肝移植受者应对方式与生活质量相关性研究

目的探讨肝移植受者应对方式与其生活质量的相关性。方法采用便利抽样方法选取141例肝移植受者,用一般情况调查表、医学应对问卷(MCMQ)和简明健康调查表(SF-36)对肝移植受者进行调查。MCMQ得分采用Feifel调查数据作为常模进行比较,SF-36得分与四川省常模进行比较,并对肝移植受者应对方式与生活质量进行相关性分析。结果肝移植受者面对应对方式得分为(19.38±3.98)分,回避应对方式得分为(15.01±3.17)分,屈服应对方式得分为(8.01±2.67)分。回避方式得分显著高于Feifel常模(P=0.008),面对和屈服方式得分均显著低于Feifel常模(P=0.046和P=0.001)。肝移植受者生理健康生活质量(PCS)得分为(50.96±6.80)分,精神健康生活质量(MCS)得分为(50.10±9.22)分。PCS中生理功能(PF)、躯体疼痛(BP)和一般健康状况(GH)维度得分均显著低于四川省常模(均P0.05),而生理职能(RP)维度得分与四川省常模比较差异无统计学意义(P=0.581)。MCS中精力(VT)、社会功能(SF)、情感职能(RE)维度得分与四川省常模比较差异均无统计学意义(均P0.05),而精神健康(MH)维度得分显著高于四川省常模(P0.01)。肝移植受者的生活质量得分与面对和回避应对方式均无相关性,与屈服应对方式呈显著负相关(r=-0.310~-0.542,P0.05或P0.01)。结论肝移植术后精神方面各维度得分显著优于生理方面各维度得分。屈服应对方式对肝移植受者生活质量有负性影响。     

用健康调查量表评价肝移植受者生命质量的研究

目的 调查和了解肝移植受者术前和术后的生命质量状况.方法 在施行肝移植手术的受者中随机抽取102例(术前30例、术后72例)进行问卷调查.健康调查(SF-36)量表共有36个条目,覆盖生命质量的8个维度,分别命名为:生理功能、生理职能、躯体疼痛、总体健康白评、活力、社会功能、情感职能和精神健康.所有的维度选项得分经线性转换为0～100分.分析和比较受者肝移植术后与术前生命质量的差别;对影响生命质量的因素进行分析.结果 肝移植术后受者的各个维度得分为(44.51±38.22)～(86.74±11.66)分.远远高于术前受者.原发病、术前终末期肝病模型(MEID)评分、术后并发症对生命质量的某些维度有影响.而性别、年龄及原发病复发等因素对生命质量影响不大.结论 肝移植受者术后生命质量较术前明显提高,SF-36量表可用于肝移植受者术后生命质量的评估和研究.     

儿童肝移植受者术后五年生存和睡眠质量调查研究

目的探究长期存活(≥5年)的儿童肝移植受者生存和睡眠质量及其影响因素。 方法采用儿童生存质量量表3.0(PedsQL? 3.0)移植模块和儿童睡眠质量调查问卷调查2006年1月至2013年6月在上海交通大学医学院附属仁济医院肝脏外科接受肝移植术后存活5年以上的30例儿童受者生存和睡眠质量。采用电子邮件发送并回收调查问卷,调查问卷均由家长填写。调查问卷发放时间为2018年6月第1周,回收时间为6月第2周。采用成组t检验比较不同性别和供肝来源儿童受者生存质量得分,采用单因素方差分析比较不同血型儿童受者生存质量得分。采用Mann－Whitney U检验比较不同性别和供肝来源儿童受者睡眠质量得分,采用Kruskal－Wallis检验比较不同血型儿童受者睡眠质量得分。P<0.05为差异有统计学意义。 结果实际回收有效问卷27份,其中男性14例,女性13例,移植和调查时中位年龄分别为11个月(5～12个月)、80个月(66～180个月)。27例受者平均身高、体质量、体质指数分别为(127±13)cm、(25±6)kg、(15.7±1.9)kg/m²。27例受者生存质量总分为(73±14)分,其中药物依从性、药物不良反应、移植后社会关系、疼痛、对健康状况的担忧、对治疗的焦虑、对外貌的自我感觉和交流问题8个维度得分分别为(82±13)、(78±17)、(71±16)、(72±19)、(56±28)、(67±28)、(68±21)和(80±16)分。睡眠质量总分中位数为0.23分(0～0.63)分,其中打鼾、日间过度嗜睡、行为和睡眠相关性呼吸问题4个维度得分中位数分别为0.22分(0～0.78分)、0.14分(0～0.57分)、0.50分(0～1.00分)和0.25分(0～0.50分)。不同性别、血型和供肝来源儿童受者生存和睡眠质量得分差异均无统计学意义(P均>0.05)。 结论肝移植术后存活5年以上儿童受者生存和睡眠质量尚可,性别、血型和供肝来源均不是生存和睡眠质量的影响因素。     

