scholarly journals Evaluation of Quality of Life and Surgical Outcomes for Treatment of Diverticular Disease

2018 ◽  
Vol 31 (04) ◽  
pp. 251-257
Author(s):  
Mayin Lin ◽  
Shankar Raman
Keyword(s):  
Quality Of Life ◽  
Diverticular Disease ◽  
Surgical Intervention ◽  
Bowel Function ◽  
Operative Management ◽  
Postoperative Function ◽  
Prospective Data ◽  
Industrialized Nations ◽  
The Impact

AbstractThe prevalence of diverticular disease in the Western and industrialized nations has increased over the last century, and our understanding of this disease and its management continues to evolve. In this article, we review the literature regarding the postoperative quality of life (QOL) and functional outcomes following surgical management of diverticulitis, including information regarding bowel function, recurrence of symptoms, and other postoperative sequelae. While objective parameters, such as attacks of diverticulitis, complications, and clinical episodes have been studied, there is a paucity of data on less objective factors, such as overall patient satisfaction after operative management of diverticular disease. The literature shows improvement in QOL following surgical intervention for diverticulitis if preoperative QOL was significantly low, secondary to severe/complicated diverticulitis. However, a subset of patients does continue to have symptoms following surgical intervention for diverticulitis. Often neglected in the literature, there remains a need for prospective data evaluating preoperative function to ascertain the impact of surgery on patients' QOL and postoperative function.

scholarly journals Quality of Life following Chemoradiotherapy for Localized Muscle Invasive Bladder Carcinoma: A Systematic Review

2021 ◽  
pp. 1-13
Author(s):  
Ben-Max De Ruiter ◽  
Abel N. Keijzer ◽  
Maarten C.C.M. Hulshof ◽  
Adriaan D. Bins ◽  
Theo M. de Reijke ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Sexual Function ◽  
Bladder Carcinoma ◽  
Bowel Function ◽  
Definitive Treatment ◽  
Cochrane Library ◽  
Social And Emotional ◽  
Muscle Invasive ◽  
The Impact

BACKGROUND: Health related Quality of Life (HRQoL) is an important factor regarding treatment for localized Muscle Invasive Bladder Carcinoma (MIBC), as it may affect choice of treatment. The impact of chemoradiotherapy (CRT) for MIBC on HRQoL has not yet been well-established. OBJECTIVE: To systematically evaluate evidence regarding HRQoL as assessed by validated questionnaires after definitive treatment with CRT for localized MIBC. METHODS: We performed a critical review of PubMed/MEDLINE, EMBASE, and the Cochrane Library in October 2020. Two reviewers independently screened articles for eligibility and assessed the methodological quality of the included articles using Joanna Briggs Institute critical appraisal tools. A narrative synthesis was undertaken. RESULTS: Of 579 articles identified, 11 studies were eligible for inclusion, including three RCTs and 8 non-randomized studies, reporting on HRQoL data for 606 CRT patients. Global health declined at End of treatment (EoT), and recovered 3 months following treatment. Physical function declined from baseline at EoT and recovered between 3 and 24 months and was maintained at 5 years follow up. CRT had little effect on social and emotional function in the short-term, but HRQoL results in the long-term were lower compared to the general population. Urinary function declined from baseline at EoT, but returned to baseline at 6 months following CRT. After initial decline in bowel function, a complete return to baseline occurred 4 years following treatment. The majority of studies assessing sexual function showed no to little effect on sexual function. CONCLUSIONS: HRQoL recovers to baseline within 3 months to 2 years in almost all domains. The amount of available evidence regarding HRQoL following CRT for MIBC is limited and the quality of evidence is low.

scholarly journals Effectiveness of the surgical intervention in the quality of life and survival of patients with metastatic lesions in the spine

2014 ◽  
Vol 13 (1) ◽  
pp. 57-62
Author(s):  
Luiz Cláudio Lacerda Rodrigues ◽  
Adalberto Bortoletto ◽  
Marcelo Hide Matsumoto
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
Surgical Intervention ◽  
Neurological Status ◽  
Lumbar Region ◽  
Metastatic Lesions ◽  
Spinal Lesions ◽  
Pathologic Fractures ◽  
The Impact

OBJECTIVE: To evaluate the impact of surgical treatment of metastatic epidural spinal lesions on the quality of life of patients, pain relief and survival. METHODS: Patients with single or double spinal lesions, in good clinical conditions to undergo surgery, were included. Staging and prognostic evaluation were performed, based on imaging studies, according to the criteria of Enneking and Tokuhashi, and neurological status (Frankel), pain (visual analogue scale, VAS) and quality of life index (Oswestry) were also assessed. Survival was calculated. RESULTS: The study included 67 patients, 34 men and 33 women, aged 13-88 years (mean: 53). Most had the breast (23 cases) as the primary site of the tumor and metastasis in the lumbar region, especially in L2 and L3. Pathologic fractures were diagnosed in 45 patients. The mean VAS score was initially 9 (5-10) reducing in the second day after surgery to 2 (1-7) and to 1 (0-6) in the first and sixth months. Following 6 months, 18 deaths were observed (one intraoperatively, five in the first month and 12 at 6 months). The neurological status was correlated with survival: patients who were Frankel E before surgery showed increased survival. CONCLUSION: The surgery does not influence patient survival, except for patients with neurological deficits, who have a worse prognosis. Treatment of metastatic lesions is often palliative, but patients present improved neurological and pain relief and few complications after surgery, justifying surgical intervention.

