scholarly journals Impact of a Tailored Nutritional and Physical Exercise Programme on Efficacy and Functional Outcomes in Older Patients with Hematological Malignancies Classified By Frailty Profile

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3424-3424
Author(s):  
Maite Antonio ◽  
Montserrat Arnan Sangerman ◽  
Eva Domingo-Domenech ◽  
Eva González-Barca ◽  
Casimiro Javierre ◽  
...  

BACKGROUND As the result of population aging, hematologists increasingly face the challenge of effectively managing older adults with oncological diseases. The heterogeneity of the aging process means that chronological age does not serve as a pivotal variable on which the clinical or treatment decisions are based. To improve outcomes in older population it is critical to select treatment considering patients' frailty profile and patients' needs to ensure they complete the treatment proposedComprehensive geriatric assessment (CGA) is a gold-standard multidimensional tool to characterize older patients according to their biological frailty profile. CGA identifies patient- and condition-related factors that might be potentially reversible through subsequent clinical interventions Older patient may present some degree of physical decline during the treatment due to variables related to the disease itself and/or to the treatment. This can lead to an accelerated decline from aging, affect their functional independence, their quality of life, and their ability to complete the treatment There is evidence that nutritional support and physical exercise during and after oncological treatments provides benefits in muscular and aerobic condition, quality of life, fatigue and adherence to treatment. But data on hematological patient, usually treated with more intensive schemes associated with a higher incidence of cytopenia and fatigue is scarce ENDPOINT - PRIMARY To determine the impact of an individualized geriatric intervention program of physical exercise and nutritional support on adherence to planned oncological treatment in patients ≥ 70 years with hematological malignancies - SECONDARY Analyze the relation between CGA and aging biomarkersEvaluate adherence to the intervention programDetermine the rate of completion and causes for non-completion of treatmentMeasure at the beginning and end of intervention, and 6 months after treatment completion: The program's effect on physical condition parametersChanges in functional capacity: basic and instrumental activities of daily lifeLevels of fatigueQuality of lifeDetermine the incidence and degree of severity of toxicityDetermine treatment response parameters: time to treatment failure and to progression, disease-free, overall and cancer-specific survival METHODS DESIGN Prospective clinical trial, randomized, parallel and open groupsSETTING Comprehensive cancer centerINCLUSION CRITERIA Histopathological diagnosis of hematological malignancies: multiple myeloma, lymphoproliferative syndromes and myelodisplastic syndromesPatients who meet criteria for medical treatment: chemotherapy, radiotherapy, immunotherapy or targeted therapiesPatients in optimal conditions to perform moderate intensity physical exercise (responsible doctor's judgement)Signature of informed consentEXCLUSION CRITERIA Failure to meet any of the inclusion criteria.INTERVENTION All patients will be assessed through a CGA. The intervention group will received the standard treatment according to the clinical protocol of the institution and will participate in a program of personalized physical exercise and nutritional support. The control group will be treated in a standard manner according to the institution's clinical protocolRANDOMIZATION Subjects will be assigned a 1.1 ratio to one of the groups using a simple randomisation methodMAIN VARIABLE: rate of treatment compliance (relationship between the prescribed dose and the dose administered)SECONDARY VARIABLES: CGA scales, aging biomarkers, nutritional parameters and basal body composition before and after the intervention, quality of life before and after the intervention, toxicity and complications during treatment and response to treatment.STATISTICAL ANALYSIS The comparability of the components of the intervention and control group will be analyzed by Chi square test (qualitative variables) and Student's t test and Wilcoxson test (quantitative variables). The analysis of the intervention will be carried out according to the intention of treatment. The main variable will be analyzed by comparison test of chi-square proportions and confidence intervals will be calculated. The variable will be measured at the end of the intervention, according to the degree of compliance with the nutritional and physical exercise program. Disclosures Domingo-Domenech: Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel expenses; Seattle Genetics: Research Funding; Bristol-Myers Squibb: Other: Travel expenses; Roche: Other: Travel expenses. González-Barca:Kiowa: Consultancy; Roche: Consultancy, Honoraria; Celgene: Consultancy; Celtrion: Consultancy; AbbVie: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Takeda: Honoraria. Sureda:Roche: Honoraria; BMS: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Gilead: Consultancy; Sanofi: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Speakers Bureau.

