Time Course of Autonomic Symptoms in Postural Orthostatic Tachycardia Syndrome (POTS) Patients: Two-Year Follow-Up Results

Postural orthostatic tachycardia syndrome (POTS) is a multifactorial condition capable of chronically reducing the quality of life and the work ability of patients. The study aim was to assess the burden of autonomic symptoms in a cohort of POTS patients over 2 years. Patients’ clinical profiles were assessed by the 31-item Composite Autonomic Symptom Score questionnaire (COMPASS 31) and a visual analog scale (VAS). One-way ANOVA for repeated measures followed by Dunnett’s post-hoc test were used to compare symptoms at baseline and at 1 and 2 years. Out of 42 enrolled patients, 25 had a 1-year follow-up and 12 had a 2-year follow-up. At baseline, the reported burden of autonomic symptoms was high (overall COMPASS 31 = 49.9 ± 14.3 /100). Main complaints were related to orthostatic intolerance according to both COMPASS 31 and VAS. Fourteen patients were rendered inactive because of symptoms. At 1-year follow-up, a statistically significant improvement in pupillomotor function and overall score was detected by the COMPASS 31. These findings were confirmed at 2 years, together with a significant reduction in quality of life impairment, assessed by VAS. However, these improvements did not change patients’ occupational status. Awareness of POTS diagnosis, patient monitoring, and tailored therapies can help to improve patients’ condition.

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Quality of Life and Hemodynamic Effects of Switching From Hemodialysis to Hemodiafiltration: A Canadian Controlled Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211057717 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110577

Author(s):

Isabelle Ethier ◽

Immaculate Nevis ◽

Rita S. Suri

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Repeated Measures ◽

Recovery Time ◽

Randomized Clinical Trials ◽

Analysis Of Covariance ◽

Intradialytic Hypotension ◽

Laboratory Values

Background: Recent randomized clinical trials have demonstrated beneficial effects of hemodiafiltration (HDF) compared with hemodialysis (HD) on mortality and hemodynamic stability. Data on quality of life in HDF compared with HD is limited. Objective: This study aimed to determine whether patients receiving HD experience improvements in quality of life, hemodynamic and laboratory parameters after switching to HDF. Design: Observational controlled cohort study. Setting & Patients: Adult patients receiving maintenance dialysis were followed for 3 months both before and after transfer to a new unit, where they received HDF. Prior to transfer, control patients were already treated by HDF. Methods: Quality of life at baseline and follow-up was measured using the validated minutes to recovery (MR) question. Dialysis data were collected for 3 consecutive sessions monthly; laboratory values were collected monthly. Wilcoxon signed rank test and repeated measures analysis of covariance were used to evaluate pre/post transfer changes and quantile regression to identify predictors of change in recovery time. Results: Of 227 patients, 82 died, were transplanted, were hospitalized or did not transfer, leaving 123 subjects and 22 controls for analysis. MR did not improve with switching to HDF, although patients with MR > 60 min before transfer experienced a significant decrease in their MR, compared with controls. There was no improvement in intradialytic hypotension with HDF. There were no differences in laboratory values before vs after switch. Limitations: Nonrandomized single-center study, including only small numbers of patients and covering a short follow-up period; hemodynamic values only evaluated over 1 week per month; residual kidney function not recorded. Conclusions: In this Canadian experience of HDF, patients remained stable with respect to several laboratory and dialysis related parameters. Switch to HDF was associated with substantially reduced recovery time in patients with MR > 60 minutes at baseline.

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Long-Term Patient Satisfaction and Quality of Life After Breast-Conserving Therapy: A Prospective Study Using the BREAST-Q

Annals of Surgical Oncology ◽

10.1245/s10434-021-10377-4 ◽

2021 ◽

Author(s):

Ilona Stolpner ◽

Jörg Heil ◽

Fabian Riedel ◽

Markus Wallwiener ◽

Benedikt Schäfgen ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Patient Satisfaction ◽