Recent developments in the assessment of quality of life in Multiple Sclerosis (MS)

1999 ◽  
Vol 5 (4) ◽  
pp. 251-259 ◽  
Author(s):  
J S Fischer ◽  
N G LaRocca ◽  
D M Miller ◽  
P G Ritvo ◽  
H Andrews ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Bowel Function ◽  
Bladder Function ◽  
Allied Health Professionals ◽  
Hrql Instrument ◽  
Related Quality ◽  
Perceived Cognitive Function ◽  
The Impact

Multiple sclerosis (MS) and its treatment have broad-ranging effects on quality of life. This article reviews recent efforts to assess the impact of MS on activities of daily living (ADLs) and health-related quality of life (HRQL), and describes the development of the Multiple Sclerosis Quality of Life Inventory (MSQLI). The MSQLI is a modular MS-specific HRQL instrument consisting of a widely-used generic measure, the Health Status Questionnaire (SF-36), supplemented by nine symptom-specific measures (covering fatigue, pain, bladder function, bowel function, emotional status, perceived cognitive function, visual function, sexual satisfaction, and social relationships). Content validation consisted of evaluating its adherence to a conceptual model of the impact of MS, and review by MS specialists (neurologists and allied health professionals), HRQL experts, patients, and caregivers. The reliability and construct validity of the MSQLI were rigorously evaluated in a field test with 300 North American patients (198 female, 102 male) with definite MS (Poser criteria) and a broad range of physical impairment (EDSS=0.0-8.5). This article concludes by comparing the MSQLI with two other MS-specific HRQL measures (MS Quality of Life-54 (QOL-54) and Functional Assessment of Multiple Sclerosis (FAMS)) and discussing key issues to consider in selecting an HRQL instrument for a collaborative database.

scholarly journals Quantifying the impact of surgical decompression on quality of life and identification of factors associated with outcomes in patients with symptomatic metastatic spinal cord compression

2020 ◽  
Vol 33 (2) ◽  
pp. 237-244
Author(s):  
Asad M. Lak ◽  
Amina Rahimi ◽  
Abdullah M. Abunimer ◽  
Ian Tafel ◽  
Sharmila Devi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Intervention ◽  
Cord Compression ◽  
Surgical Decompression ◽  
First Year ◽  
Motor Weakness ◽  
The Mean ◽  
The Impact

OBJECTIVEMetastatic spinal cord compression (MSCC) imposes significant impairment on patient quality of life and often requires immediate surgical intervention. In this study the authors sought to estimate the impact of surgical intervention on patient quality of life in the form of mean quality-adjusted life years (QALY) gained and identify factors associated with positive outcomes.METHODSThe authors performed a retrospective chart review and collected data for patients who had neurological symptoms resulting from radiologically and histologically confirmed MSCC and were treated with surgical decompression during the last 12 years.RESULTSA total of 151 patients were included in this study (mean age 60.4 years, 57.6% males). The 5 most common metastatic tumor types were lung, multiple myeloma, renal, breast, and prostate cancer. The majority of patients had radioresistant tumors (82.7%) and had an active primary site at presentation (67.5%). The median time from tumor diagnosis to cord compression was 12 months and the median time from identification of cord compression to death was 4 months. Preoperative presenting symptoms included motor weakness (70.8%), pain (70.1%), sensory disturbances (47.6%), and bowel or bladder disturbance (31.1%). The median estimated blood loss was 500 mL and the average length of hospital stay was 10.3 days. About 18% of patients had postoperative complications and the mean follow-up was 7 months. The mean pre- and postoperative ECOG (Eastern Cooperative Oncology Group) performance status grades were 3.2 and 2.4, respectively. At follow-up, 58.3% of patients had improved status, 31.5% had no improvement, and 10.0% had worsening of functional status. The mean QALY gained per year in the entire cohort was 0.55. The mean QALY gained in the first 6 months was 0.1 and in the first year was 0.4. For patients who lived 1–2, 2–3, 3–4, or 4–5 years, the mean QALY gained were 0.8, 1.4, 1.7, and 2.3, respectively. Preoperative motor weakness, bowel dysfunction, bladder dysfunction, and ASA (American Society of Anesthesiologists) class were identified as independent predictors inversely associated with good outcome.CONCLUSIONSThe mean QALY gained from surgical decompression in the first 6 months and first year equals 1.2 months and 5 months of life in perfect health, respectively. These findings suggest that surgery might also be beneficial to patients with life expectancy < 6 months.

