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Quality-of-life
Kinds of Quality-of-life Terms modified by Quality-of-life Selected AbstractsQuality-of-Life and Behavioral Outcome Measures in Randomized Controlled Trials of Antiepileptic Drugs: A Systematic Review of Methodology and Reporting StandardsEPILEPSIA, Issue 11 2000Gus A. Baker Summary: Purpose: To review the methodology and use of quality-of-life and behavioral measures used in randomized controlled trials (RCTs) of antiepileptic drugs in patients with epilepsy. Methods: Trial reports were found by searching a previously developed comprehensive database of epilepsy RCTs and searching through journals by hand. Inclusion and exclusion criteria were applied, and methodological and quality-of-life and behavioral measure data were extracted. Results: There were 52 different measures used in 46 trials, with the Profile of Mood States, the Minnesota Multiphasic Personality Inventory, and the Washington Psychosocial Seizure Inventory being applied the most frequently. Overall, evidence of the reliability, validity, and sensitivity of measures used in populations of people with epilepsy was sparse. There was also little information on the clinical interpretation of the results. Conclusion: Our results highlight a consistent failure to apply quality-of-life and behavioral measures in RCTs in a systematic way. We found repeated evidence of researchers' failure to review the use of previous measures and selection of measures without evidence of their appropriateness for use in a population with epilepsy. We recommend the use of quality-of-life and behavioral measures in RCTs with proven psychometric properties in a population with epilepsy. [source] Effect of symptomatic gastroesophageal reflux disease on quality of life of patients with chronic liver diseaseHEPATOLOGY RESEARCH, Issue 4 2008Kazutomo Suzuki Aim:, Reflux esophagitis is becoming increasingly more prevalent in Japan. It has been noted that symptomatic gastroesophageal reflux disease (GERD) and chronic liver disease may adversely affect patients' quality of life. Methods:, In the present study, 238 chronic liver disease patients (151 patients with chronic hepatitis and 87 patients with liver cirrhosis) were enrolled. The diagnosis of GERD was made based on the Quality-of-Life and Utility Evaluation Survey Technology questionnaire. Health-related quality of life was evaluated using the Short Forum 36 questionnaire. Results:, Symptomatic GERD was present in 31.8% (48/151) of patients with chronic hepatitis and 36.8% (32/87) of patients with liver cirrhosis. Among the chronic hepatitis group, compared to the GERD-negative group, the GERD-positive group had significantly lower scores in six domains, including "rolelimitation due to physical problem", "bodily pain", "general health perception", "vitality", "role limitation due to emotional problem", and "mental health". Among the cirrhotic group, compared to the GERD-negative group, the GERD-positive group had significantly lower scores in the "role limitation due to emotional problem" domain. Significant improvement in the "physical functioning", "bodily pain", and "general health perception" domain scores was noted in chronic hepatitis patients treated with rabeprazole. Conclusion:, The QOL of chronic liver disease patients with symptomatic GERD was impaired. [source] Successful Pulmonary Vein Isolation Using Transvenous Catheter Cryoablation Improves Quality-of-Life in Patients with Atrial FibrillationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2005HUNG-FAT TSE Background: Recent studies have demonstrated that transvenous catheter cryoablation is a safe and effective technique for creating pulmonary veins (PVs) electrical isolation for the treatment of atrial fibrillation (AF). However, the impacts of this procedure on quality-of-life (QoL) have not been evaluated. Methods and Results: We studied the effects of PV isolation using transvenous catheter cryoablation on QoL in 46 patients (34 men, mean age: 50 ± 12 years) with drug-refractory AF. QoL was assessed by Medical Outcomes Study Short Form-36 (SF-36) and Symptom Checklist at baseline and 3-month after cryoablation, and compared with those in a sex-age matched normal control. At 3-month follow-up, 24 of 46 patients (52%) had no recurrence of AF, including 11 patients who were not taking antiarrhythmic drugs. At baseline, patients with AF had significantly lower QoL scores in overall and in 5/8 subscales of SF-36 than the sex-age matched control group (P < 0.05). In patients with successful outcome after cryoablation showed a significant improvement in overall and in 5/8 subscales of SF-36 QoL scores have significantly increased as compared with the baseline (P < 0.05). Furthermore, their QoL scores in overall and in 6/8 subscales of SF-36 were similar to the sex-age matched control group (P > 0.05). The Symptom Checklist also showed significant reduction in both the symptoms frequency scores and symptoms severity scores at 3-month follow-up as compared with baseline (P < 0.05). Conclusions: Successful PV isolation using transvenous catheter cryoablation is associated with significant reduction in the frequency and severity of AF symptoms and improvement in the general QoL, reaching the levels of normal controls. [source] Quality-of-Life in Pacemaker and Implantable Cardioverter Defibrillator RecipientsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2000CECILIA LINDE No abstract is available for this article. [source] Deficits in Psychological Well-Being and Quality-of-Life in Minor Depression: Implications for DSM-VCNS: NEUROSCIENCE AND THERAPEUTICS, Issue 4 2010Andrew A. Nierenberg Objective: To examine deficits in psychological well-being (PWB) and quality-of-life (QOL) in minor depressive disorder (Min D). Method: Ninety-three subjects entering a treatment study for Min D were assessed using the QOL, Enjoyment and satisfaction questionnaire (Q-LES-Q), and the Psychological Well-Being Scale (PWBS). Scores were compared with major depressive disorder (MDD) and normative community samples. Results: Even though subjects had mild depressive severity, Q-LES-Q total scores for the Min D sample averaged nearly two standard deviations below the community norm. Almost 40% of Min D cases had Q-LES-Q scores in the lowest 1% of the population. Responses to most Q-LES-Q items