2021 ◽  
Vol 28 (12) ◽  
pp. 1-8
Author(s):  
Burak Yilmaz ◽  
Cagtay Maden ◽  
Begümhan Turhan

Background/aims Workers engaged in vehicle spray painting are at a risk of developing respiratory problems because of the solvents in the spray paints. Changes in respiratory functions and functional capacities caused by spray painting can be improved with respiratory exercises. The aim of this study was to examine the effects of respiratory exercises on the respiratory functions, functional capacity and quality of life in vehicle spray painters. Methods A total of 70 volunteers with similar characteristics participated in the study. The groups were divided into two groups randomly (35 study group, 35 control group). Respiratory functions (value of forced expiratory volume percentage in 1 second [FEV1]), forced vital capacity percentage [FVC], FEV1/FVC percentage, peak expiratory flow percentage [PEF (%)] and maximum voluntary ventilation percentage [MVV (%)]), functional capacity (6-Minute Walk Test) and quality of life (Short Form Health Survey [SF-36]) were evaluated. The study group undertook supervised breathing exercises 3 days a week for 6 weeks. The same exercises were given to the control group as a home programme. Home programmes were followed up by telephone calls. Evaluations were performed again after 6 weeks. Results In the study group, FEV1 (%) increased more than in the control group (P<0.05). The increase in PEF (%) was similar in both groups (P>0.05). In the study group, FEV1/FVC (%) and MVV (%) were significantly different before and after the intervention (P<0.05), but there was no difference in the control group (P>0.05). There was a greater increase in the study group than in the control group (P<0.05). 6-Minute Walk Test distance (m) before and after the intervention in both groups were similar (P>0.05). Before and after the intervention, a significant difference was found in the vitality and the social function domains of the SF-36 in the study group. In the comparisons of groups, a significant difference was found in the study group in the role-emotional, social function and bodily pain domains of the SF-36 after the intervention (P<0.05). Conclusions Breathing exercises can be recommended for vehicle spray painters to avoid an increase in respiratory resistance and to improve their quality of life.


2021 ◽  
Vol 27 (8) ◽  
pp. 783-785
Author(s):  
Mian Wang ◽  
Fan Wu

ABSTRACT Introduction: Myocardial infarction caused by human obesity can cause a decline in mobility and a decline in the quality of a healthy life. Sports training is beneficial to maintain early physical functions after myocardial infarction. Objective: This article deals with the effect of applying walking aerobic exercise in the rehabilitation treatment of patients with myocardial infarction. Methods: We enrolled 91 patients with myocardial infarction in the early exercise group and 90 patients in the control group. The control group received the routine nursing intervention, and the early exercise group received early physical exercise rehabilitation therapy. Results: The actual quality of life of the early exercise group was higher than that of the control group. The incidence of cardiovascular adverse events was lower than that of the control group. Conclusion: Physical exercise therapy used in acute myocardial infarction can reduce adverse cardiovascular events and improve the quality of life of patients. Level of evidence II; Therapeutic studies - investigation of treatment results.


2021 ◽  
Vol 1 (4) ◽  
pp. 165-177
Author(s):  
Sergey V. Sviridov ◽  
Kirill Y. Krylov ◽  
Irina V. Vedenina ◽  
Rubenas Mohan

