impact and relationship between CD, TG and falls pre-/post-liver transplant (LT) is unclear. We aimed to determine the impact of LT on CD, abnormal TG, and HRQOL in cirrhosis. We analyzed patients who underwent complete neurological examination, cognitive testing by psychometric hepatic encephalopathy score (PHES), and HRQOL assessment using sickness impact profile (SIP). All patients were followed for 1 post-LT visit at 6 or 12months post-LT for clinical course and falls. Change in CD, TD, and falls pre-/post-LT were compared. Off 131 recruited, 61 patients completed all visits. Majority were men (84%), with HCV etiology (34%). Pre-LT: Abnormal TG trended towards increased falls (OR 3.3, P = 0.08). Forty-nine % had abnormal TG, 61% had CD, 32.7% had CD + abnormal TG, 62% had prior OHE, and 14.7% had falls. Abnormal and normal TG patients had similar ages, BMI, sex, education level, and MELD scores. Abnormal TG group had higher prior overt HE (P = 0.03) and worse physical SIP score (P = 0.008). Post-LT: There was sustained improvement in CD, HRQOL, falls, and TG post-LT more at 12 than 6months in all patients. Patients who had abnormal TG pre-LT continued to have a worse PHES (P = 0.0064) and physical SIP score (P = 0.008) compared to normal pre-LT TG patients. After LT, there is a sustained improvement in coordination measured via tandem gait, accompanied by a lower rate of falls.

Management of post-traumatic long bone defects: A comparative study based on long-term results

BackgroundReconstruction of post-traumatic long bone defects is a formidable problem. To date, the approaches for bony reconstruction remain controversial. Thus, we aimed to compare the different methods in the treatment of patients with post-traumatic long bone defects, based on the long-term functional and self-evaluation results. MethodsWe retrospectively reviewed data on patients with post-traumatic long bone defects of the lower extremities from January 2006 to January 2015. The patients were divided into three groups according to the surgical method used to treat the defects (group 1, free vascularized fibular transfer; group 2, distraction osteogenesis; group 3, the induced membrane technique). Data including the complication rates, entire treatment period, long-term visual analog scale scores, and Sickness Impact Profile (SIP) scores during follow-up were recorded. ResultsA total of 317 patients were included, with 106, 132, and 79 patients in groups 1, 2, and 3, respectively. The major complication rates were 22.6%, 25.8%, and 26.6% for the groups (P > 0.05), respectively. The mean treatment durations for bony defects, from surgery to non-protected weight-bearing, were 65.1, 46.5, and 56.6 weeks for each group, respectively. At 2 years postoperatively, the average SIP scores for each group were 10.5, 11.7, and 11.5, respectively (P > 0.05). ConclusionPatients who sustained long bone defects can be advised that either one of these three methods which typically results in long-term outcomes equivalent to others.Level of evidence: retrospective study

Secondary prophylaxis of hepatic encephalopathy in cirrhosis of liver: a double-blind randomized controlled trial of L-ornithine L-aspartate versus placebo.

Hepatic encephalopathy (HE) is associated with a poor prognosis. There is no study on the prevention of recurrence of encephalopathy with L-ornithine L-aspartate (LOLA). We conducted a double-blind randomized controlled trial at a tertiary center. Consecutive patients with cirrhosis who had recovered from HE were randomized to receive LOLA (6 g thrice daily) or similar amount of placebo by computer-based randomization for 6 months. Patients were assessed by psychometric HE scores using five paper-pencil tests, critical flicker frequency test, arterial ammonia, and sickness impact profile scores at inclusion. Primary end point was development of overt HE. Of 306 patients, 150 patients were enrolled. HE recurred in nine (12.3%) of 73 and in 20 (27.7%) of 72 patients receiving LOLA and placebo, respectively (P=0.02), with hazard ratio of 0.389 (95% confidence interval=0.174-0.870). Mortality was similar in both groups (6.8 vs. 13.8%, P=0.18). At 6 months follow-up, there was a significant change in the psychometric hepatic encephalopathy score (2.53±2.18 vs. -0.01±1.92, P<0.001), ammonia level (-23.58±14.8 vs. 1.41±13.34 μmol/l, P<0.001), CFF (5.85±4.82 vs. 0.58±4.53, P<0.001), and SIP scores (-7.89±5.52 vs. -0.95±4.25, P<0.001) in patients treated with LOLA compared with placebo. On multivariate analysis, only MELD score predicted the recurrence of overt HE, with odds ratio of 2.21 (95% confidence interval: 1.526-3.204, P<0.001). LOLA is effective in the secondary prophylaxis of HE and is associated with significant improvements in psychometric hepatic encephalopathy score, ammonia level, critical flicker frequency scores, and health-related quality of life.

