Quality of Life of Patients Operated on for Low Rectal Cancer: Impact of the Type of Surgery and Patients’ Characteristics

PURPOSE This study was designed to compare the impact of a permanent colostomy and sociodemographic characteristics on the quality of life of patients operated on for low rectal cancer. METHODS A cross-sectional study was performed by use of the European Organization for Research and Treatment of Cancer QLQ-C30 and CR-38 questionnaires. Patients came to the hospital to fill out the self-administered questionnaire or were sent the questionnaire by mail, followed by a live or telephone interview. All patients had undergone one of four operations: low anterior resection with colorectal or coloanal anastomosis (non-stoma group), or abdominoperineal resection with pseudocontinent perineal colostomy (nonstoma group) or left lower quadrant colostomy (stoma group). RESULTS A total of 132 patients were included for analysis and there were no missing data. For the majority of quality of life scores (26/29), there was no significant difference between stoma and nonstoma patients. However, stoma patients complained of diminished body image (P = 0.0022), and this was especially true for married (P = 0.0073) and less educated (P = 0.0014) patients at subgroup analysis. Stoma patients experienced greater financial worries (P = 0.0029), whereas nonstoma patients had greater gastrointestinal concerns (P = 0.0098). CONCLUSIONS Although most quality of life scores between stoma and nonstoma patients were similar, significant differences regarding body image, finance, and gastrointestinal symptoms, especially for married and less educated patients, were noticed. These factors should be taken into account, along with oncologic criteria, to better tailor treatments to patients.     

Expression of CD55 on Red Blood Cells of β-Thalassemia Patients

CD55 is a complement regulatory protein expressed by cells to protect them from bystander lysis by complement. It prevents the formation of C3/C5 convertase. In β-thalassemia (β-thal), the defective hemoglobin (Hb) production makes red blood cells (RBCs) lyse early and frequently. Loss of CD55 expression in those patients compromises the complement regulatory function, thereby accelerating RBC lysis. In this study, we aimed to evaluate the expression of CD55 on erythrocytes of β-thal patients. Flow cytometry analysis of CD55 was conducted on RBCs of 21 β-thalassemia major (β-TM) patients, 11 β-thalassemia intermedia (β-TI) patients and 10 healthy volunteers. The results showed a significant decrease in CD55 expression in β-TM (57.5?±?16.7%), while there was a slight decrease in β-TI patients (81.8?±?3.8%) in comparison with that of the normal controls (88.7?±?0.8%). The diminished expression of CD55 was not accompanied by decrease in CD59 expression in β-thal patients (97.2?±?2.3%). This could suggest a mechanism (could be genetic) responsible for low CD55 expression. It may be related to defective Hb genes in thalassemia, but it does not relate to cell membrane changes.     

Patients’ use of the internet for medical information

OBJECTIVES: To determine the percentage of patients enrolled in a primary care practice who use the Internet for health information, to describe the types of information sought, to evaluate patients' perceptions of the quality of this information, and to determine if patients who use the Internet for health information discuss this with their doctors. DESIGN: Self-administered mailed survey. SETTING: Patients from a primary care internal medicine private practice. PARTICIPANTS: Randomly selected patients ( N=1,000) were mailed a confidential survey between December 1999 and March 2000. The response rate was 56.2%. MEASUREMENTS AND MAIN RESULTS: Of the 512 patients who returned the survey, 53.5% (274) stated that they used the Internet for medical information. Those using the Internet for medical information were more educated ( P <.001) and had higher incomes ( P <.001). Respondents used the Internet for information on a broad range of medical topics. Sixty percent felt that the information on the Internet was the "same as" or "better than" information from their doctors. Of those using the Internet for health information, 59% did not discuss this information with their doctor. Neither gender, education level, nor age less than 60 years was associated with patients sharing their Web searches with their physicians. However, patients who discussed this information with their doctors rated the quality of information higher than those who did not share this information with their providers. CONCLUSIONS: Primary care providers should recognize that patients are using the World Wide Web as a source of medical and health information and should be prepared to offer suggestions for Web-based health resources and to assist patients in evaluating the quality of medical information available on the Internet.     

