scholarly journals Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up

2011 ◽  
Vol 165 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Hermann L Müller ◽  
Ursel Gebhardt ◽  
Carmen Teske ◽  
Andreas Faldum ◽  
Isabella Zwiener ◽  
...  
Keyword(s):  
Negative Impact ◽  
Prospective Trial ◽  
Multivariable Analysis ◽  
Multidisciplinary Teams ◽  
Hypothalamic Obesity ◽  
Surgical Strategies ◽  
Hypothalamic Lesions ◽  
Patient Load

BackgroundHypothalamic obesity has major impact on prognosis and quality of life (QoL) in childhood craniopharyngioma.Patients and methodsFor this study, 120 patients were prospectively recruited during 2001 and 2007 and evaluated after 3 years of follow-up (KRANIOPHARYNGEOM 2000). Body mass index (BMI) and QoL at diagnosis and 36 months after diagnosis were analysed based on the reference assessment of tumour localisation and post-surgical hypothalamic lesions. Treatment was analysed based on the neurosurgical strategy of 50 participating neurosurgical centres, the centre size based on the patient load.ResultsBMI SDS at diagnosis was similar in patients with or without hypothalamic involvement. Surgical lesions of anterior and posterior hypothalamic areas were associated with higher increase in BMI SDS during 36 months post-diagnosis compared with patients without or only anterior lesion (+1.8 BMISD, P=0.033, +2.1 BMISD; P=0.011), negative impact on QoL in patients with posterior hypothalamic lesions. Surgical strategies varied among the 50 neurosurgical centres (three large-sized, 24 middle-sized and 23 small-sized centres). Patients treated in small-sized centres presented with a higher rate of hypothalamic involvement compared with those treated in the middle- and large-sized centres. Treatment in large-sized centres was less radical, and the rates of complete resection and hypothalamic surgical lesions were lower in large-sized centres than those of the middle- and small-sized centres. However, a multivariable analysis showed that pre-operative hypothalamic involvement was the only independent risk factor for severe obesity (P=0.002).ConclusionsRadical neurosurgical strategies leading to posterior hypothalamic lesions are not recommended due to the potential to exacerbate hypothalamic obesity and impaired QoL. Treatment should be confined to experienced multidisciplinary teams.

Association between multimodality measures of aortic stenosis severity and quality-of-life improvement outcomes after transcatheter aortic valve replacement

2021 ◽  
Author(s):  
Michael A Catalano ◽  
Shahryar G Saba ◽  
Bruce Rutkin ◽  
Greg Maurer ◽  
Jacinda Berg ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Computed Tomography ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Multivariable Analysis ◽  
Calcium Score ◽  
Post Intervention ◽  
Transcatheter Aortic Valve

Abstract Aims Up to 40% of patients with aortic stenosis (AS) present with discordant grading of AS severity based on common transthoracic echocardiography (TTE) measures. Our aim was to evaluate the utility of TTE and multi-detector computed tomography (MDCT) measures in predicting symptomatic improvement in patients with AS undergoing transcatheter aortic valve replacement (TAVR). Methods and results A retrospective review of 201 TAVR patients from January 2017 to November 2018 was performed. Pre- and post-intervention quality-of-life was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Pre-intervention measures including dimensionless index (DI), stroke volume index (SVI), mean transaortic gradient, peak transaortic velocity, indexed aortic valve area (AVA), aortic valve calcium score, and AVA based on hybrid MDCT-Doppler calculations were obtained and correlated with change in KCCQ-12 at 30-day follow-up. Among the 201 patients studied, median KCCQ-12 improved from 54.2 pre-intervention to 85.9 post-intervention. In multivariable analysis, patients with a mean gradient >40 mmHg experienced significantly greater improvement in KCCQ-12 at follow-up than those with mean gradient ≤40 mmHg (28.1 vs. 16.4, P = 0.015). Patients with MDCT-Doppler-calculated AVA of ≤1.2 cm2 had greater improvements in KCCQ-12 scores than those with computed tomography-measured AVA of >1.2 cm2 (23.4 vs. 14.1, P = 0.049) on univariate but not multivariable analysis. No association was detected between DI, SVI, peak velocity, calcium score, or AVA index and change in KCCQ-12. Conclusion Mean transaortic gradient is predictive of improvement in quality-of-life after TAVR. This measure of AS severity may warrant greater relative consideration when selecting the appropriateness of patients for TAVR.

scholarly journals Factor Structure of the Edinburgh Postnatal Depression Scale in a Sample of Postpartum Slovak Women