Secondary Prophylaxis of Hepatic Encephalopathy in Cirrhosis: A Double Blind Randomized Controlled Trial of l-Ornithine l-Aspartate Vs Placebo

Background and Aim: Hepatic encephalopathy is associated with a poor prognosis. l-Ornithine l-aspartate has been useful in treatment of hepatic encephalopathy. There is no study on the prevention of recurrence of encephalopathy with l-ornithine l-aspartate. Methods: We conducted a double blind randomized controlled trial at a tertiary center OPD clinic. Consecutive cirrhotic patients who recovered from HE were randomized to receive LOLA (6 g thrice daily) or similar amount of placebo by computer based random numbers for 6 months. Patients were assessed by number connection tests or figure connection tests (if illiterate), digit symbol test, serial dotting test, line tracing test, critical flicker frequency test, arterial ammonia and Sickness impact profile scores at inclusion. Primary end point was development of overt HE. Results: Of 306 patients, 150 patients were enrolled. HE recurred in 9/73 (12.3%) and in 20/72 (27.7%) patients receiving LOLA and placebo respectively, P = 0.02 and hazard ratio = 0.389 (95% CI = 0.174–0.870). Mortality was similar in both groups (6.8% vs 13.8% P = 0.18). At 6 months follow up, there was significant change in the PHES (2.53 ± 2.18 vs −0.01 ± 1.92, P < 0.001), ammonia (−23.58 ± 14.8 vs 1.41 ± 13.34 μmol/L P < 0.001) and CFF (5.85 ± 4.82 vs 0.58 ± 4.53 P < 0.001) in patients treated with LOLA compared to placebo. The health related quality of life also improved in LOLA group compared to placebo (−7.89 ± 5.52 vs −0.95 ± 4.25 P = 0.001). On multivariate analysis only MELD score predicted the recurrence of overt HE with odds ratio 2.21 (95% CI: 1.526–3.204 P < 0.001). Conclusions: LOLA is effective in the secondary prophylaxis of HE and is associated with significant improvements in PHES, ammonia and CFF scores and HRQOL (Figure 1 and Table 1).Table 1Delta Change in Parameters in LOLA and Placebo Groups at 3 Months and 6 Months Compared to Baseline.ΔChangeLOLAPlaceboΔPHES 31.28 ± 1.670.30 ± 1.97<0.001ΔPHES 62.53 ± 2.18−0.01 ± 1.92<0.001ΔCFF 33.28 ± 3.650.39 ± 3.59<0.001ΔCFF 65.85 ± 4.820.59 ± 4.53<0.001ΔNH3 3−12.92 ± 9.04−0.66 ± 10.72<0.001ΔNH3 6−23.58 ± 14.81.41 ± 13.34<0.001ΔSIP 3−4.56 ± 3.27−0.74 ± 3.21<0.001ΔSIP 6−7.89 ± 5.52−0.95 vs 4.25<0.001Abbreviations: CTP: Child Turcotte Pugh score; MELD: model for end stage liver disease; PHES: pychometric hepatic encephalopathy scores; CFF: critical flicker frequency. Δ = Delta = change in value of parameters from baseline; 3 is at 3 months and 6 is at 6 months follow up; − value denotes decrease from the baseline and + value denotes increase from baseline. Open table in a new tab Abbreviations: CTP: Child Turcotte Pugh score; MELD: model for end stage liver disease; PHES: pychometric hepatic encephalopathy scores; CFF: critical flicker frequency. Δ = Delta = change in value of parameters from baseline; 3 is at 3 months and 6 is at 6 months follow up; − value denotes decrease from the baseline and + value denotes increase from baseline. The authors have none to declare.