Repeated Measures ◽

Aesthetic Surgery ◽

Well Being ◽

Breast Conserving Therapy ◽

Patient Reported

Abstract Background Poor patient-reported satisfaction after breast-conserving therapy (BCT) has been associated with impaired health-related quality of life (HRQOL) and subsequent depression in retrospective analysis. This prospective cohort study aimed to assess the HRQOL of patients who have undergone BCT using the BREAST-Q, and to identify clinical risk factors for lower patient satisfaction. Methods Patients with primary breast cancer undergoing BCT were asked to complete the BREAST-Q preoperatively (T1) for baseline evaluation, then 3 to 4 weeks postoperatively (T2), and finally 1 year after surgery (T3). Clinicopathologic data were extracted from the patients’ charts. Repeated measures analysis of variance (ANOVA) was used to determine significant differences in mean satisfaction and well-being levels among the test intervals. Multiple linear regression was used to evaluate risk factors for lower satisfaction. Results The study enrolled 250 patients. The lowest baseline BREAST-Q score was reported for “satisfaction with breast” (mean, 61 ± 19), but this increased postoperatively (mean, 66 ± 18) and was maintained at the 1 year follow-up evaluation (mean, 67 ± 21). “Physical well-being” decreased from T1 (mean, 82 ± 17) to T2 (mean, 28 ± 13) and did not recover much by T3 (mean, 33 ± 13), being the lowest BREAST-Q score postoperatively and in the 1-year follow-up evaluation. In multiple regression, baseline psychosocial well-being, body mass index (BMI), and type of incision were risk factors for lower “satisfaction with breasts.” Conclusion Both the aesthetic/surgery-related and psychological aspects are equally important with regard to “satisfaction with breasts” after BCT. The data could serve as the benchmark for future studies.

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Effectiveness of the Electromagnetic Shock Wave Therapy in the Treatment of Cellulite

Dermatology Research and Practice ◽

10.1155/2019/8246815 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Débora Apª O. Modena ◽

Caroline Nogueira da Silva ◽

Talita C. P. Delinocente ◽

Tatiane Bianca de Araújo ◽

Tania Maria de Carvalho ◽

...

Keyword(s):

Quality Of Life ◽

Evaluation Method ◽

The Body ◽

P Value ◽

Therapeutic Modalities ◽

Shockwave Therapy ◽

Deformation Ability ◽

Post Hoc

In the past centuries, the human body was undervalued; nowadays, however, it is overvalued, and thus the manifestation of the dissatisfactions regarding the body has been increasing. Most of the time, these dissatisfactions are related to cellulite, which is most common in women. Its treatment is one of the challenges which encourage the development of new therapeutic modalities, among them the shockwave therapy. Objective. To evaluate the efficacy of ESWT in the treatment of cellulite in gluteus and posterior of thigh. Method. This is a prospective and comparative study, in which volunteer women who attended the criteria of inclusion were selected and who were subjected to 10 sessions of ESWT. The following were performed as an evaluation method: anthropometry, perimetry, skin viscoelasticity with the Cutometer®, thickness of hypodermis with diagnostic ultrasound, analysis of the scale of severity of cellulite (CSS), and quality of life by the Celluqol® questionnaire. The evaluations occurred before the first session (baseline), after 6 and 10 sessions, and during a follow-up of 3 months after the last session. The statistical test applied was the ANOVA one-way with post hoc of Tukey (P-value < 0.05). Results. There was significant improvement (P<0.05) for CSS, for the variable referring to gross elasticity and skin deformation ability evaluated in the Cutometer® and improvement of quality of life represented by Celluqol®. The result was maintained particularly in the follow-up of 3 months after the end of the treatment. Conclusion. The results presented demonstrated the effectiveness and safety of ESWT in the treatment of cellulite and in the decrease of the degrees, improvement of the aspect of the skin, and reestablishment of quality of life. This trial is registered with ClinicalTrials: NCT03275259.

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Health-Related Quality of Life During the 10 Years After Diagnosis of Colorectal Cancer: A Population-Based Study

Journal of Clinical Oncology ◽

10.1200/jco.2010.31.4013 ◽

2011 ◽

Vol 29 (24) ◽

pp. 3263-3269 ◽

Cited By ~ 95

Author(s):

Lina Jansen ◽

Antje Herrmann ◽

Christa Stegmaier ◽

Susanne Singer ◽

Hermann Brenner ◽

...

