中医护理干预对脊椎骨折术后并发症及患者生活质量的影响

目的 分析中医护理干预对脊椎骨折术后并发症及患者生活质量的影响.方法 将行脊椎骨折术的患者90例随机分为研究组与对照组,每组45例.研究组采用中医护理干预,对照组采用常规护理干预.对比分析两组干预总满意率、骨折愈合时间、术后并发症和住院时间及干预前和干预后VAS评分和生活质量各量表评分变化.结果 研究组总满意率(95.56％)高于对照组(75.56％),差异有统计学意义(P＜0.05);研究组骨折愈合时间快于对照组[(51.32±7.52)d比(74.52±11.20)d],术后并发症发生率低于对照组(4.44％比26.67％),住院时间短于对照组[(8.37±1.68)d比(12.51±3.14)d],差异均有统计学意义(均P＜0.05)研究组干预后VAS评分低于对照组[(2.31±0.43)分比(4.27±0.67)分],差异有统计学意义(P＜0.05);研究组干预后生活质量各量表评分高于对照组,差异有统计学意义(均P＜ 0.05).结论 中医护理干预脊椎骨折患者效果显著,可降低患者术后并发症和改善患者生活质量.     

老年股骨颈骨折患者内固定与关节置换术后近期生存质量的比较分析

目的：比较切开复位内固定术与全髋关节置换术治疗股骨颈骨折术后老年患者的生存质量。方法回顾性分析了2011年1月至2012年12月在我科室手术治疗股骨颈骨折的老年患者89例。其中行切开复位内固定手术治疗的为对照组,行全髋关节置换术治疗的为观察组。采用Harris评分及SF-36量表评估患者术后1个月、2个月、3个月、6个月及12个月等不同时间点的生存质量。结果共75例患者获得全程随访,随访时间为12个月。前3个月Harris评分及优良率观察组均高于对照组,有统计学差异（P＜0.05）;第6个月及第12个月比较两组间无统计学差异（P＞0.05）;前两个月SF-36量表躯体健康评分观察组高于对照组,有统计学差异（P＜0.05）;第3个月、第6个月及第12个月两组间比较均无统计学差异（P＞0.05）;而SF-36量表精神健康评分两组间比较均无统计学差异（P＞0.05）。结论老年股骨颈骨折患者无论采取切开复位内固定术还是全髋关节置换术治疗,患者术后半年至1年即能获得满意的生存质量;但由于全髋关节置换术治疗患者比切开复位内固定术治疗患者能够更早下床活动,术后并发症相对较少,故患者能够更早获得满意的近期生存质量。     

抑郁情绪对慢性阻塞性肺疾病患者疾病转归和生活质量的影响

目的 调查住院慢性阻塞性肺疾病(COPD)患者抑郁症的发病率,研究其对患者健康相关生活质量的影响.方法 对65例住院COPD患者进行汉密尔顿抑郁量表(HAMD),StGeorge呼吸问卷(SGRQ),简明健康调查问卷(SF-36)调查.结果 共调查COPD患者65例.HAMD分值8～20分者10例,21～35分者5例,35分以上者2例.不合并抑郁(HAMD＜8分)与合并抑郁(HAMD≥8分)的COPD患者SGRQ总分[(38.6士19.4)分比(53.3±27.6)分]、活动受限[(39.8±18.5)分比(57.7 ±24.4)分]、疾病影响[(33.9±13.7)分比(43.5±18.9)分]差异均有统计学意义(P＜0.05),不合并抑郁的COPD患者低于合并抑郁的COPD患者.与合并抑郁的COPD患者比较,不合并抑郁的患者SF-36的8个维度分值均较高,其中生理功能[(51.1±10.8)分比(26.9±14.4)分]、生理职能[(26.6±11.7)分比(8.3±1.4)分]、社会功能[(33.3±14.5)分比(17.9±7.5)分]、情感职能[(41.7±19.2)分比(23.8±8.8)分]、精神健康[(37.4±11.4)分比(23.8±8.0)分]分值相比,差异有统计学意义.较轻的COPD患者(Ⅰ期和Ⅱ期)和较重的COPD患者(Ⅲ期和Ⅳ期)SGRQ总分[(37.8±15.7)分比(58.6±20.4)分]、活动受限[(37.8±16.4)分比(59.2±21.6)分]、疾病影响[(31.7±8.2)分比(45.6±17.8)分]相比,较轻的COPD患者均低于较重的COPD患者,差异有统计学意义(P＜0.05).较轻和较重的COPD患者SF-36表的生理机能[(57.5±29.7)分比(27.0±12.9)分]、生理职能[(33.0±13.9)分比(6.0±2.7)分]、一般健康状况[(76.6±l9.4)分比(55.1±24.8)分]、社会功能[(41.1±16.8)分比(10.3±2.8)分]和精神健康[(40.6±1.6)分比(24.6±6.6)]相比,较轻的COPD患者评分均高于较重的COPD患者,差异有统计学意义(P＜0.05).结论 抑郁症在COPD患者中有一定的发生率,且严重影响COPD患者的健康生活质量.     