were closer to subjects with MDD than to community norms. Mean standardized PWB scores were extremely low for subscales of Environmental Mastery and Self-Acceptance, low for Purpose in Life and Positive Relations with others, but within the normal range for Personal Growth and Autonomy. QOL and PWB measures had low correlations with depressive symptom severity, and scores were similar in the presence or absence of a prior history of MDD. Conclusions: Mild depressive symptoms with Min D are associated with major deficits in QOL and PWB measures of environmental mastery and poor self-acceptance. Our findings suggest that diminished QOL and PWB may be intrinsic cognitive aspects of Min D with or without a history of MDD. It may be unnecessary in the DSM IV-TR to exclude the diagnosis of Min D if a subject has had a past episode of MDD. ,,Minor depression exists along a continuum of depression. ,,Deficits in psychological well-being and quality-of-life in minor depression are severe. ,,No difference in these measures if minor depression existed with or without a history of major depression. [source] Quality-of-life and asthma-severity in general population asthmatics: results of the ECRHS II studyALLERGY, Issue 5 2008V. Siroux Background: Health-related quality-of-life (HRQL) has been poorly studied in large samples of asthmatics from the general population. HRQL and its relationship to asthma-severity were assessed among 900 asthmatics enrolled in the European Community Respiratory Health Survey. Methods: Among asthmatics, 864 completed the short form-36 (SF-36) questionnaire and 477 also completed the Asthma Quality-of-life Questionnaire (AQLQ). A 4-class asthma-severity scale, combining clinical items, forced expiratory volume in 1 s and the level of treatment and the different asthma-severity components (each of the clinical items and hospitalization) were studied in relation to HRQL. Results: Mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores (45.5 and 48.8 respectively) were lower than expected in a general population. The mean total AQLQ score was 5.8. The AQLQ score and to a lesser extent the PCS score were significantly related to the 4-class asthma-severity scale, although the risk of having a lower HRQL score did not vary proportionally across the levels of severity. Asthma-severity had no impact on the MCS score. Asthma attack frequency and hospitalization were associated with both total AQLQ and PCS scores, whereas nocturnal symptoms and lung function were more strongly related to the AQLQ and PCS score respectively. Conclusion: In population-based asthmatics, the specific AQLQ questionnaire, and also to a lesser extent the generic SF-36 questionnaire, were sensitive to asthma-severity. Frequencies of asthma attacks, of nocturnal symptoms and hospitalization for asthma have independent impact on HRQL. [source] Effects of severe dentoalveolar trauma on the quality-of-life of children and parentsDENTAL TRAUMATOLOGY, Issue 5 2009Teresa D. Berger Sample: A visual analogue scale (VAS) was used to assess the pain of injury and treatment for 27 individuals 8,20 years and their parents. The Child Oral Health Quality of Life (COHQoL) survey was used to assess the effects of dental injuries on the QoL of 23 children aged 8,14 and their parents. Results: Mean VAS scores revealed that all patients and parents perceived the pain of initial injury to be significantly greater than pain of splint removal (P , 0.05) and that pain decreased in a stepwise manner from injury through emergency treatment to splint removal. The COHQoL questionnaire demonstrated a profound and continuing effect on children and their parent's QoL following severe dental injury. The initial parental COHQoL score was significantly greater than the 12-month score (P , 0.05) in both 8,10 and 11-14- year-olds. The COHQoL results indicated a measurable reduction in the QoL of patients and parents was still present 12-months after the injuries. At the end of one-year children were still affected by the social and well-being aspects of the injury yet parents exclusively reported that one-year effects were limited to their children's oral symptoms and functional limitations. Conclusions: Severe dental injuries produce initial and ongoing pain. Detrimental effects on the QoL of both children and parents are still present at one-year and these long-term effects are different for children and parents. [source] EXPERIENCES OF SELF-EXPANDABLE METALLIC STENT FOR COLORECTAL OBSTRUCTIONS: 70 CASESDIGESTIVE ENDOSCOPY, Issue 2004Yoshihisa Saida ABSTRACT Clinical utilization of self-expandable metallic stent (EMS) endoprosthesis has come later for colorectal diseases than for other lesions. Recently, EMS has been used for palliative insertions for strictures caused by malignant diseases or as a ,bridge to surgery' for obstructive colorectal cancers, with good clinical results increasingly reported in many western countries. Its application for benign strictures has been reported, but we believe that the surgical indications require more careful analysis because of the absence of data concerning long-term prognosis. The advantage of this technique in the treatment of colorectal strictures is that it limits invasiveness, such as in palliative or temporary stoma creation, thereby improving patient quality-of-life. Therefore, we believe that EMS endoprosthesis will play a key role in this field. We are awaiting the introduction of the metallic stent for the colon and the associated kit, as well as the Japanese government's approval for reimbursement for this procedure. [source] Changes in Quality of Life in Epilepsy: How Large Must They Be to Be Real?EPILEPSIA, Issue 1 2001Samuel Wiebe Summary: ,Purpose: The study goal was to assess the magnitude of change in generic and epilepsy-specific health-related quality-of-life (HRQOL) instruments needed to exclude chance or error at various levels of certainty in patients with medically refractory epilepsy. Methods: Forty patients with temporal lobe epilepsy and clearly defined criteria of clinical stability received HRQOL measurements twice, 3 months apart, using the Quality of Life in Epilepsy Inventory-89 and -31 (QOLIE-89 and QOLIE-31), Liverpool Impact of Epilepsy, adverse drug events, seizure severity scales, and the Generic Health Utilities Index (HUI-III). Standard error of measurement and