scholarly journals Exploring what is important to patients with regards to quality of life after experiencing a lower limb reconstructive procedure: a qualitative evidence synthesis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
H. Leggett ◽  
A. Scantlebury ◽  
A. Byrne ◽  
M. Harden ◽  
C. Hewitt ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lower Limb ◽  
Qualitative Evidence Synthesis ◽  
Limb Reconstruction ◽  
Reconstruction Surgery ◽  
Thematic Synthesis ◽  
Qualitative Evidence ◽  
Lower Limb Reconstruction ◽  
The Way

Abstract Background Patient reported outcome measures (PROMs) are used to understand the impact of lower limb reconstruction surgery on patients’ quality of life (QOL). Existing measures have not been developed to specifically capture patient experiences amongst adults with lower limb conditions that require reconstruction surgery. This review aimed to synthesise qualitative evidence to identify what is important to patients requiring, undergoing, or following reconstructive surgery for lower limb conditions. Methods MEDLINE, Embase, PsychINFO and Cinahl were searched from inception until November 2020. Studies were included if they employed qualitative research methods, involved patients requiring, undergoing or following lower limb reconstruction and explored patients’ experiences of care, treatment, recovery and QOL. Mixed methods studies that did not separately report qualitative findings, mixed population studies that were not separately reported and studies in languages other than English were excluded. Included studies were analysed using thematic synthesis. The Critical Appraisal Skills Programme qualitative studies checklist was used to undertake quality assessment. Results Nine studies met the inclusion criteria. The thematic synthesis identified two overarching themes: (1) areas of living key to QOL for lower limb reconstruction patients and (2) moving towards a new normal. The way in which lower limb reconstruction affects an individual’s QOL and their recovery is complex and is influenced by a range of inter-related factors, which will affect patients to varying degrees depending on their individual circumstances. We identified these factors as: pain, daily functioning and lifestyle, identity, income, emotional wellbeing, support, the ability to adapt and adjust and the ability to move forwards. Conclusions The way patients’ QOL is affected after a lower limb reconstruction is complex, may change over time and is strongly linked to their recovery. These findings will aid us in developing a conceptual framework which identifies the outcomes important to patients and those that should be included in a PROM. Further research is then required to establish whether the range of factors we identified are captured by existing PROMs. Depending on the outcome of this work, a new PROM for patients following lower limb reconstruction may be required.

scholarly journals Quality of life following a lower limb reconstructive procedure: a protocol for the development of a conceptual framework

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040378
Author(s):  
Heather Leggett ◽  
Arabella Scantlebury ◽  
Hemant Sharma ◽  
Catherine Hewitt ◽  
Melissa Harden ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Conceptual Framework ◽  
Reconstructive Surgery ◽  
Lower Limb ◽  
Phase 1 ◽  
Patient Reported Outcome ◽  
Qualitative Evidence Synthesis ◽  
Patient Reported ◽  
Registration Number

IntroductionLower limb conditions requiring reconstructive surgery can be either congenital or acquired from trauma, infection or other medical conditions. Patient-reported outcome measures (PROMs) are often used by healthcare professionals to assess the impact of a patient’s condition (and treatment) on quality of life. However, we are not aware of any measures developed specifically for people requiring lower limb reconstructive surgery. Consequently, it is not clear the extent to which current PROMs accurately and specifically measure the outcomes that are important to these patients.Methods and analysisThe ‘PROLLIT’ (Patient-Reported Outcome Measure for Lower Limb Reconstruction) involves three phases: to explore what is important to patients with regard to quality of life (phase 1), ascertain whether current measures adequately capture these experiences (phase 2) and if not begin, the development of a new PROM (phase 3). The population of interest is people requiring, undergoing or after undergoing reconstructive surgery for a lower limb condition. In this paper, we describe phase 1, which aims to develop a conceptual framework to identify and map what is important to this group with regard to social interactions, employment, perceived health and quality of life after condition onset/injury and throughout recovery. The conceptual framework will be developed through three steps: (step A) a qualitative evidence synthesis, (step B) a qualitative study with patients and staff to explore patient’s views and experiences of lower limb reconstructive surgery and (step C) a round table discussion with key stakeholders where findings from step A and step B will be brought together and used to finalise the conceptual framework.Ethics consideration and disseminationEthical approval has been granted for the qualitative data collection (step B) from South Central Berkshire Research Ethics committee (REF:20/SC/0114). Findings from steps A and B will be submitted for peer-reviewed publication in academic journals, and presented at academic conferences.PROSPERO registration numberCRD42019139587.ISRCTN registration numberISRCTN75201623.

Free Flaps in Complex Lower Limb Reconstruction - 2-Year Experience

2014 ◽  
Vol 30 (S 01) ◽  
Author(s):  
Horácio Zenha ◽  
Carla Diogo ◽  
Sara Ramos ◽  
Susana Pinheiro ◽  
Ricardo Carvalho ◽  
...  
Keyword(s):  
Lower Limb ◽  
Free Flaps ◽  
Limb Reconstruction ◽  
Lower Limb Reconstruction

Strategic threats to energy security as risks of quality of people's life

2020 ◽  
Vol 16 (4) ◽  
pp. 730-744
Author(s):  
V.I. Loktionov
Keyword(s):  
Quality Of Life ◽  
Energy Security ◽  
Well Being ◽  
Scientific Methods ◽  
Analysis And Synthesis ◽  
General Scientific ◽  
And Performance ◽  
Economic Well Being ◽  
The Way

