Study Short Form 36-item Questionnaire Research Articles

Cross-sectional review of effects of laparoscopic sleeve gastrectomy at 1, 3, and 5 years

Background Laparoscopic sleeve gastrectomy evolved as a primary bariatric procedure without data on longer term outcomes. Our objective was to measure the weight changes and quality of life after laparoscopic sleeve gastrectomy at a university hospital. Methods The patients scheduled follow-up visits for clinical measurements, blood sampling, and form completion, including the Medical Outcomes Study 36-item short-form questionnaire, the Impact of Weight on the Quality of Life-Lite questionnaire, and Beck depression inventory. Comparisons were performed among patients with a follow-up of 1, 3, and 5 years after laparoscopic sleeve gastrectomy. Results A total of 77 patients (35 at 1, 19 at 3, and 23 at 5 yr) were similar in gender (70.1% women), percentage of body fat, and body mass index by analysis of variance ( P = .12; 1 versus 3 yr, P = .04). The 5-year group was older ( P = .07). The 3 groups were different in the percentage of excess body mass index loss ( P = .04). Differences in the Beck depression inventory were not significant by analysis of variance but were for 1 year versus 5 years ( P = .04). For the Impact of Weight on the Quality of Life-Lite total scores, the difference was significant ( P = .06; 1 versus 5 yr, P = .027; and public distress subscore at 1 and 5 yr, P = .04). The differences in the other domains were not significant. For the Medical Outcomes Study 36-item short-form, differences in the physical differences domain was significant ( P = .001). The differences in physical function, social function, general health, vitality, body pain, and role physical were significant. The differences in mental health and role emotional were not. The differences in the Beck depression inventory scores were not significant using analysis of variance but were between the 1-year and 5-year scores ( P = .04). Conclusion Patients undergoing laparoscopic sleeve gastrectomy had a similar body mass index at 1, 3, and 5 years. However, the percentage of excess body mass index loss was different. No differences were found in the percentage of body fat. The health-related quality of life scores resembled community norms, although the physical health differences in the 3 groups were significant, The Beck depression inventory scores were elevated at 5 years compared with at 1 year.

Patellar Articular Surface Replacement in Total Hip Arthroplasty

Examination of 249 patients with unilateral coxarthrosis was performed after total knee arthroplasty with (group 1) and without (group 2) patellar resurfacing performed at orthopaedic department of National Medical Surgical Center named after N.I. Pirogov. Total arthroplasty outcomes were assessed using knee-specific Oxford Knee Score (OKS), general questionnaire Medical Outcome Study 36-item Short-Form Health Survey (MOS Sf-36) and patellofemoral-specific questionnaire (PFQ). The following indications to patellar resurfacing were determined: body weight over 95 kg, patellar lateral shift ratio over 9%, 3rd and 4th degree of patellar chondromalacia by Outerbridge. Outcomes of patellar resurfacing were independent of patellar tilt angle (б), Insall-Salvati index, patient's height, body mass index, 1st and 2nd degree of patellar chondromalacia by Outerbridge.

Fear-Avoidance Beliefs Are Associated With Disability in Older American Adults With Low Back Pain

Although fear-avoidance beliefs (FABs) have been explored in younger adults and Spanish older adults, their relationships to measures of low back pain (LBP)-related disability, overall physical health, and falling have not been investigated in older American adults. The purpose of this study was to examine the association of FABs with self-reported disability, physical health, and falling among community-dwelling older adults with LBP in the United States. This was a cross-sectional study. Ninety-three community-dwelling men and women with current LBP were included in this analysis. Participants completed the Fear-Avoidance Beliefs Questionnaire physical activity subscale (FABQ-PA). The modified Oswestry Disability Questionnaire (mOSW) and the Quebec Back Pain Disability Scale (QUE) were used to measure self-reported disability, and the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire (SF-36) physical component summary (PCS) score was used to assess physical health. Participants provided demographic information and information regarding LBP duration and intensity. Linear regression models were developed using the following dependent variables: mOSW, QUE, and SF-36 PCS scores. Logistic regression was used to determine the association between high FABs and falling. For each analysis, the FABQ-PA score independently explained 3% to 6% of the variance in the LBP-related disability score and 3% of the variance in the SF-36 PCS score. For all dependent variables, the strongest contributors to explained variance were pain intensity, assistive device use, and FABQ-PA score. High FABs were associated with falling. Future investigations might seek a more diversified sample and utilize both qualitative and quantitative measures for assessing disability and physical health. Physical activity FABs are independently associated with self-reported disability and overall physical health in older American adults with LBP. High FABs may warrant balance and falls assessment.