test-retest reliability were obtained for all scales and for QOLIE-89 subscales. Using the Reliable Change Index described by Jacobson and Truax, we assessed the magnitude of change required by HRQOL instruments to be 90 and 95% certain that real change has occurred, as opposed to change due to chance or measurement error. Results: Clinical features, point estimates and distribution of HRQOL measures, and test-retest reliability (all > 0.70) were similar to those previously reported. Score changes of ±13 points in QOLIE-89, ±15 in QOLIE-31, ±6.3 in Liverpool seizure severity,ictal, ±11 in Liverpool adverse drug events, ±0.25 in HUI-III, and ±9.5 in impact of epilepsy exclude chance or measurement error with 90% certainty. These correspond, respectively, to 13, 15, 17, 18, 25, and 32% of the potential range of change of each instrument. Conclusions: Threshold values for real change varied considerably among HRQOL tools but were relatively small for QOLIE-89, QOLIE-31, Liverpool Seizure Severity, and adverse drug events. In some instruments, even relatively large changes cannot rule out chance or measurement error. The relation between the Reliable Change Index and other measures of change and its distinction from measures of minimum clinically important change are discussed. [source] Quality-of-Life and Behavioral Outcome Measures in Randomized Controlled Trials of Antiepileptic Drugs: A Systematic Review of Methodology and Reporting StandardsEPILEPSIA, Issue 11 2000Gus A. Baker Summary: Purpose: To review the methodology and use of quality-of-life and behavioral measures used in randomized controlled trials (RCTs) of antiepileptic drugs in patients with epilepsy. Methods: Trial reports were found by searching a previously developed comprehensive database of epilepsy RCTs and searching through journals by hand. Inclusion and exclusion criteria were applied, and methodological and quality-of-life and behavioral measure data were extracted. Results: There were 52 different measures used in 46 trials, with the Profile of Mood States, the Minnesota Multiphasic Personality Inventory, and the Washington Psychosocial Seizure Inventory being applied the most frequently. Overall, evidence of the reliability, validity, and sensitivity of measures used in populations of people with epilepsy was sparse. There was also little information on the clinical interpretation of the results. Conclusion: Our results highlight a consistent failure to apply quality-of-life and behavioral measures in RCTs in a systematic way. We found repeated evidence of researchers' failure to review the use of previous measures and selection of measures without evidence of their appropriateness for use in a population with epilepsy. We recommend the use of quality-of-life and behavioral measures in RCTs with proven psychometric properties in a population with epilepsy. [source] Experiences with a group intervention for adolescents with type 1 diabetes and their parentsEUROPEAN DIABETES NURSING, Issue 1 2008RN Lřding RN Registered Nurse Abstract Background: Increased adolescent-parent engagement in diabetes-related tasks appears to decrease diabetes-related family conflict. Group intervention may be a good approach when caring for adolescents with chronic conditions, including diabetes. Aim: This article aims to describe how group intervention may be useful in the treatment of adolescents with type 1 diabetes. When these children enter puberty and become adolescents, it can become difficult. In many cases, family-related conflict has a negative impact on an adolescent's blood sugar levels and self-care behaviour. Method: 19 adolescents (age 13,17 years) and their parents participated in group intervention. Families were recruited from outpatient clinics in two centres in Middle-Norway. Separate groups met once a month for 1 year. All adolescents and parents completed a battery of self-report measures. In addition, HbA1c values were obtained five times from the adolescents' medical records. Results: In terms of metabolic control there was a significant decrease in HbA1c values in the girls studied. In adolescents of both sexes, the process of deterioration was stopped. Conclusion: The development of efficient interventions for this group of patients is highly needed. Our intervention was peer-oriented and psycho-educative. Although the sample size in this study was small, one may still consider that group intervention may improve parent-adolescent relationships. Results from the study also demonstrate that group intervention may improve metabolic control in girls, without deterioration in health-related quality-of-life. Copyright © 2008 FEND [source] Quality of Life and the Migration of the College-Educated: A Life-Course ApproachGROWTH AND CHANGE, Issue 1 2008RONALD L. WHISLER ABSTRACT This paper examines how the college-educated population,segmented into selective demographic groups, from young adults to the elderly,differentially values quality-of-life (QOL) indicators of metropolitan areas in the United States. Using data from the 2000 Census and the 1997 Places Rated Almanac, out-migration patterns are shown to depend jointly upon stage in the life course, the spatial-demographic setting, and QOL characteristics. An abundance of cultural and recreational amenities lowers out-migration rates of young college-educated. For the older college-educated population, the revealed preferences shift toward concerns for safety and a strong preference for milder climates. The study also finds significantly lower out-migration rates for metropolitan areas with growing human capital. In light of shifting age distributions and rising educational attainment levels, the results have important implications for the emergence of new migration patterns and the concentration of human capital. [source] Political and social drivers for access to the countryside: the need for research on birds and recreational disturbanceIBIS, Issue 2007GRAHAM BATHE The introduction of a statutory right of access to open country and registered common land in England and Wales in 2005 was a major milestone in a campaign traceable to the 19th century, with views strongly polarized between social classes and political parties, and between land owners and campaigners. More recently, access has also been recognized as a factor contributing to quality-of-life, public health, social