2021 ◽  
Vol 18 (12) ◽  
pp. 6298
Author(s):  
Zuzana Škodová ◽  
Ľubica Bánovčinová ◽  
Eva Urbanová ◽  
Marián Grendár ◽  
Martina Bašková
Keyword(s):  
Factor Structure ◽  
Postnatal Depression ◽  
Convergent Validity ◽  
Edinburgh Postnatal Depression Scale ◽  
Negative Impact ◽  
Depression Scale ◽  
Depression Symptoms ◽  
Three Dimensional Model

Background: Postpartum depression has a negative impact on quality of life. The aim of this study was to examine the factor structure and psychometric properties of the Slovak version of the Edinburgh Postnatal Depression Scale (EPDS). Methods: A paper and pencil version of the 10-item EPDS questionnaire was administered personally to 577 women at baseline during their stay in hospital on the second to fourth day postpartum (age, 30.6 ± 4.9 years; 73.5% vaginal births vs. 26.5% operative births; 59.4% primiparas). A total of 198 women participated in the online follow-up 6–8 weeks postpartum (questionnaire sent via e-mail). Results: The Slovak version of the EPDS had Cronbach’s coefficients of 0.84 and 0.88 at baseline (T1) and follow-up, respectively. The three-dimensional model of the scale offered good fit for both the baseline (χ2(df = 28) = 1339.38, p < 0.001; CFI = 0.99, RMSEA = 0.02, and TLI = 0.99) and follow-up (χ2(df = 45) = 908.06, p < 0.001, CFI = 0.93, RMSEA = 0.09, and TL = 0.90). A risk of major depression (EPDS score ≥ 13) was identified in 6.1% in T1 and 11.6% in the follow-up. Elevated levels of depression symptoms (EPDS score ≥ 10) were identified in 16.7% and 22.7% of the respondents at baseline and follow-up, respectively. Conclusions: The Slovak translation of the EPDS showed good consistency, convergent validity, and model characteristics. The routine use of EPDS can contribute to improving the quality of postnatal health care.

scholarly journals A cross-sectional audit of distress in patients undergoing adjuvant therapy or follow-up in central nervous system malignancies

2018 ◽  
Vol 6 (4) ◽  
pp. 305-310
Author(s):  
Vijay M Patil ◽  
Mridul Malhotra ◽  
Raees Tonse ◽  
Jayita Deodhar ◽  
Arun Chandrasekharan ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Negative Impact ◽  
Distress Screening ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Distress Score ◽  
High Distress ◽  
Cancer Network

Abstract Background Unaddressed high distress leads to noncompliance with treatment, negatively affects quality of life, and may also have a negative impact on the prognosis of cancer patients. Patients with brain tumors have higher levels of distress than the general population and hence we hypothesize that even routine visits during adjuvant treatment or follow-up are likely to be stressful. This analysis was performed to identify the incidence of distress and factors affecting it. Methods This was an audit of 84 consecutive patients seen in an adult neuro-medical oncology outpatient department who were either receiving adjuvant chemotherapy or were on follow-up. Distress screening with the National Comprehensive Cancer Network (NCCN) distress thermometer was performed. Patients in whom distress was scored as 4 or above were considered as having high distress. Descriptive statistics and logistic regression analysis were performed to identify factors affecting distress. Results The median age of the cohort was 40 years (interquartile range, 28.3 to 50 years). Actionable distress defined as a distress score of 4 or more was seen in 52 patients (61.9%, 95% CI 51.2% to 71.5%). Presence of physical deficit (odds ratio [OR] = 3.412, P = .020) and treatment under the private category (OR = 5.273, P = .003) had higher odds of having high distress. Conclusion A high proportion of brain tumor patients either on adjuvant chemotherapy or on follow-up have high distress levels that need to be addressed even during follow-up.

Three-year follow-up of prospective trial of focused ultrasound thalamotomy for essential tremor

Neurology ◽  
2019 ◽  
Vol 93 (24) ◽  
pp. e2284-e2293 ◽  
Author(s):  
Casey H. Halpern ◽  
Veronica Santini ◽  
Nir Lipsman ◽  
Andres M. Lozano ◽  
Michael L. Schwartz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Essential Tremor ◽  
Focused Ultrasound ◽  
Rating Scale ◽  
Prospective Trial ◽  
Postural Tremor ◽  
Hand Tremor