Midterm Results of Uterine Artery Embolization Using Narrow-Size Calibrated Embozene Microspheres

To evaluate safety and efficacy of uterine artery embolization using narrow-size-range polyphosphazene-coated hydrogel microspheres (Embozene, CeloNova Biosciences, Newnan, GA). Between May 2006 and September 2008, a total of 121 consecutive patients (mean ± SD age 42.1 ± 5.4 years, range 30.5-51.5 years) were enrolled onto this single-center study. The primary study endpoint was safety as assessed by the society of interventional radiology (SIR) classification. The secondary endpoint was efficacy, which was based on a 1-year magnetic resonance imaging study and relief of symptoms documented by the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire over a 2-year interval. The mean ± SD diameter of the dominant fibroid was 6.4 ± 2.6 (range, 2.9-13.9) cm and the mean volume 137.2 ± 245.1 (range, 5.3-1184) ml. Most patients had multiple fibroids with 11% more than 10. A total of 240 of 242 interventions were completed as planned, a technical success rate of 99.2%. According to the SIR classification, one type A, eight type C, and one type D complication occurred. Total devascularization was noted in 96% (116 of 121) of dominant fibroids. Volume decrease was 4% at 2 weeks, 52% (P < 0.001) at 3 months, 78% (P < 0.001) at 6 months, and 91% at 12 months (P < 0.001). The latter difference was statistically significant (P = 0.007). A total of 92% had improved hypermenorrhea at 1 year and 94% at 2 years. Dysmenorrhea was improved in 96% at 1 year and in 95% at 2 years. The overall health status score was 60.4 ± 26.2 points at baseline and 96.9 ± 3.8 after 1 year (P = 0.0019). Uterine artery embolization with Embozene microspheres is a safe procedure. Its efficacy is demonstrated by high fibroid devascularization and volume reduction rates and significant improvements of clinical symptoms and quality-of-life scores during follow-up.

The Cost of Achalasia: Quantifying the Effect of Symptomatic Disease on Patient Cost Burden, Treatment Time, and Work Productivity

Although the incidence of achalasia is low, the burden of suffering is high because it is a chronic incurable disease that predominantly affects young persons. This article aims to describe the impact of achalasia on health-related quality of life, patient cost burden, time dedicated to treatment, and work productivity. Consecutive patients enrolled in a clinical trial comparing laparoscopic myotomy with pneumatic dilatation from 4 sites across Canada (whose clinical and manometric diagnosis was confirmed) were studied using standardized patient-reported outcomes instruments, including the Achalasia Severity Questionnaire (ASQ), the Medical Outcomes Study 36-item Short Form Questionnaire (SF-36), and the Gastrointestinal Disease-Specific Quality of Life (GIQLI) questionnaire. The authors also measured health care utilization. Questionnaires were completed by 54 patients (median age = 53.5 years; range = 25-78 years; 50.0% male). Patients had been experiencing symptoms for a mean of 4.5 years (standard deviation = 6.1), and 42.6% were on medication for symptom relief. Among them, 74.1% reported that their disease limited their lifestyle. Patients spent an average of CAD$30.70 a month on medication; 37.0% reported that their disease interfered with their work, and patients missed an average of 10.2 days per 6 months. Patients also spent an average of CAD$24.30 on transportation to and from each clinical appointment. Achalasia substantially limits the lifestyle of patients with the disease. It also implies a financial burden of care for patients and leads to decreased work productivity.

