Comparison of approaches in the assessment of myocardial viability and follow-up of PTCA/CABG

Dysfunctional myocardium may be viable in patients with acute myocardial infarction. Although viable but dyssynergic myocardium may be recognized a posteriori by the occurrence of functional recovery, prospective identification of the actual myocardial state is more important for optimal therapeutic management.Echocardiography during pharmacological interventions is a useful clinical tool, as changes in regional myocardial thickening may be continuously monitored. Stunned myocardium exhibits contractile dysfunction after an ischemic episode despite normalized or near normalized myocardial flow, but stunned myocardium retains contractile reserve. It may be identified by improvement in contractility during a low dose dobutamine infusion in segments showing a mismatch between normal perfusion and reduced contractility. In regions of viable but stunned myocardium corresponding to an artery with reduced coronary flow reserve, contractility may improve at low dose dobutamine infusion and may later deteriorate at high dose, indicating the presence of jeopardized myocardium. Ischemia at a distance observed with dobutamine indicates the presence of multivessel coronary artery disease. These informations are useful for clinical decision making.     

肠易激综合征患者的症状和生存质量与性别的关系

目的 探讨肠易激综合征（IBS）患者症状、生存质量与性别的关系。方法 将500例IBS患者按性别分为两组，采用症状发生频数指标对所有患者进行肠内症状和肠外症状评估。患者生存质量采用世界卫生组织推荐的SF-36量表，对患者的一般健康状况、生理机能、生理职能、情感职能、社会功能、精神健康、躯体疼痛以及精力等8个方面进行评估，并将原始得分按SF-36操作手册换算成0～100之间对应的数值。所有结果行X^2检验。结果 女性在一般健康状况、生理机能、生理职能、情感职能、社会功能、精神健康、躯体疼痛以及精力等8个方面均显著低于男性（P〈0．01）。结论 IBS患者的症状和生存质量与性别有关。     

10-year follow-up of chronic non-malignant pain patients: opioid use, health related quality of life and health care utilization.

BACKGROUND: In Denmark, opioids have been used liberally for many years in the treatment of non-malignant pain, but long-term consequences as tolerance and influence on health related quality of life remain unknown. AIM: Adherence to medical treatment, opioid dose escalation, health related quality of life, anxiety, depression, coping strategies and health care utilization were evaluated in chronic pain patients 10 years after treatment in a multidisciplinary pain centre. METHODS: Information was gathered from medical records, postal questionnaires and a central hospital register. RESULTS: Opioid dose escalation occurred in only a few patients. Increase and decrease in opioid dose were almost equally frequent. Sixty percent of those discharged on long acting opioids were still on that treatment at follow-up. Twenty-eight percent of the patients initiated opioid treatment after discharge from the pain centre. Occupational status was identified as a determining factor for future opioid use. Opioid users had a lower health related quality of life, higher occurrence of depression and more frequent use of coping strategies like 'Catastrophizing' and 'Hoping and Praying'. Adjuvant analgesics were highly discontinued. Multidisciplinary pain treatment reduced the number of hospital admissions and in-hospital days. CONCLUSION: We recommend that future research on opioid treatment does not only focus on biological issues. The effect of opioids needs to be viewed in a much more complex context where consequences like health related quality of life, depression and the role of various coping strategies are included.     

Relationship between dialysis adequacy and quality of life in long-term peritoneal dialysis patients.

OBJECTIVE: The purpose of this study was to compare quality of life (QOL) between peritoneal dialysis (PD) patients with adequate and inadequate total solute clearance (TSC). We also tried to determine the relationship between QOL and TSC. DESIGN: A cross-sectional study design was used in which QOL was evaluated and compared between PD patients with adequate and inadequate TSC. SETTING: The PD unit of a university teaching hospital. PATIENTS: Sixty-seven patients were recruited, 38 on continuous ambulatory PD and 29 on continuous cyclerassisted PD. METHODS: Patients were divided into adequate and inadequate groups, based on the results of either total urea clearance (Kt/Vurea) or total creatinine clearance (weekly CCr). The demographic data, dialysis variables, and clinical parameters of these patients were all collected. QOL was evaluated using the SF-36 questionnaire, which contains eight domains and is a comprehensive and validated instrument for QOL evaluation. QOL of patients in adequate and inadequate groups was compared. The relationship between QOL and TSC was also examined. RESULTS: Among patients grouped by Kt/Vurea, patients in the adequate group had significantly higher scores in two domains of the SF-36, that is, physical and emotional role functioning, than did those in the inadequate group. The total SF-36 scores were positively correlated with Kt/Vurea when all patients were pooled together. However, among patients grouped by weekly CCr, there was no significant difference in any of the eight domains of the SF-36 between patients in the adequate and inadequate groups. No correlation was found between the total SF-36 scores and weekly CCr. CONCLUSION: Our study had two important findings: First, PD patients with adequate total solute clearance, based on Kt/Vurea and not on weekly CCr, had a better QOL. Second, Kt/Vurea is better correlated with QOL than weekly CCr. These findings suggest that Kt/Vurea is a better parameter for the clinical evaluation of total solute clearance from the viewpoint of QOL.     

