AQ20问卷在慢阻肺社区干预评价中的应用

目的：评价社区干预对慢阻肺（COPD）患者健康相关生命质量的影响。方法：采用慢阻肺健康相关生命质量问卷AQ20问卷，并用因子分析法，将问卷划分为四个维度，比较社区干预前后生命质量各维度的变化。结果：患者干预前后生命质量有所提高，尤以疾病症状改善明显。结论：AQ20问卷适用于我国慢阻肺患者的生命质量评价，本次社区干预对改善患者的生命质量产生了初步效果。     

Agreement between a generic and disease-specific Quality-of-Life Instrument: The 15D and the SGRQ in asthmatic Patients

The generic health-related quality of life (HRQOL) instrument 15D, and the disease-specific St. George's Respiratory Questionnaire (SGRQ) were highly correlated in cross-sectional and in follow-up data among asthmatic patients. However, a high correlation does not mean that these instruments yield similar results about outcome. We measured among 134 asthmatic patients the mathematical relationship between the changes in the scores of these instruments by regression techniques and agreement by cross-tabulation. The prospective data included measurements at baseline and at one, three and five years. The three measurements of change in HRQOL were compared with the baseline. There was a close mathematical relationship between the scores, but it was affected significantly by confounding factors such as patient's age, gender and smoking habits. The instruments agreed on the direction of change in HRQOL (positive or negative) in 64.8% of patients, while in 15.8% the changes were in opposite direction. There was a statistically significant difference in indicating the direction of changes (improvement or decline) of these instruments. The changes in the SGRQ scores agreed slightly better than those in the 15D with the changes in clinical parameters. The conclusion was that these instruments do not necessarily yield similar results of effectiveness. Therefore, the choice of HRQOL instrument may influence the economic attractiveness of different asthma interventions. The disease-specific SGRQ agreed slightly better than the generic 15D with the changes in clinical parameters. This revised version was published online in July 2006 with corrections to the Cover Date.     

Responsiveness of disease-specific and generic utility instruments in prostate cancer patients

Background Preferences (utilities) for health outcomes have an important role in decisions about prostate cancer screening and treatment. The responsiveness of utility instruments has not been evaluated. Subjects Prostate cancer outpatients from the Princess Margaret Hospital, Toronto (n = 248) were allocated into three cohorts: N – newly diagnosed and treated; M – metastatic disease; O – all others. Measures We measured quality of life at 3 points within 12 months using 3 disease-specific utility instruments (Patient Oriented Prostate Utility Scales), 3 generic utility instruments (Health Utilities Index, EQ-5D, Quality of Well-Being Scale), and 3 profile scales (PORPUS-P profile, Prostate Cancer Index, QLQ-C-30). Responsiveness was assessed using measures of internal responsiveness (standardized effect size, standardized response mean) and external responsiveness (receiver operator curve analysis, mixed model regression). Results Cohort N patients showed post-treatment declines followed by improvement in global health and functional status. Disease specific instruments detected moderate (0.4–1.3) decrements followed by small increments (0.1–0.4) in standardized effect size and standardized response mean. Most instruments detected change using external responsiveness measures (all cohorts). Conclusions Disease-specific utility instruments appeared to be more responsive than generic instruments. Use of generic instruments should be supplemented with a responsive disease-specific instrument, particularly for applications in early prostate cancer.     

Correlations between disease-specific and generic health status questionnaires in patients with advanced COPD: a one-year observational study

Background

Although osteoarthritis (OA) often affects older persons, it has a profound effect on individuals actively employed. Despite reports of reduced productivity among workers with OA, data are limited regarding the impact of OA among workers. The objective of this study was to evaluate the impact of self-rated OA severity on quality of life, healthcare resource utilization, productivity and costs in an employed population relative to employed individuals without OA.

