Substantial Improvement In Quality Of Life Research Articles

Associations between pain, function and quality of life after total hip arthroplasty

ObjectivesThis study investigated patient reported outcomes, and associations with improvement in quality of life 12-months after total hip arthroplasty (THA). Materials and MethodsParticipants were adults (n = 433) undergoing THA for osteoarthritis between January 2017 and October 2020 in a large publicly funded tertiary hospital in [country]. Participants completed patient reported outcome measures of pain, function and quality of life (QOL) preoperatively, 6- and 12-months following THA. ResultsClinically significant changes in domains of pain and function were associated with improved QOL, even when pre-operation scores were controlled for. The largest gains in all three domains occurred in the pre- to 6-month post-operation period. Baseline demographic variables such as gender and comorbidities were not associated with change in QOL pre- to post-operation. However, although modest, age at surgery was negatively correlated with change in QOL. ConclusionsTHA contributes to substantial improvements in QOL, pain and function outcomes, and although possibly tempered by age, these relationships are likely to be inter-related and mutually reinforcing. Future QOL outcomes research should also consider the impacts on QOL improvement of other aspects of functioning such as psychological and social wellbeing.

Impact of Catheter Ablation on Quality of Life and Healthcare Utilisation.

Impairment of quality of life (QoL) is a well-known complication of AF. Because of the association of AF with older age and many other cardiovascular comorbidities, there are multiple factors that could influence QoL score even after successful AF intervention. However, substantial improvement in QoL has been reported following catheter ablation for AF regardless of ablation outcomes. In terms of healthcare resource utilisation, the expenses associated with AF are very high because of the hospitalisations for AF-related thromboembolic complications, aggravation of heart failure, AF interventions, and emergency room visits for incessant arrhythmia episodes, and they represent a large economic burden worldwide. Several trials have shown a drastic reduction in healthcare costs following successful AF ablation. In this review, the authors discuss this evidence systematically.

Effectiveness of Integrated Palliative and Oncology Care for Patients With Acute Myeloid Leukemia

Patients with acute myeloid leukemia (AML) receiving intensive chemotherapy experience substantial decline in their quality of life (QOL) and mood during their hospitalization for induction chemotherapy and often receive aggressive care at the end of life (EOL). However, the role of specialty palliative care for improving the QOL and care for this population is currently unknown. To assess the effect of integrated palliative and oncology care (IPC) on patient-reported and EOL outcomes in patients with AML. We conducted a multisite randomized clinical trial of IPC (n = 86) vs usual care (UC) (n = 74) for patients with AML undergoing intensive chemotherapy. Data were collected from January 2017 through July 2019 at 4 tertiary care academic hospitals in the United States. Patients assigned to IPC were seen by palliative care clinicians at least twice per week during their initial and subsequent hospitalizations. Patients completed the 44-item Functional Assessment of Cancer Therapy-Leukemia scale (score range, 0-176) to assess QOL; the 14-item Hospital Anxiety and Depression Scale (HADS), with subscales assessing symptoms of anxiety and depression (score range, 0-21); and the PTSD Checklist-Civilian version to assess posttraumatic stress disorder (PTSD) symptoms (score range, 17-85) at baseline and weeks 2, 4, 12, and 24. The primary end point was QOL at week 2. We used analysis of covariance adjusting and mixed linear effect models to evaluate patient-reported outcomes. We used Fisher exact test to compare patient-reported discussion of EOL care preferences and receipt of chemotherapy in the last 30 days of life. Of 235 eligible patients, 160 (68.1%) were enrolled; of the 160 participants, the median (range) age was 64.4 (19.7-80.1) years, and 64 (40.0%) were women. Compared with those receiving UC, IPC participants reported better QOL (adjusted mean score, 107.59 vs 116.45; P = .04), and lower depression (adjusted mean score, 7.20 vs 5.68; P = .02), anxiety (adjusted mean score, 5.94 vs 4.53; P = .02), and PTSD symptoms (adjusted mean score, 31.69 vs 27.79; P = .01) at week 2. Intervention effects were sustained to week 24 for QOL (β, 2.35; 95% CI, 0.02-4.68; P = .048), depression (β, -0.42; 95% CI, -0.82 to -0.02; P = .04), anxiety (β, -0.38; 95% CI, -0.75 to -0.01; P = .04), and PTSD symptoms (β, -1.43; 95% CI, -2.34 to -0.54; P = .002). Among patients who died, those receiving IPC were more likely than those receiving UC to report discussing EOL care preferences (21 of 28 [75.0%] vs 12 of 30 [40.0%]; P = .01) and less likely to receive chemotherapy near EOL (15 of 43 [34.9%] vs 27 of 41 [65.9%]; P = .01). In this randomized clinical trial of patients with AML, IPC led to substantial improvements in QOL, psychological distress, and EOL care. Palliative care should be considered a new standard of care for patients with AML. ClinicalTrials.gov Identifier: NCT02975869.