心脏移植受者社会支持和应对方式对其生存质量的影响

目的 探讨心脏移植受者社会支持和应对方式对其生存质量的影响.方法 应用简明健康调查问卷(SF-36)、社会支持评定量表(SSRS)、简易应对方式问卷对35例心脏移植受者进行调查.结果 心脏移植受者SF-36各维度得分显著低于常模(均P<0.01);心脏移植受者的社会支持、积极应对方式与其生存质量呈正相关(P<0.05,P<0.01).结论 心脏移植受者的生存质量水平较低.生存质量与社会支持和应对方式密切相关.医务人员应重视社会支持系统对心脏移植受者生存质量的作用,有效引导其采取积极的应对方式,以提高生存质量.     

肝硬化患者肝移植术后生存质量的变化

目的调查肝硬化患者肝移植前后生存质量的变化情况。方法研究对象为在中山大学附属第三医院移植中心行首次肝移植手术的68例肝硬化患者。分别在术前,术后0～6个月、7～12个月、12个月以上对患者进行问卷调查。问卷采用健康调查简表(medical outcome study 36-item short form health survey,SF-36)与疾病专用调查表——慢性肝病问卷(chronic liver disease questionaire,CLDQ)。结果在肝移植术前,肝硬化患者的SF-36和CLDQ各维度评分均偏低。术后各时段SF-36的生理机能、躯体疼痛、一般健康、精力和CLDQ的腹部症状、乏力、全身症状、活动评分均较术前明显升高(均为P<0.05);与术前比较,术后0～6个月SF-36的生理职能、社会功能、情感职能、精神健康和CLDQ的情感功能、焦虑评分差异无统计学意义(均为P>0.05),但术后7～12个月、术后12个月以上述维度评分比较差异均有统计学意义(均为P<0.05);术后随着时间的推移,两表各维度得分逐步升高。结论肝硬化肝移植患者术后的生存质量与术前比较有明显改善,术后早期以生理功能方面改善明显,随时间的推移,生存质量其他指标如心理状态和社会功能也得到明显的改善。     

就业状况对肾移植受者生活质量和社会支持的影响

目的探讨就业状况对肾移植受者生活质量和社会支持的影响。方法使用简明健康状况调查表(SF-36)和领悟社会支持量表(PSSS)测量65例就业和71例非就业的门诊肾移植受者的术后生活质量和社会支持程度,并对资料进行统计分析。结果就业组性别、年龄、移植术后时间和移植肾来源与非就业组比较,差异有统计学意义(P0.05,P0.01);就业组SF-36生理领域总分、生理功能、生理职能、躯体疼痛、精力和情感职能5个维度得分显著高于非就业组(P0.05,P0.01);就业组领悟社会支持总分及各分量表得分显著高于非就业组(均P0.01)。结论肾移植受者术后就业状况与其性别、年龄、移植术后时间和移植肾来源相关,术后就业的肾移植受者生活质量和社会支持均高于未就业的肾移植受者。     

