Outcome and quality of life after central pulmonary embolism: surgical embolectomy versus medical treatment

Abstract Purpose There is no consensus on quality of life (QOL) in patients with acromegaly requiring medical treatment after surgery compared with those achieving remission by surgery alone. Methods QuaLAT is a cross-sectional study comparing QOL in surgery-only treated acromegaly patients versus those requiring medical treatment post-surgery. Patients attending clinics were identified and divided into—Group 1: patients who had surgery only and were in biochemical remission, Group 2: all patients on medical treatment post-surgery, Group 3: patients from Group 2 with biochemical control. Participants were asked to fill three questionnaires; Acromegaly Quality of Life Questionnaire (ACROQOL), 36-Item Short Form Survey (SF36), and Fatigue Severity Scale (FSS). Results There were 32 patients in Group 1 and 25 in Group 2. There was no difference in QOL scores between groups 1 and 2, as measured by ACROQOL (mean difference [MD] = − 2.5, 95% CI − 16.6 to 11.6; p = 0.72), SF36v2 [Physical component score (PCS) MD = − 4.9, 95% CI − 10.9 to 1.2; p = 0.12; mental component score MD = − 3.0, 95% CI − 10.5 to 4.4; p = 0.44], or FSS (MD = − 0.004, 95% CI − 1.14 to 1.33; p = 0.1). Comparison between groups 1 and 3 however showed that PCS (and 3 subdomains) was significantly better in group 3 (MD = − 8.3, 95% CI − 14.8 to -1.8; p = 0.01). All three QOL scores were lower when compared with healthy controls. Conclusions Medical treatment not only achieves a QOL comparable to surgery, it may also be associated with better QOL in physical subdomains. When compared with healthy controls, QOL remains worse in treated acromegaly patients compared to controls.

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Functional outcomes and quality of life during long-term follow-up after acute pulmonary embolism: analysis of the prospective multicentre FOCUS study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2277 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Cited By ~ 1

Author(s):

S Barco ◽

L Valerio ◽

M Jankowski ◽

M.M Hoeper ◽

F.A Klok ◽

...

Keyword(s):

Quality Of Life ◽

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Medical Center ◽

Combination Group ◽

Funding Source ◽

Median Score ◽

Persistent Symptoms

Abstract Background It is unclear to which extent persistence of symptoms and/or residual haemodynamic impairment clinical course of pulmonary embolism are associated with worse quality of life (QoL). Aims To study the correlation between symptoms and haemodynamic impairment with QoL during the first year after acute pulmonary embolism (PE). Methods The Follow-Up after acute pulmonary embolism (FOCUS) study prospectively enrolled and followed consecutive adult patients diagnosed with acute symptomatic objectively diagnosed PE. In the present analysis, we considered patients who completed the Pulmonary Embolism QoL (PEmb-QoL) Questionnaire at predefined visits 3 and 12 months after acute PE. The PEmb-QoL score ranges from 0% (best QoL) to 100% (worst QoL). We evaluated at these two time points the correlation between persisting symptoms (group: symptoms), elevation of natriuretic peptides or residual right ventricular dysfunction (group: RVD), or their combination (group: symptoms + RVD) and QoL. Results A total of 617 patients were included; their median age was 62 years, 44% were women; 8% had active cancer, and 21% previous venous thromboembolism. At 3 months, patients with neither symptoms nor RVD (n=302) had the highest quality of life (median score 18%, 25th–75th percentile: 8%–34%), followed by those without symptoms but with RVD (n=255; median score 19%, 25th–75th percentile: 7%–34%), and by those with symptoms only (n=131; median PEmb-QoL 31%, 25th–75th percentile: 18%–49%). Patients with both symptoms and RVD (n=170) had the worst quality of life (median score 38%, 25th–75th percentile: 19%–53%); Figure 1A. At 12 months, we found an overall improvement of PEmb-QoL score. The degree of this QoL improvement varied across groups, being largest for patients who recovered from having symptoms + RVD at 3 months to normalization of at least one at 12 months. The change in QoL from 3 to 12 months was smaller both in patients who had neither symptoms nor RVD and in patients who had no recovery in either symptoms or RVD; Figure 1B. Conclusions Persistent symptoms after PE, especially in patients with elevated biomarkers or residual echocardiographic dysfunction, were the main drivers of QoL at 3 months as well as of the course of QoL over time. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): University Medical Center of the Johannes Gutenberg University, Mainz, Germany; German Federal Ministry of Education and Research

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Effect of Hysterectomy vs Medical Treatment on Health-Related Quality of Life and Sexual Functioning

JAMA ◽

10.1001/jama.291.12.1447 ◽

2004 ◽

Vol 291 (12) ◽

pp. 1447 ◽

Cited By ~ 93

Author(s):

Miriam Kuppermann ◽

R. Edward Varner ◽

Robert L. Summitt, Jr ◽

Lee A. Learman ◽

Christine Ireland ◽

...