Biopsychosocial variations in quality of life outcome following microdiscectomy.

Background: Lumbar microdiscectomy is one of the most frequently performed neurosurgical procedures. In this review, we ask why patients’ outcomes vary so widely even within the same unit, with the same surgeon performing the procedure and utilizing the technique?Methods: In a cohort of 87 patients, we investigated how/whether multiple patient variables impacted outcomes following single-level lumbar microdiscectomy. We studied whether early surgical intervention improved the patients’ quality of life (QOL) versus late intervention. Furthermore, we assessed other variables that could influence patient-perceived improvement. Preoperatively and postoperatively, we additionally utilized the following internationally standardized questionnaires (EQ-5D, Oswestry, and Core Outcome Measures Index [COMI]).Results: A generalized substantial improvement in QOL was identified throughout the cohort population (<0.05). There was no difference in health measurement scores for those undergoing early versus late surgery. However, there was a statistically significant improvement in all QOL scores for privately insured patients versus publicly insured patients (e.g., on COMI, EQ-5D, and ODI Scores).Conclusion: There was no objective statistically significant difference in QOL health scores between patients undergoing early versus late surgical lumbar microdiscectomy. This would suggest that the length of time patients is symptomatic before surgery did not significantly impact postoperative outcome. Of interest, however, was the difference in QOL health scores for private versus public patients suggesting that there are more subjective, complex, and psychosocial issues that influence outcome.

The Impact of Laparoscopic Gastric Bypass on Comorbidities and Quality of Life in the Older Obese Patients (Age &gt; 60): Our UK Experience

With population ageing, more older patients would benefit from the reduced comorbidities associated with laparoscopic Roux-en-Y gastric bypass (LRYGB). However, health care providers are still reluctant to offer bariatric surgery to older obese patients due to the perceived increased risk and possible reduced benefit. Here, we report the outcomes of first UK series of LRYGB in patients (> 60years) with emphasis on quality of life (QoL). University hospital. Data was collected prospectively on all patients aged > 60years undergoing LRYGB between 2006 and 2011. Patients had a minimum 1-year follow-up. Data related to weight loss, peri-operative complications and obesity-related morbidity (ORM) was collected. Patients' QoL was assessed by postal questionnaire. Forty-six patients with a median age of 63 (60-71) underwent LRYGB with a median follow-up of 23 (12-55) months. There was a significant drop in patients' BMI [mean (SD) 47.5 (6.2) to 31.2 (4.4) kg/m2]. Patients had an average 69% (SD 17%) excess weight loss and 34% (SD 10%) total body weight loss. The median hospital stay was 3 (1-16) with 13% peri-operative morbidity and no mortality. There was a 25% (30/123) resolution and 54% (66/123) 'improvement' in ORM. The QoL score increased significantly in several domains particularly physical performance (2.8 to 8.0, p < 0.001), self-esteem (3.6 to 8.3, p < 0.001) and mobility (2.9 to 7.5, p < 0.001). LRYGB in patients aged > 60years can be performed safely and with weight loss comparable to younger patients. There is associated benefit in reducing ORM and substantial improvement in QoL.

Levothyroxine/Liothyronine Combination Therapy and Quality of Life: Is It All about Weight Loss?