Patients’ Views of a Colostomy for Fecal Incontinence

INTRODUCTION Formation of a permanent stoma often is seen as a last resort when all other interventions for fecal incontinence have failed. However, no previous study has examined patients views of a colostomy to manage fecal incontinence.METHODS People who had a colostomy to manage fecal incontinence were recruited via an advertisement in the magazine of the British Colostomy Association or from those operated at a specialist colorectal hospital. Four questionnaires were sent, asking about the stoma, previous incontinence, anxiety and depression, and quality of life.RESULTS A total of 69 replies were received. Respondents were 11 males and 58 females with a median age of 64 years and a median of 59 months since the operation. Rating their ability to live with their stoma now on a scale of 0 to 10, the median response was 8 (range, 0–10). The majority (83 percent) felt that the stoma restricted their life a little or not at all (a significant improvement from perceived restriction from former incontinence, P = 0.008). Satisfaction with the stoma was a median of 9 on a scale of 0 to 10 (range, 0–10). Eighty-four percent would probably or definitely choose to have the stoma again. Quality of life (SF-36) was poor, but neither depression nor anxiety was a prominent feature.CONCLUSIONS The majority of previously incontinent people were positive about the stoma and the difference it had made to their life. However, a few had not adapted and disliked the stoma intensely. Health care professionals should discuss a stoma as an option with patients whose lives are restricted by fecal incontinence.Presented at The International Continence Society Annual Conference, Florence, Italy, October 8 to 10, 2003.     

Prospective Evaluation of Quality of Life in Patients with Zollinger–Ellison Syndrome

Background  

Zollinger–Ellison syndrome (ZES) is associated with complicated ulcer disease of the upper gastrointestinal tract. While management of ZES has dramatically improved with proton pump inhibitor therapy, quality of life in medically treated patients has not been evaluated.     

How Well Do Doctors Know their Patients? Factors Affecting Physician Understanding of Patients’ Health Beliefs

BACKGROUND  

An important feature of patient-centered care is physician understanding of their patients’ health beliefs and values.     

Determinants of the Severity of Exercise‐Induced Bronchoconstriction in Patients with Asthma

Aim. In examining the mechanisms of exercise‐induced bronchoconstriction (EIB), it is important to determine which factors most strongly affect the severity of EIB. We determined such factors in patients with asthma by stepwise multiple‐regression analysis. Methods. Twenty‐three patients with asthma underwent pulmonary function tests, methacholine provocation test, and sputum induction. Eosinophilic inflammatory indices and airway vascular permeability index (ratio of albumin concentrations in induced sputum and serum) were examined in sputum samples, and then an exercise test was performed by all asthmatics. Results. There was a significant correlation between the severity of EIB and degree of eosinophilic inflammation in induced sputum. Moreover, there was a significant correlation between the severity of EIB and airway vascular permeability index. Although we could not find a significant correlation between the severity of EIB and 1‐sec forced expired volume, 20% provocation concentration of (PC₂₀) methacholine tended to be correlated with the severity of EIB. By stepwise multiple‐regression analysis, we also found that airway vascular permeability index, eosinophil cationic protein levels in sputum, and PC₂₀ methacholine are independent predictors of the severity of EIB. Conclusion. We found that airway vascular hyperpermeability, eosinophilic inflammation, and bronchial hyperreactivity are independent factors predicting the severity of EIB.     