Keyword(s):

Quality Of Life ◽

Medical Treatment ◽

Sexual Functioning ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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Quality of Life 3 and 12 Months Following Acute Pulmonary Embolism

CHEST Journal ◽

10.1016/j.chest.2021.01.071 ◽

2021 ◽

Author(s):

Luca Valerio ◽

Stefano Barco ◽

Marius Jankowski ◽

Stephan Rosenkranz ◽

Mareike Lankeit ◽

...

Keyword(s):

Quality Of Life ◽

Pulmonary Embolism ◽

Acute Pulmonary Embolism

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Searching for the ‘winner’ hip fracture patient: the effect of modifiable and non-modifiable factors on clinical outcomes following hip fracture surgery

Hip International ◽

10.1177/1120700019878814 ◽

2019 ◽

pp. 112070001987881 ◽

Cited By ~ 1

Author(s):

Konstantinos G Makridis ◽

Leonidas S Badras ◽

Stelios L Badras ◽

Theofilos S Karachalios

Keyword(s):

Quality Of Life ◽

Hip Fracture ◽

Medical Treatment ◽

Clinical Outcomes ◽

Hip Fractures ◽

Mortality Rates ◽

Factors Affecting ◽

Modifiable Factors ◽

Modifiable Factor

Background: Various factors, other than the quality of surgery, may influence clinical outcomes of hip fracture patients. We aimed to evaluate the relative impact of several factors on functional outcome, quality of life, re-fracture and mortality rates following surgery for hip fractures. Methods: We studied 498 (62.2%) women and 302 (37.8%) men with a mean age of 81.3 years (range, 60–95) with hip fractures (femoral neck and pertrochanteric). The mean follow-up was 74 months (range 58–96). Various patient-related and surgery-related parameters were recorded and correlated to both objective and subjective mobility, functional recovery and quality of life scales. Mortality and re-fracture rates were also evaluated. Results: Using multiple regression analysis, age >80 years ( p = 0.000; 95% CI, 1.077–1.143) and ASA score III and IV ( p = 0.000; 95% CI, 2.088–3.396) (both non-modifiable factors) both proved to be independent (s.s.) factors affecting mortality rates. Age <80 years ( p = 0.000; 95% CI, 0.932–0.974), surgery delay less (modifiable factor) than 48 hours ( p = 0.046; 95% CI, 0.869–0.999), low dementia CDR index ( p = 0.005; 95% CI, 0.471–0.891) (non-modifiable factor), and osteoporosis medical treatment (modifiable factor) ( p = 0.006; 95% CI, 0.494–0.891) were shown to be independent (s.s.) factors affecting HOOS-symptoms. Osteoporosis medical treatment used proved to be an independent (s.s.) factor affecting HOOS-daily activities ( p = 0.049; 95% CI, 0.563–1.000) and quality of life (E-Qol-5D) ( p = 0.036; 95% CI, 0.737–1.325). Conclusions: A hip fracture patient aged <80 years old, with an ASA I-II, with low dementia CDR index and on osteoporosis medication has a better chance of an improved outcome (winner patient).

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Quality of Life and its Determinants in Patients With Treated Acromegaly: A Cross-Sectional Nationwide Study in China

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa750 ◽

2020 ◽

Vol 106 (1) ◽

pp. 211-225

Author(s):

Xiaopeng Guo ◽

Kailu Wang ◽

Siyue Yu ◽

Lu Gao ◽

Zihao Wang ◽

...

Keyword(s):

Quality Of Life ◽

Medical Treatment ◽

Short Form ◽

Somatostatin Analogs ◽

Chinese Patients ◽

Treatment Modalities ◽

Biochemical Control ◽

Cross Sectional

Abstract Context Quality of life (QoL) continues to be impaired in acromegaly after treatment. Objective We conducted the first nationwide survey assessing QoL status among Chinese patients with treated acromegaly and explored correlations with clinical parameters, treatment modalities, and outcomes. Design Cross-sectional study. Setting Survey via Chinese Association of Patients with Acromegaly (CAPA) online platform. Patients Treated patients from CAPA. Main Outcome Measures QoL was assessed using acromegaly QoL questionnaire (AcroQoL), 5-level EuroQoL five-dimensional questionnaire (EQ-5D-5L), and 12-item short-form health survey questionnaire (SF-12). Results Complete, valid questionnaires from 327 patients (mean age: 39.2 years, 61.5% females) at a mean of 10 years after treatment were included. Biochemical control was satisfied in 52.9% of these patients. The controlled patients had significantly better QoL than the uncontrolled patients in all AcroQoL dimensions, most SF-12 dimensions, and pain/discomfort and anxiety/depression dimensions of the EQ-5D-5L. Patients with either controlled or uncontrolled acromegaly had significantly worse QoL than the age- and sex-adjusted population reference in most SF-12 dimensions except for physical functioning. More acromegaly-associated symptoms and comorbidities at follow-up were independent risk factors for decreased QoL across all questionnaires. Medical treatment, especially with somatostatin analogs (SSAs), and radiotherapy were predictors of worse QoL. Female patients had lower scores of physical-related QoL than male patients. Conclusions Our study suggests that biochemical control improved but did not normalize QoL in acromegaly. Numbers of symptoms and comorbidities at follow-up, sex, radiotherapy, and medical treatment with SSAs were factors determining QoL of patients with treated acromegaly.