diversity and rural economic issues. The mapping of access land revealed that 55% of it is also designated Site of Special Scientific Interest, where wildlife is legally conserved. This has generated a need to assess the implications of access in each case, and take measures to ensure nationally and internationally important features are protected, drawing on sound scientific principles. Early research, although competently undertaken, often failed to address population-scale effects significant at the designated-site level, enabling disputes and polarized ,beliefs' to be articulated. Hence, in addition to drawing up formal and transparent procedures for evaluating impacts and resolving difficulties, funds were released and a major programme initiated, commissioning applied research of direct relevance to the implementation of the legislation. This has pushed forward the boundaries of knowledge in a field which is both difficult and expensive to study. By gradually replacing ,belief' with evidence, this represents a case study in resolving environmental disputes. [source] Prostate cancer treatment options (observation versus prostatectomy) , the available evidenceINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 3 2007Josephine Hegarty Abstract Advanced screening programmes have led to an increased incidence of prostate cancer worldwide. Prostate Cancer is currently the most common site of male cancers worldwide; accounting for 21% of all male cancers in Ireland. This article presents an in-depth review of the available evidence (January 1997 to April 2007), which directly compares outcomes (in terms of urinary function, bowel function, sexual function, quality-of-life (QOL) outcomes and survival statistics) post radical prostatectomy versus a conservative watch-and-wait approach for the treatment of clinically localized prostate cancer. The aim of this paper is to equip health-care professionals with the best available research evidence. Best research evidence is a component of evidence-based practice, which is very much ,in vogue' in health care today. The authors recommend that practitioners utilize this, the available evidence in combination with their clinical expertise and their patients' opinions in order to assist these patients' to make wise and informed treatment decisions. As this paper will demonstrate, the treatment chosen can have important implications in terms of patient outcomes. Therefore, making an informed decision early on can prevent any regret at a later stage. Overall this review of the literature revealed significant disparity in terms of which treatment option is more favourable. Patients overall are faced with a difficult dilemma when making this treatment decision , to live longer at the expense of potential erectile dysfunction and possible urinary incontinence or to live for a potentially shorter time without these adverse consequences. [source] Lessons learned from the Oklahoma Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome RegistryJOURNAL OF CLINICAL APHERESIS, Issue 4 2008James N. George Abstract The Oklahoma TTP-HUS Registry provides a complete community perspective of thrombotic thrombocytopenic purpura (TTP). This is possible because plasma exchange is the essential treatment for TTP and the Oklahoma Blood Institute provides all plasma exchange procedures for a region encompassing most of the State, including 58 of Oklahoma's 77 counties. The Registry is an inception cohort of consecutive patients for whom plasma exchange treatment was requested for a diagnosis of either TTP or hemolytic uremic syndrome (HUS). All 382 patients identified from January 1, 1989 to December 31, 2007 have consented to be enrolled. Complete follow-up is available for 380 of 382 patients. Patients are described both by clinical categories, related to their associated conditions and clinically apparent etiologies, and by the presence of severe ADAMTS13 deficiency. ADAMTS13 activity has been measured on 235 (93%) of 254 patients since 1995. Registry data have provided new perspectives on the definition and diagnoses of these syndromes as well as their outcomes. Long-term follow-up has documented that relapse is common among patients with ADAMTS13 deficiency but rarely occurs in patients without ADAMTS13 deficiency. Long-term follow-up has also documented persistent abnormalities of health-related quality-of-life and cognitive function. In addition to providing new perspectives on the natural history of these syndromes, The Oklahoma TTP-HUS Registry provides a support group for our patients, information about evaluation and management for community physicians, and a resource for research and educational programs. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. [source] A psychometric evaluation of the Chinese version of the Cardiovascular Limitations and Symptoms Profile in patients with coronary heart diseaseJOURNAL OF CLINICAL NURSING, Issue 17 2008Violeta Lopez Aims and objectives., The aim of this study was to translate from English and evaluate the validity, reliability and cultural relevance of the Cardiovascular Limitations and Symptoms Profile (CLASP) as a health-related quality-of-life (HRQL) measure in Chinese patients with coronary heart disease. Background., Improvement in HRQL is increasingly used as a primary outcome in determining the treatment benefit using a generic instrument. However, disease-specific instruments are being cited as more responsive and sensitive in detecting even the smallest changes in health status. Therefore, valid and reliable disease-specific measures for patients with coronary heart disease are now being developed and evaluated. Design., Questionnaire design. Methods., The translation equivalence and content validity of the Chinese version of CLASP were evaluated by an expert panel. Measurement performance was tested on a convenience sample of 369 Chinese coronary heart disease patients. Results., The instrument demonstrated good content validity (content validity index 0·94), acceptable internal consistency (>0·70), except for two subscales of angina and tiredness and significant positive correlations among the subscales of CLASP, Hospital Anxiety Depression Scale and the Short Form 36 Health Survey. Principal components analysis revealed nine factors that together explained 69% of the variance. Conclusions., The results of this study support that CLASP is a valid and reliable disease-specific health status measure for Chinese patients with coronary heart disease. However, further item modifications and testings are needed when considering the cross-cultural context. Relevance to clinical practice., The use of disease-specific HRQL measures could effectively evaluate nursing interventions in clinical practice. Further validations of CLASP among different diagnostic groups, such as patients with heart failure and those who have survived an acute myocardial infarction, would provide further empirical support for its use with all patients with heart disorders. [source] Review article: lymphatic system and associated adipose tissue in the development of inflammatory bowel diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2010P.