Background. Nutritional insufficiency and decreased muscle mass of patients diagnosed with COVID-19 leads to prolonged respiratory support, stay in ICU and hospital, as well as reduced muscle strength and quality of life in the recovery period after a viral pneumonia caused by COVID-19. Aims: To study the effects of oral nutritional support on the physical health recovery of COVID-19 patients. Materials and methods. A prospective, open, multicenter, comparative observative study of two groups, observational study was initiated to evaluate the effects of oral nutritional support (ONS) by Nutridrink 200 ml on the ability of COVID-19 patients to recover. The patients with these criteria were included in the study: aged 1869; a confirmed COVID-19 infection; requires respiratory support; ability to consume more than 60% of food from the total required; presence of a signed consent form. One group received supplementary oral nutritional support (ONS) everyday for 28 days from the day of inclusion. The other group received standard diet. The primary endpoint was the evaluation of quality of life using the SF-36 questionnaire and the changes in the hand grip strength between the 3rd and 1st visits. Secondary endpoints of the study were length of stay in hospital and duration of respiratory support in the hospital. Results. 205 patients with a COVID-19 infection were included in the study. The final number of patients included in the study was 185 patients. Median age was 55 years old. The majority of patients were male 57.84% (107 patients). Upon evaluation of the physical component of quality of life using the SF-36 questionnaire, we obtained a statistically significant difference between the control and study groups on the 4th visit 44.285.45 and 46.586.76 respectively (p=0.012). Muscle strength was statistically different in the control (4.011.15 daN) and study (6.12.06 daN) groups (p 0.0001). The duration of respiratory support was significantly lower in the study group, 6.71.30 days as opposed to 8.141.52 days in the control group (p 0.0001). Also, in the group with oral nutritional support, there was a statistically significant decrease in the length of stay in hospital. In the control group, the average length of stay in hospital was 16.472.93 days, whereas in the study group it was 13.162.69 days (p 0.0001). Conclusion. Oral nutritional support given to oxygen dependent COVID-19 patients improves rehabilitation potential including preservation of muscle mass and function, reducing oxygen support requirements and length of stay in hospital.


2018 ◽  
Vol 12 (5) ◽  
pp. 1325
Author(s):  
Hashilley Alberto da Silva ◽  
Gleice Kelle Beserra Viana ◽  
Ana Karine Girão Lima ◽  
Carla Monique Lopes Mourão ◽  
Ana Luiza Almeida de Lima

RESUMOObjetivo: avaliar a percepção dos enfermeiros sobre cuidado paliativo antes e depois de uma intervenção. Método: estudo quantitativo, quase experimental, desenvolvido nas unidades de um hospital de atenção secundária. O instrumento de coleta de dados foi adaptado de um estudo realizado com anestesiologistas, esses foram analisados no programa Excel e organizados em tabelas, sendo aplicado o teste estatístico de qui-quadrado de Pearson, com tabelas que apresentam os valores obtidos dentro de categorias distintas, mas que eram relacionáveis. Foi calculada, também, a proporção das diferenças entre as respostas do pré-teste e pós-teste, sendo considerados significantes os resultados com p<0,05. Resultados: houve predominância dos profissionais antes da intervenção que escolheram a expressão Morte Digna para designar cuidado paliativo (72,9%). Após a intervenção, os profissionais escolheram a expressão Qualidade de Vida (55,9%). Conclusão: a percepção dos enfermeiros acerca dos cuidados paliativos foi deficiente. Esse fato esteve associado à deficiência na formação técnico-científica ainda na graduação. A intervenção realizada promoveu melhoria da compreensão de conceitos relacionados ao cuidado paliativo colaborando para a assistência diferenciada e promotora da qualidade de vida dos profissionais. Descritores: Cuidados Paliativos; Enfermagem; Qualidade de Vida; Assistência Hospitalar.ABSTRACTObjective: to evaluate nurses' perception of palliative care before and after an intervention. Method: quantitative, almost experimental study, developed in the units of a secondary care hospital. The data collection instrument was adapted from a study carried out with anesthesiologists, these were analyzed in the Excel program and organized into tables, being applied the statistical test of chi-square of Pearson, with tables that present the values obtained within distinct categories, but that they were relatable. The proportion of differences between pre-test and post-test responses was also calculated, and the results with p <0.05 were considered significant. Results: there was a predominance of professionals before the intervention who chose the term Digned Death to designate palliative care (72.9%). After the intervention, professionals chose the term Quality of Life (55.9%). Conclusion: nurses' perception about palliative care was deficient. This fact was associated to the deficiency in the technical-scientific formation still in the graduation. The intervention promoted an improvement of the understanding of concepts related to palliative care collaborating for differentiated assistance and promoting the quality of life of professionals  Descriptors: Palliative Care, Nursing, Quality of Life, Hospital Care.RESUMENObjetivo: evaluar la percepción de los enfermeros sobre el cuidado paliativo antes y después de una intervención. Método: estudio cuantitativo, casi experimental, desarrollado en las unidades de un hospital de atención secundaria. El instrumento de recolección de datos fue adaptado de un estudio realizado con anestesiólogos, se analizaron en el programa Excel y organizados en tablas, siendo aplicado el test estadístico de chi-cuadrado de Pearson con tablas que presentan los valores obtenidos dentro de categorías distintas, pero que eran relacionables. Se calculó, también, la proporción de las diferencias entre las respuestas del pre-test y post-test, siendo considerados significantes los resultados con p <0,05. Resultados: hubo predominancia de los profesionales antes de la intervención que eligieron la expresión Muerte Digna para designar cuidado paliativo (72,9%). Después de la intervención, los profesionales escogieron la expresión Calidad de Vida (55,9%). Conclusión: la percepción de los enfermeros acerca de los cuidados paliativos fue deficiente. Este hecho estuvo asociado a la deficiencia en la formación técnica-científica aún en la graduación. La intervención realizada promovió la mejora de la comprensión de conceptos relacionados al cuidado paliativo, colaborando para la asistencia diferenciada y promotora de la calidad de vida de los profesionales. Descriptores: Cuidados Paliativos, Enfermeira, Calidad de Vida, Atención Hospitalaria.