等待肺移植患者生存质量及其影响因素研究

目的了解等待肺移植患者的生存质量及其影响因素。方法采用简明健康问卷(SF-36)、焦虑自评量表(SAS)、抑郁自评量表(SDS)和领悟社会支持量表(PSSS)对55例等待肺移植患者进行调查。结果等待肺移植患者SF-36各维度得分23.18~74.57,显著低于常模(均P<0.01);SAS、SDS得分分别为48.09±9.06、52.18±9.98,显著高于常模(均P<0.01);PSSS社会总支持因子得分为5.56±1.04,其中家庭内支持因子得分显著高于家庭外支持因子(P<0.05)。多因素分析结果显示生存质量的影响因素为呼吸困难和抑郁(P<0.05,P<0.01)。结论等待肺移植患者的生存质量较低,其生存质量受呼吸困难和抑郁的影响。医务人员应从患者生理及心理方面进行有效干预,以提高其生存质量。     

SF-36量表用于国人脊髓型颈椎病的信度分析及其与神经功能的相关性研究

目的:评估SF-36量表用于国人脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者健康相关生活质量(quality of life,QOL)的信度,并验证术后疗效评价中,生活质量评价与神经功能评估的一致性。方法:本研究前瞻性收集了接受手术治疗的脊髓型颈椎病患者142例,男84例,女58例,年龄60.0±10.9岁。所有患者均接受手术治疗。分别于术前、术后3个月、术后1年和术后2年以上末次随访时分别使用改良日本骨科协会评分法(modified Japanese Orthopaedic Association,mJOA)评分和健康状况调查简表(SF-36量表)进行神经功能和生活质量评估,并与正常人群的常模进行对比。使用克隆巴赫系数(Cronbachα)分析SF-36量表八个维度的信度,并进一步分析在术后不同随访时间节点SF-36各维度与神经功能评价的相关性。根据患者各项评分的变化趋势,分析患者的康复峰值时间。结果:术前CSM患者SF-36量表8个维度中,除“精神健康”维度外,其余7各维度较健康成年人常模均存在显著功能缺陷。SF-36量表各维度的Cronbachα介于0.73~0.85之间(Cronbachα:生理功能=0.85、生理职能=0.83、躯体疼痛=0.80、整体健康=0.81、活力=0.81、社会功能=0.79、情感职能=0.73、精神健康=0.75)。术后3个月时,mJOA评分的改善仅与患者SF-36量表中生理功能和躯体疼痛两个维度得分有显著相关性(相关系数R:生理功能=0.32,躯体疼痛=0.20;P<0.05);术后1年时,mJOA评分的改善与SF-36量表中生理功能、整体健康、社会功能和情感职能四个维度有显著相关性(相关系数R:生理功能=0.39,整体健康=0.24,社会功能=0.22,情感职能=0.19;P<0.05);在术后2年以上末次随访时,mJOA评分的改善与SF-36量表中生理功能、活力和情感职能三个维度显著相关(相关系数R:生理功能=0.38,活力=0.20,情感职能=0.20;P<0.05)。SF-36量表的生理总评分和心理总评分分别在17.7个月和18.9个月达到峰值。结论:SF-36量表各维度的信度较高,是一项可靠的评估CSM患者健康相关生活质量的方法。在术后不同随访期的疗效评估中,SF-36量表各维度与神经功能改善评估的一致性不尽相同:在术后恢复早期,mJOA评分的改善与SF-36量表中的生理相关维度显著相关;随着术后恢复期延长,mJOA评分的改善则与生理、心理相关维度均显著相关。     

EQ-5D量表与SF-36量表在DKD患者生命质量评价中的应用

目的:对比EQ-5D量表及SF-36量表对DKD患者健康相关生命质量的评估效果。方法:应用EQ-5D量表及SF-36量表进行生命质量的评估。分析DKD患者生命质量的一般情况,使用多元线性回归等统计学方法分析生命质量的影响因素。结果:SF-36各维度中得分最高的是生理机能;得分最低的是一般健康状况。PCS患者数在低分数段时高于MCS患者数; EQ-5D量表中度、重度及非常严重的比例中,疼痛/不适最高,其次为焦虑/抑郁; EQ-5D不同水平下PCS及MCS分数均不完全相同,差异均具有统计学意义(P 0. 01),EQ-VAS评分在MCS、PCS不同分数段差异具有统计学意义(P 0. 01); PCS与行动能力、日常生活能力、疼痛/不适关系较为密切,MCS与焦虑/抑郁关系较为密切,P 0. 01;性别、疾病分期、并发症等对DKD的患者生命质量有不同程度的影响。结论:两量表均能够在一定程度上反映DKD患者的生命质量,对于不同水平的DKD患者的生命质量均有区分能力,两量表具有对比性和互补性。     