Primary Sjögren’s syndrome activity and damage indices comparison

Significant differences exist in outcome measures developed to assess patients with primary Sjögren's Syndrome (pSS). In this review, we have compared proposed indices. Three activity - SSDAI (SS Disease Activity Index), SCAI (Sjögren's Systemic Clinical Activity Index) and ESSDAI (EULAR SS Disease Activity Index) - and two damage indices - SSDDI (SS Disease Damage Index) and SSDI (SS Damage Index) have been analysed. Assessment 'tools' for perspectives of outcome (PROFAD - Profile of Fatigue and Discomfort, SF-36 - Medical Outcomes Study Short-Form 36-item questionnaire and ESSPRI - EULAR Sjögren's Syndrome Patients Reported Index) were also considered. SSDAI and ESSDAI are global scores. SCAI is a composite score. Validity is a limitation for SSDAI and SCAI. ESSDAI is complemented by ESSPRI for the assessment of subjective features. It is more accurate in detecting changes in activity. Damage indices differ with respect to observation period and external validation but both have low content validity. Main limitations for all indices are: inclusion of patients with mainly mild stable disease and lack of information about the completion time of the forms. All indices demonstrate a potentially useful benefit but further, larger studies are needed to assess reliability and sensitivity to change, to validate their use in clinical trials. Improvement in our knowledge of pathophysiology and clinical evolution of pSS is important to address unresolved issues: whether to include prognostic factors for an adverse outcome, an agreed definition of flare and most notably the distinction between activity and damage.

Patients having haemodialysis: physical activity and associated factors

This paper is a report of a study exploring the physical activity status of Beijing patients having haemodialysis and its associated factors. Inactivity is widely regarded as a risk factor for the development and progression of chronic diseases. Patients having dialysis could obtain important health benefits by participating in a moderate amount of physical activity. A cross-sectional survey using convenience sampling was conducted in 2008 at outpatient haemodialysis centres of two tertiary Peking University-affiliated hospitals. Physical activity status and health status were assessed using the International Physical Activity Questionnaire and the medical outcomes study Short Form 36-Item Questionnaire respectively. The participants were 95 men and 92 women aged from 18 to 86 years (median 59 years). Transport-related walking and household work were the main types of physical activity. Median of metabolic equivalent-minutes/week was 1743.0 (0-13482.0); 26.7% of participants were inactive and 73.3% were minimally active or active. Factors associated with physical activity energy expenditure were age (rho = -0.334 P < 0.001), serum albumin concentration (rho = 0.155 P < 0.05), physical function (rho = 0.469 P < 0.001) and physical component summary (rho = 0.315 P < 0.001) scores on the Short Form 36-Item Questionnaire. Advice on exercise is needed for patients having haemodialysis, especially for young patients. Individualized physical activity programmes are strongly recommended for patients having haemodialysis, according to their physical capacity.

Novel Concentrated Cranberry Liquid Blend, UTI-STAT With Proantinox, Might Help Prevent Recurrent Urinary Tract Infections in Women

To determine the safety, tolerability, maximal tolerated dose, and efficacy of a concentrated cranberry liquid blend, UTI-STAT with Proantinox, in female patients with a history of recurrent urinary tract infections (rUTIs). The study agent was administered orally at 15, 30, 45, 60, and 75 mL daily for 12 weeks to women with a history of 2.78 ± 0.73 rUTIs <6 months. Blood and urine samples were collected at baseline and weeks 4 and 12. The women took daily doses of the agent. The primary endpoints were the safety, tolerability, and maximal tolerated dose. The secondary endpoints were the efficacy with regard to rUTI and quality-of-life (QOL) symptoms. A total of 28 subjects were included in the study. Of these 28 women, the data from 23 were analyzable. The average age was 46.5 ± 12.8 years. The maximal tolerated dose of UTI-STAT was 75 mL/d, and the recommended dose was set at 60 mL/d. The secondary endpoints demonstrated that only 2 (9.1%) of 23 reported a rUTI, a markedly better rate than the historical data. At 12 weeks, the reduction in worry about rUTIs and increased QOL with regard to the physical functioning domain and role limitations from physical health domain, as measured by the Medical Outcomes Study short-form 36-item questionnaire, were significant (P = .0097). A lower American Urological Association Symptom Index indicating greater QOL was also significant (P = .045). The novel concentrated cranberry liquid blend showed a good safety profile and tolerability in both pre- and postmenopausal women with history of rUTIs. The secondary endpoints demonstrated its effectiveness in reducing the incidence of rUTI and increasing QOL. Given this evidence, supplementation might be beneficial in the prevention of rUTIs in this population.