2020 ◽  
Author(s):  
Fatemeh Pyri ◽  
Parvin Abedi ◽  
Elham Maraghi ◽  
Maryam Gholamzadeh Jashreh

Abstract Background: Premature menopause may impair the quality of life and expose women to disorders such as cardiovascular disease, osteoporosis, and depression. This study aimed to evaluate the effectiveness of mindfulness on the quality of life of women with premature menopause. Methods: This was a quasi-experimental study in which 62 women were recruited and randomly allocated in two groups of mindfulness and control. The mindfulness group received eight sessions of training. A demographic questionnaire, Menopause-Specific Quality of Life (MENQOL) and a checklist (for assessing frequency and intensity of hot flashes) were used to collect data. The quality of life, frequency, and intensity of hot flashes measured at baseline, after eight weeks and in three months follow-up. The Independent t-test, the chi-square test, and the repeated measure test were used for analyzing data. Results: The score of quality of life was significantly improved after the intervention and in three months follow-up in the mindfulness group compared to the control group (p<0.001). The scores of vasomotor, psychological, physical, and sexual domains also improved significantly in the mindfulness group compared to the control group. The severity and the frequency of hot flashes were significantly reduced in the mindfulness group in comparison to the control group. Conclusion: The results of this study showed that eight weeks of mindfulness training could significantly improve the quality of life and also could reduce the frequency and intensity of hot flashes in women with premature menopause. Using mindfulness for women with premature menopause is recommended.


Author(s):  
Aurelio Arnedillo ◽  
Jose L. Gonzalez-Montesinos ◽  
Jorge R. Fernandez-Santos ◽  
Carmen Vaz-Pardal ◽  
Carolina España-Domínguez ◽  
...  