Patients’ perceptions of quality of care and follow-up in inflammatory bowel disease

Background and aims Quality of care (QoC) has gained increased attention in IBD. A better QoC has, historically, been linked to improved treatment outcomes. Even so, factors of equal importance to patients may be quality of life (QoL), patient–physician communication and access to care. Recent surveys suggest that IBD care in Europe is suboptimal. Methods Patients were recruited from nine hospitals in the south-eastern and western part of Norway as a part of an observational, multicenter study In addition to clinical and socio-demographic factors; a purposely designed 26 item questionnaire was used to quantify aspects related to IBD care, including QoC. Moreover, the Fatigue Questionnaire (FQ) was used to investigate fatigue. Results In total, 411 patients were included. Of these, 231 were diagnosed with CD and 180 with UC. Furthermore, 86.1% (354/411) were satisfied with the quality of IBD follow-up and only 4.1% (17/411) were dissatisfied. Most dissatisfaction was related to: lack of focus on personal relations (18.2%), HRQoL (15.1%), general practitioner knowledge of IBD (13.9%), ability to talk about important topics (7.8%), and hospital discharge communication (9.4%). Higher age and longer disease duration was associated with improved QoC scores in both UC and CD. Fatigue was associated with decreased QoC scores in both diagnoses. Conclusions Patients are satisfied with quality of care in IBD. However, communication seems to be an important area of improvement – not only related to patient–physician communication, but also to transitional communication between different health-care levels.     

Medical Record Documentation of Patients’ Hearing Loss by Physicians

BACKGROUND  Anecdotal evidence suggests that hearing loss, even when sufficient to prevent full access to spoken communication, often is underreported by patients and not documented by physicians. No published studies have investigated this issue quantitatively. OBJECTIVE  To assess the documentation of hearing loss in comprehensive physician notes in cases where the patients are known to have substantial binaural loss. DESIGN  Electronic medical record (EMR) notes for 100 consecutive patients with substantial binaural hearing loss were reviewed retrospectively at a large academic medical center. All records reviewed were created within 2 years before the patient’s audiometry. Comprehensive physician notes containing the headings “History” and “Physical Exam” were examined for documentation of hearing loss and scored as: no mention of loss; finding of loss; or hearing reported as normal. PARTICIPANTS  Consecutive adult patients with substantial binaural hearing loss by audiometry who also had a comprehensive medical assessment in their electronic medical record created within 2 years before audiometry. RESULTS  Thirty-six percent of EMRs had no mention of hearing loss, 28% reported some loss, and 36% percent indicated that hearing was normal. CONCLUSIONS  Substantial hearing loss, sufficient to prevent effective communication in the medical setting, often is underdocumented in medical records.     

The Study of hemodynamics and coronary arteriography of Patients with Different Types of Unstable Angina Pectoris

Objectives To explore the basic heart functional state and cardiac reserve function of patients with different types of unstable angina pectoris (UAP) and observe the relations between the heart function and severity of coronary arterial disease. Methods 70 cases with UAP were enrolled including 25 patients with angina decubitus (AD), 23 patients with mixed angina (MA) , and 22 patients with accelerated effort angina (AEA). All patients underwent a series of examination such as UCG, ECT, hemodynamics and volume-loading test. The patients were divided into three groups in light of the results of the hemodynamic examination: ① diastolic dysfunction group ② systolic dysfunction group ③ normal heart function group. We assessed the basic heart function and cardiac reserve function of patients with different types of UAP and also observed the relations between coronary arteriography and heart function. Results ① Under basic conditions, patients with angina decubitus suffered from the systolic (36%) or dia     

Change of Esophageal Motility in Cirrhotic Patients with Hepatitis Virus

Our previous study showed that two MKN45 variants, namely MKN45Lm-and MKN 45Lm selected by laminin adhesion in vitro, had different abilities of invasion and metastasis in vivo (inoculated in nude mice) and in vitro (in Boyden chamber), also had different expression of cysteine proteinase. In the present study, we investigated the cell apoptosis of this MKN45 variants by TUNEL and FACS methods. The results were shown significant different of cell apoptosis in this cell sublines. The MKN45Lm- cells had a small subdiploidy peak (3.5%) in DNA content analyzed by flow cytometry,     