Keyword(s):

Quality Of Life ◽

Colorectal Cancer ◽

General Population ◽

Time Course ◽

Population Based ◽

Age At Diagnosis ◽

Life Questionnaire ◽

Health Related

Purpose To compare long-term quality of life (QoL) of colorectal cancer survivors with QoL in the general population and investigate changes in QoL of survivors during the 10 years after diagnosis. Patients and Methods Health-related QoL was assessed 1, 3, 5, and 10 years after diagnosis in a population-based cohort starting with 439 patients with colorectal cancer from Saarland, Germany, using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. QoL after 5 and 10 years and time course of QoL during the 10 years after diagnosis were compared with controls from the general population of Germany, after controlling for sex and age. Results Overall, 234 and 196 patients were still alive after 5 and 10 years, respectively. Of these survivors, 178 (76%) responded in the 5-year follow-up, 133 (68%) in the 10-year follow-up, and 117 (60%) participated in all follow-ups. Over the entire follow-up, younger survivors (age at diagnosis, < 60 years) reported restrictions in role, social, emotional, and cognitive functioning and specific problems like constipation, diarrhea, fatigue, and insomnia. Older survivors (age at diagnosis, ≥ 70 years) reported comparable or even better QoL than controls within the first 3 to 5 years after diagnosis and comparable to worse QoL 5 to 10 years after diagnosis. Conclusion Although younger survivors continuously reported detriments in various QoL dimensions during the 10-year period after diagnosis, detriments in older survivors became apparent in the long run only.

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Time Course of Quality of Life Improvement Between Resection Arthroplasty and Metatarsophalangeal Joint-Preserving Forefoot Arthroplasty for Rheumatoid Arthritis

Foot & Ankle International ◽

10.1177/1071100720962096 ◽

2020 ◽

pp. 107110072096209

Author(s):

Kota Shimomura ◽

Tetsuro Yasui ◽

Atsushi Teramoto ◽

Yasuhiro Ozasa ◽

Toshihiko Yamashita ◽

...

Keyword(s):

Quality Of Life ◽

Rheumatoid Arthritis ◽

Time Course ◽

Resection Arthroplasty ◽

Forefoot Deformity ◽

Resection Group ◽

Significant Difference ◽

Life Improvement

Background: Resection arthroplasty has long been a major treatment option for forefoot deformity caused by rheumatoid arthritis (RA). However, metatarsophalangeal (MTP) joint–preserving surgery is now surpassing classic resection arthroplasty. This study was performed to compare the postoperative results of these 2 operative methods. Methods: Fifty-one toes of 40 patients with RA who underwent resection arthroplasty (resection group) or MTP joint–preserving arthroplasty (preservation group) from 2014 to 2017 for forefoot deformity were followed up for >1 year and were retrospectively analyzed. In the preservation group, open reduction of joint dislocation was performed if needed, and the deformity was corrected by metatarsal shortening osteotomy. The mean follow-up period was 21 months. The Japanese Society for Surgery of the Foot (JSSF) scales (objective outcome measures), the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) (subjective outcome measure), and radiographic indices were compared between the groups. The resection group and preservation group comprised 15 toes of 11 patients and 36 toes of 29 patients, respectively. Results: There were no significant differences in the preoperative radiographic indices, JSSF scales, or SAFE-Q results between the 2 groups. The preservation group showed better JSSF scores at the last follow-up (median hallux scale, 89 vs 74; median lesser scale, 87 vs 79). In the preservation group, the SAFE-Q scores gradually improved with time until 12 months postoperatively. In the resection group, the scores decreased 3 months postoperatively and then improved and reached a plateau 6 months postoperatively. At 12 months postoperatively, there was no significant difference in the SAFE-Q scores between the 2 groups. Conclusions: MTP joint–preserving arthroplasty resulted in superior objective scores to resection arthroplasty in patients with RA forefoot deformity. Although the subjective scores did not differ between the groups at the last follow-up, the time course of postoperative quality of life improvement was different between the 2 surgeries. Level of Evidence: Level III, retrospective comparative study.