Need assessment and quality of life in outpatients with schizophrenia: a 5-year follow-up study

The present study is a 5-year follow-up of patients with schizophrenia who were in-patients for more than 3 months in 1993. In all, 19 patients fulfilled the criteria and were interviewed 6 months after their discharge. Seventeen of them also participated in a follow-up 5 years later. Their needs were independently rated by themselves and by their key workers according to the Camberwell Assessment of Need (CAN, research version 3.0). The interview with the patients also included quality of life assessed by the Quality of Life Scale (QLS-100). The results from CAN showed a difference when using a cut-off point for higher vs. lower problem at 10 needs. Using this cut-off point, five patients at the baseline and one at the follow-up had higher problems. The need ranking with key workers showed a correlation of rho = 0.68 at the baseline and rho = 0.74 at the follow-up. QLS-100 showed that the patient's total number of unsatisfied items were significantly higher (p = 0.01) at the baseline than at the follow-up. At the follow-up, full insight into their illness was shown by most of the patients. There are several possible explanations associated with the increased quality of life, e.g. less unsatisfied items among some patients and greater autonomy at the follow-up.     

家庭随访对老年卧床患者康复依从性及生活质量的影响

目的评价家庭随访对老年卧床患者康复依从性和生活质量的效果。方法将120名老年卧床患者分为试验组与对照组各60例。对照组出院时给予常规出院指导,对患者及其家属进行家庭康复训练指导,并进行定期电话随访。试验组在出院时,由医生、治疗师、护士、营养师、患者和家属共同制订家庭康复计划,并进行家庭随访指导。出院6个月两组进行康复依从性和生存质量的评价。结果出院6个月后,试验组的康复依从性及生存质量的评分均高于对照组,差异有统计学意义(P0.05)。结论家庭随访能提高老年卧床患者的康复依从性,增强患者的日常生活能力,减少卧床时间,提高其生活质量。     

痴呆病人直系亲属照料者生活质量及相关因素调查研究

[目的]调查居家痴呆病人直系亲属照料者生活质量状况,分析其影响因素。[方法]选取连续照料痴呆病人≥2个月的直系亲属65人,采用简明健康调查量表、Zarit照料者负担问卷、领悟社会支持问卷、简易应对方式问卷对其进行调查,分析影响其生活质量的因素。[结果]痴呆病人直系亲属照料者生理功能、生理职能、躯体疼痛、总体健康、活力、情感职能、精神健康7个维度得分显著低于我国常模;患病情况、亲属关系、朋友支持、消极应对、照料负担等为影响生活质量的主要因素。[结论]痴呆病人直系亲属照料者直系亲属生活质量较差,应加强对照料负担重、应对消极、社会支持较差直系亲属的干预,以提高其生活质量。     

Catastrophizing and health-related quality of life: a 6-year follow-up of patients with chronic low back pain.

A pain rehabilitation model that focused on emotions was implemented to influence catastrophizing by, and health-related quality of life (HRQL) for, persons with chronic low back pain. Twelve individuals, 7 men and 5 women (aged 33 to 57 years), all with long-term pain despite treatment, were included in the study and a single case research experimental design (SCRED) was used to follow the patterns of coping with pain for 6 years. The HRQL was measured before and 6 years after the intervention. Coping strategies and HRQL were evaluated with the Coping Strategy Questionnaire (CSQ) and the SF-36, respectively. The evaluation of pain coping strategies after 3 years found decreased catastrophizing, a decrease that had continued 3 years later. HRQL showed significantly improved mental health and impaired physical capacity at the 6-year follow-up. Changes in catastrophizing or in HRQL did not appear to influence self-scored bodily pain. Altered catastrophizing appeared to be a long-term process. This research indicates the need for rehabilitation programs to assess and evaluate patients' pain and their need for improved quality of life, rather than focusing only on the elimination of pain.     