The relationship between recovery and health-related quality of life

Building upon recommendations to broaden the conceptualization of recovery and to assess its relationship with health-related quality of life (HRQoL), this study addressed three primary aims. These included: 1) testing the model fit of a hypothesized latent measure of recovery, 2) examining the extent to which this multidimensional measure of recovery was associated with concurrently measured HRQoL, and 3) examining the extent to which this multidimensional measure of recovery predicted changes in HRQoL during the subsequent year. Data were from 1,008 adults who completed follow-up assessments at 15 and 16 years post-intake. Confirmatory factor analysis indicated a good fit for a hypothesized recovery measure (CFI = .98; RMSEA = .06). Additionally, structural equation modeling suggested that this recovery measure was not only concurrently associated with HRQoL (β = .78, p < .001), but was also a significant predictor of changes in HRQoL during the subsequent year (β = .25, p < .001).     

Pharmaceutical care for patients with ischemic stroke: improving the patients quality of life

Objectives To improve patients health-related quality of life (HQL) after transient ischemic attack (TIA) or ischemic stroke; to guarantee an effective secondary prevention; to increase the patient’s satisfaction with recommendations regarding their medication by pharmacists. Setting Stroke Unit, neurological ward at the Klinikum Fulda, rehabilitation hospitals and community-based pharmacies in the region of Fulda, Germany. Method Patients with TIA or ischemic stroke were included. The patients were assigned to an intervention group (IG) or a control group (CG). The individual assignment of patients to IG or CG was based on the type of the local pharmacy to which patients belong. Community-based pharmacies either delivered standard care (CG) or provided additional intensified pharmaceutical care (PC; IG). Pharmacies delivering PC belong to a pre-existing “Quality Assurance Working Group” (QAWG). To evaluate the patient’s HQL, the Short Form-36 (SF-36) was used at study entry in hospital and at 12 months. The secondary prevention was documented at study entry in hospital and at 12 months. The patients’ satisfaction was measured by a questionnaire at the end of the study. Main outcome measures Patients’ HQL; secondary prevention; patients’ satisfaction with recommendations of the pharmacists with regards to their medication. Results Out of 1316 patients screened for participation in this study, 255 were recruited with 90/255 patients assigned to the IG and 165/255 patients assigned to the CG. During the study, the HQL of the patients in the IG did not change significantly. A significant decrease in the HQL was observed for the CG in 7/8 subscales and in both summary measures of the SF-36. After 12 months, 85.3% of the patients in the IG and 86.3% of the patients in the CG were treated with antiplatelet drugs or oral anticoagulants in accordance to treatment guidelines. Patients in the IG were significantly more satisfied with the individualized recommendations of the pharmacists than patients in the CG. Conclusion Our findings indicate that an intensified PC of patients after ischemic stroke by dedicated pharmacists may have a positive impact on HQL and patients’ satisfaction. PC in this study had no impact on adherence to secondary prevention medication.     

Solifenacin treatment for overactive bladder in black patients: patient-reported symptom bother and health-related quality of life outcomes*

ABSTRACT

Objective: Health-related quality of life (HRQoL) data for black patients receiving overactive bladder (OAB) treatment have not been previously reported. This study presents patient-reported outcomes, measured by symptom bother and HRQoL, in black patients participating in an open-label study of solifenacin succinate. Results are presented, as are those from the full study population.