脊髓型颈椎病患者术后神经功能与生活质量的变化及其之间的相关性分析

目的:分析脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者术后生活质量的康复规律及其与神经功能康复的相关性。方法:收集北京大学第三医院骨科2008年2月~2013年5月收治的280例诊断为CSM并接受手术治疗患者的资料。术前使用改良JOA评分(mJOA评分)评价患者的神经功能,使用SF-36评价患者的生活质量,在术后3个月、1年和末次随访时使用上述两项评价方法对患者进行连续性随访。采用Wilcoxon rank-sum检验探讨患者神经功能及生活质量的变化规律,采用Spearman相关检验探讨生活质量与神经功能康复的相关性,采用受试者工作特征(receiver operating characteristic,ROC)曲线评价mJOA评分的变化值、mJOA评分的改善率、SF-36的生理维度(PCS)及心理维度(MCS)四项指标对于患者主观评价健康变化(health transition item,HTI)的判断价值,使用ROC曲线下面积(area under the curve,AUC)评价ROC曲线的准确性,同时用Spearman相关检验进一步探讨四个指标对于HTI的敏感性及可靠性。结果:随访50.5±10.3个月(24~84个月)。术后3个月、1年和末次随访时的神经功能改善率分别为(45.0±42.4)%、(64.4±31.6)%和(66.8±36.9)%。在SF-36的各个维度上,患者手术前的评分均较正常人群有不同程度的下降(P0.05);术后3个月时,除了总体健康(GH)和社会功能(SF)两项外,其他各维度均有显著改善(P0.05);术后1年以及末次随访时,SF-36的8个维度均有显著改善(P0.05)。术后3个月时,只有PCS有显著改善(P=0.000),而MCS则较术前无明显变化(P=0.103);术后1年及末次随访时PCS及MCS均有显著改善(P0.05)。术后3个月、1年和末次随访时的HTI分别为2.27±1.06、1.84±0.90和1.84±0.88。在术后3个月时,只有PCS改善与神经功能改善显著相关(P0.05);术后1年与末次随访时,PCS及MCS的改善均与神经功能改善相关(P0.05)。术后3个月时SF-36的PCS对于HTI的判别价值最高(AUC=0.97,相关系数=-0.81);术后1年时为mJOA评分改善率(AUC=0.93,相关系数=-0.82);末次随访时SF-36的MCS与HTI的相关性最高(相关系数=-0.67),而mJOA评分改善率与HTI的AUC最大(AUC=0.95)。结论:CSM患者术后神经功能和生活质量显著改善;神经功能改善早期只与PCS相关,中期则与PCS和MCS两个方面相关;随着CSM患者术后随访时间的变化,判别患者主观评价最有效的指标是不同的。     

Quality of Life and Psychologic Distress of Recipients after Adult Living-Donor Liver Transplantation (LDLT)—A Study from Mainland China

This cross-sectional study investigated potential factors impacting quality of life in 125 recipients after living-donor liver transplantation (LDLT). Health-related quality of life (HRQoL) was measured by using the Chinese version of Medical Outcomes Study Short Form-36 (SF-36), and psychologic symptoms by using the Symptom Checklist-90-Revised (SCL-90-R). Clinical and demographic data were collected from the records of the Chinese Liver Transplant Registry and via questionnaire. A total of 102 recipients (81.6%) completed the questionnaires. All SF-36 domain scores (except the mental health score) were lower in the study than in the general population of Sichuan. The mental quality of life was significantly lower in female than in male subjects (P = .000). Regarding the role-physical (P = .016), social functioning (P = .000), and role-emotional (P = .004) domains, recipients >1 year after transplantation scored higher than those <1 year. Bodily pain scores were lower in recipients with prior acute liver failure than those with hepatic carcinoma or hepatic cirrhosis (P = .032). Social functioning was poorer in recipients with than in those without complications (P = .039). Mental component summary scale (MCS) scores and some of physical component summary scale (PCS) significantly correlated with symptom dimension scores of the SCL-90-R (P < .05). In conclusion, gender, time since transplant, etiology of disease, complications, occupation, and some psychologic symptoms were possible factors influencing postoperative HRQoL of LDLT recipients.     