Preoperative expectations and postoperative quality of life in liver transplant survivors

OBJECTIVE: To assess normalization in the lives of liver transplant patients and the impact of preoperative expectations on postoperative quality of life (QOL). DESIGN: A semistructured interview, 2 QOL questionnaires, and chart reviews of medical histories. SETTING: Internal medicine department at Innsbruck university hospital, Austria. PARTICIPANTS: Fifty-five patients (32 men, 23 women) with liver transplants. INTERVENTIONS: The Sickness Impact Profile (SIP) and Functional Assessment of Cancer Therapy-General. RESULTS: Patients' preoperative expectations of a normal life style posttransplantation were predominantly optimistic (60%), but postoperatively only 40% thought that their expectations had been realized. The patients' SIP values showed significant impairments in nearly every area of life when compared with the values of a healthy control group. Only "complications during the hospitalized phase" had a statistically significant impact among the sociodemographic and clinical parameters on postoperative QOL. The lowest QOL scores were found among patients whose expectations of a return to normal life style had not been realized. CONCLUSION: Unmet life-style expectations after liver transplantation may lead to increased stress, which affects QOL long term. This finding is of clinical relevance; therapeutic measures, particularly professional pretransplant counseling, are indicated.     

A 3-year follow-up of participation in peer support groups after a cardiac event.

Secondary prevention is an important component of a structured rehabilitation programme following a cardiac event. Comprehensive programmes have been developed in many European countries, the vast majority of which are hospital based. In Sweden, all patients with cardiac disease are also given the opportunity to participate in secondary prevention activities arranged by the National Association for Heart and Lung Patients [The Heart & Lung School (HL)]. The aim of this 3-year longitudinal study was to compare persons who attended the HL after a cardiac event and those who declined participation, with regard to health aspects, life situation, social network and support, clinical data, rehospitalisation and mortality. Totally 220 patients were included in the study. The patients were asked to fill in a questionnaire on four occasions, in addition to visiting a health care center for physical examination. After 3 years, 160 persons were still participating, 35 of whom attended the HL. The results show that persons who participated in the HL exercised more regularly, smoked less and had a denser network as well as more social support from nonfamily members than the comparison groups. This study contributes to increased knowledge among healthcare professionals, politicians and decision makers about peer support groups as a support strategy after a cardiac event.     

血液透析患者生活质量与社会支持的相关性研究

目的：分析临床血液透析患者的生活质量与社会支持的相关性及如何组建相应的护理措施。方法：采取问卷调查方式对2013年上半年度来我院接受维持性血液透析患者共计42例进行访问调查,结合社会领悟支持量表和世界卫生组织生存质量测定量表简表对患者的各项得分进行统计,与正常组进行对比。结果：列表对比分析显示,血液透析患者的生存质量均低于常规模式,患者社会领悟支持总分与患者的生存环境领域、心理领域及社会领域等因素存在明显正相关性(r=0.682,P＜0.05);而其中的朋友支持深度影响着患者的生存质量,而环境领域中的深度影响因子则为家庭支持。多数患者表现为屈服和回避两种医学应对姿态。心理领域及患者生理领域严重影响着其回避态度;结论：有较高社会支持水平的血液透析患者其生活质量也较高,尤其是朋友支持,血液透析专科护士应加之正确的引导及相应的护理干预,提高患者生存质量。     

"Floppy" Nissen vs. Toupet laparoscopic fundoplication: quality of life assessment in a 5-year follow-up (part 2)

BACKGROUND AND STUDY AIMS: Quality of life as an outcome variable has become an important measure in clinical research. This study is the second part of a prospective assessment of the quality of life outcome, in a 5-year follow-up of patients who underwent laparoscopic Nissen fundoplication or Toupet fundoplication. Data from a 1-year follow-up have been previously published (part I). PATIENTS AND METHODS: Using the Gastrointestinal Quality of Life Index (GIQLI), the quality of life data of 169 consecutive patients who had undergone a laparoscopic Nissen fundoplication (LNF; n = 104) or a laparoscopic Toupet fundoplication (LTF; n = 65), were evaluated 3 years and 5 years postoperatively. Six patients out of the initial study group (n = 175), including three from each group, were excluded from the main analysis because they had undergone laparoscopic re-fundoplication during the 1-year follow-up. Data from patients with repeat surgery have been analysed separately. In addition to administering the GIQLI, we evaluated patient satisfaction with surgery, possible surgical side effects or recurrent disease-related symptoms, the use of antireflux medication, and also surgical interventions in relation to initial antireflux surgery. In those patients, who were willing (n = 111) we also performed esophageal manometry and 24-hour pH monitoring 5 years postoperatively. RESULTS: At 3 years and 5 years postoperatively, the analysis of quality of life data showed that the GIQLI score remained stable in comparison with the 1-year follow-up data, with mean scores of 121 +/- 8.7 points in the LNF-group and 119.8 +/- 9 points in the LTF-group, at 5 years after surgery. Laparoscopic re-fundoplication was necessary in four patients due to a "slipping" Nissen (LNF group n = 1) or recurrent symptoms (LTF group, n = 3). In two patients in the LTF group herniation of a trocar incision was found. No patient suffered from severe surgical side effects. Patient satisfaction with surgery was rated as "excellent" or "good" in 97.9 % of patients. There were no significant differences between the groups concerning these data. The results of esophageal manometry and 24-hour pH monitoring also remained stable and showed normal values in all but two patients (in the LTF group), who suffered from mild and infrequent symptoms of recurrent heartburn without endoscopic signs of esophagitis. The outcome in patients who underwent laparoscopic re-fundoplication is comparable to the outcomes for those with a successful primary intervention. CONCLUSIONS: Both Nissen and Toupet laparoscopic fundoplication can significantly improve patients' quality of life during the 5 years following surgical intervention. Quality of life scores for both surgical groups were almost equal and postoperative outcomes were comparable to values in healthy controls. Patient satisfaction with surgical treatment was very high, even though repeat laparoscopic surgery was necessary in some cases. Patients who had a repeat procedure experienced nearly identical outcomes.     