Objective: The objective was to assess the effects of a nasal restriction device for inspiratory muscle training, called Feelbreathe®, added to a rehabilitation program (RP) on exercise capacity, quality of life, dyspnea and inspiratory muscle strength in patients with stable COPD. Methods: Patients were randomized into three groups, one performed a supervised RP using the Feelbreathe® device (FB group), the second group developed the same RP with oronasal breathing without FB (ONB group) and the third was the control group (CG). We evaluated inspiratory muscle strength (PImax), dyspnea (mMRC), quality of life (CAT) and exercise capacity (6MWT) before and after 8-week of RP. Results: A total of 16 patients completed the study, seven in FB group, five in ONB group and four in the CG. After the RP, the FB group showed a significant increase in PImax (93.3 ± 19.1 vs. 123.0 ± 15.8 mmHg) and in the 6MWT distance (462.9 ± 71.8 m vs. 529.1 ± 50.1 m) and a decrease in the CAT score (9.7 ± 6.5 vs. 5.9 ± 6.0) and in the mMRC dyspnea score. FB provides greater improvement in PImax, dyspnea, quality of life and 6MWT than ONB. Conclusions: The Feelbreathe® device provides greater improvements in quality of life, dyspnea, exercise capacity and inspiratory muscle strength compared to patients that did not use it.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12051-12051
Author(s):  
Isacco Montroni ◽  
Giampaolo Ugolini ◽  
Nicole Saur ◽  
Antonino Spinelli ◽  
Siri Rostoft ◽  
...  

12051 Background: Older cancer patients value quality of life (QoL) and functional outcomes as much as survival but surgical studies lack specific data. The international, multicenter GOSAFE study (ClinicalTrials.gov NCT03299270) aims to evaluate patients’ QoL and functional recovery (FR) after cancer surgery and to assess predictors of FR Methods: GOSAFE prospectively collected functional and clinical data before and after major elective cancer surgery on senior adults (≥70 years). Surgical outcomes were recorded (30, 90, and 180 days post-operatively) with QoL (EQ-5D-3L) and FR (Activities of Daily Living (ADL), Timed Up and Go (TUG) and MiniCog), 26 centers enrolled patients from February 2017 to April 2019. Results: 942 patients underwent a major cancer resection. Median age was 78 (range 70-95); 52.2% males, ASA III-IV 49%. 934 (99%) lived at home, 51% lived alone, and 87% were able to go out. Patients dependent (ADL < 5) were 8%. Frailty was detected by means of G8 ≤14 in 68.8% and fTRST ≥2 in 37% of patients. Major comorbidities (CCI > 6) were reported in 36% and 21% had cognitive impairment according to MiniCog (2.2% self-reported). 25% had > 3 kg weight loss, 27% were hospitalized in the last 90 days, 54% had ≥3 medications (6% none). Postoperative overall morbidity was 39.1% (30 day) and 22.5% (90 day), but Clavien-Dindo III-IV complications were only 13.4% and 6.9% respectively. 30/90/180-day mortality was 3.6/6/8.9% (10/30/33% in patients with severe functional disability). At 3 months after surgery, QoL was stable/improved (mean EQ-5D index 0.78 was equivalent before vs. after surgery, while the EQ-5D VAS score > 60 raised from 74.3% at baseline to 80.2%, p < 0.01). 76.6% experienced postoperative FR/stability. Logistic regression analysis showed that ASA 3-4, CCI≥7 and CD III-IV complications are significantly associated with functional decline while a G8 > 14 has a positive association with functional recovery. Age is not associated with functional outcomes. Conclusions: The largest prospective study on older patients undergoing structured frailty assessment before and after major elective cancer surgery has shown that QoL remains stable/improves after cancer surgery. The majority of patients return to independence and G8 can predict functional recovery. Older patients with multiple comorbidities, high ASA score or postoperative severe complications are likely to functionally deteriorate after oncologic surgery Clinical trial information: NCT03299270 .