Efficacy of Nutritional Therapy for Patients With Cirrhosis and Minimal Hepatic Encephalopathy in a Randomized Trial.

Minimal hepatic encephalopathy (MHE) impairs health-related quality of life (HRQOL), leads to the development of overt HE, and is associated with poor outcome. We performed a randomized controlled trial to assess the effects of nutritional therapy on cognitive functions and HRQOL in patients with cirrhosis with MHE. In a tertiary care setting in New Delhi, India, patients with cirrhosis with MHE were assigned randomly to groups given nutritional therapy (30-35 kcal/kg/d, 1.0-1.5 g vegetable protein/kg/d; n = 60; age, 42.1 ± 10.3 y; 48 men) or no nutritional therapy (patients continued on their same diet; n = 60; age, 42.4 ± 9.6 y; 47 men) for 6 months in 2014. MHE was diagnosed based on their psychometry hepatic encephalopathy score (PHES). HRQOL was assessed by a sickness impact profile (SIP) questionnaire. Primary end points were improvement or worsening in MHE and improvement in HRQOL. There was no significant difference in baseline PHES (-8.12 ± 1.32 vs -8.53 ± 1.38; P = .08) or SIP (14.25 ± 5.8 vs 15.44 ± 5.03; P = .85) scores. After the 6-month study period, a higher proportion of patients in the nutritional therapy group had reversal of MHE (71.1% vs 22.8%; P = .001). Patients in the nutritional therapy group also had larger increases in PHES (3.86 ± 3.58 vs 0.52 ± 4.09; P = .001) and HRQOL (improvement in SIP score of 3.24 ± 3.63 vs 0.54 ± 3.58; P = .001). Overt HE developed in 10% of patients in the nutritional therapy group vs 21.7% of the control group (P = .04). Based on a randomized controlled trial performed in India, nutritional therapy is effective in the treatment of MHE and is associated with improvement in HRQOL. Clinical Trial Registry-India registration no: CTRI/2013/07/003851.

Covert Hepatic Encephalopathy: “Minimal” Changes Cause a Major Screening Problem

Introduction: Covert hepatic encephalopathy (CHE) is seen in up to 80% of cirrhotic patients and significantly impacts quality of life and daily function of cirrhotic patients. Because of the lack of clinically detectable changes in verbal skills or motor function, the diagnosis of CHE is difficult and typically requires specialized testing to discern the subtle changes in cognition. Recently a four-question Sickness Impact Profile Score for CHE (SIP CHE Score) was found useful to detect CHE in the clinic. The goal of this study was to evaluate our group's practice of screening for CHE. Methods: Single-center retrospective chart review of patients followed in general gastroenterology and hepatology clinics at an academic medical center. Patient charts were reviewed including nursing and physician visits to ascertain if screening for CHE had occurred. Results: A total of 49 patients (61% male) charts were reviewed. Cirrhosis was diagnosed by liver biopsy in 60%, and by imaging or clinical criteria in 40%. Child-Pugh A, B, and C classes were 69%, 29%, and 2% respectively. 57% had HCV as the etiology of cirrhosis. Of the 49 patients 18% (9/49) carried a diagnosis of overt hepatic encephalopathy. Of the remaining patients, 15% (6/40) were diagnosed with CHE and treatment initiated. Of the remaining 34 patients only 11% (3/34) received any directed questioning for minimal changes consistent with CHE and none of the cohort received any specialized neurocognitive testing. Conclusion: The majority of cirrhotic patients are not screened for CHE. A standardized screening tool, such as the recently validated four-question Sickness Impact Profile Score for CHE (SIP CHE Score), should be incorporated in the routine evaluation of patients with cirrhosis.

