Effects of sleep disorders and sedative–hypnotic medications on health-related quality of life in dialysis patients

International Urology and Nephrology - Sleep disorders are very common among dialysis patients, leading patients to frequently take sedative–hypnotic medications; however, the effects of...     

Quality of life in rectal cancer surgery:What do the patient ask?

Rectal cancer surgery has dramatically changed with the introduction of the total mesorectal excision (TME), which has demonstrated to significantly reduce the risk of local recurrence. The combination of TME with radiochemotherapy has led to a reduction of local failure to less than 5%. On the other hand, surgery for rectal cancer is also impaired by the potential for a significant loss in quality of life. This is a new challenge surgeons should think about nowadays: If patients live more, they also want to live better. The fight against cancer cannot only be based on survival, recurrence rate and other oncological endpoints. Patients are also asking for a decent quality of life. Rectal cancer is probably a paradigmatic example: Its treatment is often associated with the loss or severe impairment of faecal function, alteration of body anatomy, urogenital problems and, sometimes, intractable pain. The evolution of laparoscopic colorectal surgery in the last decades is an important example, which emphasizes the importance that themes like scar, recovery, pain and quality of life might play for patients. The attention to quality of life from both patients and surgeons led to several surgical innovations in the treatment of rectal cancer: Sphincter saving procedures, reservoir techniques (pouch and coloplasty) to mitigate postoperative faecal disorders, nerve-sparing techniques to reduce the risk for sexual dysfunction. Even more conservative procedures have been proposed alternatively to the abdominal-perineal resection, like the local excisions or transanal endoscopic microsurgery, till the possibility of a wait and see approach in selected cases after radiation therapy.     

What is the impact of hospital and surgeon volumes on outcomes in rectal cancer surgery?

Aim

Evidence for a positive volume–outcome relationship for rectal cancer surgery is unclear. This study aims to evaluate the volume–outcome relationship for rectal cancer surgery at hospital and surgeon level in the English National Health Service (NHS).

Method

All patients undergoing a rectal cancer resection in the English NHS between 2015 and 2019 were included. Multilevel multivariable logistic regression was used to model relationships between outcomes and mean annual hospital and surgeon volumes (using a linear plus a quadratic term for volume) with adjustment for patient characteristics.

Results

A total of 13 858 patients treated in 166 hospitals were included. Six hospitals (3.6%) performed fewer than 10 rectal cancer resections per year, and 381 surgeons (45.0%) performed fewer than five such resections per year. Patients treated by high-volume surgeons had a reduced length of stay (p = 0.016). No statistically significant volume–outcome relationships were demonstrated for 90-day mortality, 30-day unplanned readmission, unplanned return to theatre, stoma at 18 months following anterior resection, positive circumferential resection margin and 2-year all-cause mortality at either hospital or surgeon level (p values > 0.05).

Conclusion

Almost half of colorectal surgeons in England do not meet national guidelines for rectal cancer surgeons to perform a minimum of five major resections annually. However, our results suggest that centralizing rectal cancer surgery with the main focus of increasing operative volume may have limited impact on NHS surgical outcomes. Therefore, quality improvement initiatives should address a wider range of evidence-based process measures, across the multidisciplinary care pathway, to enhance outcomes for patients with rectal cancer.     

Effects of PTH(1–84) therapy on muscle function and quality of life in hypoparathyroidism: results from a randomized controlled trial

Summary

The effects of treatment with 100 μg parathyroid hormone (PTH) (1–84) or an identical placebo on muscle function and quality of life (QoL) was studied in hypoparathyroid patients. At baseline, we found reduced QoL but no myopathy in the patients. Six months of treatment did not improve QoL, and muscle strength decreased slightly.

Introduction

A reduced quality of life (QoL) and myopathy that may be due to the absence of PTH have been reported in patients with hypoparathyroidism (hypoPT).