Objectives: According to one hypothesis, the popularity of levothyroxine (L-T₄)/liothyronine (L-T₃) combination therapy relates to weight loss. The purpose of this study was to detect a possible correlation between thyroid-related quality of life (QoL) and weight loss in hypothyroid patients switched from L-T₄ monotherapy to L-T₄/L-T₃ combination therapy. Methods: In an open-label cohort study, all hypothyroid patients referred to the University Hospital endocrine clinic due to persistent symptoms despite adequate L-T₄ monotherapy (without other explanations for the symptoms) were switched from L-T₄ monotherapy to L-T₄/ L-T₃ combination therapy at a ratio of approximately 17/1. At baseline and after 3 months of treatment we measured: QoL by the Thyroid Patient-Reported Outcome (ThyPRO-39) questionnaire, thyroid hormones, body weight, body composition by a DEXA-scan, and cognitive function by evaluating participants’ reaction time as well as working memory by the California Computerized Assessment Package (CalCAP®). QoL was re-evaluated after 12 months. Results: Twenty-three patients participated (91% women, median age 47 years). The ThyPRO-39 composite score decreased from a median of 54 (quartiles: 34, 74) to 15 (11, 28) after 3 months (p < 0.0001), and 20 (14, 26) after 12 months, indicating a better QoL. There was no change in body weight, and no correlations between QoL and weight. There was a slight improvement in cognitive function, whereas body composition, heart rate, and serum TSH did not change. Conclusion: Our study on hypothyroid patients switched from L-T₄ monotherapy to L-T₄/L-T₃ combination therapy showed a substantial improvement in QoL measured by the ThyPRO-39. This improvement could not be explained by weight loss.

Effect of SAPIEN 3 Transcatheter Valve Implantation on Health Status in Patients With Severe Aortic Stenosis at Intermediate Surgical Risk: Results From the PARTNER S3i Trial

ObjectivesThe aim of this study was to evaluate whether transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve (S3-TAVR) results in improved quality of life (QoL) compared with previous-generation TAVR devices or surgical aortic valve replacement (SAVR). BackgroundIn patients with severe aortic stenosis at intermediate surgical risk, TAVR using the SAPIEN XT valve (XT-TAVR) results in similar QoL compared with SAVR. Compared with SAPIEN XT, the SAPIEN 3 valve offers a lower delivery profile and modifications to reduce paravalvular regurgitation. MethodsBetween February and December 2014, 1,078 patients at intermediate surgical risk with severe aortic stenosis were treated with S3-TAVR in the PARTNER S3i (Placement of Aortic Transcatheter Valve) trial. QoL was assessed at baseline, 1 month, and 1 year using the Kansas City Cardiomyopathy Questionnaire, Medical Outcomes Study Short Form-36, and EQ-5D. QoL outcomes of S3-TAVR patients were compared with those in the SAVR and XT-TAVR arms of the PARTNER 2A trial using propensity score stratification to adjust for differences between the treatment groups. ResultsOver 1 year, S3-TAVR was associated with substantial improvements in QoL compared with baseline. At 1 month, S3-TAVR was associated with better QoL than either SAVR or XT-TAVR (adjusted differences in Kansas City Cardiomyopathy Questionnaire overall summary score 15.6 and 3.7 points, respectively; p < 0.001). At 1 year, the differences in QoL between S3-TAVR and both SAVR and XT-TAVR were reduced but remained statistically significant (adjusted differences 2.0 and 2.2 points, respectively; p < 0.05). Similar results were seen for generic QoL outcomes. ConclusionsAmong patients at intermediate surgical risk with severe aortic stenosis, S3-TAVR resulted in improved QoL at both 1 month and 1 year compared with both XT-TAVR and SAVR.

Use of Dr. Tan's Chinese Balance Acupuncture for Treatment of Chronic Neck–Shoulder Pain

Abstract Introduction: Neck–shoulder pain is a common musculoskeletal problem that is often chronic or recurrent. The mechanism of the neck–shoulder pain musculoskeletal disorder is complicated, multifactorial, and sometimes unclear. Cases: Seven patients presented at an outpatient pain clinic, each with a chief complaint of chronic neck–shoulder pain that these patients had had for various time periods. Intervention: The patients were treated with 45-minute sessions of Chinese Balance Acupuncture per the protocol of Richard Teh-Fu Tan, OMD, LAc. Main Outcome Measures: Pain intensity, pain duration, and quality of life (QoL) were measured during the treatment period, and the QoL was measured during the 3-month follow-up after three acupuncture sessions. Results: After the third session (1.5 weeks after the beginning of treatment), the patients reported complete dissipation of pain or significant reductions in pain intensity. There was also substantial improvement in QoL during the treatment period and dur...