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Quality of life in patients with symptomatic multivessel coronary artery disease: ten-year follow-up of a comparative post hoc analyses of medical, angioplasty or surgical strategies-MASS II trial

European Heart Journal ◽

10.1093/eurheartj/eht310.p5466 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P5466-P5466

Author(s):

A. L. O. Carvalho ◽

M. E. Takiuti ◽

P. Girardi ◽

M. F. Silva ◽

C. L. Garzillo ◽

...

Keyword(s):

Quality Of Life ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Multivessel Coronary Artery Disease ◽

Surgical Strategies ◽

Artery Disease ◽

Post Hoc

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Autonomic Symptoms in Older Adults Are Common and Associated With Health-Related Quality of Life

Frontiers in Neurology ◽

10.3389/fneur.2021.757748 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sarah Renno-Busch ◽

Hanna Hildesheim ◽

Janet M. T. van Uem ◽

Ulrike Sünkel ◽

Benjamin Röben ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Orthostatic Intolerance ◽

Linear Regression Analysis ◽

Health Related Quality ◽

Autonomic Symptom ◽

Autonomic Symptoms ◽

Related Quality ◽

Health Related

Background: Autonomic symptoms are common in older adults, and a large body of literature focusing on age-related diseases shows that autonomic symptoms in these diseases constrain Health-Related Quality of Life (HRQoL). To our best knowledge, the association between autonomic symptoms in older adults, independent of specific diseases, and HRQoL has not yet been assessed.Aim: To assess the frequency and the effect of autonomic symptoms in general, as well as orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor symptoms, on HRQoL in older adults.Methods: Cross-sectional data of the fourth visit of the Tübinger evaluation of Risk factors for Early detection of Neurodegeneration (TREND) study were included. Autonomic symptoms, as assessed with the Composite Autonomic Symptom Score 31 (COMPASS 31), were quantified and compared with HRQoL, as assessed with the EuroQol five-level version (EQ-5D-5L). Statistical analyses included Spearman's rank correlation and multiple linear regression analysis.Results: The analysis included 928 participants with a median of 68 years; 47% were women. Of those, 85% reported at least one autonomic symptom. Gastrointestinal and secretomotor symptoms were most common. The COMPASS 31 total score and all subdomains were significantly associated with reduced HRQoL. Among the subdomains, the strongest correlations with HRQoL were found for gastrointestinal and bladder symptoms. Overall, autonomic symptoms alone explained 20% of the variance of HRQoL; when depressive mood was added, the model explained 32%.Conclusion: Autonomic symptoms are associated with HRQoL and depressive symptoms in older adults.

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Secondary Prophylaxis with rFVIIa Improves Quality of Life of Hemophilia Patients with Inhibitors and Frequent Bleeds.

Blood ◽

10.1182/blood.v108.11.1028.1028 ◽

2006 ◽

Vol 108 (11) ◽

pp. 1028-1028 ◽

Cited By ~ 1

Author(s):

Barbara A. Konkle ◽

Liselotte S. Ebbesen ◽

Guenter K.H. Auerswald ◽

Ute Friedrich ◽

Rolf C.R. Ljung ◽

...

Keyword(s):