Methods: In the 12-week, VESIcare Open-Label Trial (VOLT), patients received solifenacin 5?mg or 10?mg once daily according to an individualized, flexible-dosing regimen. A post-hoc analysis assessed solifenacin efficacy and safety in blacks (n = 274). Three patient-derived indices served as study endpoints. The Patient Perception of Bladder Condition (PPBC) scale assessed overall symptom bother, a visual analog scale (VAS) recorded individual symptom bother, the Overactive Bladder Questionnaire (OAB-q) measured OAB-related HRQoL.

Results: Blacks reported significant reductions in bladder-related problems based on PPBC scores (?p < 0.001) and improvements in all OAB-q subscales (symptom severity, coping, concern, sleep, social, and HRQoL; p < 0.001). Based on VAS ratings, significant improvements were reported for urinary urgency, urge incontinence, frequency, and nocturia (?p < 0.001 for change from baseline). Although this study was not placebo-controlled and statistical comparisons were not made, results were similar in the full study population. In total, 46% of black patients experienced adverse events (mostly anticholinergic) and 7.6% discontinued treatment as a result.

Conclusions: Solifenacin treatment was perceived as offering relief from symptom bother and improving HRQoL in the black cohort from VOLT. These results are similar to those in the full VOLT population.     

急诊护理中运用损伤控制理论对骨盆骨折病人预后的影响

目的 探讨急诊护理中运用损伤控制理论对骨盆骨折病人降低并发症、病死率和改善生活质量的影响。方法 选择2013年1月至2016年10月无锡市第九人民医院骨盆骨折病人104例,按先后顺序分为对照组和观察组,各52例。对照组采用常规护理,观察组采用损伤控制理论护理。记录并比较两组骨盆骨折病人的预后效果、并发症发生率、病死率和生活质量评分。结果 观察组住院时间、下床活动时间及骨折愈合时间均短于对照组,差异有统计学意义(P＜0.05)。观察组总并发症发生率为5.77%,低于对照组的23.08%;观察组病死率为1.92%,低于对照组的19.23%,差异有统计学意义(P＜0.05)。观察组护理后心理健康、社会功能、情感角色、生命力、躯体疼痛、角色、躯体功能、一般健康状况评分分别为(80.89±5.36)分、(88.79±2.46)分、(72.51±4.37)分、(79.96±5.89)分、(74.26±4.51)分、(68.85±5.03)分、(63.56±4.75)分和(89.92±5.32)分,均高于对照组,差异有统计学意义(P＜0.05)。结论 损伤控制理论应用于骨盆骨折病人急诊护理中效果显著,可明显提高骨盆骨折恢复效果,降低并发症发生率和病死率,改善生活质量,值得推广。     

The impact of anemia on quality of life and healthcare resource utilization in patients with HIV/AIDS receiving antiretroviral therapy*

ABSTRACT

Objective: To understand the impact of anemia on health-related quality of life (HRQOL) and healthcare resource utilization (HRU) in patients with HIV/AIDS.

Methods: In 2003, adults with HIV/AIDS were recruited through 114 US STD/HIV clinics to complete self-administered questionnaires. Adults reporting anemia as a side-effect of antiretroviral therapy (ART) during the past month were considered anemic. HRU was evaluated by emergency room (ER) visits, days of hospitalization, and healthcare provider visits in the past 6 months. The SF?8 was used to measure HRQOL. Linear regression was used to evaluate independent effects of anemia on HRQOL and HRU controlling for demographics, years since HIV diagnosis, HIV viral load, CD4⁺ count, and ART use.

Results: 2044 patients were enrolled, with 498 (24%) experiencing anemia. Anemic patients had lower SF?8 summary scores (mental: 38.2 ± 11.6 vs. 42.9 ± 11.9, p < 0.001; physical: 40.1 ± 10.0 vs. 45.5 ± 10.4, p < 0.001) than nonanemic patients. HRU in the anemic group was significantly higher (?p < 0.05), with respect to percentage of patients visiting ER, mean number of ER visits, mean number of days hospitalized, and mean number of total visits to providers. In linear regression models, anemic patients had mental and physical HRQOL scores more than 4 points lower than nonanemic patients (?p < 0.001 for both). Additionally, anemic patients had 2.7 more visits to healthcare providers (?p < 0.001).