ObjectiveTo test the hypothesis that transcranial magnetic resonance–guided focused ultrasound (tcMRgFUS) thalamotomy is effective, durable, and safe for patients with medication-refractory essential tremor (ET), we assessed clinical outcomes at 3-year follow-up of a controlled multicenter prospective trial.MethodsOutcomes were based on the Clinical Rating Scale for Tremor, including hand combined tremor–motor (scale of 0–32), functional disability (scale of 0–32), and postural tremor (scale of 0–4) scores, and total scores from the Quality of Life in Essential Tremor Questionnaire (scale of 0–100). Scores at 36 months were compared with baseline and at 6 months after treatment to assess for efficacy and durability. Adverse events were also reported.ResultsMeasured scores remained improved from baseline to 36 months (all p < 0.0001). Range of improvement from baseline was 38%–50% in hand tremor, 43%–56% in disability, 50%–75% in postural tremor, and 27%–42% in quality of life. When compared to scores at 6 months, median scores increased for hand tremor (95% confidence interval [CI] 0–2, p = 0.0098) and disability (95% CI 1–4, p = 0.0001). During the third follow-up year, all previously noted adverse events remained mild or moderate, none worsened, 2 resolved, and no new adverse events occurred.ConclusionsResults at 3 years after unilateral tcMRgFUS thalamotomy for ET show continued benefit, and no progressive or delayed complications. Patients may experience mild degradation in some treatment metrics by 3 years, though improvement from baseline remains significant.Clinicaltrials.gov identifierNCT01827904.Classification of evidenceThis study provides Class IV evidence that for patients with severe ET, unilateral tcMRgFUS thalamotomy provides durable benefit after 3 years.

scholarly journals A Review of Psychosocial Factors of Marfan Syndrome: Adolescents, Adults, Families, and Providers

2019 ◽  
Vol 08 (03) ◽  
pp. 109-122 ◽  
Author(s):  
Cory Nielsen ◽  
Ileana Ratiu ◽  
Mitra Esfandiarei ◽  
Angela Chen ◽  
Elif Seda Selamet Tierney
Keyword(s):  
Psychosocial Factors ◽  
Marfan Syndrome ◽  
Satisfaction With Life ◽  
Negative Impact ◽  
Multidisciplinary Teams ◽  
Exclusion Criteria ◽  
Current Review ◽  
Reproductive Decision Making ◽  
Academic Search

AbstractThe purpose of this article was to review the current literature on psychosocial implications of Marfan syndrome (MFS) and its impact on adolescents, adults, their families and to provide important considerations for providers. Since the previous reviews in 2015, numerous studies have been published that are included in the current review. This literature review was conducted using PubMed, Medline, PsychINFO, ERIC, Web of Science, and Academic Search Premier databases and only articles that studied psychosocial factors that influence MFS patients as adolescents, adults, family members, or their interactions with providers were included in this review. Of the 522 articles reviewed, 41 were selected based on the inclusion and exclusion criteria. All articles were peer-reviewed. MFS has various implications that can impact one's life; studies have shown that MFS causes a negative impact on an individual's formative years, quality of life, reproductive decision-making, work participation, and satisfaction with life. Clinicians and multidisciplinary teams should be aware of these factors to provide support focusing on coping strategies for the patient and their family.

EORTC QLQ CR-29 evaluation in 500 patients with colorectal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 429-429 ◽  
Author(s):  
José Pedro Carvalho Moreira da Silva
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Global Health ◽  
Negative Impact ◽  
Neoadjuvant Treatment ◽  
Multivariable Analysis ◽  
Disease Recurrence ◽  
Face Validity ◽  
Patient Acceptability

429 Background: Colorectal cancer represents the 4th most frequent cancer in the world and is the 2nd leading cause of death due to cancer. This disease has a negative impact in the Quality of Life (QoL), due to its associated symptoms and due to the used treatments (surgery, chemotherapy and radiotherapy). Therefore it is fundamental to evaluate and assure a good quality of life of this patients and define the best QoL instrument in Colorectal cancer. Methods: Type of study: Transversal study The main objective was: validate for Portuguese population CR29 instrument. The QLQ-CR29 was administered with the QLQ-C30, core questionnaire, to 500 portuguese patients. Questionnaire scaling and reliability were established and clinical and psychometric validity examined. Patient acceptability and understanding were assessed with a debriefing questionnaire. Results: 57.4% (287) are male with a median of age of 66,67 years (Min.: 34 e Máx.: 88), 55.2% had rectal cancer (35.7% were Stage III disease at diagnosis. 46.4% had adjuvant and 27.4% had neoadjuvant treatment. The mean value of the QLQ-C30 Global Health Status was 58,75. The CR29 Multi-trait scaling analyses and face validity refined the module to four scales assessing urinary frequency, faecal seepage, stool consistency and body image and single items assessing other common problems following treatment for colorectal cancer identifying different groups of patients. High scores of cognitive and social functioning scales (QLQ C30), Subscale Corporal Image and the functional item Female Sexual function (QLQ-CR29) were related with good QoL. Low scores of Emotional Functioning subscales (QLQ C30) and Anxiety (QLQ-CR29), were related with poor QoL. A multivariable analysis reveals that sex, scholarship, marital status, distance between home and hospital and disease recurrence affect significantly the global health score. Conclusions: QLQ-CR29 Scale did not correlate with QLQ-C30 scales, demonstrating construct validity and it is a good instruments to identify a poor QoL in patients with colorectal cancer.