Methods

Sixty-two patients with chronic hypoPT were randomized to 6 months of treatment with either PTH(1–84) 100 μg/d s.c. or placebo, given as add-on therapy to conventional treatment. Muscle function and postural stability were investigated using a dynamometer chair, a stadiometer platform, the repeated chair stands test, the timed up and go test, and electromyography. QoL was assessed using the 36-item Short Form Health Survey and the WHO-5 Well-Being Index.

Results

The mean age of the patients was 52?±?11 years, and 85 % were females. At baseline, QoL was significantly reduced in comparison with norm-based scores. Compared with placebo, PTH did not improve QoL or muscle function. Rather, max force production decreased significantly by 30 % at elbow flexion in the PTH group compared with the placebo group. Moreover, there was a nonsignificant trend for muscle strength to decrease in the upper extremities and on knee extension in response to PTH. Treatment did not affect postural stability. Electromyography showed a slight decrease in the duration of motor unit potentials in the PTH group, indicating a tendency toward myopathy, which, however was not symptomatic.

Conclusions

Overall, our data do not support an immediate beneficial effect of PTH replacement therapy on muscle function or QoL. A high frequency of hypercalcemia among our patients may have compromised the potential beneficial effects of reversing the state of PTH insufficiency.     

The quality of life and associated factors in patients on maintenance hemodialysis – a multicenter study in Shanxi province

Objectives: To assess the quality of life (QOL) and factors affecting QOL in hemodialysis patients so as to improve QOL of dialysis patients and provide the basis for better clinical care.

Methods: A retrospective study was performed to assess the QOL and factors affecting QOL in hemodialysis patients. We recruited 125 patients who had been receiving hemodialysis for at least 2?years in the dialysis units of nine hospitals in Shanxi Province, China, and conducted a multi-center questionnaire survey between 1 May 2015 and 1 July 2016. We investigated the patients’ general condition and clinical data and used the Short Form-36 (SF-36) scale to measure QOL in these patients.

Results: The overall SF-36 score was 107.55?±?14.50 in patients who had received hemodialysis for more than 2 years. Age (p?<?.05, F?=?4.972) and gender (p?<?.01, t?=?3.993) significantly affected the overall QOL score in these patients. Education level was also an influencing factor (p?<?.05, Z=??0.838), especially on the mental health of these patients. In addition, residual urine volume (p?<?.05, Z=??2.465) and diabetic nephropathy (p?<?.05, Z=??2.062) were important factors that affected the physical strength and QOL score in these patients. However, sources of medical expenses, marital status and different methods of dialysis, had no effect on the QOL score.

Conclusion: The overall score of QOL in patients who have received maintenance hemodialysis for more than 2 years is higher in Shanxi Province than that in other provinces of China. Only a few factors influenced the QOL of these patients.     

Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas – a study on 721 patients

Summary ¶Introduction. The aim of this study was to define the impact of surgery on pituitary function in a large consecutive series of patients harbouring non-functioning pituitary adenomas. Materials and method. Between December 1982 and December 2000, a total of 822 patients underwent primary surgery in the authors department. In 721 cases a complete set of endocrinological data was available. Functions of the pituitary-gonadal, pituitary-thyroid and pituitary-adrenal axes were assessed immediately before surgery and again one week, 3 months and 1 year after the operation, utilizing standardized tests and commercially available assays. Results. There was some degree of pre-operative hypopituitarism in 561 (85%) and 53 (86.3%) of the patients belonging to the transsphenoidal and the transcranial groups, respectively. Prior to transsphenoidal [transcranial] surgery, 163 (31%) [34 (55.7%)] of the patients had secondary adrenal deficiency, 463 (76.6%) [49 (89%)] had hypogonadism and 105 (19.1%) [14 (25.4%)] were hypothyroid. Preoperatively, prolactin levels were mildly elevated in 167 patients (25.3%), whereas 1 year after surgery, levels were elevated in only 5 patients. Permanent diabetes insipidus occurred in 4 patients, 2 from the transsphenoidal group (0.3%) and 2 from the transcranial group (3.2%). Following transsphenoidal surgery 110 (19.6%) of patients had normal pituitary function [versus 0% after transcranial surgery], 169 (30.1%) [6 (11.3%)] showed improvement, 274 (48.9%) [49 (73.7%)] had persistent deficits and 8 (1.4%) [8 (15%)] showed deterioration of pituitary function. Discussion. These data indicate that transsphenoidal surgery for non-functioning pituitary adenomas in expert hands is, relatively, far less detrimental to patients compared with transcranial surgery. The latter carries a much greater risk of post-operative deterioration in pituitary function.     