Limitations: Data were cross-sectional, self-reported by patients, and did not include clinical measures of anemia.

Conclusion: Based on this survey, self-reported anemia appears to be associated with worsened HRQOL and greater HRU among HIV/AIDS patients using ART.     

健康教育对绝经后骨质疏松患者生活质量的影响

目的：探讨健康教育对绝经后骨质疏松症患者生活质量的影响。方法将160例绝经后骨质疏松患者随机分为实验组和对照组各80例,实验组进行系统健康教育并于出院后随访,对照组只进行常规的健康教育指导,应用SF-36生活质量量表分别对两组干预前及干预6个月后的生活质量进行评分。结果实验组干预后的各维度（总体健康、生理职能、社会功能、情感职能等）评分均明显升高,与干预前及对照组比较,差异有统计学意义（P＜0.05）。对照组干预前后的各维度评分比较,差异无统计学意义（P＞0.05）。结论对绝经后骨质疏松症患者实施系统的健康教育,可以提高患者的生活质量。     

非酒精性脂肪肝与非酒精性脂肪肝炎患者健康相关生活质量调查比较

目的 通过慢性肝病调查问卷,比较非酒精性脂肪肝与非酒精性脂肪肝炎对患者健康相关生活质量的影响,为后续治疗提供依据与指导。方法 选择2014年11月至2015年12月成都市第六人民医院门诊非酒精性肝病患者63例,按非酒精性脂肪肝病临床类型分组,其中非酒精性脂肪肝患者44例,非酒精性脂肪肝炎患者19例,采用慢性肝病问卷量表进行健康相关生活质量调查。比较两组患者评分负担总体情况和在腹部症状、疲劳、全身症状、活动、情感功能、焦虑6个维度的分布。在组内分别评估性别、病程时间、肥胖、代谢性疾病等对患者慢性肝病问卷评分的影响。结果 63例非酒精性脂肪肝病患者问卷评分在各个维度综合评分为（5.66±0.50）分。非酒精性脂肪肝炎患者评分低于非酒精性脂肪肝患者,差异有统计学意义（P=0.0004）,以焦虑（P=0.0081）、活动（P=0.0275）、情感功能（P=0.0243）维度最为突出。在非酒精性脂肪肝组,肥胖（P=0.0135）与慢性代谢性疾病（P=0.0162）患者问卷评分更低;但在非酒精性脂肪肝炎组,病程>6个月患者评分低于对照组,差异有统计学意义（P=0.0020）。结论 非酒精性脂肪肝炎对患者健康相关生活质量影响高于非酒精性脂肪肝,其差异主要体现在活动、情感和焦虑纬度。可以对不同临床特点患者在相应维度进行针对性干预。     

Health-related quality of life burden of women with endometriosis: a literature review

ABSTRACT

Purpose: The purpose of this study was to conduct a comprehensive and systematic literature review of the health-related quality of life (HRQL) burden of endometriosis in adults and adolescents.

Methods: We conducted a systematic search and review of studies published between January 1999 and January 2006 using MEDLINE and relevant online resources. Search terms used included endometriosis, quality of life, burden of illness, psychology, and adolescent. We assessed: (1) the HRQL impact of endometriosis and related key symptoms; (2) the impact of specific pharmacologic and surgical treatments of endometriosis on HRQL; and (3) the presence and impact of endometriosis in adolescents.

Results: Twenty relevant studies were identified and reviewed. Generic instruments most commonly used to assess HRQL in patients with endometriosis included the SF‐36 and the SF‐12. The EQ‐5D was used to measure utilities. The Endometriosis Health Profile-30 (EHP‐30) and its subset, the EHP‐5, have been recently developed for use in endometriosis studies. Endometriosis was associated with significant impairments in pain, psychological functioning, and social functioning. Pharmacological and surgical treatments for endometriosis improved patients physical functioning, psychological functioning, vitality, pain level, and general health. Few studies used disease specific instruments to characterize the HRQL burden of endometriosis, addressed the HRQL impact of endometriosis-related infertility, and examined endometriosis in adolescents. Instruments specifically validated to measure HRQL in adolescents were not identified.