Adult CHD patients under clinical follow-up have a similar quality of life to the general population in Malta

2016 ◽  
Vol 27 (6) ◽  
pp. 1051-1059
Author(s):  
Maryanne Caruana ◽  
Victor Grech
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
General Population ◽  
Negative Impact ◽  
Adult Survivors ◽  
Cardiac Medication ◽  
Self Reporting Questionnaire ◽  
The Impact

AbstractBackgroundThe improved survival of patients born with CHD has led to increasing interest in research on quality of life of adult survivors. We report the findings of the first study in Malta carried out to investigate quality of life in adults with CHD under follow-up.MethodsA self-reporting questionnaire modelled on the basis of the European Health Interview Survey 2008, including questions on mental health and vitality, was administered to consecutive adult CHD outpatients, aged 16 years and over, between May, 2013 and May, 2014. Foreigners and patients with learning difficulties or cognitive impairment were excluded. Quality-of-life data were compared with that from 371 age- and sex-matched 2008 survey responders – general population cohort. The impact of congenital lesion complexity, hospitalisation in the preceding 12 months, arrhythmias, co-morbidities, and cardiac medication use on quality of life of the CHD cohort was also investigated.ResultsThere were a total of 120 patient responders (63 males; mean age 30.53, SD 12.77 years). Overall, there were no significant differences in mental health and vitality between patient and general population cohorts, although older patients had better mental health scores compared with age-matched controls. Within the adult CHD cohort, hospitalisation in the preceding 12 months was the only factor associated with a poorer quality of life.ConclusionsOverall, CHD has no negative impact on mental health and vitality in Maltese adult patients under follow-up. Patients needing frequent hospitalisations might warrant closer attention by clinical psychologists.

scholarly journals The Effect of Referral Process and Complications to Maternal Mortality

2015 ◽  
Vol 3 (3) ◽  
pp. 400
Author(s):  
Indah Handriani ◽  
Soenarnatalina Melaniani
Keyword(s):  
High Risk ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Medical Records ◽  
Multivariable Analysis ◽  
Secondary Data ◽  
Case Control ◽  
Referral Process

ABSTRACTMaternal Mortality Rate (MMR) in East Java was still high. in 2013, MMR in sidoarjo district has readed 96.27 per 100,000 live birth. This aim of this study was to the effect of the referral process to maternal mortality in RSUD Sidoarjo. This research was analytic observational with case control design. The Samples of this study were 25 pregnant women who were referred to RSUD Sidoarjo and death. The case controls were 50 pregnant women who were referred to RSUD Sidoarjo who did not experience death. Techniques of data collection using secondary data from the register book maternal and neonatal Emergency (MNE) and medical records and interviews with the mother/family/husband of respondents. The data was analyzed by using univariable, bivariable and multivariable analysis with logistic regression. The results of this study confirmed that the referral process was poor (OR=9,783,95% CI: 2,275 to 42,072, p=0,002) and the complications (OR=0,005,95%CI: 0,001-0,057, p=0,000).thus, the incidence maternal mortality increased. The conclusion of this study is the referral process and the complications to maternal mortality affect the occurrence of maternal mortality. Midwives need to conduct health education should be given to women in their productive age, increase the participation of families, communities and cadres in the process of early detection of complications during pregnancy, childbirth and postpartum, the quality of antenatal care (ANC) and the quality of referrals should be improved by creating a close referral system in a region associated with a high risk pregnant women were detected inventoried and scheduled control/termination and monitored (follow-up) so that high risk always monitored.Keywords: maternal mortality, referral process, complications

scholarly journals Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity

2021 ◽  
Vol 10 (21) ◽  
pp. 4826
Author(s):  
Han Jo Kim ◽  
Sohrab Virk ◽  
Jonathan Elysee ◽  
Christopher Ames ◽  
Peter Passias ◽  
...  
Keyword(s):  
Neck Disability Index ◽  
Treatment Strategies ◽  
Surgical Approaches ◽  
Surgical Strategies ◽  
Cervical Deformity ◽  
Related Quality ◽  
Health Related ◽  
Neck Disability