Rectal cancer therapy: decision making on basis of quality of life?

BACKGROUND: As colorectal malignancies are relatively well treatable and show acceptable survival rates, the quality of life indicators are very important in this group of patients. PATIENTS AND METHODS: 372 patients with rectal cancer were included on a voluntary basis in this prospective study. The patient material consisted of two groups, those who underwent sphincter saving operation (64.51 %), and those who underwent Miles operation (35.49 %). The patients answered a colorectal cancer specific questionnaire on quality of life (CRC_QoL) 1 year after surgery. A CRC_QoL was prepared to analyze the correlation between the characteristics of the colorectal cancer and its treatment versus the physical and psychological state, somatic sensations and social connections of the patients. Our QoL questionnaire consists of 62 questions. Internal consistency of each factor was assessed by calculating Cronbach alpha values and was found satisfactory. For the test-retest reliability analysis the questionnaires were re-assessed. Correlation analysis showed that the answers were consistent (p < 0.01 in all cases). Discriminative validity analysis of the factors showed a significant difference in all cases. In self made score system higher numbers mean (9) worse, the smaller mean (0) better quality of life. The scale can also be seen as a percent distribution, where - in turn - the best quality is 100. The CRC_QoL questionnaire, scoring system, and score-to-percent transformation were done in this study. The results were evaluated by question and by patient group too. RESULTS: Our indicator did not show poor QoL for ostomates. Physical function was quite good in both groups: non-ostomates 87.69 +/- 20.85, ostomates: 96.46 +/- 8.25, p = 0.05 respectively. The cumulated converted percentile value for general state was significantly better (p = 0.03) for the ostomates (86.18 +/- 13.43) compared to non-ostomates (69.80 +/- 31.37). The cumulative gastrointestinal problem score did not reveal any significant difference (non-ostomates: 90.19 +/- 12.50, ostomates: 95.62 +/- 9.04, p = 0.11). Non-ostomates and ostomates did not differ regarding the cumulative score of stool-related questions: 83.75 +/- 20.53 versus 89.85 +/- 10.01 respectively, p = 0.14. The score for the peristomal problems was as high as 90.00 +/- 16.12. There was no difference in the cumulative gender specific indicators for both sexes, which showed the value 72.50 +/- 44.35 at non-ostomates and 63.64 +/- 50.45 at ostomates (p = 0.31). None of the patients regarded the chemotherapy problem as a factor diminishing the quality of their life. After calculating the total of all above mentioned functional parameters the score for non-ostomates results 82.50 +/- 19.83, and that of ostomates results 88.60 +/- 8.48, what is about the same, p = 0.12. The cumulative score of the two groups concerning emotional indicators did not really differ (non ostomates 78.69 +/- 24.19, ostomates 84.95 +/- 12.08, p = 0.11). The total cumulative scores among the groups did not show significant difference (non-ostomates 81.67 +/- 31.48, ostomates 87.12 +/- 16.40, p = 0.27). The global QoL was high in both groups with no significant difference among non-ostomates and ostomates (82.00 +/- 24.86 versus 88.60 +/- 8.48, respectively, p = 0.12). CONCLUSION: The quality of life of all patients was poorer than it was prior to the onset of the disease, but most of them could return to their prior way of living with not too many compromises. This process can be well monitored with our score system.     