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Clinical Holistic Medicine: Applied Consciousness-Based Medicine

The Scientific World JOURNAL ◽

10.1100/tsw.2004.8 ◽

2004 ◽

Vol 4 ◽

pp. 96-99 ◽

Cited By ~ 5

Author(s):

Søren Ventegodt ◽

Joav Merrick

Keyword(s):

Quality Of Life ◽

Medical Treatment ◽

Family Physician ◽

Holistic Medicine ◽

Doctor Who ◽

The Family ◽

Biomedical Treatment ◽

Based Medicine ◽

The Village

Consciousness-based medicine is our term for a form of medical treatment that works by direct appeal to the consciousness of the patient, in contrast to modern biomedical treatment where drugs are used to affect body chemistry. With this concept, maybe we are (in a sense) turning back to the “old medicine”, where the family physician was the all-concerned “old country doctor” who knew the child, the siblings, the parents, the family, and the village. In a series of papers on clinical holistic medicine, we would like to present the classic art of healing, where the physician works mostly with his hands, then show how the modern biomedical physician performs with biochemistry, and finally introduce consciousness-based medicine. Some of our questions will be: If you improve your quality of life, will you also improve your health? Will learning more about yourself bring more purpose in your life? Will finding someone to live with in a loving and mutually respectful relationship improve your health? Scientists and thinkers like Antonovsky, Frankl, Maslow, and Jung have pointed to love as a unique way to coherence in life, and thus to biological order and a better health. Several scientific studies have also suggested that patients who focus on improving their quality of life usually will not follow the general statistics for survival, since somehow other factors are at play, which sometimes you will find referred to as “exceptional”.

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Validating the Chinese version of the PEmb-QoL questionnaire: A measure for quality of life assessment after pulmonary embolism

Thrombosis Research ◽

10.1016/j.thromres.2018.04.020 ◽

2018 ◽

Vol 166 ◽

pp. 86-91 ◽

Cited By ~ 1

Author(s):

Xuefeng Sun ◽

Jingyu Li ◽

Juhong Shi

Keyword(s):

Quality Of Life ◽

Pulmonary Embolism ◽

Chinese Version ◽

Life Assessment ◽

Quality Of Life Assessment

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Quality of Life in Primary Aldosteronism: A Comparative Effectiveness Study of Adrenalectomy and Medical Treatment

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2017-01442 ◽

2017 ◽

Vol 103 (1) ◽

pp. 16-24 ◽

Cited By ~ 21

Author(s):

Marieke Velema ◽

Tanja Dekkers ◽

Ad Hermus ◽

Henri Timmers ◽

Jacques Lenders ◽

...

Keyword(s):

Quality Of Life ◽

General Population ◽

Medical Treatment ◽

Primary Aldosteronism ◽

Comparative Effectiveness ◽

Effectiveness Study ◽

Analog Scale ◽

Sf 36 ◽

Comparative Effectiveness Study

Abstract Context In primary aldosteronism (PA), two subtypes are distinguished: aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH). In general, these are treated by adrenalectomy (ADX) and mineralocorticoid receptor antagonists (MRA), respectively. Objective To compare the effects of surgical treatment and medical treatment on quality of life (QoL). Design Post hoc comparative effectiveness study within the Subtyping Primary Aldosteronism: A Randomized Trial Comparing Adrenal Vein Sampling and Computed Tomography Scan (SPARTACUS) trial. Setting Twelve Dutch hospitals and one Polish hospital. Participants Patients with PA (n = 184). Interventions ADX or MRAs. Main Outcome Measures At baseline and 6-month and 1-year follow-up, we assessed QoL by two validated questionnaires: RAND 36-Item Health Survey 1.0 (RAND SF-36) and European Quality of Life–5 Dimensions (EQ-5D). Results At baseline, seven of eight RAND SF-36 subscales and both summary scores, as well as three of five EQ-5D dimensions and the visual analog scale, were lower in patients with PA compared with the general population, especially in women. The beneficial effects of ADX were larger than for MRAs for seven RAND SF-36 subscales, both summary scores, and health change. For the EQ-5D, we detected a difference in favor of ADX in two dimensions and the visual analog scale. Most differences in QoL between both treatments exceeded the minimally clinically important difference. After 1 year, almost all QoL measures had normalized for adrenalectomized patients. For patients on medical treatment, most QoL measures had improved but not all to the level of the general population. Conclusion Both treatments improve QoL in PA, underscoring the importance of identifying these patients. QoL improved more after ADX for suspected APA than after initiation of medical treatment for suspected BAH.

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