Medical Treatment for Epistaxis in Hereditary Hemorrhagic Telangiectasia: A Meta-analysis

Objectives The aim of this study (PROSPERO ID: CRD42017081952) was to evaluate medical treatment for epistaxis from hereditary hemorrhagic telangiectasia (HHT). Data Sources PubMed, Embase, Scopus, and Cochrane Library databases were interrogated from their inceptions to November 2017. Review Methods Randomized clinical trials comparing medical treatment with placebo for epistaxis of HHT were included. We used a random-effects model to synthesize overall effects. Heterogeneity was evaluated with the I2 statistic. Results Eight studies were identified after systematic searching. The use of bevacizumab (BV), tranexamic acid, and estrogen, regardless of the route of administration, had no significant influence on frequency of episodes. Tamoxifen was superior to placebo in both frequency and severity of epistaxis. For duration of epistaxis, nasal spray BV, oral or nasal spray tranexamic acid, and nasal spray estrogen had no significant differences versus placebo, but patients receiving submucosal BV showed lower duration of epistaxis (mean difference: −219.00 min/mo, 95% CI: −271.90 to −166.10). Medical treatment for HHT had no significant changes of mean hemoglobin concentration (pooled mean difference: −0.23 mg/dL, 95% CI: −0.65 to 0.20, I2 = 0%) or quality of life (pooled standardized mean difference: 0.07, 95% CI: −0.16 to 0.30, I2 = 0%). Conclusions Only limited evidence provides a benefit on frequency of epistaxis by treatment with tamoxifen and duration of epistaxis by treatment with submucosal BV among patients with HHT. Mean hemoglobin concentration and quality of life were not influenced by medical treatment.

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Effectiveness of massage therapy on fatigue and pain in patients with multiple sclerosis: A systematic review and meta-analysis

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/20552173211022779 ◽

2021 ◽

Vol 7 (2) ◽

pp. 205521732110227

Author(s):

Shahin Salarvand ◽

Mohammad Eghbal Heidari ◽

Kazem Farahi ◽

Erfan Teymuri ◽

Mohammad Almasian ◽

...

Keyword(s):

Quality Of Life ◽

Multiple Sclerosis ◽

Systematic Review ◽

Massage Therapy ◽

Pharmacological Therapy ◽

Mean Difference ◽

Cochrane Library ◽

Clinical Value ◽

Significant Trial

Background Fatigue and pain are prevalent symptoms of multiple sclerosis (MS) and frequent complaint in MS patients, which reduce their quality of life. This study aimed to assess the effect of massage therapy on pain and fatigue in MS Patients. Method The original and Persian databases were searched included PubMed, web of science, embase, ovid, scopus, and the Cochrane Library, SID, and Iranedex from inception to November 2020. Studies that reported the effect of massage on fatigue and pain were included. Two investigators extracted all relevant data, independently. For deriving analysis, mean difference (MD) and standardized mean difference (SMD) were used. Result Ten studies were eligible acoording criteria. The effect of massage on fatigue showed significant improvement (−1.62; 95% CL −2.40, −0.83; p < .00001), also results of the systematic review showed a significant reduction in pain severity. Conclusion Massage as a complementary and non-pharmacological therapy might have been associated with alleviating fatigue and pain in M.S. patients. Based on the current study, massage intervention for MS patients could have possible clinical value for palliating pain and fatigue and improving quality of life; however, this matter needs further and more significant trial studies.

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The Effect of Preoperative Education on Psychological, Clinical and Economic Outcomes in Elective Spinal Surgery: A Systematic Review

Healthcare ◽

10.3390/healthcare7010048 ◽

2019 ◽

Vol 7 (1) ◽

pp. 48 ◽

Cited By ~ 4

Author(s):

Louise Burgess ◽

Joe Arundel ◽

Thomas Wainwright

Keyword(s):