Carbon dioxide laser treatment for Hailey-Hailey disease: a retrospective chart review with patient-reported outcomes.

Hailey-Hailey disease (HHD) is an autosomal dominant genodermatosis that leads to skin breakdown and blister formation, usually in intertriginous areas. Laser ablation is a known surgical treatment for HHD. We report outcomes in a series of patients with HHD treated with carbon dioxide (CO2 ) laser ablation. A retrospective chart review of data for 13 patients who underwent CO2 laser ablation for HHD was conducted. Questionnaires assessing effectiveness, pain, healing time, recurrence, new disease, complications, additional ablation, improvement in quality of life (QoL), and overall satisfaction were completed by all patients. All patients had been recalcitrant to previous treatments prior to CO2 laser ablation. Anatomic sites treated and anesthesia techniques for the procedure varied. The mean ± standard deviation (SD) score for the effectiveness of CO2 laser ablation for HHD was 9.3 ± 0.9 (maximum: 10). All patients reported improved QoL. No patient had recurring disease within the treatment field. Five patients underwent additional CO2 laser treatments at new sites. One patient reported postoperative infection. No other complications were identified. The mean ± SD score for overall satisfaction with CO2 laser ablation was 8.9 ± 1.1. Treatment with CO2 laser ablation is very effective and can lead to prolonged or permanent remission in most HHD patients. Patients are highly satisfied with the results and report a substantial improvement in QoL.

Changes in Quality of Life after 3 months of Usual Care in a Large Sample of Patients with Noncancer Pain: The "QOOL: Quality of Life and Pain" Study.

Large-scale observational studies can provide useful information on changes in health outcomes over time. The aim of this study was to investigate the effect of 3 months of usual care on quality of life (QOL) and pain outcomes in noncancer chronic pain patients managed by pain specialists and to examine factors associated with changes in QOL. This was assessed using the EQ-5D and pain outcomes using the Brief Pain Inventory (BPI). Changes in QOL and pain were studied for the overall sample and in subgroups defined by baseline pain severity. Multivariate regression was used to investigate factors associated with change on EQ-5D. Three thousand and twenty-nine patients were included for analysis. After 3 months of usual care, a mean of 40.9% of patients showed improvement on individual EQ-5D dimensions, with the highest rates of improvement seen on the pain/discomfort (50.8%) and anxiety/depression (48.3%) dimensions. The EQ-5D Index increased from a mean (SD) of 0.35 (0.2) to 0.58 (0.21) points between baseline and month 3, and the thermometer from 41.5 (19.4) to 58.7 (17.8), indicating a large effect. Improvements in QOL were larger in those with severe baseline pain. The BPI severity summary score improved from a mean (SD) of 6.5 (1.4) to 4.1 (1.7) and the interference summary score from 6.6 (1.5) to 4.2 (1.9). Changes on the BPI severity and interference scores were associated with changes in the EQ-5D Index and thermometer. In conclusion, 3 months of usual care in noncancer pain patients led to substantial improvements in QOL and pain outcomes.

Specialized Pediatric Palliative Home Care: A Prospective Evaluation

In Germany since 2007 children with advanced life-limiting diseases are eligible for Pediatric Palliative Home Care (PPHC), which is provided by newly established specialized PPHC teams. The objective of this study was to evaluate the acceptance and effectiveness of PPHC as perceived by the parents. Parents of children treated by the PPHC team based at the Munich University Hospital were eligible for this prospective nonrandomized study. The main topics of the two surveys (before and after involvement of the PPHC team) were the assessment of symptom control and quality of life (QoL) in children; and the parents' satisfaction with care, burden of patient care (Häusliche Pflegeskala, home care scale, HPS), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), and QoL (Quality of Life in Life-Threatening Illness-Family Carer Version, QOLLTI-F). Of 43 families newly admitted to PPHC between April 2011 and June 2012, 40 were included in the study. The median interval between the first and second interview was 8.0 weeks. The involvement of the PPHC team led to a significant improvement of children's symptoms and QoL (P<0.001) as perceived by the parents; and the parents' own QoL and burden relief significantly increased (QOLLTI-F, P<0.001; 7-point change on a 10-point scale), while their psychological distress and burden significantly decreased (HADS, P<0.001; HPS, P<0.001). The involvement of specialized PPHC appears to lead to a substantial improvement in QoL of children and their parents, as experienced by the parents, and to lower the burden of home care for the parents of severely ill children.