Methods

This cross-sectional analysis used data derived from the 2009 National Health and Wellness Survey (NHWS). Multivariable analyses characterized outcomes and costs (direct medical costs and indirect) among workers (full-time, part-time, or self-employed) ?? 20 years of age who were diagnosed with OA and who self-rated their OA severity as mild, moderate, or severe relative to workers without OA. Evaluated outcomes included productivity, assessed using the Work Productivity and Impairment (WPAI) scale; health-related quality of life, using the SF-12v2 Health Survey; and healthcare resource utilization.

Results

4,876 workers reported being diagnosed with OA (45.0% mild, 45.9% moderate, and 9.1% severe); 34,896 workers comprised the non-OA comparator cohort. There was a greater proportion of females in the OA cohort (55.5% vs 45.6%; P < 0.0001) and more individuals in the 40-64 year and ?? 65 year age ranges (P < 0.0001). As OA severity increased, workers reported more frequent pain, poorer quality of life, greater use of specific healthcare resources (hospitalizations) and reduced productivity. All outcomes indicated a significantly greater burden among workers with OA relative to those without OA (P < 0.0001). Estimated total annual costs per worker were $9,801 for mild OA, $14,761 for moderate OA, $22,111 for severe OA compared with $7,901 for workers without OA (P < 0.0001).

Conclusions

Workers with OA were characterized by significant disease and economic burdens relative to workers without OA that substantially increased with greater self-rated OA severity. Greater levels of OA severity were associated with reductions in quality of life and productivity, and increases in healthcare resource utilization and costs.     

Correlations between disease-specific and generic health status questionnaires in patients with advanced COPD: a one-year observational study

ABSTRACT: BACKGROUND: Longitudinal studies analyzing the correlations between disease-specific and generic questionnaires at different time points in patients with advanced COPD are lacking. The aim of this study was to determine whether and to what extent a disease-specific health status questionnaire (Saint George's Respiratory Questionnaire, SGRQ) correlates with generic health status questionnaires (EuroQol-5-Dimensions, EQ-5D; Assessment of Quality of Life instrument, AQoL; Medical Outcomes Study 36-Item Short-Form Health Survey, SF-36) at four different time points in patients with advanced COPD; and to determine the correlation between the changes in these questionnaires during one-year follow-up. METHODS: Demographic and clinical characteristics were assessed in 105 outpatients with advanced COPD at baseline. Disease-specific health status (SGRQ) and generic health status (EQ-5D, AQoL, SF-36) were assessed at baseline, four, eight, and 12 months. Correlations were determined between SGRQ and EQ-5D, AQoL, and SF-36 scores and changes in these scores. Agreement in direction of change was assessed. RESULTS: Eighty-four patients (80%) completed one-year follow-up and were included for analysis. SGRQ total score and EQ-5D index score, AQoL total score and SF-36 Physical Component Summary measure (SF-36 PCS) score were moderately to strongly correlated. The correlation of the changes between the SGRQ total score and EQ-5D index score, AQoL total score, SF-36 PCS, and SF-36 Mental Component Summary measure (SF-36 MCS) score were weak or absent. The direction of changes in SGRQ total scores agreed slightly with the direction of changes in EQ-5D index score, AQoL total score, and SF-36 PCS score. CONCLUSIONS: At four, eight and 12 months after baseline, SGRQ total scores and EQ-5D index scores, AQoL total scores and SF-36 PCS scores were moderately to strongly correlated, while SGRQ total scores were weakly correlated with SF-36 MCS scores. The correlations between changes over time were weak or even absent. Disease-specific health status questionnaires and generic health status questionnaires should be used together to gain complete insight in health status and changes in health status over time in patients with advanced COPD.     