Conclusions: Endometriosis impairs HRQL, especially in the domains of pain, psychological and social functioning. Therapies have been shown to alleviate symptoms and improve HRQL. Further research is warranted to evaluate the impact of endometriosis on HRQL in adolescents and the impact of infertility due to endometriosis on HRQL.     

Effect of ustekinumab on physical function and health-related quality of life in patients with psoriatic arthritis: a randomized,placebo-controlled,phase II trial

Abstract

Objective:

To use data from a phase II clinical trial to evaluate the effect of ustekinumab, a human immunoglobulin monoclonal antibody that binds with high affinity to the shared p40 subunit of human interleukins-12 and -23, on physical disability and health-related quality of life (HRQoL) in patients with psoriatic arthritis (PsA).     

Health-related quality of life during bosutinib (SKI-606) therapy in patients with advanced chronic myeloid leukemia after imatinib failure

Objectives: The tyrosine kinase inhibitor (TKI) bosutinib has demonstrated activity in patients with advanced phase chronic myeloid leukemia (CML), but effects on health-related quality of life (HRQoL) remain unexplored. This study evaluated HRQoL in advanced CML patients receiving bosutinib in an ongoing phase 2 study following resistance or intolerance to prior imatinib therapy.

Methods: This analysis included data from 76 accelerated-phase (AP) and 64 blast-phase (BP) patients resistant/intolerant to prior imatinib with or without prior exposure to other TKIs. Patient-reported HRQoL assessments completed at baseline; weeks 4, 8, and 12; every 12 weeks thereafter; and at treatment completion included the Functional Assessment of Cancer Therapy–Leukemia (FACT-Leu); general health status was assessed using the 5-item EuroQol (EQ-5D) instrument and a visual analog scale (VAS).

Results: HRQoL at baseline was somewhat worse in BP versus AP CML patients. There was a significant improvement in the mean FACT-Leu Total scale at weeks 24, 36, and 48 in AP CML patients and at weeks 4, 8, 12, 24, 36, 48, and 96 in BP CML patients compared with baseline. EQ-5D Utility scores were stable throughout treatment in AP CML patients but significantly improved versus baseline in BP CML patients at weeks 4, 8, 12, and 36. Mean VAS scores were significantly improved at weeks 8, 36, and 48 in AP CML patients and at weeks 4, 8, 12, 24, 36, and 96 in BP CML patients. The lack of a comparison group limits attribution of improvements in HRQoL specifically to bosutinib treatment; potential bias due to non-ignorable dropout may limit the ability to generalize these findings to situations where durations of therapy exceed the 96-week follow-up duration of the present study.

Conclusion: These findings suggest that bosutinib therapy is associated with improved HRQoL in advanced phase CML patients.

Clinical trial registration: NCT00261846.     

坦度螺酮治疗广泛性焦虑及对生命质量影响：多中心开放性研究

目的：观察坦度螺酮对广泛性焦虑症(GAD)的疗效及其对生命质量的影响。方法：多中心开放性研究。共入组广泛性焦虑症病人157例,完成的有效例数为122例。坦度螺酮剂量为30～60 mg·d~(-1),每日3次,疗程6 wk。采用汉密尔顿焦虑量表(HAMA)、临床总体评定量表-严重程度量表(CGI-SI)评定疗效,健康状况调查问卷量表(SF-36)评定生活质量。统计分析采用全分析集(FAS)分析,最接近一次观察的结转(LOCF)。结果：治疗1 wk后,HAMA总分和因子分显著低于治疗前(P＜0.01),治疗后总有效率67.4%；治疗前后SF-36各分量表得分均有显著改善(P＜0.01)；不良反应发生率为7.9%。结论：坦度螺酮对广泛性焦虑疗效肯定,不良反应较少,并能显著提高病人的生命质量。