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Social Limitations (social + limitation)
Selected AbstractsImprovement in quality of life after botulinum toxin-A injections for idiopathic detrusor overactivity: results from a randomized double-blind placebo-controlled trialBJU INTERNATIONAL, Issue 11 2009Arun Sahai OBJECTIVE To determine whether botulinum toxin-A (BTX-A) treatment has an effect on the quality of life (QoL) of patients with overactive bladder (OAB) refractory to anticholinergics. PATIENTS AND METHODS This was a single centre, randomized, double-blind, placebo-controlled trial. Participants were men and women with idiopathic detrusor overactivity (IDO). Participants were randomised to receive either 200 U of BTX-A (Botox®, Allergan Inc., Irvine, CA, USA; n = 16) or placebo (n = 18) via a trigone-sparing flexible cystoscopic technique. QoL was assessed using the King's Health Questionnaire (KHQ) at baseline and at 4 and 12 weeks, after injection. At 12 weeks patients were ,unblinded' and a further open-label follow-up in the BTX-A group occurred at 24 weeks. The changes in the subdomains of the KHQ were assessed over the study period. RESULTS Overall QoL was significantly improved in the BTX-A treated patients compared with placebo in the blinded part of the study. When analysing the KHQ subdomains, ,Incontinence Impact', ,Emotions', ,Physical Limitations', ,Social Limitations' and ,Severity Measures' were significantly improved in those that received BTX-A compared with placebo. The ,Symptom Severity' domain was also significantly improved at 4 weeks but not at 12 weeks. At 12 weeks ,Role Limitations' also became statistically significant in favour of BTX-A. The open-label extension study suggested these benefits last for at least 24 weeks. CONCLUSIONS BTX-A bladder injections at 200 U appear to improve QoL in patients with OAB symptoms and IDO refractory to anticholinergics for at least 24 weeks. As well as the improvement seen in clinical parameters with this form of therapy, perhaps of more importance to the patient, is the improvement in QoL. [source] The impact of food hypersensitivity reported in 9-year-old children by their parents on health-related quality of lifeALLERGY, Issue 2 2008E. Östblom Background:, There are only a few studies on the impact of food hypersensitivity (FHS) in children on health-related quality of life (HRQL). The present study was designed to examine this impact in a population-based birth cohort (BAMSE). Methods:, A nested case,control study was performed within the cohort. The parents of 1378 nine-year-old children filled out a generic questionnaire with 13 subscales (Child Health Questionnaire Parental Form 28 , CHQ-PF28) supplemented with disease-specific questions concerning FHS. There were 212 children with report of FHS. Another 221 children with allergic diseases but not FHS were examined for comparison. Furthermore, the impact of pronounced symptoms of FHS and of increasing levels of food-specific IgE antibodies on HRQL was also analysed. Results:, The children with FHS exhibited significantly lower scores on the subscales physical functioning, role/social limitations , physical and general health in the generic instrument. Furthermore, children with food-related symptoms from the lower airways were scored lower on Self Esteem, Parental Impact , time and Family Cohesion. Sensitization per se did not alter these patterns, but high levels of food-specific IgE-antibodies affected mental health and general health negatively. A physician's diagnosis of food allergy did not affect any of the subscales negatively. Conclusions:, Parents reported that FHS exerts a negative impact on the HRQL of 9-year-old children, in particular in children with symptoms from the lower airways or if the FHS is associated with high levels of food-specific IgE-antibodies. Healthcare-givers must put major effort into improving and maintaining the HRQL of these children. [source] An epidemiological survey of overactive bladder symptoms in JapanBJU INTERNATIONAL, Issue 9 2005Yukio Homma OBJECTIVE To report an epidemiological survey of lower urinary tract symptoms (LUTS) to determine the prevalence of overactive bladder (OAB) symptoms (defined as a symptom complex of daily urinary frequency of eight or more times and urgency once or more per week) in Japan. SUBJECTS AND METHODS A self-administered questionnaire was mailed to 10 096 Japanese men and women aged ,,40 years selected by a two-stage randomized process. Survey questions, developed by members of the Japan Neurogenic Bladder Society Committee, covered four areas: demographic characteristics, LUTS, health-related quality of life (HRQoL), and