The problem of 'noise' in monitoring patient-based outcomes: generic, disease-specific and site-specific instruments for total hip replacement

OBJECTIVES: To compare the performance of three types of patient-based health status instrument--generic, disease-specific and site-specific--in assessing changes resulting from total hip replacement (THR). METHODS: A two-stage prospective study of patients undergoing surgery for THR involving an assessment at a pre-surgical clinic and a follow-up clinic at 6 months. 173 patients with a diagnosis of arthritis and being admitted for unilateral THR were recruited in the outpatient departments of a specialist orthopaedic hospital and peripheral clinics within Oxfordshire. Patients' health status was assessed using the 12-item Oxford Hip Score, the Arthritis Impact Measurement Scales (AIMS) and SF-36 general health questionnaire together with their surgeons' assessment using Charnley hip score obtained before and 6 months after surgery. RESULTS: Effect sizes, used to compare change scores, revealed that pain and function domains changed most following THR on both the AIMS and the SF-36. 71 patients (41%) were assessed as having symptoms or problems currently affecting lower limb joints other than the hip recently replaced. Change scores were compared between these patients and all other patients who reported no current problems with other joints. The Oxford Hip Score found no significant difference between change scores for these two groups of patients while both AIMS and SF-36 physical and pain dimensions recorded significant differences of similar magnitude (physical P < 0.01, pain P < 0.05). Likely reasons for this were apparent on closer inspection of the item content of each instrument. CONCLUSIONS: Assessment of outcomes in THR is necessarily long-term. Within studies of this kind, a hip-specific instrument (Oxford Hip Score) is likely to be more able to distinguish between symptoms and functional impairment produced by the index joint, as compared with other joints and conditions, than either a disease-specific instrument (AIMS) or a generic health status measure (SF-36). This is important given the high probability of existing and subsequent co-morbidity affecting such populations of patients. This consideration is likely to be relevant to any long-term assessment programme following treatment for a condition which threatens bilateral expression over time.     

Responsiveness of the generic EQ-5D summary measure compared to the disease-specific EORTC QLQ C-30

Introduction: We investigated whether the sensitivity of the generic health-related quality of life (HRQoL) EQ-5D summary measure (or index) to detect changes over time in a clinical setting is comparable with that of a disease-specific HRQoL questionnaire. Methods: Patients with liver metastases (n = 75) filled out the five domains of the EQ-5D self-classifier, the EQ VAS, and the EORTC QLQ C-30 (a disease-specific (cancer) HRQoL questionnaire). The HRQoL instruments were completed before intervention, and 1/2 month and 3 and 6 months after intervention. Three analyses were performed. First, the EQ-5D index (based on self-classification) was compared to the EQ VAS. Second, the EQ-5D domains were compared to corresponding EORTC QLQ C-30 scales. Third, EQ-5D index and EQ VAS were compared with the EORTC QLQ C-30 global health-status scale. Effect size was chosen as the metric of responsiveness. Results: The EQ-5D index was slightly less responsive than the EQ VAS. Overall, the responsiveness of the EQ-5D index and EQ VAS was equal to the EORTC QLQ C-30 global health-status scale. Conclusion: Despite its generic principle and the apparent crudeness of its framework, the responsiveness of the EQ-5D proved to be comparable to that of a disease-specific HRQoL questionnaire in this specific clinical setting.     

Relation between level or change of hemoglobin and generic and disease-specific quality of life measures in hemodialysis

Objective We sought to examine the relation between meeting or exceeding the current minimum guideline for hemoglobin (11 g/dl) in dialysis patients and generic and disease-specific QOL scores at 1 year. Methods In 438 incident hemodialysis patients from a national prospective cohort study, we used regression models to predict QOL score (all scaled 0–100) at 1 year using 6-month values of hemoglobin, adjusting for potential confounders. Results Compared to values <11 g/dl, hemoglobin ≥11 g/dl at 6 months was associated with higher scores for the general domains of physical functioning, role physical, mental health, social functioning, and bodily pain at 1 year; cognitive function, diet restriction, and dialysis access dialysis-specific domain scores were also higher for these patients. Each 1 g/dl greater hemoglobin was also statistically significantly associated with higher QOL scores for most domains. In longitudinal analyses, most of the domains showed that, with each 1 g/dl increase in hemoglobin concentration from baseline to 6 months, QOL score increased significantly over the first year. Conclusions Hemodialysis patients who attain higher hemoglobin concentration at 6 months, especially ≥11 g/dl, have better QOL at 1 year, with regard to important physical, mental, social, and cognitive domains.     