Probiotics can improve the clinical outcomes of hepatic encephalopathy: An update meta-analysis

Although the efficacy of probiotics has been extensively studied in hepatic encephalopathy (HE), the results remain controversial. The objective of this study is to identify and update the association between probiotics and HE. Up to December 2014, we searched Medline, Embase, Web of Science, Cochrane CENTRAL, and SinoMed of China for all relevant articles about probiotics and HE. Jadad score was used to evaluate the quality of studies. Pooled relative risk (RR), publication bias and heterogeneity were assessed. Nine studies met the inclusion criteria. Probiotics was associated with improvement of minimal HE and prophylaxis of overt HE [RR 1.52; 95% confidence intervals (95% CI) 1.00-2.33]. Studies with probiotics showed reduction of ammonia concentration [standard mean difference (SMD) -0.32, 95% CI -0.54 to -0.11]. Probiotics could reduce physical and psychosocial sickness impact profile (SIP) score with weight mean difference (WMD) -3.13 (95% CI -4.10 to -2.17) and WMD -3.50 (95% CI -4.91 to -2.08), respectively. Similar result was obtained with total SIP score (WMD -4.83; 95% CI -6.24 to -3.43). Reduction of severe adverse events, defined as minimal HE developing into overt HE, hospitalizations, infections or unrelated emergency room (ER) visits, was observed in HE with probiotics (RR 0.59; 95% CI 0.39-0.90). Our pooled results indicated that probiotics was associated with improvement of minimal HE, prophylaxis of overt HE, and reduction of SIP score and severe adverse events. Large well-designed randomised controlled trials are needed to confirm these results.

P0171 : Invasive fungal infections in patients with cirrhosis - subanalysis of the fungal infection risk evaluation (FIRE) study

of overt hepatic encephalopathy (HE) and associated with poor prognosis. Preliminary studies showed improvement in cognitive functions and HRQOL with nutritional supplementation in MHE but there is no study on nutritional management in patients with MHE. We assessed the effects of nutritional therapy on cognitive functions and HRQOL in patients of cirrhosis with MHE. Methods: Consecutive patients of cirrhosis with MHE were randomized to group A received nutritional therapy (30–35kcal/kg/day and 1.0–1.5 gram of vegetable protein/kg/day) and group B on no nutritional therapy (diet as patient was taking before) for 6 months. MHE was diagnosed based on psychometry hepatic encephalopathy score (PHES) and HRQOL assessed by Sickness impact profile (SIP) questionnaire. Primary endpoints were improvement or worsening in MHE and improvement in HRQOL. Results: 120 patients were randomized into two groups; group-A (n = 60, age 42.1±10.3 yr, 48 men) and group-B (n = 60, age 42.4±9.6 yr, 47 men). There was no significant difference in baseline characteristics between the two groups. Baseline PHES (−8.12±1.32 vs −8.53±1.38; p = 0.08) and SIP score (14.25±5.8 vs 15.44±5.03; p = 0.85) were similar in both the groups. Reversal of MHE was higher in group A (71.1% vs 22.8%; p =0.001) and improvement in HRQOL was also higher in group A (D SIP 3.24±3.63 vs 0.54±3.58; p = 0.001) compared to group B. Conclusions: Nutritional therapy is effective in treatment of MHE and associated with improvement in HRQOL.

Use of ImPACT to Diagnose Minimal Hepatic Encephalopathy: An Accurate, Practical, User-Friendly Internet-Based Neuropsychological Test Battery

An effective, user-friendly neurocognitive test to diagnose minimal hepatic encephalopathy (MHE) is needed. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) is a brief, validated, Web-based, neuropsychological test battery resulting in four composite scores [Verbal Memory (VrbM), Visual Memory, Visual Motor Speed (VMS), Reaction Time (RT)]. We compared ImPACT to traditional paper-and-pencil tests in patients at risk for MHE versus controls. Ninety cirrhotic patients with no history of overt hepatic encephalopathy were compared with 131 controls on standard psychometric tests (SPT) [Trail Making Test-A, Trail Making Test-B, Digit Symbol Test], 4 ImPACT composite scores, and the Sickness Impact Profile (SIP). MHE+ was defined by a score 2 SD below the normative mean on at least one of the SPT. ImPACT (ImP+) scores of patients were defined as 2 SD from the control mean. Cirrhotic patients scored more poorly than controls on 3/4 of ImPACT scores: VrbM (78.88 vs. 71.37, p<0.001), VMS (26.47 vs. 22.68, p<0.001) and RT (0.89 vs. 1.00, p<0.01), as well as on all 3 SPT. Of the 90 cirrhotics, 16 (18%) were MHE+, who performed more poorly (p<0.001) than patients without MHE on VrbM (58.13 vs. 74.19), VMS (16.77 vs. 23.95) and RT (1.24 vs. 0.95). Of the 90 cirrhotics, 25 (27.8%) were ImP+. MHE+ and ImP+ patients had increased SIP scores versus controls (p<0.001). Compared to paper-and-pencil testing, ImPACT provides a brief, user-friendly, neuropsychological evaluation of MHE. ImPACT could become a new standard for MHE diagnosis.