Impact of duration and treatment of arterial hypertension on health-related quality of life

Arterial hypertension (AH) is one of the most important risk factors for development of ischemic heart disease; thus, control of AH and effective treatment are of great importance. Since arterial hypertension is commonly referred as asymptomatic condition, the question whether hypertensive condition is associated with the change of well-being and health-related quality of life is still debatable. To evaluate the impact of duration and treatment of AH on health-related quality of life. The contingent of the study consisted of patients who arrived for a cardiologist's consultation at the Clinic of Cardiology, Hospital of Kaunas University of Medicine. The patients were randomly selected for the study. The inclusion criteria were as follows: diagnosed arterial hypertension, diabetes mellitus, and the metabolic syndrome. Diagnosed ischemic heart disease (chronic and acute coronary syndromes and their complications) and severe concomitant diseases were exclusion criteria. A total of 101 patients (19 males and 82 females) met the inclusion criteria and consented to participate in the study. Their mean age was 58.03+/-5.63 years. The patients' quality of life was evaluated using the Medical Outcomes Study short form 36-item questionnaire (SF-36 questionnaire), which comprises 36 questions grouped into eight domains. The questionnaire was filled in by the subjects independently. Other methods applied to the study were inquiry (for the evaluation of risk factors, lifestyle, and medical history), analysis of medical documents (cholesterol levels and glycemia in blood), and objective examination (height, weight, waist circumference, and arterial blood pressure). The subjects with AH showed lower values compared to normotensive patients in the following domains: physical functioning (P=0.014), role limitations due to physical health (P=0.012), energy/vitality (P=0.016), and general health evaluation (P=0.023). We have not determined the differences in quality of life of the patients whose AH was regulated if compared to those patients without AH. The patients whose treatment of AH was not effective reported lower quality of life in the following SF-36 domains: physical functioning (P=0.003), role limitations due to physical health (P=0.003), general evaluation of health (P=0.017), energy/vitality (P=0.008), and emotional status (P=0.015), if compared to the patients without AH. Patients with AH reported lower quality of life in the following domains: physical functioning, role limitations due to physical health, energy/vitality, and general evaluation of health. Compared to patients without AH, the quality of life of the patients who had the effective treatment did not differ, whereas patients with ineffective treatment had the lower quality of life. Functioning is more statistically significantly limited due to physical health in patients with AH.

Quality-of-life assessment in patients with pemphigus using a minimum set of evaluation tools

Pemphigus is a rare but severe autoimmune disease caused by autoantibodies directed against desmosomes, and clinically characterized by bullae and painful erosions of the skin and mucous membranes. The two major subtypes, vulgaris and foliaceus, are distinguished by the depth of the cleavage plane in the epidermis. Very few studies have investigated the quality of life (QoL) of patients with pemphigus, all reporting a strong impact on physical and emotional status. We sought to achieve an exhaustive description of health status in a large sample of patients with pemphigus, assess the impact on QoL, and define a minimum set of QoL tools for clinical practice. In all, 139 patients with pemphigus enrolled at our bullous skin diseases department from February 2007 to February 2008 were given the Medical Outcome Study 36-item short form health survey questionnaire to assess the health status, the Skindex-29 to evaluate the impact of dermatologic-specific aspects, and the 12-item General Health (GH) Questionnaire to detect patients with psychological problems. Clinical severity of the disease was assessed by a dermatologist by the Physician Global Assessment index and the Ikeda index. A strong impact of pemphigus on health status was observed, especially in women and older patients, and in patients with mucocutaneous involvement. A significant association between disease severity and lower Medical Outcome Study 36-item short-form questionnaire values was also observed. Patients with pemphigus showed a markedly impaired overall QoL compared with healthy control subjects on all 3 Skindex-29 scales (symptoms mean scores 37 vs 8, in patients and control subjects, respectively; emotions 37 vs 14; functioning 33 vs 4; P < .001); disease severity was also significantly associated with Skindex-29 scores, on all 3 scale scores for both Physician Global Assessment and Ikeda values (P < .05). GH Questionnaire positivity, reflecting probable minor psychiatric nonpsychotic conditions, such as depression and anxiety, was detected in 39.7% of patients. The small sample size in the different treatment groups prevented a more detailed analysis, failing to highlight an association between treatment type and QoL impairment. In this study we described a strong impact of pemphigus on patients' QoL both for the dermatology-specific and the GH aspects. The prevalence of patients with GH Questionnaire positivity was also very high (almost 40%). The introduction of the proposed minimal set of QoL evaluation tools would provide additional useful information to guide clinicians in the treatment of these patients.

