Life Assessment (life + assessment)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Validation of the WHOQOL-BREF among women following childbirth

Background:, There is increasing interest in measuring quality of life (QOL) in clinical settings and in clinical trials. None of the commonly used QOL instruments has been validated for use postnatally. Aim:, To assess the psychometric properties of the 26-item WHOQOL-BREF (short version of the World Health Organization Quality of Life assessment) among women following childbirth. Methods:, Using a prospective cohort design, we recruited 320 women within the first few days of childbirth. At six weeks postpartum, participants were asked to complete the WHOQOL-BREF, the Edinburgh Postnatal Depression Index and the Australian Unity Wellbeing Index. Validation of the WHOQOL-BREF included an analysis of internal consistency, discriminate validity, convergent validity and an examination of the domain structure. Results:, In all, 221 (69.1%) women returned their six-week questionnaire. All domains of the WHOQOL-BREF met reliability standards (alpha coefficient exceeding 0.70). The questionnaire discriminated well between known groups (depressed women and non-depressed women. P , 0.000) and demonstrated satisfactory correlations with the Australian Unity Wellbeing index (r , 0.45). The domain structure of the WHOQOL-BREF was also valid in this population of new mothers, with moderate-to-high correlation between individual items and the domain structure to which the items were originally assigned. Conclusion:, The WHOQOL-BRF is a well-accepted and valid instrument in this population and may be used in postnatal clinical settings or for assessing intervention effects in research studies. [source]

Doppler guided haemorrhoidal arterial ligation with recto-anal-repair (RAR) for the treatment of advanced haemorrhoidal disease

COLORECTAL DISEASE, Issue 10Online 2010
P. Walega
Abstract Objective, A modification of Doppler guided haemorrhoidal artery ligation (DGHAL) to include the addition of recto-anal repair is reported. Preliminary results of function and safety of third and fourth degree haemorrhoidals are given. Method, Thirty patients underwent DGHAL combined with recto-anal-repair (RAR). Each had rectal examination, anorectal manometry and Quality of Life assessment before and 3 months after the procedure. Results, Twenty-nine patients were included in the final analysis. There were three (10.34%) patients of intra-operative and one (3.45%) of postoperative bleeding. Three months after RAR (17.24%) patients with minor residual mucosal prolapse were detected, three (10.34%) patients reported residual symptoms. There was no case of recurrent bleeding. Anal manometry at 3 months after RAR was significantly lower than before the procedure (P < 0.05). One (3.45%) patient reported occasional soiling 3 months after RAR. Conclusion, Recto-anal-repair is safe in treating third and fourth degree haemorrhoids with no major complications and low rate of residual disease. [source]

Health-related quality of life assessment in randomised controlled trials in multiple myeloma: a critical review of methodology and impact on treatment recommendations

Ann Kristin Kvam
Abstract Objectives:, Patients with multiple myeloma (MM) often have pronounced symptoms and substantially reduced quality of life. The aims of treatment are to control disease, maximise quality of life and prolong survival. Hence, health-related quality of life (HRQOL) should be an important end-point in randomised controlled trials (RCTs) in addition to traditional endpoints. We wanted to evaluate whether trials reporting HRQOL outcomes have influenced clinical decision making and whether HRQOL was assessed robustly according to predefined criteria. Methods:, A systematic review identified RCTs in MM with HRQOL assessment as a study end-point. The methodological quality of these studies was assessed according to a checklist developed for evaluating HRQOL outcomes in clinical trials. The impact of the HRQOL results on clinical decision making was assessed, using published clinical guidelines as a reference. Results:, Fifteen publications presenting RCTs with HRQOL as a study end-point were identified. In 13 trials, the author stated that HRQOL results should influence clinical decision making. We found, however, that the HRQOL data only had a limited impact on published treatment guidelines for bisphosphonates, high-dose treatment, interferon, erythropoiesis-stimulating agents and novel agents. Conclusion:, The present review indicates that the there are still few RCTs in MM including HRQOL as a study end-point. Systematic incorporation of HRQOL measures into clinical trials allows for a comparison of treatment arms that includes the patients' perspective. Before the full impact on clinical decisions can be realised, the quality and methodology of collecting HRQOL data must be further improved and the results rendered more comprehensible to clinicians. [source]

Predicting the J integral fracture toughness of Al 6061 using the small punch test