Telephone‐delivered health education and interpersonal counseling improve quality of life for Latinas with breast cancer and their supportive partners

This study aims to test two telephone-delivered interventions for their efficacy in improving quality of life (QOL) (psychological, physical, social, and spiritual) among Latinas with breast cancer and their family members or friends (labeled supportive partners in this study). Latinas with breast cancer and their supportive partners (SPs) were randomly assigned to one of two telephone delivered 8-week interventions: (i) telephone interpersonal counseling (TIP-C) or (ii) telephone health education (THE). QOL assessments were made at baseline, immediately after the 8-week interventions ended, and at an 8-week follow-up. Seventy Latinas and their 70 SPs completed all assessments (36 in health education and 34 in counseling) and were included in the final analysis. Both Latinas with breast cancer and their SPs had significant improvements in virtually all dimensions of QOL over the 16 weeks of the investigation. However, there was no evidence documenting the superiority of either intervention for improving QOL. Preliminary cost analysis found that the counseling intervention cost about $164.68 for one dyad compared with $107.03 for health education. The majority of participants reported benefit from the intervention and liked that the intervention was in Spanish, included SPs, and was delivered by telephone. The results of this study show that relatively brief, culturally appropriate, and highly accessible telephone-delivered interventions that provide emotional and information support can bring about substantial improvements in QOL for both Latinas with breast cancer and their SPs.

Is Nephrology More at Ease Than Oncology with Erythropoiesis-Stimulating Agents? Treatment Guidelines and an Update on Benefits and Risks

Erythropoiesis-stimulating agents (ESAs), which promote RBC production, have been extensively used to reduce transfusion requirements and improve quality of life (QoL) in both cancer patients and those with chronic kidney disease (CKD). However, the likelihood of response and duration of treatment differ in the two settings. In renal anemia, ESAs act straightforwardly as hormone-replacement therapy. The anemia of cancer, however, relates not to a lack of endogenous erythropoietin production but to diverse aspects of the disease (including a relevant inflammatory component) and chemotherapy. Response to ESAs is slower and less certain than in nephrology. In both settings, early studies showed that reversal of severe anemia was accompanied by substantial improvement in QoL. However, again in both settings, subsequent studies indicated that efforts to normalize hemoglobin might worsen outcome. In the context of cancer, this concern was reinforced by the suggestion that malignant cells had erythropoietin receptors and that its administration might therefore accelerate tumor growth, and moreover that cancer patients are more susceptible to venous thrombosis. The absence of these concerns for nephrologists, and their greater experience in managing ESAs and patients' iron status, may make them more at ease with ESAs than their counterparts in oncology. However, both groups of specialists have had to deal with reversals in recommended thresholds for intervention and restrictions imposed by regulatory authorities. In both specialties, the broad consensus now emerging is that the optimum balance of benefits and risks lies in using ESAs aimed at a hemoglobin level in the range of 11-12 g/dl, although for CKD patients there is still room for an individualized approach.

Predictors of early quality-of-life improvement after laparoscopic gastric bypass surgery