Effect of Physical Activity Guidelines on Physical Function in Older Adults

To determine whether elderly people who meet national guidelines have higher physical function (PF) scores than those who do not and the effect on functional trajectory when physical activity (PA) levels change from above to below this threshold, or vice versa. Pooled data. Two 6-month randomized controlled trials aimed at increasing PA in adults. Adults aged 65 to 94 (N=357). PA counseling over the telephone and through mailed materials. Self-reported PA dichotomized at 150 minutes/week and PF using the Medical Outcomes Study 36-item Short Form Questionnaire PF subscale. At baseline, individuals reporting 150 minutes or more of moderate PA/week had mean PF scores that were 20.3 points higher than those who did not (P<.001). Change in PA minutes from above threshold to below threshold or from below threshold to above threshold from baseline to 6 months resulted in an average change in PF of -11.18 (P<.001) and +5.10 (P=.05), respectively. These findings suggest that PA is an important predictor of functional status. Older sedentary adults can improve PF by meeting recommended PA levels. Conversely, dropping below recommended PA levels has a deleterious effect on PF. Given the importance of PF in maintenance of independence and quality of life in older adults, adherence to recommended PA guidelines should be endorsed.

The Influence of Age on Changes in Health‐Related Quality of Life over Three Years in a Cohort Undergoing Hemodialysis

To assess the extent to which persons aged 70 and older undergoing hemodialysis (HD) had greater changes in health-related quality of life (HRQOL) over 3 years than younger patients undergoing HD. Longitudinal. The Hemodialysis Study (HEMO Study) was a randomized, clinical trial of the effects of HD dose and membrane flux on mortality and morbidity in patients undergoing chronic dialysis. Secondary analysis of the HEMO Study. Participants completed the Index of Well-Being (IWB) and the Kidney Disease Quality of Life-Long Form (KDQOL-LF), which also includes the Medical Outcomes Study 36-item Short Form Questionnaire (SF-36) annually. Changes in subjects those aged 70 and older were compared with changes in subjects aged 55 to 69 and 18 to 54. At baseline, 1,813 (98%) of HEMO participants completed HRQOL surveys. Their mean age was 58, 56% were female, 64% were black, and mean duration of dialysis was 3.8 years. In subjects with HRQOL data at the first three annual assessments, there were no substantial mean declines in the SF-36 Physical or Mental Component Summary scales over 3 years. In models incorporating effects of attrition, the differences in average change over 3 years between patients undergoing HD aged 70 and older and the younger cohorts were small in magnitude. There were high rates of adverse HRQOL events in all age groups and significantly higher composite event rates of death or clinically significant decline in HRQOL over 3 years was found in subjects aged 70 and older. Although HRQOL was impaired in the population undergoing HD, HRQOL scores at baseline reflect a better-preserved multidimensional quality of life in respondents in the HEMO Study aged 70 and older than in younger patients undergoing HD. There was no substantial relationship between age and average decline in HRQOL score over 3 years in participants in the HEMO Study.

Effectiveness of a Falls‐and‐Fracture Nurse Coordinator to Reduce Falls: A Randomized, Controlled Trial of At‐Risk Older Adults

To assess the effectiveness of a community-based falls-and-fracture nurse coordinator and multifactorial intervention in reducing falls in older people. Randomized, controlled trial. Screening for previous falls in family practice followed by community-based intervention. Three hundred twelve community-living people aged 75 and older who had fallen in the previous year. Home-based nurse assessment of falls-and-fracture risk factors and home hazards, referral to appropriate community interventions, and strength and balance exercise program. Control group received usual care and social visits. Primary outcome was rate of falls over 12 months. Secondary outcomes were muscle strength and balance, falls efficacy, activities of daily living, self-reported physical activity level, and quality of life (Medical Outcomes Study 36-item Short Form Questionnaire). Of the 3,434 older adults screened for falls, 312 (9%) from 19 family practices were enrolled and randomized. The average age was 81+/-5, and 69% (215/312) were women. The incidence rate ratio for falls for the intervention group compared with the control group was 0.96 (95% confidence interval=0.70-1.34). There were no significant differences in secondary outcomes between the two groups. This nurse-led intervention was not effective in reducing falls in older people who had fallen previously. Implementation and adherence to the fall-prevention measures was dependent on referral to other health professionals working in their usual clinical practice. This may have limited the effectiveness of the interventions.