ABSTRACT The 6000 series aluminium alloys (Al,Mg,Si systems) are commonly used as medium-strength structural materials; in particular, the 6061 (Al,1Mg,0.6Si) alloy is widely utilized as a general-purpose structural material due to its excellent formability and corrosion-resisting capabilities. The objective of this study was to obtain a correlation between the small punch (SP) test estimated equivalent fracture strain (,qf) and fracture toughness (J1C) property for 6061 aluminium, and determine its viability as a non-destructive fracture toughness test technique for remaining life assessment of in-service components. Samples of 6061-T6 aluminium were cut from bulk plate, in both the longitudinal and transverse directions, for the as-received condition as well as subjected to three different over-ageing heat-treatment schedules. A strong linear correlation between valid J1C and SP estimated biaxial fracture strain ,qf is presented for aluminium 6061 at room temperature. [source]

Computational prediction of fatigue crack paths in ship structural details

ABSTRACT The characteristics of fatigue crack propagation and the remaining life assessment of ship structures are investigated focusing attention on a curved crack path due to the effects of welds, complicated stress distributions at three-dimensional structural joints and structural redundancy. An advanced numerical simulation method is demonstrated for the remaining life assessment for curved crack propagation. The simulation method is based on a step-by-step finite-element analysis. The crack path is predicted by the perturbation method with the local symmetry criterion, which gives a higher order approximation of the crack path, while the finite-element re-zoning is carried out by an improved paving method. Fatigue crack paths in the welded structural details of the transverse girder of a ship structure are investigated by experiments and simulation. The present method may offer an efficient simulation-based tool for the design of critical details, which prevents the failure of the plates forming a compartment boundary. [source]

A fatigue and creep study in austenitic stainless steel 316L used in exhaust pipes of naval gas turbines

ABSTRACT Exhaust pipes of naval gas turbines are made of thin wall tubing of stainless steel grade AISI 316L. The tubes are fabricated by butt welding of different sections with longitudinal and circumferential joints. The plate thickness is about 4.0 mm, and the working temperature varies between 600 °C and 400 °C in the critical zones of the pipe, in the lower and central areas, respectively. The loadings in the tube induce high-temperature fatigue and creep-fatigue cracks have nucleated and propagated in the tube near some welded joints. The paper presents FCGR data obtained in CT specimens of used material taken from the pipes and tested at RT, 335, 500 and 600 °C. Preliminary creep data obtained in tension, in thin-sheet specimens (about 4 mm thickness), also taken from the conduct wall and tested at 500, 550 and 600 °C are also given. These results are crucial to perform a fatigue-creep interaction life assessment of the critical parts of the structure in the near future. Finally, the paper presents results of research work to investigate carbide precipitation and formation in virgin thin-sheet specimens subjected to several types of thermal exposures. In some cases, 3,4 d was the time interval between exposures. Grain size measurements were carried out together with microstructural observations in the SEM. The influence of time, temperature and time interval between thermal exposures was assessed comparing the microstructures. [source]

A Comparison of Clinically Important Differences in Health-Related Quality of Life for Patients with Chronic Lung Disease, Asthma, or Heart Disease

Kathleen W. Wyrwich
Objective. On the eight scales of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36), Version 2, we compared the clinically important difference (CID) thresholds for change over time developed by three separate expert panels of physicians with experience in quality of life assessment among patients with chronic obstructive pulmonary disease (COPD), asthma, and heart disease. Study Design. We used a modified Delphi technique combined with a face-to-face panel meeting within each disease to organize and conduct the consensus process among the expert panelists, who were familiar with the assessment and evaluations of health-related quality of life (HRQL) measures among patients with the panel-specific disease. Principal Findings. Each of the expert panels first determined the magnitude of the smallest numerically possible change on each SF-36 scale, referred to as a state change, and then built their CIDs from this metric. All three panels attained consensus on the scale changes that constituted small, moderate, and large clinically important SF-36 change scores. The CIDs established by the heart disease panel were generally greater than the CIDs agreed on by the asthma and COPD panels. Conclusions. These panel-derived thresholds reflect possible differences in disease management among the represented panel-specific diseases, and are all greater than the minimal CID thresholds previously developed for the SF-36 scales among patients with arthritis. If confirmed among patients with the relevant diseases and those patients' physicians, these disease-specific CIDs could assist both researchers and practicing clinicians in the use and interpretation of HRQL changes over time. [source]

Finite element analysis and evaluation of design limits for structural materials in a cyclic state of creep