Quality Of Life ◽

Treatment Period ◽

Secondary Prophylaxis ◽

Post Treatment ◽

School Work ◽

Post Hoc Analysis ◽

On Demand ◽

Post Hoc

Abstract Introduction: Patients with hemophilia and neutralizing antibodies (inhibitors) against exogenous factor VIII or factor IX characteristically have impaired joint function and more hospitalizations compared with those without inhibitors. We investigated the impact of secondary prophylaxis with activated recombinant factor VII (rFVIIa) on quality of life (QoL) and health-related quality of life (HRQL) in patients with congenital hemophilia A or B with inhibitors and high requirements for on-demand therapy. Methods: In a prospective, randomized, double-blind, uncontrolled trial, 22 patients (inhibitor titer >2 BU/mL; and ≥4 bleeds/month) received secondary prophylaxis with rFVIIa (90 or 270 μg/kg) once daily. This was preceded by a 3-month observation (baseline) period and followed by a 3-month post-treatment follow-up period in which patients were treated on-demand for their bleeds. QoL was evaluated by hospitalizations related to bleeds, days unable to attend/absence from school or work, or days requiring mobility aids. HRQL was assessed with the EuroQoL (EQ-5D), a 5-dimensional measure of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with 3 levels (no problem; some or moderate problems; and extreme problems/impossible to do). Results: The clinically relevant reductions in bleed frequency observed with rFVIIa 90 or 270 μg/kg during prophylaxis (45% and 59%; p<0.0001 for both) compared with on-demand therapy during the observation period (baseline) were maintained during the 3-month follow-up period and were associated with improvements in QoL. The proportion of days during prophylaxis where patients were unable to attend/absent from school/work was significantly less than at baseline (16.7% vs 38.7%; p=0.0127, in a post-hoc analysis of the two treatment arms combined) and a significantly lower percentage of days was spent in hospital (5.9% vs 13.5%; p=0.0026 [post-hoc analysis]). During the post-treatment period, there were non-significant trends towards this effect being maintained (28.1% days absent from school/work, and 10.3% days spent in hospital). Overall use of mobility aids during prophylaxis and during the post-treatment period remained unchanged from that at baseline (post-hoc analysis). With EQ-5D, 2 of the measures (pain and mobility) showed trends towards improvement over time. Fewer patients tended to have pain and mobility problems during prophylaxis and during the post-treatment period. Conclusion: Prior to entry, patients enrolled in this trial bled frequently and overall had significant joint disease. Clinically relevant reductions in the number of bleeds observed during prophylaxis with rFVIIa compared with conventional on-demand therapy were associated with considerable improvements in QoL, reflected in a variety of important measures. Our results support the concept that secondary prophylaxis with rFVIIa in patients with severe hemophilia A or B with inhibitors and frequent bleeds improves the QoL of these disabled patients.

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Long-term follow-up after radiotherapy for prostate cancer with and without rectal hydrogel spacer: A pooled prospective evaluation of quality of life.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.39 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 39-39

Author(s):

Zachary A Seymour ◽

Stephanie Daignault ◽

Walter Bosch ◽

Hiram Alberto Gay ◽

Jeff M. Michalski ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Repeated Measures ◽

Organs At Risk ◽

Logistic Models ◽

Pooled Analysis ◽

Long Term Follow Up

39 Background: Hydrogel spacers are a tool to improve dosimetry and overall quality of life with limited follow-up in men receiving radiotherapy for prostate cancer. This present study is a pooled analysis of a prospective cohorts with long-term follow-up quality of life (QOL) data with or without hydrogel spacers to minimize dose adjacent organs at risk. Methods: QOL was examined using the Expanded Prostate Cancer Index Composite (EPIC) to compare mean changes from baseline. A total of 215 patients from a randomized multi-institutional trial of radiation with or without hydrogel spacer with a QOL end-point were pooled with 165 non-randomized patients from a single institution with prospective QOL collection in both patients with or without hydrogel spacer. The proportions of men with minimally important differences (MIDs) relative to pre-treatment baseline in each domain were tested using repeated measures logistic models with pre-specified thresholds for clinically significant decline. Results: A total of 380 men were evaluated (64% with spacer and 36% without) with QOL data being available for 199 men beyond 24 months of follow-up (median: 39.5 months, range: 31-71.4 mo). Treatment with spacer was associated with less decline in average long-term bowel QOL (89.4 for control and 94.7 for experimental) with differences at > 2 years meeting the threshold of MID difference between cohorts (Bowel Score Difference from baseline: control = -5.1 spacer = 0.3 Diff = -5.4 p = 0.0003). When evaluated over time men without spacer were more likely to have 1xMID (5 points) declines in bowel QOL (p = 0.01). At long-term follow-up 1xMID was 36% without spacer vs 14% with spacer (p = 0.0006 OR = 3.5) while 2x MID was seen in 19% vs 6% (p = 0.008 OR = 3.6). The use of spacer was associated with improved bowel frequency (p = 0.002), reduced bleeding (p = 0.005) and less overall bowel problems (p = 0.007). Conclusions: In this pooled analysis of QOL after prostate radiotherapy with up to 5-years of follow-up utilization of a hydrogel spacer was associated with preservation of bowel QOL. This QOL benefit was preserved with long-term follow-up.

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