Sickness Impact Profile (SIP) Score, a Good Alternative Instrument for Measuring Quality of Life in Patients with Ileal Urinary Diversions

Objective:To determine the effectiveness of the use of the SIP score and the quality of life impairment in patients with ileal conduit and orthotropic ileal derivations by Hautmann and AbolEnein/Ghoneim.Methods:Prospectively evaluated 146 patients in different age groups. In 66 patients ileal conduit derivation was performed, in 20 patients orthotropic derivation using Hautman technique was recorded and in 20 of them AbolEnein/Ghoneim was used. Prior to examining patients with urinary diversions, 40 patients with minor urological symptoms not requiring any active treatment, were surveyed in order to validate SIP score. Six months after the operation, all patients with urinary diversions filled the SIP score questionnaire.Results:Using Crombach’s Alpha equation the high reliability of SIP questionnaire was proven. Average scale value was 0,93. Using descriptive statistics mean values of all categories and dimensions of the SIP questionnaire of examined patients were determined, calculated according to the questionnaire manual being converted to percentage. Total value of SIP score for the ileal conduit group was 34,76% and in orthotropic derivation 18,52% respectively. For Hautmann procedure total SIP score was 18,35% and for AbolEnein/Ghoneim 18,7%. In the control group total SIP score was 9%. The most influential dimensions on the total score of ileal conduit were physical and psycho-social, while independent dimension did not significantly influent total SIP score.Conclusion:Taking into consideration the lack of questionnaires on quality of life for urinary derivations, SIP score as a general disease influence to the quality of life questionnaire represents a reliable alternative for objectification and quantification of the quality of life upon urinary derivation. According to this instrument, orthotropic derivations provide significantly better quality of life compared to ileal conduit.

The Mangled Foot and Ankle

To determine the outcome of the mangled foot and ankle undergoing limb salvage surgery that required free tissue flaps for wound closure compared with a similar patient foot and ankle injury group that underwent early below knee amputation (BKA). : Prospective longitudinal study. : Eight level 1 trauma centers. LEAP (Lower Extremity Assessment Project) study. One hundred seventy-four open severely injured hindfoot or ankle injuries (116 had salvage; 58 had a BKA). Patients either required immediate amputation or salvage was attempted. The Sickness Impact Profile (SIP) was the principal measure of outcome (higher SIP scores equal greater disability). Secondary outcomes included walking speed, number of rehospitalizations for injury-related complications, time to full weight-bearing, the visual analog pain scale, and return to work at 2 years. When compared to patients treated with standard BKA, salvage patients who required free flaps and/or ankle arthrodesis had significantly worse 2-year outcomes. They had overall SIP scores that were 2.5 points higher and psychosocial SIP scores that were 8.4 points higher at 24 months (P = 0.014 and P = 0.013, respectively). Physical SIP scores were 3.7 points higher in the free flap and/or arthrodesis group but only approached statistical significance (P = 0.10). After adjusting for the need for free flap and/or arthrodesis, the salvage pathway had clinically, but not statistically, significantly better overall and psychosocial SIP scores than the standard BKA patients (P = 0.34 and P = 0.20, respectively). : Patients with severe foot and ankle injuries who require free tissue transfer or ankle fusion have SIP outcomes that are significantly worse than BKA with typical skin flap design closure. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Impact of Complications and Bladder Cancer Stage on Quality of Life in Patients with Different Types of Urinary Diversions