-Y. Von Der Weid Summary Background, The lymphatic system plays critical roles in tissue fluid homoeostasis, immune defence and metabolic maintenance. Lymphatic vessels transport lymph, proteins, immune cells and digested lipids, allowing fluid and proteins to be returned to the blood stream, lipids to be stored and metabolized and antigens to be sampled in lymph nodes. Lymphatic drainage is mainly driven by rhythmic constrictions intrinsic to the vessels and critically modulated by fluid pressure and inflammatory mediators. Aim, To collect and discuss the compelling available information linking the lymphatic system, adiposity and inflammation. Methods, A literature search was performed through PubMed focusing on lymphatic system, inflammation, immune cells and fat transport and function in the context of IBD. Results, Evidence collected allows us to propose the following working model. Compromised lymph drainage, reported in IBD, leads to oedema, lymphangiogenesis, impaired immune cell trafficking and lymph leakage. Lymph factor(s) stimulate adipose tissue to proliferate and produce cytokines, which affect immune cell functions and exacerbate inflammation. Conclusions, Understanding the lymphatic system's role in immune cell trafficking and immune responses, contribution to fat transport, distribution, metabolism and implication in the pathogenesis of chronic intestinal inflammation may provide the basis for new therapeutic strategies and improved quality-of-life. [source] Review article: anti-fibrotic agents for the treatment of Crohn's disease , lessons learnt from other diseasesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010H. SZABŇ Summary Background, The current therapies for Crohn's disease (CD) are mainly focused on blockade of inflammation. Fibrosis remains one of the major complications of CD often leading to surgery, affecting patients' quality-of-life. Aim, To summarize the published data regarding the potential anti-fibrotic role of drugs commonly used in CD and the most effective anti-fibrotic drugs used in other diseases evaluating their potential use to treat intestinal fibrosis in CD. Methods, A literature search was performed in the PubMed, Medline, Cochrane and EMBASE databases, considering in vitro, animal and human studies on fibrosis in inflammatory bowel disease and other similar chronic pathologies. Results, Treatment of fibrosis in CD is limited to surgery or endoscopic dilatation, although some of the drugs currently used may have anti-fibrotic activity. In other diseases, anti-fibrotic agents are already used or are in preclinical or clinical trials. ACE inhibitors, Angiotensin Receptor Blockers, and HMG-CoA inhibitors merit further investigation in CD because of their role in preventing fibrosis in cardiovascular and renal diseases. Conclusions, Anti-fibrotic drugs are under evaluation or already used in clinical practice in other chronic inflammatory diseases. In CD, there is a great need for investigation into agents that may prevent, reduce or reverse intestinal fibrosis. Aliment Pharmacol Ther,31, 189,201 [source] Symptoms in patients on long-term proton pump inhibitors: prevalence and predictorsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009A. S. RAGHUNATH Summary Background, Symptom control in primary care patients on long-term proton pump inhibitor (PPI) treatment is poorly understood. Aim, To explore associations between symptom control and demographics, lifestyle, PPI use, diagnosis and Helicobacter pylori status. Methods, A cross-sectional survey (n = 726) using note reviews, questionnaires and carbon-13 urea breath testing. Determinants of symptom control [Leeds Dyspepsia Questionnaire (LDQ), Carlsson and Dent Reflux Questionnaire (CDRQ), health-related quality-of-life measures (EuroQoL: EQ-5D and EQ-VAS)] were explored using stepwise linear regression. Results, Moderate or severe dyspepsia symptoms occurred in 61% of subjects (LDQ) and reflux symptoms in 59% (CDRQ). Age, gender, smoking and body mass index had little or no influence upon symptom control or PPI use. Average symptom scores and PPI use were lower in patients with non-ulcer dyspepsia and gastro-protection than gastro-oesophageal reflux disease (GERD) and uninvestigated dyspepsia. H. pylori infection was associated with lower reflux symptom scores only in patients with GERD and uninvestigated dyspepsia. EQ-5D was not able to discriminate between diagnostic groups, although the EQ-VAS performed well. Conclusions, A majority of patients suffered ongoing moderate or severe symptoms. GERD and uninvestigated dyspepsia were associated with poorer long-term symptom control; H. pylori appeared to have a protective effect on reflux symptoms in these patients. [source] Irritable bowel syndrome: patients' attitudes, concerns and level of knowledgeALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2007B. E. LACY Summary Background Irritable bowel syndrome (IBS) is a common, chronic disorder that reduces patients' quality-of-life. Although highly prevalent, little is known about patients' understanding of this disorder. Aim To evaluate the knowledge, fears and concerns of IBS patients. Methods Seven hundred thirty-six IBS patients (Rome II criteria) were eligible for inclusion in this prospective study. Each patient received a validated questionnaire to evaluate knowledge, attitudes and fears regarding IBS. Results A total of 261 of 664 potential respondents completed the questionnaire (39.3%). 