hospital attendance. RESULTS The responses from 4570 respondents (mean age 61 years) were analysed. The estimated prevalence of OAB was 12.4% (men 14%, women 11%). Prevalence rates for OAB with and without urgency incontinence (one or more episode/week) were 6.4% and 6.0%, respectively. Prevalence rates increased with age; 5% of respondents aged 40,49 and 37% of those aged ,,80 years had OAB. HRQoL was compromised in 53% of respondents with OAB symptoms, specifically emotions (42%), sleep/vitality (37%), physical limitation (34%), role limitation (29%), and social limitation (22%). Among those whose HRQoL was affected, 23% (men 36%, women 8%) had visited a medical institution because of their urinary problems. CONCLUSION The results from this survey indicate that the prevalence of OAB was high and increased with age, but the rate of hospital attendance was low. Public awareness of OAB should be increased so that there can be optimum management of this condition. [source] ICD: a qualitative study of patient experience the first year after implantationJOURNAL OF CLINICAL NURSING, Issue 8 2004Helen CM Kamphuis MSc Background., The experiences of how patients live with an implantable cardioverter defibrillator are still poorly understood. Only a few qualitative studies have investigated this phenomenon. This paper was undertaken as part of a larger project to evaluate quality of life and psychological well-being in those survivors of cardiac arrest who have received an implantable cardioverter defibrillator. Aims and objectives., The aim of this qualitative study was to explore how implantable cardioverter defibrillator recipients perceive their lives during the first year after implantation of the device. Methods., A sample of 21 patients who received an implantable cardioverter defibrillator was interviewed during three consecutive periods: one, six and 12 months postdischarge from the hospital. The semi-structured interviews were based on insights gained from a literature review. The transcripts were subjected to content analysis. Results., Analysis of the data revealed seven major categories: physical deterioration, cognitive changes, perceived social support, dependency, contact with the doctor, confrontation with mortality and uncertainty surrounding having a shock. Anxiety, uncertainty, disappointment, frustration, unexpected barriers, acceptance of and dependency on the implantable cardioverter defibrillator played a major role in the lives of implantable cardioverter defibrillator recipients. Well-being improved throughout the year. During the first months after discharge from the hospital the focus was on regaining physical health. During the early postimplantation period both the implantable cardioverter defibrillator recipient and family members had adapted to the situation. Reflection on the impact and consequences of the cardiac arrest was reported more often in the late postimplantation period. Conclusions., Content analysis is a resourceful approach giving answers to questions that have hardly been addressed within the domain of cardiology. Implantable cardioverter defibrillator recipients face a complex first year, especially the first 6 months. Cognitive deterioration and confrontation with mortality are problems that need to be researched further. Relevance to clinical practice., Caregivers are able to explain to future patients what they can expect in the first year after implantation. Caregivers may become more receptive to physical, psychological and social limitations and to emotional and social problems that occur in implantable cardioverter defibrillator recipients, enabling them to act upon them. [source] Long-term continence after surgery for Hirschsprung's diseaseJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2007Anthony G Catto-Smith Abstract Aim:, Our aim was to examine the long-term bowel dysfunction that followed surgery for Hirschsprung's disease. Methods:, Of 414 patients diagnosed with Hirschsprung's disease between 1974 and 2002, 98 were interviewed using a structured questionnaire to provide an assessment of bowel function, medication, diet, physical and social limitations. Forty-two completed a prospective 4-week toileting diary and 16 underwent anorectal manometry. Results:, Four of the 98 patients had permanent stomas and 10 had Down's syndrome. Of the remaining 84 patients (mean age 12 ± 8 years, range 1.9,41.9 years), 13% (11/84) had heavy soiling by day and 17% (14/84) by night. Fifty percent reported episodic urgency, but 36% also reported episodic constipation. Stool consistency was looser in patients with a history of long segment disease. Some aspects of bowel function