Subject. The article reviews the way strategic threats to energy security influence the quality of people's life. Objectives. The study unfolds the theory of analyzing strategic threats to energy security by covering the matter of quality of people's life. Methods. To analyze the way strategic threats to energy security spread across cross-sectoral commodity and production chains and influences quality of people's living, I applied the factor analysis and general scientific methods of analysis and synthesis. Results. I suggest interpreting strategic threats to energy security as risks of people's quality of life due to a reduction in the volume of energy supply. I identified mechanisms reflecting how the fuel and energy complex and its development influence the quality of people's life. The article sets out the method to assess such quality-of-life risks arising from strategic threats to energy security. Conclusions and Relevance. In the current geopolitical situation, strategic threats to energy security cause long-standing adverse consequences for the quality of people's life. If strategic threats to energy security are further construed as risk of quality of people's life, this will facilitate the preparation and performance of a more effective governmental policy on energy, which will subsequently raise the economic well-being of people.

scholarly journals Economic assessment of a community-based care package for people with lower limb disorder caused by lymphatic filariasis, podoconiosis and leprosy in Ethiopia

2020 ◽  
Vol 114 (12) ◽  
pp. 1021-1034
Author(s):  
Natalia Hounsome ◽  
Mersha Kinfe ◽  
Maya Semrau ◽  
Oumer Ali ◽  
Abraham Tesfaye ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lymphatic Filariasis ◽  
Lower Limb ◽  
Life Quality ◽  
Psychosocial Care ◽  
Northwest Ethiopia ◽  
World Health ◽  
Care Package ◽  
The Cost

Abstract We conducted an implementation research study to integrate a holistic package of physical health, mental health and psychosocial care for podoconiosis, lymphatic filariasis and leprosy into routine healthcare in Gusha cluster, Guagusa Shikudad district, northwest Ethiopia. The healthcare package included training patients in lower limb hygiene and skin care and provision of shoes, hygiene supplies and medication. The implementation activities included training events, workshops, awareness raising, self-help groups, supportive supervision, staff secondments and advisory board meetings. The cost of implementing the care package in Gusha cluster, with a population of 30 558 people, was 802 655 Ethiopian birr (ETB) (£48 159) and the cost of delivering care to 235 participants was 204 388 ETB (£12 263), or 870 ETB (£52) per person. There was a 35% decrease in the mean disability scores (measured using the World Health Organization Disability Assessment Schedule 2.0) and a 45% improvement in the dermatology-specific quality of life (measured using the Dermatology Life Quality Index) at the 3-month follow-up compared with baseline. There were reductions in the number of days with symptoms, days off usual activities/work and days with reduced activity due to illness, all of which were statistically significant. Our pilot suggests that integration of the care package into routine healthcare in Ethiopia may be effective in improving health-related quality of life and disability and reducing time out of economic activity due to illness.

Canadian Trends in Free Flap Management for Microsurgical Lower Limb Reconstruction

2021 ◽  
pp. 229255032110196
Author(s):  
Michelle Bonapace-Potvin ◽  
Alexander Govshievich ◽  
Laurent Tessier ◽  
Mihiran Karunanayake ◽  
Dominique Tremblay ◽  
...  
Keyword(s):  
Lower Limb ◽  
Free Flaps ◽  
Online Questionnaire ◽  
Limb Reconstruction ◽  
Changing Practice ◽  
Current State ◽  
Lower Limb Reconstruction ◽  
Tumor Extirpation ◽  
Based Medicine ◽  
Previous Training

Introduction: Free tissue transfers have become a mainstay in lower limb salvage, allowing safe and reliable reconstruction after trauma, tumor extirpation, and complex wounds. The optimal perioperative (PO) management of these flaps remains controversial. This study aims to assess the current state of practice among Canadian microsurgeons. Methods: Sixty-four Canadian microsurgeons were approached to complete an online questionnaire regarding their PO management of fasciocutaneous free flaps used for lower limb reconstruction. Trends in dangling timing and duration, use of venous couplers, compressive garments, thromboprophylaxis, and surgeons’ satisfaction with their protocol were assessed. Results: Twenty-eight surgeons responded. Fifty-seven percent did not have a specific mobilization protocol. Dangling was mainly initiated on postoperative days 5 to 6 (44%). The most common protocol duration was 5 to 6 days (43%). The concern for prolonged venous pooling was the main reason for delay of dangling (71%). Compressive garments were placed routinely by 12 surgeons (43%) with 20% starting before dangling, 46% with dangling, and 33% after dangling. Venous couplers were routinely used by 24 surgeons (85.7%). Trends in management were influenced by previous training in 53.6% of cases (vs evidence-based medicine 7.1%). Although 89.3% were satisfied with their approach, 92.8% would consider changing practice if higher-level evidence was available. Conclusions: The majority of Canadian microsurgeons initiate dangling early and utilize venous couplers. However, the use of compressive garments is limited. Trends in management are largely based on personal experience. Nearly all surgeons would consider changing their practice if higher-level evidence was available.

scholarly journals What does quality of life mean to older adults? A thematic synthesis

PLoS ONE ◽  
2019 ◽  
Vol 14 (3) ◽  
pp. e0213263 ◽  
Author(s):  
Karen M. van Leeuwen ◽  
Miriam S. van Loon ◽  
Fenna A. van Nes ◽  
Judith E. Bosmans ◽  
Henrica C. W. de Vet ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Thematic Synthesis
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