83% of respondents were women, with a mean age of 53.7 years, and mean duration of symptoms of 14.2 years. Patients frequently believed that IBS develops because of anxiety (80.5%), dietary factors (75.1%) and depression (63.2%). Few respondents (28.7%) recognized that abdominal pain is the cardinal symptom of IBS, and 40.6% stated that colonoscopy can diagnose IBS. One in seven patients stated that IBS turns into cancer, and 29.9% noted that IBS increases the risk of inflammatory bowel disease. Conclusions Many IBS patients have significant misconceptions regarding the nature of their disease and its prognosis. An overwhelming majority of IBS patients believe that anxiety, dietary factors and depression cause IBS. These findings are discordant with physicians' views and practices and highlight the need for patient-oriented educational programs. [source] Quality of life in functional dyspepsia: responsiveness of the Nepean Dyspepsia Index and development of a new 10-item short formALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2001N. J. Talley Background: The Nepean Dyspepsia Index is a reliable and valid measure of quality of life in functional dyspepsia, but responsiveness has been little studied. The Nepean Dyspepsia Index originally contained 42 items designed to measure impairment of a subject's ability to engage in relevant aspects of their life because of dyspepsia, and their enjoyment of these aspects; in addition, the individual importance of areas was assessed. It was subsequently shortened to 25 items, yielding five sub-scales. Aim: To test the Nepean Dyspepsia Index's responsiveness and develop a responsive, very short form. Methods: A randomized, double-blind controlled trial was performed in 589 patients with documented functional dyspepsia. Symptoms and quality of life were measured at baseline, 2 and 4 weeks. Responsiveness of the Nepean Dyspepsia Index quality-of-life section was evaluated by correlation with symptom scores and calculation of standardized changes in scores. Two items from each sub-scale which best represented the area of life (by factor loadings) were selected to create the 10-item short form (SF; short form-Nepean Dyspepsia Index). Internal consistency was assessed by Cronbach's alpha and responsiveness was assessed as above. Results: The Nepean Dyspepsia Index quality-of-life scales demonstrated excellent responsiveness to change in both the active and placebo arms (standardized response means all > 1.0). The Nepean Dyspepsia Index accounted for only 8% of the variance in percentage change in symptoms (by visual analogue scales), indicating that it was evaluating areas of life not covered by symptoms. The 10-item short form had adequate internal consistency (all scales , 0.70) and all strongly (and significantly) correlated with the long form sub-scales; it was also highly responsive. Conclusion: The Nepean Dyspepsia Index is a responsive disease-specific quality-of-life measure; the 10-item short form can be applied in clinical trials of functional dyspepsia. [source] The multinational birth cohort of EuroPrevall: background, aims and methodsALLERGY, Issue 4 2010T. Keil To cite this article: Keil T, McBride D, Grimshaw K, Niggemann B, Xepapadaki P, Zannikos K, Sigurdardottir ST, Clausen M, Reche M, Pascual C, Stanczyk AP, Kowalski ML, Dubakiene R, Drasutiene G, Roberts G, Schoemaker A-FA, Sprikkelman AB, Fiocchi A, Martelli A, Dufour S, Hourihane J, Kulig M, Wjst M, Yazdanbakhsh M, Szépfalusi Z, van Ree R, Willich SN, Wahn U, Mills ENC, Beyer K. The multinational birth cohort of EuroPrevall: background, aims and methods. Allergy 2010; 65: 482,490. Abstract Background/aim:, The true prevalence and risk factors of food allergies in children are not known because estimates were based predominantly on subjective assessments and skin or serum tests of allergic sensitization to food. The diagnostic gold standard, a double-blind placebo-controlled food provocation test, was not performed consistently to confirm suspected allergic reactions in previous population studies in children. This protocol describes the specific aims and diagnostic protocol of a birth cohort study examining prevalence patterns and influential factors of confirmed food allergies in European children from different regions. Methods:, Within the collaborative translational research project EuroPrevall, we started a multi-center birth cohort study, recruiting a total of over 12 000 newborns in nine countries across Europe in 2005,2009. In addition to three telephone interviews during the first 30 months, parents were asked to immediately inform the centers about possible allergic reactions to food at any time during the follow-up period. Results:, All children with suspected food allergy symptoms were clinically evaluated including double-blind placebo-controlled food challenge tests. We assessed sensitization to different food allergens by measurements of specific serum immunoglobulin E and skin prick tests, collect blood, saliva or buccal swabs for genetic tests, breast milk for measurement of food proteins/cytokines, and evaluate quality-of-life and economic burden of families with food allergic children. Conclusions:, This birth cohort provides unique data on prevalence, risk factors, quality-of-life, and costs of food allergies in Europe, leading to the development of more informed and integrated preventative and treatment strategies for children with food allergies. [source] Effects of a pseudoallergen-free diet on chronic spontaneous urticaria: a prospective trialALLERGY, Issue 1 2010M. Magerl Abstract Background:, Chronic spontaneous urticaria is a skin disorder that is difficult to manage and can last for years. ,Pseudoallergens' are substances that induce hypersensitive/intolerance reactions that are similar to true allergic reactions. They include food additives, vasoactive substances such as histamine, and some natural substances in fruits, vegetables and spices. Eliminating pseudoallergens from the diet can reduce symptom severity and improve patient quality of life. Aim:, To assess the effects of a pseudoallergen-free diet on disease activity and quality of life in patient's chronic spontaneous urticaria. Methods:, Study subjects had moderate or severe chronic spontaneous urticaria that had not responded adequately to treatment in primary care. For 3 weeks, subjects followed a pseudoallergen-free diet. They kept a clinical diary, which recorded their wheal and pruritus