improved with age. Enuresis was much more frequent than expected. Sixty-four percent reported adverse reactions to foods, particularly to fruit, vegetables, fats and diary products, and 15% limited their social activities because of fecal incontinence. There were no significant differences in manometric parameters between those patients who soiled and those who did not. Conclusions:, Fecal incontinence is common after surgery for Hirschsprung's disease and has a significant impact on social activities. Some aspects of bowel function did improve with age. Adverse reactions to food were unexpectedly frequent and need to be further studied. [source] Is there a discrepancy between patient and physician quality of life assessment?,NEUROUROLOGY AND URODYNAMICS, Issue 3 2009Sushma Srikrishna Abstract Aims Quality of Life (QoL) assessment remains integral in the investigation of women with lower urinary tract dysfunction. Previous work suggests that physicians tend to underestimate patients' symptoms and the bother that they cause. The aim of this study was to assess the relationship between physician and patient assessed QoL using the Kings Health Questionnaire (KHQ). Methods Patients complaining of troublesome lower urinary tract symptoms (LUTS) were recruited from a tertiary referral urodynamic clinic. Prior to their clinic appointment they were sent a KHQ, which was completed before attending. After taking a detailed urogynecological history, a second KHQ was filled in by the physician, blinded to the patient responses, on the basis of their impression of the symptoms elicited during the interview. These data were analyzed by an independent statistician. Concordance between patient and physician assessment for individual questions was assessed using weighted kappa analysis. QoL scores were compared using Wilcoxons signed rank test. Results Seventy-five patients were recruited over a period of 5 months. Overall, the weighted kappa showed relatively poor concordance between the patient and physician responses; mean kappa: 0.33 (range 0.18,0.57). The physician underestimated QoL score in 4/9 domains by a mean of 5.5% and overestimated QoL score in 5/9 domains by a mean of 6.9%. In particular, physicians underestimated the impact of LUTS on social limitations and emotions (P,<,0.05). Conclusion This study confirms that physicians often differ from patients in the assessment of QoL. This is most likely due to a difference in patient,physician perception of "significant" LUTS and clearly demonstrates the importance of patient evaluated QoL in routine clinical assessment. Neurourol. Urodynam. 28:179,182, 2009. © 2008 Wiley-Liss, Inc. [source] Total System Reliability: Integrated Model for Growth and Test TerminationQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 4 2005John Donovan Abstract Reliability demonstration testing is not the most efficient method of assuring product reliability prior to shipment. It is costly, time consuming and has inherent technical and social limitations. The dilemma facing the reliability and quality engineer is whether to continue demonstration testing and risk shipping a product late or ship the product and risk warranty and field service returns. Either option can cause the company to lose significant market share and profit. This paper sets out to solve this dilemma by meeting both the time to market constraints and the product reliability goals. The weaknesses of existing reliability demonstration techniques are explored and a comprehensive methodology is introduced involving controlled development processes, stress testing, root cause determination and process change feedback mechanisms. All prototype products are manufactured on the final volume process line resulting in the early identification and correction of process-related problems. Testing commences on the first available prototypes with system stress/robust testing being employed to stimulate failures, determine their root cause and correct them. Reliability growth modelling assesses the ongoing improvements occurring in reliability during the development cycle, while a statistical stopping rule is used to determine the optimal product release time without risking product warranty. The approach is applicable to systems incorporating both hardware and software elements. The methodology has been validated on three development projects of telecommunication systems comprising hardware and software. In addition to enhancing team behaviour and performance, the development times have been reduced by 14% and the ramp-up time to full worldwide product shipments has been reduced by 50%. Copyright © 2005 John Wiley & Sons, Ltd. [source] | ||||||||||