ABSTRACTGoal:Determine correlation between complications and stage of the disease and their impact on quality of life in patients with different types of ileal urinary derivation after radical cystectomy, and upon estimation of acquired results, to suggest the most acceptable type of urinary diversion.Patients and methods:In five year period a prospective clinical study was performed on 106 patients, to whom a radical cystectomy was performed due to bladder cancer. Patients were divided into two groups, 66 patients with ileal conduit derivation and 40 patients with orthotopic derivation, whereby in each group a comparison between reflux and anti-reflux technique of orthotopic bladder was made. All patients from both groups filled the Sickness Impact Profile score six months after the operation. All patients had CT urography or Intravenous urography performed, as well as standard laboratory, vitamin B12 blood values, in order to evaluate early (ileus or subileus, wound dehiscence, bladder fistula, rupture of orthotopic bladder, urine extravazation) and late complications (VUR, urethral stricture, ureter stenosis, metabolic acidosis, mineral dis-balance, hypovitaminosis of vitamin B12, increased resorption of bone calcium, urinary infection, kidney damage, relapse of primary disease), so as disease stage and it’s impact on quality of life.Results:From gained results we observe that each category of SIP score correlates with different rate of correlation with the type of operation, group, T, N, and R grade, except work category. Average value of SIP score rises depending on the type of operation and T stage. It is notable that there is no difference in T1 stage, no matter the type of operation. So the average value of SIP score in T1 stage for conduit was 20.3, for Abol-Enein and Ghoneim 17.25 and Hautmann 18.75 respectively. Average value of SIP score in T2 stage for conduit was 31, for Abol-Enein and Ghoneim 19.1 and Hautmann 17.8. Average value of SIP score in T3 stage for conduit was 38.03, for Abol-Enein and Ghoneim 18.75 and Hautmann 19.5. SIP score for T4 was present only in patients with conduit performed and average value od SIP score was 40.42. There is a high level of correlation of late complications and psychosocial and physical dimension with their parameters, while for an independent dimension of correlation is not significant. Early complications have insignificant correlation in all categories of SIP score. Conclusion:Upon analyzing quality of life and morbidity, significant advantage is given to orthotopic derivations, especially Hautmann derivation with Chimney modification, unless there are no absolute contraindications for performing this type of operation. Factors which mostly influence quality of life are cancer stage, type of derivation, late complications and patient age. SIP score, as a well validated questionnaire, are applicable in this kind of research.

Rifaximin Therapy in Minimal Hepatic Encephalopathy Cirrhotics

1Gastroenterology and Digestive Endoscopy Unit, “Nuovo Regina Margherita” Hospital, Rome, Italy Correspondence: Angelo Zullo, MD, Gastroenterologia ed Endoscopia Digestiva, Ospedale Nuovo Regina Margherita, Via E. Morosini, 30, 00153 Roma, Italy. E-mail: [email protected] This letter underwent AJG editorial review.

Identifying prediction factors for unplanned hospitalisation of an elderly population using classification and regression tree (CART) analysis

Abstract Accurate prediction of those elderly people who are at a high risk of unplanned hospitalisation may assist pharmacists and other health care providers to target health care initiatives more specifically. A prospective study of 84 elderly persons, suffering from either ischaemic heart disease or obstructive airways disease, or both, was conducted to identify health-related factors that may be used to predict unplanned hospitalisation. Non-invasive factors, including the sickness impact profile (SIP) health status measure scores, drug consumption, demographic data, smoking history and disease/symptoms experience were determined. For hospitalised patients the overall SIP score was significantly higher (18.93) than for those non-hospitalised (10.54). The physical dimension score (20.76) and the psychosocial dimension score (16.74) were also both significantly higher in the hospitalised than the non-hospitalised group (10.85 and 9.44, respectively). The number of medicines used was higher (8.2) in the hospitalised group than in the non-hospitalised group (6.3). Logistic regression determined that the overall SIP score was highly predictive (P&amp;lt;0.01) of unplanned hospitalisation. Classification and regression tree (CART) analysis was used to determine the mix of health-related factors that could best classify subjects as being at either a high or low risk for unplanned hospitalisation within the six month prospective study period. A selected CART-generated decision protocol determined that the health-related parameters that enabled a useful prediction for unplanned hospitalisation were overall SIP score, the person's age, whether the person lived alone and smoking history. Seventy-nine per cent of those hospitalised and 91 per cent of those non-hospitalised had been correctly predicted. The results of this study show that it is possible to predict unplanned hospitalisation of elderly people in a retirement village setting by using previously measured non-invasive health related parameters in a decision protocol to determine their category of risk.