Interaction between anxiety, depression, quality of life and clinical parameters in chronic tension-type headache

Our aim was to investigate the mediating or moderating role of anxiety and depression in the relationship between headache clinical parameters and quality of life in Chronic Tension-Type Headache (CTTH). Twenty-five patients diagnosed with CTTH according to the criteria of the International Headache Society were studied. A headache diary was kept for 4 weeks in order to substantiate the diagnosis and record the pain history. Quality of life was assessed by means of the Medical Outcome Study (MOS) 36-Item Short-Form (SF-36) questionnaire. The Beck Depression Inventory (BDI-II) was used to assess depression, and the Trait Anxiety Scale (TA) from the State-Trait Anxiety Inventory was administered in order to assess anxiety. Moderating and mediating analyses were conducted with ordinary least squares multiple regression analysis using the SPSS General Linear Model procedure. Anxiety mediated the effect between headache frequency and quality of life, but not the effect of either headache intensity or duration. Anxiety totally mediated the effects of headache frequency on vitality, social functioning and mental health. On the other hand, depression modulated the effect in the mental health domain. The effect in the mental health domain was a function of the interaction between headache duration and depression ( β = −0.34, p < 0.05), after controlling for age, gender, the main effects of headache duration, and depression. We did not find anxiety to be a moderating factor between intensity, frequency or duration of headache and perceived quality of life. Anxiety exerts a mediating effect, conditioning the relationship between headache frequency and some quality of life domains; depression seems to play an inherent role in the reduced quality of life of these patients, that is, it has a moderating effect.

Beneficial effects of spa treatment on functional status and quality of life of patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic constantly deteriorating disease of unpredictable clinical course, with exacerbations, remissions and damaged joints. It leads to the loss of self-sufficiency, independence in performing many daily activities, decrease of working ability and invalidity. Beside physical factors, which are regarded as most responsible for the poorer quality of life of RA patients, psychological changes are also significant, such as the feeling of helplessness, hopelessness and depression. The goal of the treatment of patients with RA is to decrease illness symptoms, slow down the development of illness progression, improvement of physical functioning and provision of expert help to the RA patients to adapt to life. The aim of the study was to assess the influence of spa therapy on the functional condition and life quality of RA patients. The study involved 69 patients with RA (51 female and 18 male, on average aged 55.2 +/- 11.4 years, with illness duration 12.5 +/- 7.5 years), and were a part of a cohort from Norway, suffering of inflammatory rheumatism. All the patients came for four-week rehabilitation at the Institute for Physical Medicine, Rehabilitation and Rheumatology "Dr. Simo Milosević" in Igalo, Montenegro. The RA patients underwent treatment with mud compresses, mud, mineral and pearl baths, as well as with underwater shower massage (balneotherapy) kinesitherapy and certain forms of electrotherapy with analgesic effects. The evaluation was done on admission and after completed physical therapy when we assessed RA patients' functional condition and quality of life. The functional condition was determined using the Modified Health Assessment Questionnaire (MHAQ), and the quality of life using the Medical Outcomes Study Short Form 36-item Questionnaire (SF-36), which encompassed eight life domains. After completion of 28-dayspa therapy, RA patients showed a significant improvement in functional condition. Their quality of life was significantly improved in all dimensions of SF-36 Questionnaire (p < 0.01), and the functional status (MHAQ score) was also significantly better (p < 0.01). Balneotherapy, together with climatic factors in Igalo, leads to a significant improvement of functional status and quality of life in patients suffering from RA.