Brain infarction following meningioma surgery—incidence,risk factors,and impact on function,seizure risk,and patient-reported quality of life

Neurosurgical Review - In this study, we seek to explore the incidence of and potential risk factors for postoperative infarctions after meningioma surgery, in addition to the possible association...     

Targeted-cryosurgical ablation of the prostate with androgen deprivation therapy： quality of life in high-risk prostate cancer patients

Aim:To present preliminary results on health-related quality of life(QoL),prostate-associated symptoms and thera-peutic effects of targeted-cryosurgical ablation of the prostate(TCSAP)with androgen deprivation therapy(ADT)inhigh-risk prostate cancer(PCa)patients.Methods:Thirty-four men with high-risk PCa features underwent TCSAP,and ADT was added to improve the treatment outcomes.High-risk parameters were defined as either prostate-specific antigen(PSA)≥10ng/mL,or Gleason score≥8,or both.The Genito-Urinary Group of the European Orga-nization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30(EORTC QLQ-C30)withprostate-cancer-specific module(QLQ-PR25)was used for evaluating morbidities and PSA levels were recordedevery 3 months.PSA failure was defined as the inability to reach a nadir of 0.4 ng/mL or less.Results:Although itwas not statistically significant,the global health status scores increased after TCSAP with ADT.The scores for fivefunctional scales also became higher after treatment.The most prominent symptom after treatment was sexualdysfunction,followed by treatment-related and irritative voiding symptoms.Conclusion:TCSAP with ADT appearsto be minimally invasive with high QoL except for sexual dysfunction.Long-term follow-up of PSA data and survivalis necessary before any conclusions can be made on the efficacy of this promising new therapeutic modality in thetreatment of PCa.(Asian J Androl 2006 Sep;8:629-636)     

Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life?

Aim A poor functional outcome is often reported after total mesorectal excision (TME) for rectal cancer, especially when sphincter‐saving resection with intersphincteric dissection is performed for low tumours. Anal sphincter rehabilitation is widely proposed for faecal incontinence. Very few studies have reported results to improve anal dysfunction following rectal surgery. This prospective study aimed to assess the benefits of sphincter training after TME in terms of functional outcome and quality of life. Methods Anal sphincter training was performed in patients undergoing laparoscopic sphincter‐saving TME for rectal cancer. Rehabilitation was performed after ileostomy closure. This group was compared with 24 matched patients. Assessment included one functional and two quality of life questionnaires (SF‐36 Health Status and Faecal Incontinence Quality of Life score). Results From 2007 to 2009, 22 patients underwent laparoscopic TME. The median follow‐up after stoma closure was 21.2 (range 8–46) months. The mean stool frequency per day was significantly lower after sphincter training (2.6 in the training group vs 4.0 in the control group, P = 0.025). Following rehabilitation, patients complained significantly less about dyschezia (22 vs 63%, P = 0.008). Both groups had similar continence (Wexner score 8.3 after training vs 9.9 in controls, NS). Quality of life was significantly improved by sphincter training as measured by the vitality (P = 0.004) and mental functioning (P = 0.02) subscales on the SF‐36 Health Status questionnaire and by the depression and self‐perception (P = 0.005) categories of the Faecal Incontinence Quality of Life score. Conclusion This study suggests that anal sphincter training following TME could decrease stool frequency and improve both general and specific quality of life.     

A case for anatomic correction in atrioventricular discordance? Effects of surgery on tricuspid valve function