The Impact of the Type of Surgical Treatment on the Quality of Life of Portuguese Women with Breast Cancer

2017 ◽  
Vol 41 (S1) ◽  
pp. S252-S252
Author(s):  
H. Pereira ◽  
R. Castelo
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Surgical Intervention ◽  
Pain Treatment ◽  
Radical Surgery ◽  
Well Being ◽  
Sexual Intimacy ◽  
Measurement Instruments ◽  
The Impact

IntroductionBreast cancer significantly impacts dimensions of quality of life such as mental health, one's level of activity, family well-being, physical concerns (symptoms and pain), treatment satisfaction, emotional well-being, sexual intimacy, and social functioning.AimThe aim of this study is to evaluate the impact of the type of surgery on the quality of life of women being treated for breast cancer, based on the comparison of samples of women who have undergone different types of surgery.MethodOur sample consists of 90 Portuguese women divided into three groups of 30 participants each. The first group underwent radical surgery in order to treat their breast cancer. The second group of women had conservative surgery as a breast cancer treatment. Finally, the last group of women did not have any type of surgical intervention. We use a socio-demographic questionnaire and the Portuguese version of the EORTC QLQ-30 as measurement instruments. The sample consists of patients from a central hospital in Lisbon, Portugal, and the data were collected anonymously.ResultsWe find that in all dimensions of quality of life measured, including general health, physical functioning, social roles, and all emotional, cognitive, and social dimensions, the group of women who underwent radical surgery shows lower scores when compared to the other two groups. This indicates that this group has lower levels of quality of life.ConclusionThe use of surgery for the treatment of breast cancer leads to a diminished quality of life following surgical intervention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Establishing Clinically Significant Patient-reported Outcomes for Diverticular Disease – A Prospective Cohort Study

2020 ◽  
Author(s):  
Sara Khor ◽  
David R. Flum ◽  
Lisa L. Strate ◽  
Mariam N. Hantouli ◽  
Heather H. Harris ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Diverticular Disease ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Area Under The Curve ◽  
Meaningful Improvement ◽  
Patient Reported ◽  
The Impact

AbstractBackground & AimsDiverticular disease can undermine health-related quality of life (HRQoL). The diverticulitis quality of life (DV-QOL) instrument was designed and validated to measure the patient-reported burden of diverticular disease. However, in order for the DV-QOL to capture longitudinal outcomes, values reflecting meaningful improvement (i.e., minimal clinically important difference (MCID)) and the patient acceptable symptom state (PASS) need to be established. We sought to establish the MCID and PASS of the DV-QOL, and describe the characteristics of those with DV-QOL above the PASS threshold.MethodsWe performed a prospective cohort study of adults with diverticular disease from 7 centers in Washington and California (2016-2018). Patients were surveyed at baseline, then quarterly up to 30 months. To determine the PASS for DV-QOL, we used an anchor-based approach and performed receiver operating characteristic analyses using baseline data. A range of MCID values were calculated using distribution-based and anchor-based approaches.ResultsThe study included 177 patients (mean age 57, 43% female). A PASS threshold of 3.2/10 distinguished between those with and without HRQoL-impacting diverticulitis with acceptable accuracy (area under the curve (AUC) 0.76). A change of 2.2 points in the DV-QOL was the most appropriate MCID: above the measurement error and corresponding to patient perception of importance of change (AUC 0.70). Patients with DV-QOL≥PASS were more often male, younger, had Medicaid, less educated, and had more serious episodes of diverticulitis.ConclusionsOur study is the first to define MCID and PASS for DV-QOL. These thresholds are critical for measuring the impact of diverticular disease and the evaluation of treatment effectiveness.

scholarly journals Study of impact of surgical intervention (adenotonsillectomy) and conservative management on quality of life in patients with SDB

2018 ◽  
Vol 4 (2) ◽  
pp. 448
Author(s):  
Arshed Ali ◽  
Jasif Nisar ◽  
Ihsan Ali ◽  
Rauf Ahmad
Keyword(s):  
Quality Of Life ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Diagnostic Methods ◽  
Before And After ◽  
The Impact