Organ quality and quality of life after liver transplantation

Not only is there a limited supply of organs for liver transplantation, but the quality of the available organs is not uniform. Risk factors such as donor age and cause of death are known to predict graft failure, but their impact on the recipient's quality of life (QOL) has not been reported. We sent a QOL survey to 299 adults at our institution who had received a liver transplant 1 to 7 years before the study. For the 171 patients (57%) who completed the Medical Outcomes Study Short Form 36 (SF-36), the mean Physical Composite Score (PCS) and the mean Mental Composite Score (MCS) were 61 and 66, respectively; the highest scores were for the Social Functioning subscale, and the lowest scores were for the Role Functioning/Physical and Energy/Fatigue subscales. The mean donor risk index (DRI) of the organs that the subjects received was 1.4 (range = 0.8-2.4). There was no correlation between the SF-36 scores and the DRI [there were changes of -4.8 and -2.8 in the PCS and MCS per unit increase in the DRI (P = 0.4 and 0.6, respectively)], even though we controlled for potential confounders such as age, sex, hospitalization before transplantation, the Model for End-Stage Liver Disease score at transplantation, years since transplantation, previous transplantation, and the Charlson comorbidity index. In conclusion, we found no association between organ quality and QOL after liver transplantation. If this finding is confirmed in prospective, multicenter studies, it will be useful in counseling patients about the decision to accept or not accept high-risk organ offers.     

Self-assessed quality of life in peritoneal dialysis patients.

BACKGROUND/AIMS: Studies comparing quality of life (QOL) between peritoneal and hemodialysis patients have yielded inconsistent results. Physical (PCS) and mental component summary (MCS) scales of Short Form 36 (SF-36) health survey are highly validated measures of self-assessed QOL. We sought to evaluate these indices in PD patients: (1) as measures of QOL, (2) predictors of QOL, (3) to study change in QOL over time, and (4) to compare QOL in PD vs. hemodialysis patients. METHODS: SF-36 questionnaires were administered every 3 months to patients over a 2-year period and PCS and MCS were calculated. Mean follow-up was 15.3 +/- 6.6 months for PD and 14.5 +/- 5.7 months for HD. RESULTS: Average PCS in PD (31.8 +/- 7.8) was lower than HD (36.9 +/- 9.8) (p < 0.02), while MCS was similar in the groups (p = NS). The prevalence of depression was 26.1% in PD and 25.4% in HD patients (p = NS). Serum albumin was the only significant predictor of PCS among PD patients and explained much of the decrease in PCS in them. The number of hospitalizations and in-hospital days were significantly lower for PD compared to HD patients (p < 0.05). PCS as well as MCS remained stable in both groups throughout the observation period. CONCLUSION: Self-assessed physical function is diminished, while mental function is similar in PD compared to HD patients. When corrected for serum albumin, this difference is eliminated. Over time, QOL in patients treated with PD remained stable.     

Do varicose veins affect quality of life? Results of an international population-based study.