A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis

Rheumatoid arthritis (RA) is a common, chronic disease where health-related quality of life (HRQL) is one of the main goals of therapy. As such, instruments used to measure HRQL in RA must be able to discriminate across RA severity. The two basic categories of instruments used to measure HRQL are generic instruments and disease-specific instruments. Generic instruments can be further subdivided into preference-based measures which yield both single and multi-attribute utility values anchored at zero (death) and 1.00 (perfect health) as a measure of HRQL. The scores from these types of instruments can be integrated into cost-utility analyses as the weightings for quality adjusted life years. We assessed the construct validity of utility scores from four generic preference-based measures (the Health Utilities Index 2 and 3 (HUI2, HUI3), the EuroQol 5D (EQ-5D), and the Short Form 6-D (SF-6D) and disease specific measures (the Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL) and the Health Assessment Questionnaire (HAQ)) in a sample of 313 RA patients in British Columbia, Canada. We also estimated the minimally important differences (MID) for each of the measures. Generally, as anticipated, the disease-specific measures were better able to discriminate across groups with higher RA severity; however, utility scores from each of the scales also appeared to discriminate well across RA severity categories. The MID values agreed with those previously reported in the literature for the HUI2, SF-6D and the HAQ and provided new information for the HUI3, EQ-5D and the RAQoL. We conclude that the all of the preference-based utility measures that were evaluated appear to adequately discriminate across levels of RA severity.     

Comparison of generic and condition-specific oral health-related quality of life instruments in patients with oral submucous fibrosis

Quality of Life Research - With the growing interest in health economics, there is a demand for best valid instrument to assess quality of life (QoL) in patients with oral submucous fibrosis (OSF)....     

Health-related quality of life in inflammatory bowel disease measured with the generic 15D instrument

Objectives  

In many surveys, inflammatory bowel disease (IBD) has been shown to have a negative impact on health-related quality of life (HRQoL), especially when the disease is active. The purpose of this study was to compare a disease-specific HRQoL tool (Inflammatory Bowel Disease Questionnaire, IBDQ) and a generic HRQoL tool (15D) in a large cohort of IBD patients, to assess the ability of the 15D to detect differences in HRQoL between disease states and to compare the HRQoL of IBD patients with that of the general population.     

Development,validity and responsiveness of the Clinical COPD Questionnaire

Background  

The new Global Obstructive Lung Disease (GOLD) guidelines advice to focus treatment in Chronic Obstructive Pulmonary Disease (COPD) on improvement of functional state, prevention of disease progression and minimization of symptoms. So far no validated questionnaires are available to measure symptom and functional state in daily clinical practice. The aim of this study was to develop and validate the Clinical COPD Questionnaire (CCQ).     

A questionnaire to assess the generic and disease-specific health outcomes of patients with chronic hepatitis C

A 69-item questionnaire measuring generic functioning and well-being and disease-specific health outcomes was developed and tested using the pre-treatment data from patients with chronic hepatitis C (CHC) participating in two randomized trials of interferon -2b (n = 157). The questionnaire included all eight scales from the SF-36 and measures of nine other generic and disease-specific health concepts. Psychometric tests confirmed the assumptions underlying the construction and scoring of all generic and disease-specific scales. Cross-sectional tests of known groups validity showed that CHC patients scored worse on the generic scales than patients with other chronic conditions and worse than a healthy general population. The generic and disease-specific scale scores were lower in the presence of physical findings of CHC, as hypothesized, but only the physical functioning and bodily pain scales were linked to cirrhosis or extreme alanine aminotransferase (ALT) ratios. This instrument will be useful in studies of health outcome among patients with CHC, a condition whose health burden appears to have been underestimated in studies to date.     