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">SDB is an important cause of morbidity in children. SDB has been associated with decreased quality of life (QOL). In this study, we tried to determine The impact of surgical intervention (adenotonsillectomy) and conservative management on quality of life in patients with SDB. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A total of 112 pediatric patients were included with SDB, who visited our OPD. Diagnostic methods include history and physical examination, audiotaping or videotaping, pulse oximetry. OSA 18 questionnaire was used to assess the quality of life with conservative treatment (pre and post-treatment) and after surgical intervention-before and after adenoidectomy or adenotonsillectomy.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">We had 112 patients with majority being males 69 (61.60%) and females 43 (38.30%), majority of patients were in the age group of 5-7 yrs (49.10%). In 47 patients (who underwent adenotonsillectomy/tonsillectomy), OSA-18 questionnaire was used pre-operatively, at 2 and 6 months. OSA-18 when used pre-operatively showed majority of patients 33 (70.21%) having score &gt;80, and 14 (29.79%) patients having score between 60-80. No patient was below 60 score. Mean OSA-18 score pre-operatively was 84.15. OSA-18 score at 2 months and at 6 months were 30.06 and 26.40 respectively, which showed a lot of improvement in post-operative score and hence the post –operative quality of life. In 65 patients (conservative treatment) OSA-18 was used pre-conservative, at 2 and 6 months of treatment. OSA-18 when used before conservative treatment<strong> </strong>showed majority of patients 44 (67.6 9%) having score 60-80, and 21 (32.30%) patients having score between &gt;80. No patient was below 60 score. OSA-18 score at 2 months showed improvement in 69.23% patients (&lt;40), OSA-18 at 6 months showed recurrence in 12.33% patients. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">SDB substantially impact QOL in pediatric patients. QOL significantly improves following adenotonsillectomy. There is subset of patients 12.33% with SDB in whom there was recurrence of symptoms after conservative treatment. Thus showing that conservative management is inferior to surgical management in the treatment of SDB. SDB improved after an observation period. Thus, observation with close follow-up is another treatment option.</span></p><p> </p>

scholarly journals The impact of mode of subsequent birth after obstetric anal sphincter injury on bowel function and related quality of life: a cohort study

2020 ◽  
Vol 31 (11) ◽  
pp. 2237-2245 ◽  
Author(s):  
Sara S. Webb ◽  
Alice Sitch ◽  
Christine MacArthur
Keyword(s):  
Quality Of Life ◽  
Caesarean Section ◽  
Bowel Function ◽  
Sphincter Injury ◽  
Bowel Symptoms ◽  
Anal Sphincter Injury ◽  
Subsequent Birth ◽  
Related Quality ◽  
The Impact

Abstract Introduction and hypothesis The objective was to assess the impact of mode of subsequent birth on bowel function and related quality of life (QoL) in pregnant women with previous obstetric anal sphincter injury (OASI). Methods A prospective cohort study, designed, undertaken and reported using the Strengthening the Reporting of Observational Studies in Epidemiology statement and checklist. All pregnant women with previous OASI recruited at a specialist antenatal OASI clinic in a tertiary hospital to discuss mode of subsequent birth, between 1 January 2014 and 31 October 2015. Women are counselled in line with local guidelines based on Royal College of Obstetricians and Gynaecologists Green-top recommendations. In addition to routine endoanal ultrasound scan (EAUS), women recruited to the study were asked to complete the validated Manchester Health Questionnaire (MHQ) at both 34 weeks’ gestation and 6 months postnatally. Results Of the 175 study participants, 125 (71.4%) completed follow-up at 6 months. There was no significant change in frequency of bowel symptoms or QoL domain scores in women who had a subsequent vaginal birth compared with caesarean section. Multivariate analysis showed the odds of having poor “incontinence impact” (OR 2.91, 95% CI 1.03–8.21) and “physical limitations” (OR 4.56, 95% CI 1.02–20.45) were significantly higher for women who had a subsequent caesarean section. Conclusions For women with previous OASI, a subsequent vaginal birth is suitable for those with no bowel symptoms and normal EAUS and caesarean section is reasonable for women who do not have normal bowel function and/or normal EAUS findings; however, for some of these women bowel symptoms and QoL may be worsened.

scholarly journals Immunomodulatory Second-Line Therapies for Immune Thrombocytopenia

2019 ◽  
Vol 39 (03) ◽  
pp. 266-271
Author(s):  
Michele P. Lambert
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Immune Thrombocytopenia ◽  
Surgical Intervention ◽  
Mutual Understanding ◽  
Second Line ◽  
Available Information ◽  
The Impact

AbstractManagement of immune thrombocytopenia (ITP) is complex requiring communication between patients and caregivers to establish a mutual understanding of the impact of the patient's disease on quality of life, the current symptoms and risk of morbidity/mortality and the goals of therapy. The currently available second-line therapies for ITP provide potential for management of thrombocytopenia and bleeding symptoms with medical therapy or surgical intervention potentially offering long-term remission. All therapies are associated with potential side effects and necessary monitoring or modifications/risks and careful discussion of these is necessary to determine the optimal therapy for each patient. This review covers second-line therapies for ITP and discusses the currently available information on immunomodulatory second-line treatments for ITP.

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