PURPOSE: This study assessed the impact of varicose veins (VV) on quality of life (QOL) and patient-reported symptoms. METHODS: A cross-sectional population-based study was held in 166 general practices and 116 specialist clinics for venous disorders of the leg in Belgium, Canada (Quebec), France, and Italy. Study subjects included a sample of 259 reference patients without VV (CEAP class 0 or 1) and 1054 patients with VV who were classified as having VV alone (367; 34.8%), VV with edema (125; 11.9%), VV with skin changes (431; 40.9%), VV with healed ulcer (100; 9.5%), and VV with active ulcer (31; 2.9%). The main outcome measure was generic and disease-specific QOL, as measured by means of the Short-Form Health Survey-36 (SF-36) and the VEINES-QOL scale, and patient-reported symptoms as measured by the VEINES-SYM scale. RESULTS: In patients with VV, age-standardized mean SF-36 physical (PCS) and mental (MCS) scores were 45.6 and 46.1 in men and 44.2 and 43.2 in women, respectively, compared with population norms of 50. PCS scores decreased according to increasing severity of concomitant venous disease, with the lowest mean scores of 37.3 and 35.5 found in patients with VV and active ulcer. However, adjusted analyses showed no statistically significant differences between patients with VV alone and patients without VV for PCS (0.0), MCS (1.0), VEINES-QOL (-0.1), or VEINES-SYM (0.0) scores. In comparison with patients without VV, the largest differences were seen in patients with VV and edema (PCS, VEINES-QOL, and VEINES-SYM score differences of -1.8, -2.5, and -2.9, respectively) and in patients with VV and ulceration (differences of -3.3, -3.4, and -2.7, respectively). The high prevalence of major symptoms of venous disorders in patients in CEAP class 0 or 1 being treated for venous disorders (76.1% of patients had heaviness, aching legs, or swelling) might have contributed to the impairment of QOL in the reference group. CONCLUSION: Results indicate that impairment in physical QOL in patients with VV is associated with concomitant venous disease, rather than the presence of VV per se. Findings concerning QOL in patients with VV can only be reliably interpreted when concomitant venous disease is taken into account. In patients with VV alone, the objectives of cosmetic improvement and the improvement of QOL should be considered separately.     

Evaluation of quality of life after simultaneous pancreas and kidney transplantation from living donors using short form 36

We performed the first case of simultaneous pancreas and kidney transplantation from a living donor (LDSPK) in 2004. We examined the quality of life (QOL) of performed 6 recipients and 5 donors among 8 LDSPK from 2004 to 2007 at our institution using Short Form 36. All recipients achieved insulin and hemodialysis independence after LDSPK with positive serum C-peptide levels. Before LDSPK, all scores of the 8 specific domains of the recipients were low (28.2 ± 10.6), indicating extremely poor QOL. Both the Physical and the Mental Component Summary Scores (PCS/MCS) quickly increased after LDSPK. PCS at 6, 12, and 24 months after LDSPK were significantly higher than the pretransplantation level. MCS were also significantly higher than the pretransplantation level. LDSPK showed prominent QOL improvement for the recipient. Complications were not observed in any donor. Although PCS decreased at 6 months after the operation, it recovered at 12 and at 24 months after the operation. MCS was maintained at more than 50 from 6 to 24 months after the operation. QOL was well preserved in the LDSPK donors despite the major surgery. In conclusion, LDSPK was confirmed to be a potent tool for treatment of type 1 diabetes mellitus patients with end-stage renal disease (ESRD) by complete normalization of glucose metabolism and renal function. In addition to these medical advantages, both their physical and mental QOL were improved by LDSPK.     

Quality of life and emotional responses in cadaver and living related renal transplant recipients.

BACKGROUND: The specific impact of transplantation on living related donor (LRD) and cadaver (CAD) kidney transplant recipients and their health-related quality of life (HQoL) has received little attention. This study examined the role of sociodemographic, medical and psychological factors in these two groups. METHODS: A total of 347 transplant recipients (76 LRD and 271 CAD patients) completed the Short Form 36 Health Survey and Transplant Effects Questionnaire. RESULTS: Overall, transplant patients showed satisfactory HQoL particularly with respect to emotional well being. HQoL levels were found to be equivalent in both transplant groups. ANCOVAs showed that LRD recipients expressed more guilt in relation to the donor (P<0.001). Multivariate analysis revealed that worry about the viability and functioning of the transplant alone predicted 15.1% of the variance in the SF-36 mental composite score (MCS) whereas age, income, comorbidities and time on dialysis explained 37.8% of the variance in the SF-36 physical composite score (PCS). Multiple regression analyses performed separately for LRD and CAD patients showed that predictors of MCS and PCS between the two groups were similar. CONCLUSIONS: Our results indicate that different forms of transplantation (LRD vs CAD) may lead to different emotional responses albeit with no apparent quality of life differences. In particular, feelings of guilt appear to be prominent in LRD transplantation.     