Quality Of Life ◽

Spine Surgery ◽

Spinal Surgery ◽

Randomized Clinical Trials ◽

Economic Outcomes ◽

Cochrane Library ◽

Education Session ◽

Preoperative Education ◽

Life Years

Psychosocial factors related to different degrees of clinical impairment and quality of life in the preoperative period may influence outcomes from elective spine surgery. Patients have expressed a need for individualized information given in sufficient quantities and at the appropriate time. Therefore, this review article aims to determine whether a preoperative education session improves clinical, psychological and economic outcomes in elective spinal surgery. PubMed, Cochrane Library, CINAHL Complete, Medline Complete and PsychINFO were searched in July 2018 for randomized clinical trials to evaluate the effects of a preoperative education intervention on psychological, clinical and economic outcomes in spinal surgery. The search yielded 78 results, of which eleven papers (seven studies) were relevant for inclusion. From these results, there is limited, fair-quality evidence that supports the inclusion of a preoperative education session for improving clinical (pain, function and disability), economic (quality-adjusted life years, healthcare expenditure, direct and indirect costs) and psychological outcomes (anxiety, depression and fear-avoidance beliefs) from spinal surgery. Other benefits are reported to be improved patient knowledge, feelings of better preparation, reduced negative thinking and increased levels of physical activity after the intervention. No differences in quality of life, return to work, physical indicators or postoperative complications were reported. From the limited evidence, it is not possible to conclusively recommend that preoperative education should be delivered as a standalone intervention before elective spine surgery; however, given the low risk profile and promising benefits, future research in this area is warranted.

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Effectiveness and feasibility of telerehabilitation in patients with COVID-19: a protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-058932 ◽

2022 ◽

Vol 12 (1) ◽

pp. e058932

Author(s):

Abubeker Alebachew Seid ◽

Setognal Birara Aychiluhm ◽

Ahmed Adem Mohammed

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Meta Analysis ◽

Risk Of Bias ◽

Mean Difference ◽

Cochrane Library ◽

P Value ◽

Published Data ◽

Respiratory Rehabilitation

IntroductionRespiratory rehabilitation is the use of exercise, education, and behavioural interventions to alleviate symptoms and improve quality of life. Recent studies highlight that respiratory rehabilitation is effective and safe for patients with COVID-19. We aim to evaluate the effectiveness and feasibility of respiratory telerehabilitation on patients infected with COVID-19 by conducting a systematic review and meta-analysis.Methods and analysisPubMed, Web of Science, Science Direct, Physiotherapy Evidence Database, Google Scholar and Cochrane Library databases will be searched from inception to the end of November 2021. Randomised controlled trials investigating the effectiveness of telerehabilitation in the management of COVID-19 will be included. The primary outcomes will be functional capacity, cardiopulmonary exercise tests and quality of life. Secondary outcomes will include anxiety/depression level, sleep quality, mortality rate, completion rate, reason for withdrawal, adverse events, service satisfaction, cost-effectiveness and other potential factors. Two reviewers will independently screen and extract data and perform quality assessment of included studies. The Cochrane risk of bias tool will be used to assess risk of bias. Review Manager V.5.4 (Cochrane Collaboration) software will be used for statistical analysis. Heterogeneity will be analysed using I² statistics. Mean difference or standardised mean difference with 95% CI and p value will be used to calculate treatment effect for outcome variables.Ethics and disseminationEthical approval is not required because this systematic review and meta-analysis is based on previously published data. Final result will be published in peer-reviewed journal and presented at relevant conferences and events.PROSPERO registration numberCRD42021287975.

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

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2008-1037688 ◽

2008 ◽

Vol 56 (S 1) ◽

Author(s):

A Kadner ◽

F Recher ◽

FF Immer ◽

J Schmidli ◽

H Tevaearai ◽

...

Keyword(s):

Quality Of Life ◽

Pulmonary Embolism ◽

Medical Treatment ◽

Surgical Embolectomy

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Outcomes Related to Percutaneous Nephrostomies (PCN) in Malignancy-Associated Ureteric Obstruction: A Systematic Review of the Literature

Journal of Clinical Medicine ◽

10.3390/jcm10112354 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2354

Author(s):

Francesca J. New ◽

Sally J. Deverill ◽

Bhaskar K. Somani

Keyword(s):