An exploration of the relationship between fatigue and physical functioning in patients with end stage renal disease receiving haemodialysis

To measure fatigue and physical functioning in patients with end stage renal disease (ESRD) receiving haemodialysis and to investigate the relationships between fatigue and physical functioning. Fatigue and reduced physical functioning are among the most bothersome symptoms experienced by individuals receiving haemodialysis for ESRD. Research has shown that increasing activity levels has resulted in decreased fatigue levels and improved physical functioning in individuals with cancer. Establishing whether or not a relationship exists between both concepts in haemodialysis patients is a preliminary step in identifying potential fatigue reducing strategies necessary for improved wellbeing. A quantitative exploratory correlational design was used with 46 individuals completing the Multi-dimensional Fatigue Inventory, the Medical Outcomes Study Short-Form 36-item questionnaire and a Demographic Questionnaire. Results indicated fatigue was prevalent with highest scores achieved for physical fatigue; reduced activity and general fatigue. Substantial limitations in physical functioning were found. A significant moderate negative relationship between general fatigue and physical functioning indicated that, as physical functioning levels increased, fatigue levels decreased. A significant difference was also found between general fatigue scores for males and females. Significant relationships were found between overall physical functioning, older age and employment status. The research indicates the prevalence of fatigue and limitations in physical functioning in individuals with ESRD. However, as physical functioning increased fatigue decreased; a finding relevant to clinical nursing. Understanding the levels of fatigue and the value of exercise is of relevance to clinical practice thus assessment of fatigue and physical functioning ability in the clinical setting is necessary.

Neoplastic pulmonary lymphangitis: Symptomatic treatment and quality-of-life evaluation in a prospective palliative care series

19536 Background: Neoplastic lymphangitis, or lymphangitis carcinomatosa, is a rare and distressing form of lung metastasis, for which symptom improvement is strongly necessary. Since measuring quality of life is an important step toward improving symptom management in cancer patients, and dyspnea in pulmonary lymphangitis is a complex syndrome in end-of-life care, we focused on evaluating a cohort of those individuals. Methods: 52 consecutive patients with neoplastic pulmonary lymphangitis (NPL) were prospectivelly followed in 3 services, with quality of life (QoL) evaluation also, using Medical Outcomes Study 36-item Short-Form Health Survey (SF- 36) and Saint George's Respiratory Questionnaire (SGRQ). Results: 65% (34) of patients were female; age ranged from 37 to 84 years (median: 60). Primary tumor sites were: 28 lung (54%), 18 breast (35%), 5 digestive (9%) and 1 bone cancer. Histological findings were of adenocarcinoma in most cases (71%). Karnofsky performance scale ranged from 10 to 90% (median: 60%); 52% (27) patients had other comorbidities (Charlson index ranged from 6–10; median 7); 48% (25) were previous smokers; hemoglobin levels ranged from 4.9 to 16.7 g/dL (median: 12). We also evaluated 33 patients with echocardiography, and 13 (43%) of them had signs of associated pulmonary hypertension; ejection fraction ranged from 46 to 83% (median: 69%); diastolic dysfunction was present in 22 and pericardial effusion in 10 patients. At accrual, median QoL scores were of: 32% (range: 0–84%) for SF-36 (scale with 0 worst) and 66% (range: 0–100%) for SGRQ (scale with 100% worst). Treatment is showed in a table below. Median survival was of 4 months (range: 0.2–40+ months); 22 (42%) of the patients had an unusual longer survival of more than 6 months, still showing good QoL scores. Conclusions: Despite the fact that QoL is generally poor and survival is short for patients with NPL, some patients may have longer survival time and some improvement is possible with active palliative care. [Table: see text] No significant financial relationships to disclose.