Objectives: Cervical deformity morphotypes based on type and location of deformity have previously been described. This study aimed to examine the surgical strategies implemented to treat these deformity types and identify if differences in treatment strategies impact surgical outcomes. Our hypothesis was that surgical strategies will differ based on different morphologies of cervical deformity. Methods: Adult patients enrolled in a prospective cervical deformity database were classified into four deformity types (Flatneck (FN), Focal kyphosis (FK), Cervicothoracic kyphosis (CTK) and Coronal (C)), as previously described. We analyzed group differences in demographics, preoperative symptoms, health-related quality of life scores (HRQOLs), and surgical strategies were evaluated, and postop radiographic and HROQLs at 1+ year follow up were compared. Results: 90/109 eligible patients (mean age 63.3 ± 9.2, 64% female, CCI 1.01 ± 1.36) were evaluated. Group distributions included FN = 33%, FK = 29%, CTK = 29%, and C = 9%. Significant differences were noted in the surgical approaches for the four types of deformities, with FN and FK having a high number of anterior/posterior (APSF) approaches, while CTK and C had more posterior only (PSF) approaches. For FN and FK, PSF was utilized more in cases with prior anterior surgery (70% vs. 25%). For FN group, PSF resulted in inferior neck disability index compared to those receiving APSF suggesting APSF is superior for FN types. CTK types had more three-column osteotomies (3CO) (p < 0.01) and longer fusions with the LIV below T7 (p < 0.01). There were no differences in the UIV between all deformity types (p = 0.19). All four types of deformities had significant improvement in NRS neck pain post-op (p < 0.05) with their respective surgical strategies. Conclusions: The four types of cervical deformities had different surgical strategies to achieve improvements in HRQOLs. FN and FK types were more often treated with APSF surgery, while types CTK and C were more likely to undergo PSF. CTK deformities had the highest number of 3COs. This information may provide guidelines for the successful management of cervical deformities.

Nomogram predicting treatment-related sexual dysfunction for men with localized prostate cancer treated by radical prostatectomy (RP), external-beam radiotherapy (EBRT), and brachytherapy (PI).

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 51-51
Author(s):  
Joseph C. Klink ◽  
Martin G. Sanda ◽  
Mark S. Litwin ◽  
Montserrat Ferrer ◽  
Meredith M. Regan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Multivariable Analysis ◽  
Sexual Problems ◽  
Localized Prostate Cancer ◽  
Patient Counseling ◽  
Patient Reported ◽  
Prospective Longitudinal

51 Background: RP, EBRT, and PI for the treatment of clinically localized prostate cancer may negatively impact sexual function. Predictions of treatment-related sexual problems from patient-reported, prospective data may be useful in decision-making. Methods: Patient-reported data on treatment-related sexual problems was obtained from 4 prospective, longitudinal, health-related quality-of-life (HRQOL) protocols comprising 2,668 patients treated between 1999 and 2011 by RP (n = 1,294), EBRT (n = 630), and PI (n = 744). A single HRQOL instrument was not uniformly used for each study, although questions pertaining to the quality and frequency of erections were identical among the studies. Only those patients with quality of erections sufficient for intercourse were included in the model. The endpoint of the model was erections suitable for intercourse on at least half of attempts at 2 years after treatment, with or without the use of oral medications. Cox proportional hazards regression analysis was used to model the clinical information and follow-up data. Internal validation was performed using bootstrapping. Results: Overall, 931 (74%), 249 (42%), and 323 (45%) patients treated by RP, EBRT, and PI were considered to be potent at baseline. Significant differences in baseline characteristics such as patient age, ethnicity, and disease severity existed between the treatment groups. The potency rate at 2 years for 1,215 patients who were potent at baseline and had complete follow-up data was 38%, 51%, and 61% for patients treated by RP, EBRT, and PI, respectively (p < 0.001). In multivariable analysis, age (p < 0.001), baseline frequency of erections (p < 0.001), EBRT (p < 0.001), PI (p < 0.001), PSA (p = 0.001), and institution (p = 0.006), were associated with potency. A nomogram based on the predictive parameters had a concordance index of 0.72 and predictions were well-calibrated with observed outcome. Conclusions: An externally-validated nomogram that predicts 2-year potency after treatment for localized prostate cancer has been developed and may be useful for patient counseling regarding treatment options.

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