Specific HRQL instruments and symptom scores were more responsive than preference-based generic instruments in patients with GERD

ObjectiveTo determine relative responsiveness of disease-specific and generic preference-based health-related quality of life instruments in gastroesophageal reflux disease (GERD).Study Design and SettingWe compared standardized response means (SRM) of disease-specific and preference-based instruments in 217 outpatients with GERD.ResultsQuality of Life in Reflux and Dyspepsia and symptom scores were responsive across all domains, whereas global rating of change and Work Productivity and Activity Impairment-GERD only in single domains. The most responsive were Quality of Life in Reflux and Dyspepsia food/drink problems (SRM: 1.90, 95% confidence interval [CI]: 1.76–2.03) and vitality (SRM: 1.68, 95% CI 1.55–1.82) domains, Work Productivity and Activity Impairment-GERD workdays with reflux symptoms (SRM: 2.02, 95% CI 1.84–2.19), symptoms of heartburn (SRM: 1.83, 95% CI 1.69–1.96) and acid reflux (SRM: 1.48, 95% CI 1.35–1.62), and global rating of change in stomach problems (SRM: 2.19, 95% CI 2.05–2.32). The least responsive were Work Productivity and Activity Impairment-GERD domains related to hours absent at work (SRM: 0.22, 95% CI 0.05–0.38), reduced productivity at work (SRM: 0.66, 95% CI 0.48–0.83) and during other activities (SRM: 0.78, 95% CI 0.65–0.92), as well as emotional global rating of change (SRM: 0.72, 95% CI 0.58–0.85), and the standard gamble (SRM: 0.35, 95% CI 0.21–0.48), which was less responsive than the feeling thermometer (SRM: 0.92, 95% CI 0.78–1.05).ConclusionsIn patients with GERD, disease-specific health-related quality of life instruments and symptom scores showed greater responsiveness than preference-based generic instruments. The feeling thermometer proved more responsive than the standard gamble.     

原研他汀药及国产仿制他汀药的依从性及成本效果比较

目的 探索原研他汀药和国产仿制他汀药在服药依从性、降胆固醇幅度和成本效果的差异。方法 从北京市朝阳区社区卫生服务中心信息系统中提取2015年1月至2017年12月首次处方他汀药的≥18岁患者处方记录,筛选出41 496条原研他汀药处方记录和60 491条国产仿制他汀药处方记录,比较首次处方后1年内的服药依从性,对服药依从性较好的患者比较服药1年后两组药物降低胆固醇的幅度,并采用成本-比值法进行成本效果分析。结果 国产仿制他汀药的服药依从性（28.2%）较原研药差（36.2%）,差异有统计学意义（P<0.001）。在服药依从性较好且1年内未更换或调整药物剂量的患者中,调整个体年龄、性别、高血压、糖尿病病史及社区内相关性的影响后,199名一直服用国产仿制阿托伐他汀（20 mg/d）的患者1年后降低TC［降低幅度：（0.86±0.07）mmol/L vs.（0.40±0.10）mmol/L,P<0.001］和LDL-C［降低幅度：（0.67±0.07）mmol/L vs.（0.42±0.08）mmol/L,P=0.003］的幅度大于服用相同成分和剂量原研药的患者（232名）,且降低相同幅度的胆固醇可以节省50%以上的医药费。结论 尽管国产仿制他汀药依从性较差,但有可能在降胆固醇效果上替代原研药并降低患者经济负担,但本研究证据级别有限且缺乏不良反应数据,有必要开展高质量的临床研究推动国产仿制药的发展。     

Comparing a disease-specific and a generic health-related quality of life instrument in subjects with asthma from the general population

Background  

Few epidemiologic studies have assessed health-related quality of life (HRQL) of asthma patients from a general population and it is unclear which instrument is best suitable for this purpose. We investigated the validity of the Asthma Quality of Life Questionnaire (AQLQ) and the SF-36 completed by individuals with asthma from the population-based SAPALDIA (Swiss study on air pollution and lung diseases in adults) cohort.     