Inguinal hernioplasty improves the quality of life in patients with cirrhosis

BACKGROUND: The optimal management of symptomatic inguinal hernia (SIH) in cirrhotics is still undefined. Both hernia and cirrhosis impair quality of life (QOL). The aim of this study was to evaluate QOL by a Short Form-36 (SF-36) questionnaire in cirrhotic patients undergoing inguinal hernioplasty. METHODS: Thirty-two cirrhotic patients undergoing inguinal hernioplasty were evaluated. They were classified according to Child's class and to the absence or presence of refractory ascites. The SF-36 questionnaire was administered the day before and 6 months after surgery. Global analyses of the 8 domains of SF-36 and of 2 comprehensive indexes of SF-36, Physical Component Summary (PCS) and Mental Component Summary (MCS), were performed. RESULTS: Lichtenstein hernioplasty for SIH originated no major complications. All 8 domains of SF-36 and MCS and PCS scores improved remarkably after hernioplasty especially in patients in Child's class C and/or with refractory ascites. CONCLUSIONS: Inguinal hernioplasty for SIH in patients with cirrhosis is a safe procedure. The improvement of QOL represents a clear cut indication for elective hernia repair.     

Quality of life and physical activity in liver transplantation patients: results of a case-control study in Italy

The aim of the study was to assess the quality of life (QOL) and the physical activity of liver transplant recipients compared with the general population. The case-controlled pilot study was accomplished through the administration of 2 questionnaires: 36-item Medical Outcomes Study, Short-Form General Health Survey (SF-36) for quality of life (10 scores) and International Physical Activity Questionnaire (IPAQ) to estimate the physical activity (metabolic equivalent score). Fifty-four patients who underwent liver transplantation using the piggyback technique and 108 controls from the general population at the orthopedic ambulatories were enrolled between 2002 and 2009. Participants had a mean age of 55 years (range, 41-73). The multivariate analysis showed significant differences for some scales of the SF-36: liver transplant recipients displayed lower values for “Mental Composite Score” (P = .043), “physical activity” (P = .001), “role limitations due to physical health” (P = .006), “role limitations due to the emotional state” (P = .006), and “mental health” (P = .010). The metabolic equivalent positively associated with all examined SF-36 scales. The present study focused on the QOL and physical activity of liver transplant recipients, demonstrating that transplant recipients scored lower than the general population. Liver transplantation may allow full recovery of health status, but the physical and social problems persist in some patients. Interventions aimed at improving rehabilitation programs, regular psychosocial support, and follow-up in all phases of treatment may give patients a more satisfying lifestyle after transplantation.     

Health-related quality-of-life changes after laparoscopic and open incisional hernia repair

BACKGROUND: The objective of this matched control study in patients suffering from incisional hernia was to compare laparoscopic open repair (LHR) with open hernia repair (OHR) in terms of long-term health-related quality of life (HRQL) according to the SF-36 Health Survey. METHODS: Twenty-four consecutive patients (18 male, six female; mean age, 55 years) prospectively underwent LHR using expanded polytetrafluoroethylene mesh. The second group, which was matched for age and gender, was subjected to OHR using large pore-sized, low-weight polypropylene meshes. Before and after surgery, HRQL was assessed by the SF-36 Health Survey, which measures eight different health-quality domains, and the SF-36 Physical (PCS) and Mental Component Summary (MCS) score. The SF-36 values were compared to the scores of age-stratified German population controls. RESULTS: The patients were reevaluated 16 months (range, 12-25) after LHR and 28 months (range, 18-52) after OHR, respectively. Before surgery, all of the eight health-quality domains as well as the PCS and MCS scores of both study groups were significantly lower than the corresponding scores of the age-stratified healthy German population. However, the OHR patients had significantly higher physical functioning and vitality scores than the LHR patients. After LHR and OHR, the scores for all eight SF-36 domains significantly increased but were still lower than those of the controls. The LHR patients were still worse than the norm population on both PCS and MCS scores, whereas OHR patients were worse only on PCS but not on MCS. In the long-term follow-up, none of the SF-36 Health Survey domains or the PCS and the MCS scores revealed significant differences between LHR and OHR patients. CONCLUSIONS: LHR was not different from OHR for selected indications that measure long-term outcome and HRQL. SF-36 appears to be an appropriate instrument to measure postoperative HRQL, showing responsiveness to changes in objective outcome measures.