M. Boulbibane
Abstract In this paper a direct non-time stepping method derived from the minimum theorems given by the authors (European Journal of Mechanics , A/Solids 2002; 21:915,925) is outlined. This method can be used in the prediction of the deformation and life assessment of structures subjected to cyclic mechanical and thermal loadings. It produces accurate predictions of failure modes based on material behaviour incorporated into constitutive equations. It also can be used to define limit loads related to certain design criteria. Generally, for complex geometries and load histories, the identification of load histories that correspond to predefined design conditions, in the form of time or number of cycles to failure, can only be achieved by extensive and repeated calculations. For the Linear Matching Method, however, the representation of materially non-linear stress and strain fields by linear behaviour with spatially varying moduli, indicates the possibility that direct evaluation of loads and temperature ranges that correspond to a design restriction may be evaluated directly through the construction of the exact cyclic state and via sequence of approximations. The technique employs the finite element method combined with the cyclic state solution. The description of the material behaviour is given by a non-linear viscous model (Norton's law). It can also apply to any class of material behaviour that includes internal state variables. This technique has been applied successfully to a set of characteristics problems (Bree problem and plate containing a circular hole and subjected to radial temperature gradient). Copyright © 2003 John Wiley & Sons, Ltd. [source]

Critical evaluation of the use of research tools in evaluating quality of life for people with schizophrenia

Jeanette Hewitt
ABSTRACT:, Schizophrenia may lead to impairments in many aspects of life, including physical, cognitive, and role functioning. The subjective quality of life of people with schizophrenia has been shown to be lower than in the general population and appropriate patient-assessed health outcome measures are necessary to capture the distress and disability experienced by people living with a serious mental illness. Although psychiatry has been slow to become involved in quality of life measurement, the use of quality of life instruments has now been recognized as a means of evaluating the outcome of care interventions, in terms of symptoms and functioning. This paper evaluates the effectiveness of two widely used instruments: The Medical Outcomes Study Short Form Health Survey (SF-36) and The Lancashire Quality of Life Profile (LQoLP) in terms of reliability and validity in measuring the quality of life of people with schizophrenia. The LQoLP appeared to be best suited for evaluation of care programmes, whereas the SF-36 was more appropriate for medical trials, comparisons between patient groups, and assessment of the direct consequences of treatment on health and function. Subjective quality of life should, however, be considered to be distinct from clinical status and quality of life assessment should include the broadest range of indicators, to reflect the holistic ethos of mental health nursing. [source]

Review Article: Economic evaluation of prostate cancer screening with prostate-specific antigen

Tomoaki Imamura
Abstract: Economic issues cannot be ignored in conducting prostate cancer screening using prostate-specific antigen (PSA). Through an electronic search, we reviewed five descriptive cost studies and nine cost-effectiveness/cost-utility analyses concerning PSA screening. Most of the existing evidence was based on mathematical model analysis and the results are enormously disparate. The cost per quality-adjusted life years (QALY) gained was estimated to be $US 63.37 to $68.32, and $8400 to $23 100, respectively, or was dominated by no screening. Economic studies evaluating PSA screening are still far from sufficient. Urologists, epidemiologists and health economists must jointly conduct further studies on not only mortality but also quality of life assessment and economic evaluation, using randomized clinical trials, for a strict evaluation of the actual efficacy of PSA screening. At present, patients should be thoroughly informed of the limitations of PSA screening and, in consultation with urological specialists, make the personal decision of whether to receive it. [source]

Assessing quality of life in paediatric clinical practice

Angela M Morrow
The rising prevalence of children with chronic conditions has made quality of life an increasingly important outcome measure in paediatric practice. The discrepancy between doctors' and patients' perceptions of quality of life makes formal assessment necessary. In this paper we use a case scenario to answer commonly asked questions. What is quality of life and who can assess it? Why assess quality of life in the clinical setting? Is it feasible to measure in routine clinical practice? How is quality of life formally assessed? We provide a basic outline of the language and methods of quality of life assessment and use the case scenario to discuss the process of choosing an appropriate instrument. We conclude that quality of life assessment in clinical practice is feasible and provides benefits for both patients and doctors. The benefits include better informed doctors, improved patient doctor communication and a means to effectively monitor quality of life as a treatment outcome. [source]

Quality of life assessment of treatment with dental appliance or UPPP in patients with mild to moderate obstructive sleep apnoea.