Stroke: A Randomized Trial of Exercise or Relaxation

To determine the feasibility and effect of exercise training after stroke. Randomized exploratory trial comparing exercise training (including progressive endurance and resistance training) with relaxation (attention control). Interventions were performed in a rehabilitation hospital. Sixty-six independently ambulatory patients (mean age 72, 36 men) without significant dysphasia, confusion, or medical contraindications to exercise training who had completed their usual rehabilitation and had been discharged from hospital. Both interventions were held three times a week for 12 weeks. Up to seven patients attended each session. The Functional Independence Measure; Nottingham Extended Activities of Daily Living; Rivermead Mobility Index; functional reach; sit-to-stand; elderly mobility score; timed up-and-go; Medical Outcomes Study 36-Item Short Form Questionnaire, version 2 (SF-36); Hospital Anxiety and Depression Score; aspects of physical fitness (comfortable walking speed, walking economy, and explosive leg extensor power) were measured at baseline, immediately after interventions (3 months), and 7 months after baseline. The median number of intervention sessions attended was 36 (interquartile range (IQR) 30.00-36.75) for exercise and 36 (IQR 30.50-37.00) for relaxation. Adherence to the individual exercises ranged from 94% to 99%. At 3 months, role-physical (an item in SF-36), timed up-and-go, and walking economy were significantly better in the exercise group (analysis of covariance). At 7 months, role-physical was the only significant difference between groups. Exercise training for ambulatory stroke patients was feasible and led to significantly greater benefits in aspects of physical function and perceived effect of physical health on daily life.

Endoscopic versus Surgical Drainage of the Pancreatic Duct in Chronic Pancreatitis

For patients with chronic pancreatitis and a dilated pancreatic duct, ductal decompression is recommended. We conducted a randomized trial to compare endoscopic and surgical drainage of the pancreatic duct. All symptomatic patients with chronic pancreatitis and a distal obstruction of the pancreatic duct but without an inflammatory mass were eligible for the study. We randomly assigned patients to undergo endoscopic transampullary drainage of the pancreatic duct or operative pancreaticojejunostomy. The primary end point was the average Izbicki pain score during 2 years of follow-up. The secondary end points were pain relief at the end of follow-up, physical and mental health, morbidity, mortality, length of hospital stay, number of procedures undergone, and changes in pancreatic function. Thirty-nine patients underwent randomization: 19 to endoscopic treatment (16 of whom underwent lithotripsy) and 20 to operative pancreaticojejunostomy. During the 24 months of follow-up, patients who underwent surgery, as compared with those who were treated endoscopically, had lower Izbicki pain scores (25 vs. 51, P<0.001) and better physical health summary scores on the Medical Outcomes Study 36-Item Short-Form General Health Survey questionnaire (P=0.003). At the end of follow-up, complete or partial pain relief was achieved in 32% of patients assigned to endoscopic drainage as compared with 75% of patients assigned to surgical drainage (P=0.007). Rates of complications, length of hospital stay, and changes in pancreatic function were similar in the two treatment groups, but patients receiving endoscopic treatment required more procedures than did patients in the surgery group (a median of eight vs. three, P<0.001). Surgical drainage of the pancreatic duct was more effective than endoscopic treatment in patients with obstruction of the pancreatic duct due to chronic pancreatitis. (Current Controlled Trials number, ISRCTN04572410 [controlled-trials.com].).

Quality of Life of Family Caregivers of Elderly Patients on Hemodialysis and Peritoneal Dialysis

Despite the growing number of elderly patients with end-stage renal disease who need support, there are few studies about their caregivers. The objective of this study is to describe caregivers' characteristics and evaluate their burden and quality of life. We studied caregivers of elderly patients (>or=65 years) on hemodialysis (HD) therapy (n = 84), on peritoneal dialysis (PD) therapy (n = 40), and a group of caregivers (n = 77) of nonelderly HD patients. Their quality of life was evaluated by using the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire, Caregiver Burden scale, and Cognitive Index of Depression. Most caregivers of the elderly were women (78%) aged 55 +/- 15 years and sons or daughters (41%) or wives or husbands (50%) of patients. Caregivers' Emotional Aspect, Vitality, and Mental Health were the most affected dimensions. The Mental Component Summary mean score, adjusted for patient race, educational level, primary diagnosis, hematocrit, comorbidities, and physical functional status, was worse for caregivers of PD than HD elderly patients (36.3 +/- 1.9 versus 44.8 +/- 1.5; P < 0.01). The most affected Caregiver Burden scale dimensions were General Strain and Environment. Thirty-two percent of caregivers showed signs of depression. Caregivers of elderly dialysis patients, especially of those on PD therapy, experience a significant burden and adverse effects on their quality of life. Educational, social, and psychological support interventions should be considered to improve the quality of life of caregivers.