Quality Of Life ◽

Advanced Cancer ◽

Previous Treatment ◽

Cochrane Library ◽

Cancer Type ◽

Ureteric Obstruction ◽

Survival Times ◽

Advanced Malignancies ◽

The Impact

Background: Malignant ureteric obstruction occurs in a variety of cancers and has been typically associated with a poor prognosis. Percutaneous nephrostomy (PCN) can potentially help increase patient longevity by establishing urinary drainage and treating renal failure. Our aim was to look at the outcomes of PCN in patients with advanced cancer and the impact on the patients’ lifespan and quality of life. Materials and Methods: A literature review was carried out for articles from 2000 to 2020 on PCN in patients with advanced malignancies, using MEDLINE, EMBASE, Scopus, CINAHL, Cochrane Library, clinicaltrials.gov, and Google Scholar. All English-language articles reporting on a minimum of 20 patients who underwent PCN for malignancy-associated ureteric obstruction were included. Results: A total of 21 articles (1674 patients) met the inclusion criteria with a mean of 60.2 years (range: 21–102 years). PCN was performed for ureteric obstruction secondary to urological malignancies (n = −633, 37.8%), gynaecological malignancies (n = 437, 26.1%), colorectal and GI malignancies (n = 216, 12.9%), and other specified malignancies (n = 205, 12.2%). The reported mean survival times varied from 2 to 8.5 months post PCN insertion, with an average survival time of 5.6 months, which depended on the cancer type, stage, and previous treatment. Conclusions: Patients with advanced malignancies who need PCN tend to have a survival rate under 12 months and spend a large proportion of this time in the hospital. Although the advent of newer chemotherapy and immunotherapy options has changed the landscape of managing advanced cancer, decisions on nephrostomy must be balanced with their survival and quality of life, which must be discussed with the patient.

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Beneficial Effects of Remote Medical Care for Patients with Hereditary Hemorrhagic Telangiectasia during the COVID-19 Pandemic

Journal of Clinical Medicine ◽

10.3390/jcm10112311 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2311

Author(s):

Eleonora Gaetani ◽

Fabiana Agostini ◽

Luigi Di Martino ◽

Denis Occhipinti ◽

Giulio Cesare Passali ◽

...

Keyword(s):

Quality Of Life ◽

Emergency Room ◽

Medical Care ◽

Hereditary Hemorrhagic Telangiectasia ◽

Iron Supplementation ◽

Quality Care ◽

Psychological Status ◽

Blood Transfusions ◽

Emergency Room Visits

Background: Hereditary hemorrhagic telangiectasia (HHT) needs high-quality care and multidisciplinary management. During the COVID-19 pandemic, most non-urgent clinical activities for HHT outpatients were suspended. We conducted an analytical observational cohort study to evaluate whether medical and psychological support, provided through remote consultation during the COVID-19 pandemic, could reduce the complications of HHT. Methods: A structured regimen of remote consultations, conducted by either video-calls, telephone calls, or e-mails, was provided by a multidisciplinary group of physicians to a set of patients of our HHT center. The outcomes considered were: number of emergency room visits/hospitalizations, need of blood transfusions, need of iron supplementation, worsening of epistaxis, and psychological status. Results: The study included 45 patients who received remote assistance for a total of eight months. During this period, 9 patients required emergency room visits, 6 needed blood transfusions, and 24 needed iron supplementation. This was not different from what was registered among the same 45 patients in the same period of the previous year. Remote care also resulted in better management of epistaxis and improved quality of life, with the mean epistaxis severity score and the Euro-Quality of Life-Visual Analogue Scale that were significantly better at the end than at the beginning of the study. Discussion: Remote medical care might be a valid support for HHT subjects during periods of suspended outpatient surveillance, like the COVID-19 pandemic.

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Non-Pharmacologic Interventions for Caregivers of People With Dementia in Latin America: A Review

Innovation in Aging ◽

10.1093/geroni/igaa057.881 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 275-276

Author(s):

Jose Aravena ◽

Jean Gajardo ◽

Laura Gitlin

Keyword(s):