A prospective randomized 1-year follow-up study
The objectives of this study were: to evaluate the change in the three quality of life (QOL) dimensions of vitality, contentment and sleep before intervention and 1 year after treatment with a dental appliance or uvulopalatopharyngoplasty (UPPP); to compare the effect of treatment between these two treatment groups on these three dimensions; and to determine the relation between the QOL scores and somnographic values. Ninety-five patients with mild to moderate obstructive sleep apnoea (OSA) (AI > 5) were randomly allocated to either a dental appliance or UPPP treatment group. Seven patients withdrew after randomization but before treatment, leaving 88 patients eligible for treatment. The patients were examined using somnography and administered the Minor Symptoms Evaluation-Profile (MSE-P), a QOL questionnaire, before and 1 year after intervention. Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 1-year follow-up. The mean values for the three dimensions vitality, contentment and sleep improved significantly 1 year after intervention in the dental appliance and UPPP groups. No difference in the QOL scores at baseline was noted between the groups. One year after intervention the UPPP group showed significantly more contentment than the dental appliance group. In contrast, vitality and sleep dimensions did not differ between the two treatment groups. No significant correlations were observed between the QOL scores and somnographic values. In conclusion, quality of life improved significantly in the dental appliance and UPPP groups 1 year after intervention. However, the dental appliance group showed a lower level of contentment than the UPPP group, even though the somnographic values were superior in the former group. [source]

Validity of the Spanish version of the Chronic Liver Disease Questionnaire (CLDQ) as a standard outcome for quality of life assessment,

Montserrat Ferrer
The Chronic Liver Disease Questionnaire (CLDQ) measures the impact on quality of life of chronic liver diseases, regardless of underlying etiology. The aim of this study was to develop a Spanish version of the CLDQ, and to assess its acceptability, reliability, validity, and sensitivity to change. The forward and back-translation method by bilingual translators, with expert panel and pilot testing on patients, was used for the adaptation. The final version was self-administered, together with the Short Form-36 Health Survey (SF-36), on 149 consecutive patients with chronic liver disease. Child-Turcotte-Pugh scores were evaluated by a physician. To assess reproducibility and responsiveness the CLDQ was readministered to a subsample of stable patients and to those who had received a liver transplant. Validity was evaluated via exploratory factor analysis, the CLDQ pattern across severity groups, and correlation coefficients with "itching" and SF-36 scores. Cronbach's alpha and Intraclass Correlation Coefficient for CLDQ global score were 0.93 and 0.90, respectively, demonstrating good reliability. Validity was supported by correlations of the CLDQ with SF-36 and "itching," and CLDQ severity gradient (global score means were 5.5, 5.2, 5.0, and 4.5 in patients with no cirrhosis, cirrhosis Child-Turcotte-Pugh A, B, and C, respectively; P = 0.012). Responsiveness was shown by a high CLDQ improvement in patients who had received liver transplant (mean change = ,1.4; P < 0.001). In conclusion, the Spanish CLDQ is reliable, valid, responsive, and equivalent to the original. These findings support its use as a standard outcome for patients with chronic liver diseases within the whole severity range, from "no cirrhosis" to transplant recipients, both in Spanish and international studies. Liver Transpl 12:95,104, 2006. © 2005 AASLD. [source]

Evaluation of the Association between Lower Urinary Tract Symptoms and Erectile Dysfunction, Considering its Multiple Risk Factors

Ernani Luis Rhoden MD
ABSTRACT Aim., To investigate the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), while considering multiple risk factors for ED, including an anthropometric evaluation of central obesity. Methods., A cross-sectional study was carried out with 192 consecutive male subjects (,40 years old). Conditions clearly associated with ED, other than obesity and age, were considered exclusion criteria. Men were evaluated routinely for clinical history, received a physical examination, and were subjected to blood analysis for fasting serum glucose, lipid profile, and serum testosterone. Patients with previous known history of diabetes mellitus or hypertension were excluded. Anthropometric measures taken included body mass index (general obesity) and waist circumference, waist-hip index, and sagittal abdominal diameter (visceral obesity). Analyses were performed using bivariate and multivariate models (multiple logistic regression). Age, education, alcohol consumption, smoking, sedentary lifestyle, fasting blood glucose level, dyslipidemia, hypogonadism, general obesity, and visceral obesity were taken into account as potential confounding factors. Main Outcome Measures., All men completed the International Index of Erectile Function and International Prostate Symptom Score (IPSS). Results., IPSS scores were low, intermediate, and high in 89 (46.4%), 76 (39.6%), and 27 (14.1%) men, respectively. Overall IPSS scores were significantly associated with ED (P = 0.002). In addition, an association between the severity of ED and LUTS was observed (P = 0.008). The mean quality of life assessment in the IPSS revealed a statistically significant difference between individuals with varying degrees of ED (P = 0.008). The logistic regression analyses showed that IPSS scores and ED remained independently associated even after the control for confounding factors (odds ratio = 1.07, 95% CI = 1.02,1.13, P = 0.01). Conclusion., This study suggests that LUTS are independently associated with ED, taking into account various risk factors for ED, including visceral obesity. Rhoden EL, Riedner CE, Fornari A, Fuchs SC, and Ribeiro EP. Evaluation of the association between lower urinary tract symptoms and erectile dysfunction, considering its multiple risk factors. J Sex Med 2008;5:2662,2668. [source]

Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladders

Ahmad Abdul-Rahman
Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate the long-term safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with neuropathic bladder dysfunction. PATIENTS AND METHODS Twelve women (mean age 53.3 years, range 41,80) with neuropathic bladder dysfunction and SUI confirmed by video-cystometrography (VCMG) were treated with a TVT in one institution by an expert neuro-urologist between November 1997 and December 2000. The patient's notes, clinical annual follow-up and VCMG after the procedure, and the incontinence impact questionnaire (IIQ) forms (Urinary Distress Inventory, and IIQ-7) were assessed during the long-term clinical follow-up for SUI, in addition to a health-related quality of life assessment. The cure of SUI was defined as no loss of urine on physical exercise, confirmed VCMG after the procedure, and by clinical assessment. RESULTS The mean (range) follow-up was 10 (8.5,12) years. Nine patients were using clean intermittent self-catheterization before the insertion of TVT and continued to do so afterward. At 10 years of follow-up, one patient had died (with failed TVT initially), and two were lost to follow-up at 5 years after surgery, but up to 5 years they did not complain of UI and VCMG did not show SUI. The remaining seven of the nine patients were completely dry, and two improved and were satisfied with using one or two pads/day. Two patients showed neurogenic detrusor overactivity confirmed on VCMG, with no evidence of SUI. One patient needed a transient urethral catheter for urinary retention after surgery, one had a bladder injury that required leaving the catheter for 5 days, but no urethral erosions were reported during the follow-up. CONCLUSIONS In women with neuropathic bladder dysfunction secondary to a variety of spinal cord pathologies, and who have SUI necessitating a definitive intervention, insertion of TVT should be considered a desirable treatment, with very good long-term outcomes. [source]

Health-related quality of life assessment after breast reconstruction,

S. Potter
Background: Health-related quality of life (HRQL) is an important outcome following breast reconstruction. This study evaluated current methods of HRQL assessment in patients undergoing latissimus dorsi breast reconstruction, hypothesizing that early surgical morbidity would be reflected by poorer HRQL scores. Methods: Patients completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and breast module (QLQ-BR23), the Functional Assessment of Cancer Therapy (FACT) general measure, and breast module and arm subscale (FACT-B + 4), and the Body Image Scale and Hospital Anxiety and Depression Scale (HADS) 3 months after surgery. They also reported additional HRQL problems not included in the questionnaires. HRQL scores were compared between patients with and without early surgical morbidity. Results: Sixty women completed the questionnaires, of whom 25 (42 per cent) experienced complications. All EORTC and FACT subscale and HADS scores were similar in patients with or without morbidity. Women with complications were twice as likely to report feeling less feminine and dissatisfied with the appearance of their scar than those without problems. Thirty-two women (53 per cent) complained of problems not covered by the questionnaires, most commonly donor-site morbidity. Conclusion: Existing HRQL instruments are not sufficiently sensitive to detect clinically relevant problems following breast reconstruction. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Sacral nerve stimulation for neurogenic faecal incontinence

B. Holzer
Background: Sacral nerve stimulation (SNS) has emerged as a promising technique for the treatment of faecal incontinence. This study assessed the outcome of SNS in a cohort of patients with incontinence of neurological aetiology. Methods: Thirty-six patients were included in a trial of SNS. Twenty-nine subsequently had a permanent implant. Evaluation consisted of a continence diary, anal manometry, saline retention testing and quality of life assessment. Results: After a median follow-up of 35 (range 3,71) months, 28 patients showed a marked improvement in or complete recovery of continence. Incontinence to solid or liquid stool decreased from a median of 7 (range 4,15) to 2 (range 0,5) episodes in 21 days (P = 0·002). Saline retention time increased from a median of 2 (range 0,5) to 7 (range 2,15) min (P = 0·002). Maximum resting and squeeze anal canal pressures increased compared with preoperative values. Quality of life on all scales among patients who received a permanent implant increased at 12 and 24 months after operation. Conclusion: SNS is of value in selected patients with neurogenic faecal incontinence. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Evaluation of quality of life, and priorities in people with glaucoma