severity each day, to yield a clinical rating of chronic spontaneous urticaria severity (the UAS4 score). The subjects also completed the DLQI, a validated quality-of-life instrument. Use of antihistamines and glucocorticoids was minimized, recorded, and analysed. Subjects were classified into nine response categories, according to the changes in symptom severity (UAS4), quality of life (DLQI) and medication usage. Results:, From the 140 subjects, there were 20 (14%) strong responders and 19 (14%) partial responders. Additionally, there were nine (6%) subjects who made a substantial reduction in their medication without experiencing worse symptoms or quality of life. Conclusions:, Altogether the pseudoallergen-free diet is beneficial for one in three patients. The pseudoallergen-free diet is a safe, healthy and cost-free measure to identify patients with chronic spontaneous urticaria that will benefit from avoiding pseudoallergens. [source] Desloratadine relieves nasal congestion and improves quality-of-life in persistent allergic rhinitisALLERGY, Issue 11 2009K. Holmberg Background:, Symptoms of allergic rhinitis (AR), particularly nasal congestion, can impair quality-of-life (QoL). However, only a modest correlation exists between these symptoms and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores, suggesting that both be evaluated for a complete assessment of health. Methods:, Subjects with a ,2-year history of moderate-to-severe AR to dust mite or cat dander were randomized to desloratadine 5 mg/day (n = 293) or placebo/day (n = 291) for 28 days. Primary endpoint was change from baseline in a.m./p.m. nasal congestion score. Secondary outcomes included change from baseline in total nasal symptom score, individual symptom scores and RQLQ scores (completed on days 1, 7, and 28). Results:, The Allergic Rhinitis and its Impact on Asthma criteria for persistent allergic rhinitis (PER) were fulfilled by 99% of subjects in the placebo arm. Between-treatment difference in a.m./p.m. nasal congestion score, observed from day 8 onward, significantly favored desloratadine (P = 0.0003). Desloratadine significantly improved a.m./p.m. nasal congestion and RQLQ scores after 1 week and at treatment end (P < 0.05). Improvements in 5 of 7 RQLQ domain scores exceeded the minimal important difference. On days 7 and 28, desloratadine was also significantly superior to placebo in mean change from baseline in a.m./p.m. total nasal symptom score and rhinorrhea score (both P , 0.01). Symptomatic benefit was primarily driven by improvement in nasal congestion and rhinorrhea. Conclusions:, Desloratadine 5 mg/day significantly improved symptoms associated with PER, including nasal congestion, and provided significant improvement in QoL after 1 week of treatment. [source] Efficacy of desloratadine in intermittent allergic rhinitis: a GA2LEN studyALLERGY, Issue 10 2009J. Bousquet Background:, The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines proposed a classification for allergic rhinitis based on the duration of symptoms (intermittent, persistent) rather than on the time of allergen exposure (seasonal, perennial). There is no placebo-controlled, randomized clinical trial on intermittent allergic rhinitis (IAR) to date. Desloratadine (DL) is recommended for the first-line treatment of seasonal and perennial allergic rhinitis. Objectives:, To assess the efficacy and safety of DL in subjects with IAR based on the ARIA classification. Methods:, Patients over 12 years of age with IAR were assessed over 15 days of treatment with DL 5 mg once daily (n = 276) or placebo (n = 271). The primary endpoint was the AM/PM reflective total 5 symptom score (T5SS). Secondary endpoints included AM/PM instantaneous T5SS and individual symptoms, therapeutic response, symptom severity by visual analogue scale, and quality-of-life. Results:, The mean reduction of AM/PM reflective T5SS was significantly greater with DL than with placebo over 15 days (,3.01 vs,2.13, P < 0.001) and on each individual day (P < 0.05). Mean AM instantaneous T5SS was reduced significantly with DL compared to placebo as early as day 2 (,1.84 vs,0.89; P < 0.001). The therapeutic response and improvement in quality-of-life were significantly greater with DL than with placebo (P < 0.001 for each). The frequency of treatment-related adverse events was low and similar between DL (7.2%) and placebo (7.0%). Conclusions:, This is the first large trial to show that treatment can be effective in IAR. Desloratadine was effective and safe. [source] The German version of the chronic urticaria quality-of-life questionnaire: factor analysis, validation, and initial clinical findingsALLERGY, Issue 6 2009ynek Background:, Chronic urticaria (CU) is a common skin disorder that causes a substantial burden on patients' quality-of-life (QoL). The aim of this work was to generate and validate a German version of the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) and to provide reference assessments of QoL. Methods:, The Italian CU-Q2oL was translated into German and administered to 157 CU patients. They also completed two well-established general dermatology QoL questionnaires, the Dermatology Life Quality Index (DLQI) and Skindex-29. Factor analysis was used to identify scales of the German CU-Q2oL. Correlation to the DLQI and Skindex-29 was used for validation. Multiple linear regression was used to determine which patient characteristics were associated with which dimensions of QoL. Results:, The factor analysis identified six scales of the German CU-Q2oL: functioning, sleep, itching/embarrassment, mental status, swelling/eating, and limits looks, which accounted for 70% of the data variance. Five of these six scales showed good internal consistency, and another five demonstrated convergent validity. On a percentile scale, they had these median CU-Q2oL scores: 29 functioning, 44 sleep, 50 itching/embarrassment, 50 mental status, 31 swelling/eating, 31 limits looks. Disease severity significantly predicted scores on all scales. Age predicted functioning, sleep, itching/embarrassment, and swelling/eating. Sex predicted itching/embarrassment and limits looks. Conclusion:, This study yielded a robust validation of the German version of the CU-Q2oL. It confirmed previous studies that CU has a clinically meaningful burden on QoL, especially for sleep and mental health, and