Background Quality of life is getting more attention in the medical literature. Treatment outcomes are now gauged by their effect on quality of life (QOL), along with their direct effect on diseases they are targeting. Similarly, in obesity, consensus has been reached on the importance of QOL as an independent outcome measure for obesity surgery along with weight loss and comorbidity. Therefore, the aim of this study was to assess the impact of patient demographics and comorbidities on short-term QOL improvement after laparoscopic gastric bypass (LGB) surgery. Methods The change in QOL after LGB was assessed in 171 patients (147 women, 24 men; mean age, 43.1 y) using the Short-Form-36 (SF-36) questionnaire. Multivariate logistic regression analysis was used to identify patients’ demographics and comorbidities predictive of major QOL improvement. Results Body mass index decreased significantly at 3 months (48.5 ± 5.8 to 38.4 ± 5.4 kg/m 2; P < .001) with excess weight loss of 37.4% ± 9.2%. The SF-36 follow-up evaluation showed significant improvement (44.2 ± 15.7 to 78.6 ± 15.5; P < .001). A significant inverse correlation was found between QOL (before and after bypass) and the number of comorbidities ( r = .29, P = .001; R = .22, P = .005; respectively), but the magnitude of QOL change did not correlate with the number of comorbidities ( P = .5). When the entire cohort of patients was dichotomized according to their magnitude of change in SF-36 scores, the univariate analysis showed that the group of patients with no improvement or minor improvement in their SF-36 was characterized by a higher percentage of male sex and a lower prevalence of diabetes. These 2 preoperative factors remained statistically significant in the multivariate analysis. Preoperative diagnosis of type 2 diabetes increased the likelihood of major improvement in QOL after LGB by 6.2 times, whereas being a woman increased this likelihood by 16.1 times. Conclusions Significant weight loss was achieved as early as 3 months after LGB, causing substantial improvement in QOL in more than 95% of patients. Women with type 2 diabetes have the highest odds to achieve a major QOL improvement after LGB and therefore they should represent the ideal target population for surgical weight loss programs.

The Impact of Therapy on Quality of Life and Mood in Neuropathic Pain: What Is the Effect of Pain Reduction?

Mood and quality of life (QOL) outcomes vary widely in neuropathic pain trials. This may be a result of variable analgesia and other treatment effects. We evaluated the relationship between pain reduction and mood/QOL in neuropathic pain. Pain, side effects, QOL, and mood from a trial of morphine, gabapentin, and a morphine-gabapentin combination were examined. Baseline QOL was impaired according to Short Form Health Survey (SF-36) scores. Baseline mood, according to Profile of Mood States scores, was comparable to that of a nondepressed population. Pain reduction with all three active trial treatments correlated with improved QOL. Pain reduction with morphine and with gabapentin correlated with improved mood. Pain reduction with a morphine-gabapentin combination correlated with improvement in only one of several domains of the Profile of Mood States. Severity of sedation, constipation, and dry mouth during any treatment did not correlate with mood/QOL changes. These results can be interpreted to imply that larger analgesic treatment effect sizes lead to more substantial improvements in QOL and/or mood. However, other beneficial or adverse treatment-related side effects may also affect mood/QOL. Therefore, future studies are needed to also evaluate the impact of treatment-related side effects on mood/QOL in analgesic trials.

The Effect of a Psychosocial Intervention and Quality of Life After Acute Myocardial Infarction

The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) clinical trial was designed to test whether intervening on depression or low perceived social support reduces mortality and reinfarction in patients with acute myocardial infarction (MI). This report analyzes the effect of the intervention on quality of life (QOL), which was an important secondary outcome. ENRICHD was a randomized controlled clinical trial comparing a psychosocial intervention based on cognitive behavioral therapy to usual medical care in 2,481 patients from 8 clinical centers. Patients with acute MI were included if they met criteria for depression, low perceived social support, or both. QOL was assessed at the 6-month clinic visit in the first 1,296 patients. QOL measures included the Medical Outcomes Study Short Form summary measures of physical functioning (SF12-PCS) and mental functioning (SF12-MCS), a Life Satisfaction Scale (LSS), and a measure of overall QOL based on the ladder of life (LOL) technique. There were significant treatment differences on the SF12-MCS (difference 2.2, 95% confidence interval [CI] 1.2-3.2), the LSS (difference 1.0, 95% CI 0.5-1.5), and the LOL (difference 0.3, 95% CI 0.1-0.6), but not on the SF12-PCS (difference 0.8; 95% CI = -0.5-2.0). Effect sizes for the intervention on QOL outcomes were modest. Psychosocial interventions of limited duration confer modest QOL benefits in post-MI patients who are depressed or have low perceived social support. Interventions of longer duration or greater intensity may be required to produce more substantial improvements in QOL in these patients.