Purpose Quality of life appears to be of increasing importance as a criterion for clinical intervention. However its meaning can be complex and its assessment varied. In social science the term has broad definitions which include terms such as autonomy, wellbeing; self esteem; sense of control etc. On the other hand within ophthalmology a narrower operational definition is mainly used which is the degree to which someone's vision impacts on a range of necessary and desirable daily tasks a person wishes to carry out. The purpose of the presentation is to compare alternative methods of quality of life assessment. Methods The assessment approaches taken in the study range from conventional questionnaire rating scales, (something NICE has questioned) and time trade off comparisons, to more recent methods of scaling generated by for example Rasch or Hierarchical Bayesian analysis. Results Data will be presented from two studies (one in Edinburgh and one in Aberdeen) on quality of life in people with glaucoma. One of the new recommended discrete choice methods (Choice based conjoint analysis with Hierarchical Bayesian estimates) will be used. The results will include quality of life outcomes and their stability; related visual factors; comparisons across methods and more general implications for quality of life assessment. Conclusion Different methods for the assessment of quality of life produce different results with relatively low correlations between them although conjoint analysis has revealed stable priorities across two independent studies. These discrepancies in quality of life assessment require further study and evaluation. [source]

Quality of life assessment of alopecia areata , a comparison of two geographic areas in Scotland

I. C. Hay
No abstract is available for this article. [source]

Quality of life assessment after non-laser endonasal dacryocystorhinostomy

A. Ho
Objective:, There has been a lack of patient-centred evidence in the Otolaryngology literature, that non-laser endonasal dacryocystorhinostomy improves the quality of life of patients. Many studies demonstrate successful outcomes based on non-validated subjective patient reporting. The aim of this survey was to evaluate the impact of non-laser endonasal dacryocystorhinostomy on the quality of life of patients using a validated questionnaire, the Glasgow Benefit Inventory (GBI). Design:, Prospective non-randomised case series. Setting:, Secondary otorhinolaryngology,ophthalmology centre, single centre. Participants:, Sixty-five consecutive patients undergoing non-laser endonasal dacryocystorhinostomy were asked to complete a questionnaire at their follow-up clinic appointment. All patients had a minimum of 9 months follow-up. Main outcome measures:, A consultant ophthalmologist reviewed each patient six months after surgery and recorded the outcomes as ,cure', ,better', ,no change' or ,worse'. We defined ,success' as cured or better. ,Failure' suggests no improvement or worsening epiphora. The validated 18-item GBI was used. Results:, Fully completed questionnaires were received from 55 patients. Mean total GBI scores were +34 for successful non-laser endonasal dacryocystorhinostomy and ,19 for failed non-laser endonasal dacryocystorhinostomy (Mann,Whitney z = 3.8, P < 0.001). Conclusion:, Successful non-laser endonasal dacryocystorhinostomy does confer significant quality of life improvement. [source]

Is good ,quality of life' possible at the end of life?

An explorative study of the experiences of a group of cancer patients in two different care cultures INFORMATION POINT: Factor analysis
,,The purpose of this paper was to explore how a group of gravely ill patients, cared for in different care cultures, assessed their quality of life during their last month of life. ,,The study material comprised quality of life assessments from 47 cancer patients, completed during their last month of life. Two quality of life questionnaires, the EORTC QLQ-C30 and a psychosocial well-being questionnaire, were used. The data were treated in accordance with instructions for the respective questionnaires, and the results are presented primarily as means, mostly at the group level. Assessments from patients in two different care cultures, care-orientated and cure-orientated, were compared. ,,The results show that despite having an assessed lower quality of life in many dimensions than people in general, several patients experienced happiness and satisfaction during their last month of life. ,,,Cognitive functioning' and ,emotional functioning' were the dimensions that differed least from those of the general population, and ,physical functioning', ,role functioning' and ,global health status/quality of life' differed the most. ,Fatigue' showed the highest mean for the symptom scales/items. ,,There was a tendency for those cared for in the cure-orientated care culture to report more symptoms than those in the care-orientated care culture. An exception to this was ,pain', which was reported more often by those in the care-orientated care culture. ,,The implications of the results are discussed from different angles. The significance of knowledge concerning how patients experience their quality of life is also discussed with respect to the care and the planning of care for dying patients. [source]

Psoriasis: is the impairment to a patient's life cumulative?