Quality Of Life ◽

Latin America ◽

Depressive Symptoms ◽

Latin American ◽

Randomized Clinical Trials ◽

Social Inequalities ◽

Neuropsychiatric Symptoms ◽

People With Dementia ◽

Person With Dementia

Abstract In a scenario of increasing longevity and social inequalities, Latin-America is an important contributor to the worldwide dementia burden. Caregivers’ health is fundamental to maintain the person with dementia quality of life. However, caregiving is a culturally sensible role that requires tailored solutions. The aim is to synthesize the evidence about non-pharmacologic interventions targeted to caregivers of people with dementia in Latin-American contexts. A comprehensive review of interventions in caregivers and persons with dementia in Latin-American countries was conducted using MEDLINE, Embase, PsycINFO, and Scopus with studies published until January 27th, 2020. Randomized clinical trials of non-pharmacologic interventions targeted to caregivers of people with dementia or dyads where included. Qualitative synthesis of the evidence was presented and analyzed. Overall, 9 pilot RCT were included for the final analysis (6 Brazil, 1 Colombia, 1 Mexico, 1 Perú). The biggest study recruited 69 caregivers and the smallest 13 dyads, with follow-up range of 3-6 months. 5 control groups received at least some other non-standard care type of intervention. 8 were targeted exclusively to caregivers (4 group intervention, 3 individual, and 1 combined) and 1 multicomponent intervention. Most frequent measured outcomes were caregiver’s burden, anxiety, depressive symptoms, and quality of life, and person with dementia neuropsychiatric symptoms. Individual interventions report better results in caregiver parameters such as burden and depressive symptoms and person with dementia neuropsychiatric symptoms. Group interventions presented mixed results. Nevertheless, the quality of evidence was low. There is a critical need to study interventions for caregivers in Latin-American contexts.

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Surgically treated acromegaly patients have a similar quality of life whether controlled by surgery or requiring additional medical therapy (QuaLAT Study)

Pituitary ◽

10.1007/s11102-021-01153-4 ◽

2021 ◽

Author(s):

Muhammad Fahad Arshad ◽

Oluwafunto Ogunleye ◽

Richard Ross ◽

Miguel Debono

Keyword(s):

Quality Of Life ◽

Medical Treatment ◽

Physical Component Score ◽

Healthy Controls ◽

Component Score ◽

Post Surgery ◽

Group 3 ◽

Group 2 ◽

Group 1

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

Bladder Cancer ◽

10.3233/blc-210011 ◽

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.

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CTNI-01. EFFECT OF STEREOTACTIC RADIOSURGERY COMPARED TO WHOLE-BRAIN RADIOTHERAPY FOR LIMITED BRAIN METASTASIS ON LONG TERM COGNITION AND QUALITY OF LIFE: A POOLED ANALYSIS OF RANDOMIZED CLINICAL TRIALS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.168 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii40-ii41

Author(s):

Joshua Palmer ◽

Brett Klamer ◽

Karla Ballman ◽

Paul Brown ◽

Jane Cerhan ◽

...

Keyword(s):

Quality Of Life ◽

Randomized Clinical Trials ◽

Whole Brain Radiotherapy ◽

Pooled Analysis ◽

Cognitive Outcomes ◽

Phase Iii ◽

Brain Radiotherapy ◽

Over Time

Abstract PURPOSE We investigated the long term impact of SRS and WBRT in two large prospective phase III trials. METHODS Patients with 1–4 BMs +/- resection were randomized to SRS or WBRT. Cognitive deterioration was a drop of >1 standard deviation from baseline in >2/6 cognitive measures (CM). Quality of life (QOL) scores were scored 0–100 point scale. CM and QOL scores were modeled using baseline adjusted Linear Mixed Models (LMM) with uncorrelated random intercept for subject and random slopes for time. Differences over time between groups and the effect of >2 cognitive scores with >2 SD change from baseline were assessed. RESULTS 88 patients were included with median follow up of 24 months. We observed decreasing CM over time (SRS: 4/6; WBRT: 5/6). Mean CM was significantly higher in SRS for Total recall and Delayed Recall at 3, 6, 9, 12 months. More patients in WBRT arm declined 1 SD in >1 and >2 CM at the 3, 6, 9, and 12 months. A 1 SD decline in >3 CM at 1 year was 21% SRS vs 47% WBRT (p=0.02). SRS had fewer patients with a 2 SD decline in >1 CM at every time point. SRS had fewer patients with a 2 SD decline at >2 and >3 CM. WBRT had lower QOL at 3 months, but switched to SRS having lower QOL at 24 months for PWB, EWB, FWB, FactG, BR, and FactBR (p< 0.05). A 2 SD decline in cognition decreased mean FWB by 6.4 units (95% CI: -11, -1.75; p=0.007) and decreased QOL by 5.1 units (95% CI: -7.7, -2.5; p< 0.001). CONCLUSIONS We report the first pooled prospective study demonstrating the long term outcomes of patients with BMs after cranial radiation. WBRT was associated with worse cognitive outcomes. Impaired cognition is associated with worse QOL.

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