Predictors for quality of life improvement after laparoscopic gastric bypass (LGB)

Abstract Introduction: This study assesses impact of patient demographics and co-morbidities on quality of life (QOL) improvement after LGB. Methods: 279 LGB were performed between 11/2000 and 2/2004. Quality of life (QOL) follow-up was completed in 162 patients (142 female, 20 male; mean age 42 yrs.) using Short-Form-36 (SF-36). Using multivariate linear regression analysis, patients' demographics and co-morbidities were run against SF-36 change to look for predictors of major QOL improvement. Results: Body Mass Index (BMI) decreased significantly at 3-months (48 ± 5 to 38 ± 5, P Conclusions: Significant weight loss is achieved as early as 3 months after LGB causing substantial improvement in QOL in more than 95% of patients. This occurs regardless of patient age, sex, race, or comorbidities.

Efficacy and Acceptability of Tadenan®(Pygeum africanum Extract) in the Treatment of Benign Prostatic Hyperplasia (BPH): A Multicentre Trial in Central Europe

SummaryPygeum africanum extract is available as Tadenan ® in many countries, including those in central and eastern Europe, for the treatment of mild to moderate BPH. Its efficacy and acceptability have been demonstrated in numerous open and placebo-controlled studies in large populations. The present open three-centre efficacy and safety study was conducted according to common protocol at urology clinics in the Czech and Slovak Republics and in Poland, in order to confirm the therapeutic profile o/Pygeum africanum in conditions of daily practice, using International Prostate Symptom Score (IPSS) andflowmetry assessments.Men aged 50-75 years and in compliance with the selection criteria (including IPSS ≥ 12, quality of life (QoL) score ≥ 3, and maximum urinary flow ≤ 15 mils) were first examined then recalled after two weeks during which no treatment was provided (washout and check of stability). If still compliant, they were entered at this point into a two-month period of treatment with Pygeum africanum extract 50 mg twice daily. There followed a further one-month period without treatment, the objective being to evaluate the persistence of any effects observed during the previous two months of Pygeum africanum administration.The primary efficacy parameter investigated was IPSS; the other efficacy parameters were QoL, nocturnal frequency, maximum urinary flow, average urinary flow, post-voiding residual volume and prostatic volume, after one and two months of Pygeum africanum treatment and one month after stopping treatment. A total of 85 patients were evenly distributed between the three centres and completed the entire study. At inclusion their mean IPSS was 16.17, QoL was 3.60 and nocturia was 2.6 times per night.The changes in subjective scores, IPSS and QoL after the two-month treatment period were highly statistically significant with mean improvements of 40% and 31 %, respectively. Nocturnal frequency was reduced by 32% and the mean reduction was again highly statistically significant. Mean maximum urinary flow, average urinary flow and urine volume were also statistically significantly improved, but the modest improvement in post-voiding volume did not reach statistical significance. The improvements, which exceeded those observed with placebo in earlier studies, were maintained after one month without treatment indicating an interesting persistence of clinically useful activity. Prostatic volume and quality of sexual life remained unchanged throughout. No treatment-related adverse effects were observed.In conclusion, under conditions of daily practice, Pygeum africanum extract induces significant improvement in IPSS and uroflowmetry parameters. These positive effects are accompanied by a very satisfactory safety profile with the overall result of a substantial improvement in QoL.

Measuring outcome in low-priority plastic surgery patients using quality of life indices

292 patients with a variety of low-priority conditions completed the Health Measurement Questionnaire self-report instrument (HMQ) on admission for surgery, and again 6 months post-operation. Comparison of the two questionnaires permitted the change in Quality of Life (QoL) to be measured. Overall, of the respondents, 73% gained benefit from surgery in terms of improvement in QoL. The largest gains were in the breast surgery group, but there were individual patients in all groups who gained substantial improvement in QoL. The results suggest that the HMQ is a useful method of measuring benefit in patients admitted for low priority plastic surgery procedures.

Measuring outcome in low-priority plastic surgery patients using Quality of Life indices

292 patients with a variety of “low-priority” conditions completed the Health Measurement Questionnaire self-report instrument (HMQ) on admission for surgery, and again 6 months post-operation. Comparison of the two questionnaires permitted the change in Quality of Life (QoL) to be measured. Overall, of the respondents, 73% gained benefit from surgery in terms of improvement in QoL. The largest gains were in the breast surgery group, but there were individual patients in all groups who gained substantial improvement in QoL. The results suggest that the HMQ is a useful method of measuring benefit in patients admitted for low priority plastic surgery procedures.