AB Kimball
Abstract Psoriasis is associated with significant physical and psychological burden affecting all facets of a patient's life , relationships, social activities, work and emotional wellbeing. The cumulative effect of this disability may be self-perpetuating social disconnection and failure to achieve a ,full life potential' in some patients. Health-related quality of life studies have quantified the burden of psoriasis providing predominantly cross-sectional data and point-in-time images of patients' lives rather than assessing the possible cumulative disability over a patient's lifetime. However, social and economic outcomes indicate there are likely negative impacts that accumulate over time. To capture the cumulative effect of psoriasis and its associated co-morbidities and stigma over a patient's life course, we propose the concept of ,Cumulative Life Course Impairment' (CLCI). CLCI results from an interaction between (A) the burden of stigmatization, and physical and psychological co-morbidities and (B) coping strategies and external factors. Several key aspects of the CLCI concept are supported by data similar to that used in health-related quality of life assessments. Future research should focus on (i) establishing key components of CLCI and determining the mechanisms of impairment through longitudinal or retrospective case,control studies, and (ii) assessing factors that put patients at increased risk of developing CLCI. In the future, this concept may lead to a better understanding of the overall impact of psoriasis, help identify more vulnerable patients, and facilitate more appropriate treatment decisions or earlier referrals. To our knowledge, this is a first attempt to apply and develop concepts from ,Life Course Epidemiology' to psoriasis research. [source]

Sustained effect of SQ-standardized grass allergy immunotherapy tablet on rhinoconjunctivitis quality of life

ALLERGY, Issue 6 2010
L. Frølund
To cite this article: Frølund L, Durham SR, Calderon M, Emminger W, Andersen JS, Rask P, Dahl R. Sustained effect of SQ-standardized grass allergy immunotherapy tablet on rhinoconjunctivitis quality of life. Allergy 2010; 65: 753,757. Abstract Background:, The prevalence of allergic rhinoconjunctivitis has increased significantly over the past decades with grass pollen being a common trigger. The impact of allergy on patient's quality of life is substantial. Aim:, To investigate the sustained effect on quality of life during the grass pollen season 1 year after 3 years of treatment with the SQ-standardized grass allergy immunotherapy tablet (AIT), Grazax® (Phleum pratense 75,000 SQ-T/2800 BAU; ALK, Denmark). Methods:, The trial was a randomized, parallel-group, double-blind, placebo-controlled trial in adult subjects with a history of moderate-severe grass pollen induced rhinoconjunctivitis inadequately controlled by symptomatic medications. Subjects received 3 years of grass AIT (n = 157) or placebo (n = 126), followed by 1 year of follow-up. Quality of life assessments were based on the standardized rhinoconjunctivitis quality of life questionnaire (RQLQ(S)); completed weekly during the entire grass pollen season. Results:, During follow-up, the overall RQLQ(S) score for the entire grass pollen season was significantly improved in the active group (relative difference to placebo: 23%, P = 0.004). The improvement was higher during the peak pollen season (28%, P = 0.001). The treatment effect of grass AIT during the follow-up year and the previous three treatment years was similar. Improvements were found in all seven RQLQ(S) domains. The RQLQ(S) as a function of the weekly average pollen counts showed a clear separation between the treatment groups (P < 0.001). Conclusion:, In subjects inadequately controlled by symptomatic medications, grass AIT provided sustained and clinically relevant improvements in rhinoconjunctivitis quality of life compared to placebo. The effect increased with increasing grass pollen exposure. [source]

Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug,induced clinical remission: Evidence from an imaging study may explain structural progression

A. K. Brown
Objective More timely and effective therapy for rheumatoid arthritis (RA) has contributed to increasing rates of clinical remission. However, progression of structural damage may still occur in patients who have satisfied remission criteria, which suggests that there is ongoing disease activity. This questions the validity of current methods of assessing remission in RA. The purpose of this study was to test the hypothesis that modern joint imaging improves the accuracy of remission measurement in RA. Methods We studied 107 RA patients receiving disease-modifying antirheumatic drug therapy who were judged by their consultant rheumatologist to be in remission and 17 normal control subjects. Patients underwent clinical, laboratory, functional, and quality of life assessments. The Disease Activity Score 28-joint assessment and the American College of Rheumatology remission criteria, together with strict clinical definitions of remission, were applied. Imaging of the hands and wrists using standardized acquisition and scoring techniques with conventional 1.5T magnetic resonance imaging (MRI) and ultrasonography (US) were performed. Results Irrespective of which clinical criteria were applied to determine remission, the majority of patients continued to have evidence of active inflammation, as shown by findings on the imaging assessments. Even in asymptomatic patients with clinically normal joints, MRI showed that 96% had synovitis and 46% had bone marrow edema, and US showed that 73% had gray-scale synovial hypertrophy and 43% had increased power Doppler signal. Only mild synovial thickening was seen in 3 of the control subjects (18%), but no bone marrow edema. Conclusion Most RA patients who satisfied the remission criteria with normal findings on clinical and laboratory studies had imaging-detected synovitis. This subclinical inflammation may explain the observed discrepancy between disease activity and outcome in RA. Imaging assessment may be necessary for the accurate evaluation of disease status and, in particular, for the definition of true remission. [source]