不同时段冠状动脉搭桥术后患者自我效能和生活质量调查与分析

目的:调查与分析不同时段的冠状动脉搭桥(CABG)术后患者自我效能和生活质量状况及其变化,分析两者之间的关系,为改善其生活质量提供理论依据。方法:于2011年6月~2013年7月采用便利抽样的方法,抽取我院行CABG的88例患者,分别于术后2周(出院前)和术后12周患者在复查或上门回访时对患者的生活质量和自我效能进行追踪调查,并进行相关性分析。结果:术后2周CABG术后患者的自我效能平均分低于正常人群(P0.05),术后12周与正常人群比较差异无统计学意义(P0.05),术后2周和术后12周比较差异有统计学意义(P0.05)。术后6周、12周总生存质量总分比较差异有统计学意义(P0.05),其中躯体疼痛、社会功能、躯体健康和躯体角色术后2周较低,随着时间延长术后12周后明显好转,两者比较差异有统计学意义(P0.05)。自我效能得分与生活质量各维度得分呈正相关(r=0.453,P0.01)。结论:CABG术后患者生活质量和自我效能水平术后2周最低,随着时间延长12周后明显好转,二者有良好的相关性,故应对此患者进行早期干预,以提高自我效能水平,改善其生活质量。     

Effects of long-term home-based exercise on health-related quality of life in patients with chronic neck pain: A randomized study with a 1-year follow-up

Purpose: To evaluate whether long-term neck and upper body exercises conducted in economical community-based outpatient clinic and home-based settings could improve health-related quality of life (HRQoL)for individuals affected by chronic neck pain. The effect of baseline HRQoL and neck pain values on training adherence was also studied. Methods: Subjects (n?=?101, 91 women/10 men, mean age 41.0?±?9.5 years) with chronic non-specific neck pain were randomized to a combined strength-training and stretching-exercise group (CSSG, n?=?49) or to a stretching exercise group (SG, n?=?52). HRQoL was assessed at baseline and after 12 months using the RAND-36 questionnaire. Comparisons between groups were performed using bootstrap-type analysis of covariance. The impact of HRQoL and neck pain values on training adherence, determined using participants' exercise logs, was studied using generalized estimating equations. Results: CSSG showed significant improvements in five and SG in four of eight of the HRQoL dimensions. There were no significant differences between the groups. Adherence to long-term training was only slightly affected by baseline-assessed HRQoL and neck pain values. Conclusions: The two training protocols were feasible and equally effective in improving HRQoL. Baseline HRQoL and pain values had only a minor effect on training adherence. [Box: see text].     

Staffing adequacy, supervisory support and quality of care in long-term care settings: staff perceptions

Title. Staffing adequacy, supervisory support and quality of care in long‐term care settings: staff perceptions Aim. This paper is a report of a study to explore relationships between perceived care quality, self‐assessed professional skills, and the perceptions of the quality‐related factors. Background. The work in long‐term care is more demanding than in the past. The quality of care is strongly related to the well‐being and job satisfaction of staff. Those emerge in part through a perception of resources allocated to caring and also through a perception of the quality achieved. Method. Data were collected in Finland in 2002 using a questionnaire sent to the nursing staff working in 112 wards in 40 long‐term care institutions monitoring their care with the Resident Assessment Instrument System. Institutions were invited to participate the survey. The response rate was 70·2% (n = 1262). The respondents represented 3·8% of nursing personnel working in long‐term care institutions. Findings. Staff members who perceived staffing levels as inadequate and supervisory support as insufficient had lower perceptions of their own professional skills and the quality of care. Perceptions of empowering support behaviour were more strongly associated to self‐assessed skills and to perceived care quality than perceptions of skills‐oriented support activities. Staff members with short professional training, older staff members and staff members with long work experience in the unit had lower perceptions of their professional skills than other groups. Conclusion. The perception of adequate staffing and of sufficient supervisory support, especially empowering support increases the probability of perceiving the care quality as good. If supervisors concern themselves with staff members’ perceptions, they can better identify the staffing needs and also the support needs of personnel.