2020 ◽  
pp. 17-23
Author(s):  
E. A. Khlystova ◽  
A. L. Savastenko

Introduction. The article provides latest data on modern methods of treating rosacea. The results of own clinical observations of patients with moderate to severe papulopustular rosacea receiving combination treatment and a comparative analysis of the efficacy of various therapy regimens are presented.Objective of the study. The aim of the study was to conduct a comparative analysis of the therapeutic efficacy of combination therapy using the ivermectin 1% topical drug combined with systemic therapy drugs (doxycycline, minocycline, isotretinoin).Materials and methods. We observed 37 patients with moderate to severe papulo-pustular rosacea subtype. The patients were divided into 4 groups (A, B, C, D). Patients in the control group received monotherapy with 1% ivemectin topical drug, patients in the other groups received combination therapy (1% ivermectin combined with low-dose doxycycline, minocycline and isotretinoin). The efficacy of the therapy was evaluated by measuring rosacea severity on the Scale for Diagnostic Assessment of Rosacea (SDAR), clinical manifestations according to the IGA (Investigator Global Assessment) criteria, and by assessing the patients' quality of life using the DLQI (Dermatology Life Quality Index) questionnaire before and after 3-month treatment.Results. The comparative analysis of changes in severity indicators of the skin process and quality of life in patients with moderate to severe papulopustular rosacea after topical and combination therapy showed that the results of the treatment in patients receiving combination therapy were more significant than those in the group receiving monotherapy.Conclusion. The concomitant use of 1% ivermectin and systemic drugs is most effective in patients with severe papulopustular rosacea subtype. The combination treatment tailored to the clinical forms and severity of rosacea allows to optimize the clinical results of the therapy, which significantly affects the patients' quality of life and opens up potential for an individual approach in the algorithms for the treatment of rosacea.


Author(s):  
Ergün Parmaksız ◽  
Hüseyin Demirbilek

Dialysis causes many psycho-social problems in patients with chronic renal failure and decreases their quality of life by increasing their anxiety. We aimed to determine the influence of artistic activities on quality of life and reducing or eliminating dialysis anxiety.Methods. Among 180 hemodialysis patients, 8 patients were randomly selected as a study group and 8 patients as a control group. We performed our theater rehearsals in 16 sessions, two hours per week. State-Trait Anxiety Inventory (STAI), STAII and  Social Anxiety Scales (SAS) were employed in both groups before and after the play. Results. The means of the eighth-month SAS fear and avoidance measures of the study group were found to be significantly lower than the control group and significantly lower than the baseline. The mean difference of the initial eighth-month SAS fear and avoidance in the study group was statistically significantly higher than the control group.Initial and eighth month SAS fear and avoidance difference averages of the study group were found statistically significantly higher than the control group.Conclusions. We determined that the therapies to be done with art have an important place in relieving or reducing anxiety in hemodialysis patients. In addition, it was the opinion that our patients would make positive contributions to their quality of life. However, further studies are needed to demonstrate whether theater rehearsals reduce anxiety in hemodialysis patients.


Author(s):  
Mariana Ayala ◽  
Margarita Marchant ◽  
Cristina Hertz ◽  
Gloria Castillo

Abstract Purpose The study assessed the impact of intradialytic oral nutritional supplementation on the quality of life in patients receiving hemodialysis and diagnosed with protein energy wasting. Methods A pre-test post-test quasi-experimental study was conducted before and after 3 months of intradialytic oral nutritional supplementation on 109 older hemodialysis patients. We measured before and after 3 months of intradialytic oral nutritional supplementation, the quality of life score, the burden of kidney disease, three quality of life scales and the mental and physical health status using KDQoL-SF™ 1.3, body composition and biochemical parameters of nutritional condition. Results The mean age of the patients was 69.4 ± 3.4 years, 59% were male, and the time on dialysis was 63.5 ± 52.6 months. Comparing the baseline with month 3 of intradialytic oral nutritional supplementation, we observed to better quality of life. In contrast to malnutrition, score, specifically increased significantly score of symptoms/problems list related to hemodialysis, sexual function, social and cognitive function, sleep, pain, energy/fatigue and general state of health. Significant changes were also found in nutritional status, energy intake and body composition indicators. After 3 months of intradialytic oral nutritional supplementation, we observed a nutritional status recovery in one or more indicators in 92% of the patients. Conclusion Our findings indicate that 3 months of intradialysis oral nutritional supplementation improves the components of physical and mental quality of life and nutritional status in older patients receiving hemodialysis diagnosed with loss of protein energy. These results are relevant to improve the experience of patients with protein energy loss receiving hemodialysis.


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