Quality of life in chronic illness: children, parents and paediatricians have different, but stable perceptions

A J Janse
Abstract Aim: Quality of life assessments can be helpful to estimate the well-being of chronically ill children. The aim of this study was to investigate the differences in perception of health-related quality of life (HRQoL) among children, parents and paediatricians at the time of diagnosis and after initial treatment in four chronic diseases. Methods: HRQoL was assessed with the Health Utilities Index mark 3 (HUI3). The HUI3 consists of eight attributes (vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain). Results: Nineteen paediatricians and 60 patients (aged 10,17 years) and their parents with newly diagnosed acute lymphoblastic leukaemia, juvenile idiopathic arthritis, asthma or with cystic fibrosis admitted for pneumonia participated in the study. Health and well-being perceptions were clearly different among paediatricians, parents and patients, both at diagnosis and after initial treatment. Perception differences were more prominent in the subjective attributes, emotion and pain. The agreement for these attributes was 23% and 5%, respectively. Paediatricians assessed the patients to have less pain than the patients and parents did. The reverse was true for the attribute emotion. At follow-up, the agreement was higher for the attributes ambulation and pain. Conclusion: At the onset of a chronic disease and after initial treatment, paediatricians, parents and children have different perceptions of the child's quality of life, particularly as to the subjective attributes pain and emotion. In view of these differences in perception among patients, their caregivers and paediatricians, this study suggests that whenever possible, multi-respondent assessment of HRQoL should be considered. [source]

Short forms of subjective quality of life assessments from cross-cultural studies for use in surveys with different populations

Holger Mühlan
Among several advances in quality of life (QOL) assessment development, such as cross-cultural comparability of measurements, inclusion of more specific target populations, and assessment on different levels of QOL generality, economy of measurement has become of increasing importance. As a consequence, construction of short forms and indices of original measures is common in QOL assessment development. The present paper puts special emphasis upon the issue of shortening measures and developing short forms in QOL assessment in relation to this development. Some basic principles and procedures of short-form development in general are outlined, and selected prominent examples of short-form development as applied to QOL assessment are described.,Copyright © 2008 John Wiley & Sons, Ltd. [source]

Quality of life before and after proctocolectomy and IPAA in patients with ulcerative proctocolitis , a prospective study

I. Berndtsson
Abstract Objective The principal aim of the present investigation was to study the general QoL and disease-specific adjustment before, and one-year after, operation with an ileal pouch anal-anastomosis (IPAA) in a consecutive series of patients with ulcerative colitis (UC). Patients and method Eleven patients were medically treated and 31 patients underwent colectomy with ileostomy. The patients were interviewed before the IPAA operation and again one-year after closure of the covering loop ileostomy. General quality of life was estimated with a Swedish instrument (according to Kajandi, score range 16,96) and a VA-scale. The instrument for disease-specific adjustment contained specific questions with five factors (score range 34,204). Open questions about quality of life were used to identify areas of concern, which were not included in the other instruments. Postoperative function was described in terms of a functional score (score range 0,15). Results The results of the general quality of life assessments did not differ significantly when comparing pre-operative to postoperative values. Disease-specific adjustment showed that the medically treated patients had a score of 162; interquartile range (IQR) 145,176. The patients with ileostomy scored 164; IQR 141,180. Postoperatively there was a statistically significant improvement in both groups to 189 (IQR 172,199), an increase of 15%. The open questions revealed restrictions in daily life for both patient groups pre-operatively with improvements after IPAA. The median grading of functional outcome according to the score system was 2. The most frequent problems were: patients who had occasional bowel movements at night, 40%; intermittent perianal soreness, 51%; antidiarrhoeal medication use, 61%. Conclusion General QoL did not change after IPAA. The bowel-specific adjustment in most factors improved in the majority of patients after IPAA. However, half of the IPAA patients had occasional bowel movements at night perianal soreness, and used antidiarrhoeal medication. [source]