that women are more severely affected by pruritus. The German CU-Q2oL should be widely adopted in clinical research on the treatment of CU. [source] Chronic urticaria: a patient survey on quality-of-life, treatment usage and doctor,patient relationALLERGY, Issue 4 2009M. Maurer Background:, Chronic urticaria (CU) is a common skin disorder characterized by recurrent spontaneous outbreaks of itchy wheals and/or angioedema. It has been shown to have substantial impact on patient quality-of-life, but little else is known about patient perspectives on CU and its treatment. Methods:, An internet survey was conducted with 321 randomly selected, representative adults in Germany and France who were diagnosed with CU. The survey included the Skindex-29 questionnaire on quality-of-life and questions about treatment usage and patients' relation to their physician. Regression analyses were used to identify predictors of quality-of-life, use of prescription medication and various aspects of the doctor,patient relation. Results:, The survey confirmed that CU has substantial impact on quality-of-life, with median Skindex scores of 68 for symptoms, 50 for functioning and 53 for emotions. Only two in three respondents were taking prescription medication for their CU. Older respondents, French respondents and fully employed respondents were significantly (P < 0.01) more likely to be taking prescription medication. Only three in five respondents under a physician's care reported that their physician had discussed the emotional impact of CU on them. Patients whose physicians had discussed this emotional impact were significantly (P < 0.001) more satisfied with treatment and more trusting of their physician. Conclusions:, CU has a heavy impact on quality-of-life. Physicians need to be aware that many patients are not taking second generation anti-histamines and counsel them better on this point. Physicians should also discuss the emotional impact of CU with patients, because it improves their satisfaction and trust. [source] Functional outcome and quality of life of Gustilo IIIB open tibial fractures requiring free tissue transfers: A report of eight cases ,MICROSURGERY, Issue 7 2005Terumasa Boku M.D. Eight patients with type IIIB open tibial fractures requiring free tissue transfers were retrospectively reviewed. The functional outcome was evaluated by using a scoring system developed by Puno et al. (Microsurgery 17:167,173, 1996). Short Form 36 (SF-36) was used as a measurement of individuals' quality-of-life (QOL) scores. The average total score of all cases was 77.6. An excellent or good functional outcome was achieved in 37.5% (3/8). Six patients were evaluated by SF-36. The average physical health summary (T-PH) score was 47.9, the average mental health summary (T-MH) score was 53.5, and the average total general health summary (T-GH) score was 50.7. The mean T-MH score was significantly higher than the mean T-PH score (P < 0.05). Treated cases showed an acceptable QOL, considering the results of the T-GH. The mental QOL was higher than the physical QOL. In severe open tibial fractures, it is difficult to obtain a good or excellent functional outcome, even with reconstruction using free tissue transfers. © 2005 Wiley-Liss, Inc. Microsurgery 25:532,537, 2005. [source] Quality-of-life and asthma-severity in general population asthmatics: results of the ECRHS II studyALLERGY, Issue 5 2008V. Siroux Background: Health-related quality-of-life (HRQL) has been poorly studied in large samples of asthmatics from the general population. HRQL and its relationship to asthma-severity were assessed among 900 asthmatics enrolled in the European Community Respiratory Health Survey. Methods: Among asthmatics, 864 completed the short form-36 (SF-36) questionnaire and 477 also completed the Asthma Quality-of-life Questionnaire (AQLQ). A 4-class asthma-severity scale, combining clinical items, forced expiratory volume in 1 s and the level of treatment and the different asthma-severity components (each of the clinical items and hospitalization) were studied in relation to HRQL. Results: Mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores (45.5 and 48.8 respectively) were lower than expected in a general population. The mean total AQLQ score was 5.8. The AQLQ score and to a lesser extent the PCS score were significantly related to the 4-class asthma-severity scale, although the risk of having a lower HRQL score did not vary proportionally across the levels of severity. Asthma-severity had no impact on the MCS score. Asthma attack frequency and hospitalization were associated with both total AQLQ and PCS scores, whereas nocturnal symptoms and lung function were more strongly related to the AQLQ and PCS score respectively. Conclusion: In population-based asthmatics, the specific AQLQ questionnaire, and also to a lesser extent the generic SF-36 questionnaire, were sensitive to asthma-severity. Frequencies of asthma attacks, of nocturnal symptoms and hospitalization for asthma have independent impact on HRQL. [source] Less is more, or almost as much: A 15-item quality-of-life instrument for myasthenia gravisMUSCLE AND NERVE, Issue 2 2008Ted M. Burns MD Abstract We describe the process whereby a recently developed myasthenia gravis (MG)-specific quality-of-life (QOL) instrument was reduced from 60 items to 15 items while maintaining potential usefulness in the clinic and in prospective treatment trials. In data from a recently completed prospective trial of mycophenolate mofetil (MMF) in MG, the MG-QOL15 correlated as highly as the 60-item MG-QOL for physical and social domains of the 36-item health survey of the Medical Outcomes Study Short Form (SF-36). Correlation coefficients for the MG-QOL15 were similar to the 60-item MG-QOL for the Quantitative Myasthenia Gravis (QMG), MG-specific Manual Muscle Testing (MG-MMT), and the MG-specific Activities of Daily Living (MG-ADL) scores at week 0 and for change in scores from week 0 to week 12 in the MMF trial. Using the physician global impression at week 12 of the trial as the "gold standard," the MG-QOL15 demonstrated high sensitivity. Because the MG-QOL15 instrument can be quickly and easily administered and interpreted, it is a potential QOL measure for treatment trials and the clinical evaluation of patients with MG. Muscle Nerve, 2008 [source] | |||||||||||||||||||||||||||||||||||||