Comparison between measured and predicted resting energy expenditure in mechanically ventilated patients with COPD

The aim of this study was to compare resting energy expenditure (REE) obtained by indirect calorimetry (IC) and Harris-Benedict (H-B) equations, and to examine whether hypocaloric nutrition support could improve protein nutritional status in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). Thirtythree COPD patients (20 males, 13 females) were recruited and REE was measured by IC. Measured REE (REEm) was compared to predictive REE by H-B equations (REEH-B) and its corrected values. Correlation between REEm and APACHE II score was also analyzed. Patients were randomly divided into hypocaloric energy group (50%-90% of REEm, En-low) and general energy group (90%-130% of REEm, En-gen) for nutrition support. The differences of albumin, prealbumin, transferrin, hemoglobin, and lymphocyte count before and after 7 days nutrition support were observed. Results show that REEH-B and REEH-B×1.2 were significantly lower than REEm (p<0.01). REEm positively correlated with APACHE II score (p<0.05 or p<0.01). After nutrition support, hemoglobin decreased significantly in En-gen group (p<0.05); lymphocyte count in both groups, and transferrin and prealbumin in the En-low group increased significantly (p<0.05 or p<0.01). Our data suggest that 1) these patients' REE were increased; 2) since IC is the best method to determine REE, in the absence of IC, H-B equations (with standard body weight) can be used to calculate REE, but the value should be adjusted by correction coefficients derived from APACHE II; 3) low energy nutrition support during mechanical ventilation in COPD patients might have better effects on improving protein nutritional status than high energy support.     

Comparison of the logistics between the conventional instruments and patient-specific templating in total knee replacement in the low-income setting

BackgroundTotal knee replacement (TKR) is a complex operation and its conventional instrumentation system has around 300 pieces to perform and more than 50 technical steps. New techniques were introduced, such as patient-specific instrumentation (PSI), robotics, and navigation to facilitate the TKR operation. This study aims to compare the logistics between conventional instrumentation and patient-specific templating (PST) in the low-income setting.MethodsWe compared the logistics for the conventional and the PST techniques while performing TKR. The comparison included the number of instruments and trays, equipment delivery, packaging, sterilization, intraoperative setup, and post-operative handling.ResultsThe surgical trays to complete one conventional TKR were 6–12 trays while for the PST, only one tray was needed. Conventional instruments can reach the hospital in 24 h while the delivery time of the PST may take from 3 to 5 days. The time needed to sterilize the conventional could be done overnight in the small hospitals as compared to a few hours in PST. In addition, PST has no special postoperative steps, unlike the conventional, which requires washing, delivery to a storage facility, re-washing, decontamination, packing, and storing till the next surgery.ConclusionThe logistics for conventional instruments are more complex. Although there was no cost-effectiveness analysis, it has been observed that the PST technique has a positive effect on rationalizing resources by consuming less time in the central sterilization unit and reducing the operating time.     

The role of generic and disease-specific measures of physical and role functioning in assessing patient outcomes: a longitudinal study

Using longitudinal data from the Veterans Health Study (VHS), we extended our earlier published cross-sectional analysis in comparing the generic SF-36 physical functioning (PF) and role limitations (role-physical [RP]) scales with the disease-specific PF and RP scales using disease attributions. The present study included 569 patients with chronic lung disease (CLD) and 352 patients with chronic low back pain (LBP) who received Veterans Affairs (VA) ambulatory care between June 1993 and March 1996. Consistent with our earlier study, we found that changes in the generic PF and RP scales had higher correlations with the other generic SF-36 scales than those in the disease-specific PF and RP scales over 12 months. On the other hand, disease-specific measures of PF and RP had larger R and t statistic values in discriminating the impacts of symptom-based illness severity as well as clinical services on physical and role functioning. These results suggest that the generic and disease-specific measures of PF and RP behave distinctly different from each other over time. The generic measures of PF and RP tend to assess a broad array of health-related quality of life, whereas disease-specific attributions of PF and RP scales tend to evaluate disease progression and clinical management associated with specific disease conditions. Disease-specific attribution is an important alternative to the development of new disease-specific instruments for assessing illness severity and the impact of clinical services.