OBJECTIVE: To assess tricuspid valve function in atrioventricular discordance after palliative procedures (pulmonary artery banding and Blalock-Taussig shunt) and corrective procedures (anatomic and physiologic repair). METHODS: Tricuspid valve dysfunction was assessed by transthoracic echocardiography and graded as no regurgitation (0), mild (1), moderate (2), and severe (3) before and after palliative and corrective procedures performed in 97 patients with atrioventricular discordance between 1988 and 1999. Thirty-two percent had an isolated ventricular septal defect, 43% had a ventricular septal defect and pulmonary stenosis, and 16% had pulmonary stenosis. Twenty-six patients underwent pulmonary artery banding and 28 had a Blalock-Taussig shunt. Seventy patients underwent physiologic and 19 underwent anatomic repair. Six patients underwent one-ventricle repair. RESULTS: After pulmonary artery banding, the tricuspid regurgitation score decreased from 1.7 +/- 0.8 to 0.9 +/- 0.6 (P <.001). In patients who underwent a Blalock-Taussig shunt, the tricuspid regurgitation score increased from 0.7 +/- 0.5 preoperatively to 1.4 +/- 0.6 postoperatively (P <.001). After physiologic repair, there was no significant change in the tricuspid regurgitation score; however, 7 patients required additional repair or replacement. The regurgitation score was significantly reduced from 1.5 +/- 0.8 to 0.4 +/- 0.5 (P <.001) after anatomic repair. The operative mortality in patients who underwent physiologic repair was 7% as compared with 0% in the anatomic repair group (P =.59). The median follow-up was 3.2 years. CONCLUSIONS: Right ventricular volume loading (shunt) worsens tricuspid regurgitation, whereas volume reduction (banding) or left-to-right septal shift (anatomic repair) has beneficial effects. We have not observed a significant change in the tricuspid regurgitation score after physiologic repair. Anatomic repair can be performed in selected patients with atrioventricular discordance and provides superior functional results.     

The quality of preoperative diagnostics and surgery and their impact on delays in breast cancer treatment – A population based study

Background and objectivesThis study aims to clarify quality of breast cancer surgery in population-based setting. We aim to elucidate factors influencing waiting periods, and to evaluate the effect of hospital volume on surgical treatment policies. Special interest was given to diagnostic and surgical processes and their impact on waiting times.MethodsAll 1307 patients having primary breast cancer surgery at the Helsinki and Uusimaa Hospital District during 2010 were included in this retrospective study.ResultsMedian waiting time for primary surgery was 24 days and significantly affected by additional imaging and diagnostic biopsies as well as hospital volume. Final rate of breast conserving surgery was surprisingly low, 51%, not affected by hospital volume, p = 0.781. Oncoplastic resection and immediate breast reconstruction (IBR) were performed more often in high volume units, p < 0.001. Quality of axillary surgery varied with unit size. Multiple operations, IBR and high volume unit were factors prolonging initiation of adjuvant treatment.ConclusionQuality of preoperative diagnostics play a crucial role in minimizing the need of repeated imaging and biopsies as well as multiple operations. Positive impact of high-volume hospitals becomes evident when analyzing procedures requiring advanced surgical techniques. High-volume hospitals achieved better quality in axillary surgery.     

Functional outcomes,quality of life,sexual function,and fertility of adult patients undergoing ileo‐anal pouch anastomosis in childhood

BackgroundWe conducted a questionnaire-based study of pouch function, quality of life, sexual function, and fertility among patients who had undergone ileal pouch anal anastomosis (IPAA) in childhood and who are now more than 18 years old.MethodsA consecutive series of patients were asked to complete the following questionnaires: Pouch function score (PFS), short form 36 (SF-36), International index of erectile function (IIEF) (males), and Female sexual function index (FSFI) (females). Fertility in females was also assessed. Data are quoted as a median (SD).ResultsOf 144 patients who had IPAA, 101 were eligible, and 70 responded. Mean age at surgery was 14 years, and mean current age is 26 years. Most patients had either ulcerative colitis or familial adenomatous polyposis. The questionnaire was completed by 38/70 (54%). Median PFS score was 6 (5). SF-36 were lower than previous reports. Median FSFI was 30 (7.6), 84% of possible maximum. Median IIEF was 69, 92% of possible maximum. Successful conception was reported in 5/7 women who had tried. However, there were several miscarriages and two surgical emergencies during pregnancies.ConclusionsIPAA can be performed in childhood with similar pouch function to reported adult series. Quality of life appears poorer, but sexual function is maintained. There may be an association with adverse events in pregnancy.Level of evidenceIV.