Change in quality of life in patients with relapsing–remitting multiple sclerosis over 2 years in relation to other clinical parameters: results from a trial of intramuscular interferon β-1a

Background: A randomized, placebo-controlled, multicenter study of weekly intramuscular injections of interferon beta-1a (IFNβ-1a) in relapsing–remitting multiple sclerosis included the Sickness Impact Profile (SIP), a validated measure of patient-reported quality of life (QoL). Objective: To demonstrate the impact of moderate to severe SIP disability at baseline and change in QoL as measured by SIP over 2 years in relation to other study parameters. Methods: In 158 patients, SIP scores were determined at baseline and 2 years. Scores were correlated with disease progression and treatment. Results: Patients who experienced disability progression, as defined by Expanded Disability Status Scale (EDSS) and annualized relapse rate, during the study demonstrated significant worsening in Physical SIP scores compared with patients who did not progress (p = 0.031). In patients with low SIP scores, indicating moderate or severe disability at baseline, treatment with IFNβ-1a significantly improved Physical SIP subscores. Conclusions: Patients with disability progression defined using EDSS, the physician-derived primary outcome measure, had Physical SIP scores indicating worsening disability, validating the physician-derived primary outcome measure using patient self-report. Treatment with IFNβ-1a had beneficial effects on QoL in patients with worse SIP scores at baseline.

Rifaximin Improves Psychometric Performance and Health-Related Quality of Life in Patients With Minimal Hepatic Encephalopathy (The RIME Trial)

Cirrhotics with minimal hepatic encephalopathy (MHE) have a poor health-related quality of life (HRQOL). Treatment of MHE is still evolving. The aim of this double-blind randomized pilot study was to assess the efficacy of rifaximin in improving neuropsychometric (NP) test performance and HRQOL in patients with MHE. MHE was diagnosed if any two NP tests (number and figure connection tests, picture completion, digit symbol, and block design tests) were deranged beyond 2 s.d. of normal. HRQOL was assessed using the sickness impact profile (SIP) questionnaire. A total of 486 patients with cirrhosis were screened and 284 were found eligible. Out of these 115 (40.9%) had MHE, of which 21 refused consent and 94 were randomized to receive placebo (n=45) and rifaximin (n=49; 1200 mg/day) for 8 weeks. At the end of treatment, significantly more number of patients in rifaximin group showed reversal of MHE (75.5% (37/49) vs. 20% (9/45) in placebo group; P<0.0001). Rifaximin group also showed significant reduction in mean number of abnormal NP tests (baseline, 2.35 (95% confidence interval (CI), 2.17-2.53); 2 weeks, 1.29 (95% CI, 1.02-1.56), P=0.002; 8 weeks, 0.81 (95% CI, 0.61-1.02), P=0.000), compared with placebo group (baseline, 2.31 (95% CI, 2.03-2.59); 2 weeks, 2.03 (95% CI, 1.74-2.31); 8 weeks, 1.97 (95% CI, 1.69-2.25), P>0.05). The mean total SIP score also improved significantly in rifaximin group (baseline, 11.67 (95% CI, 10.31-13.03); 8 weeks, 6.45 (95% CI, 5.59-7.30); P=0.000) compared with placebo group (baseline, 9.86 (95% CI, 8.66-11.06); 8 weeks, 8.51 (95% CI, 7.35-9.67); P=0.82). Improvement in HRQOL correlated with improvement in NP tests. Rifaximin was well tolerated. Rifaximin significantly improves both cognitive functions and HRQOL in patients with MHE.

Rifaximin Improves Cognitive Functions and Health-Related Quality of Life in Patients With Minimal Hepatic Encephalopathy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial (The RIME Trial)

Rifaximin Improves Cognitive Functions and Health-Related Quality of Life in Patients With Minimal Hepatic Encephalopathy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial (The RIME Trial)