Older Patients Perceptions of “Unnecessary” Tests and Referrals

Context  Unnecessary exposure to medical interventions can harm patients. Many hope that generalist physicians can limit such unnecessary exposure. Objective  To assess older Americans’ perceptions of the need for tests and referrals that their personal physician deemed unnecessary. Design  Telephone survey with mail follow-up in English and Spanish, conducted from May to September 2005 (overall response rate 62%). Study Participants  Nationally representative sample of 2,847 community-dwelling Medicare beneficiaries. Main analyses focus on the 2,319 who had a personal doctor (“one you would see for a check-up or advice if you were sick”) whom they described as a generalist (“doctor who treats many different kinds of problems”). Main Outcome Measure  Proportion of respondents wanting a test or referral that their generalist suggested was not necessary using 2 clinical vignettes (cough persisting 1 week after other flu symptoms; mild but definite chest pain lasting 1 week). Results  Eighty-two percent of Medicare beneficiaries had a generalist physician; almost all (97%) saw their generalist at least once in the past year. Among those with a generalist, 79% believed that it is “better for a patient to have one general doctor who manages most of their medical problems” than to have each problem cared for by a specialist. Nevertheless, when faced with new symptoms, many would want tests and referrals that their doctor did not think necessary. For a cough persisting 1 week after flu symptoms, 34% would want to see a lung specialist even if their generalist told them they “probably did not need to see a specialist but could if they wanted to.” For 1 week of mild but definite chest pain when walking up stairs, 55% would want to see a heart specialist even if their generalist did not think it necessary. In these same scenarios, even higher proportions would want diagnostic testing; 57% would want a chest x-ray for the cough, and 74% would want “special tests” for the chest pain. Conclusions  When faced with new symptoms, many older patients report that they would want a diagnostic test or specialty referral that their generalist thought was unnecessary. Generalists striving to provide patient-centered care while at the same time limiting exposure to unnecessary medical interventions will need to address their patients’ perceptions regarding the need for these services. Electronic Supplementary Material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

The Relationship Between Multimorbidity and Patients’ Ratings of Communication

BACKGROUND  The growing interest in pay-for-performance and other quality improvement programs has generated concerns about potential performance measurement penalties for providers who care for more complex patients, such as patients with more chronic conditions. Few data are available on how multimorbidity affects common performance metrics. OBJECTIVE  To examine the relationship between multimorbidity and patients’ ratings of communication, a common performance metric. DESIGN  Cross-sectional study SETTING  Nationally representative sample of U.S. residents PARTICIPANTS  A total of 15,709 noninstitutionalized adults living in the United States participated in a telephone interview. MEASUREMENTS  We used 2 different measures of multimorbidity: 1) “individual conditions” approach disregards similarities/concordance among chronic conditions and 2) “condition-groups” approach considers similarities/concordance among conditions. We used a composite measure of patients’ ratings of patient–physician communication. RESULTS  A higher number of individual conditions is associated with lower ratings of communication, although the magnitude of the relationship is small (adjusted average communication scores: 0 conditions, 12.20; 1–2 conditions, 12.06; 3+ conditions, 11.90; scale range 5 = worst, 15 = best). This relationship remains statistically significant when concordant relationships among conditions are considered (0 condition groups 12.19; 1–2 condition groups 12.03; 3+ condition groups 11.94). CONCLUSIONS  In our nationally representative sample, patients with more chronic conditions gave their doctors modestly lower patient–doctor communication scores than their healthier counterparts. Accounting for concordance among conditions does not widen the difference in communication scores. Concerns about performance measurement penalty related to patient complexity cannot be entirely addressed by adjusting for multimorbidity. Future studies should focus on other aspects of clinical complexity (e.g., severity, specific combinations of conditions).     

Is Subdivision of pT2 Tumors Superior to Lymph Node Metastasis for Predicting Survival of Patients with Gastric Cancer? Review of 224 Patients from Four Centers

Background

The prognostic significance of the subclassification of pT2 tumors and the association of these categories with other clinicopathological factors in gastric cancer patients were investigated.

Methods

A total of 224 patients with pT2 gastric cancer who had undergone curative gastrectomy and lymph node dissection were retrospectively analyzed. The prognostic role of the subclassification of pT2 tumors was evaluated by univariate and multivariate analysis.

Results

Of 224 patients, 75 (33.5%) were classified as having pT2a tumors and 149 (66.5%) as having pT2b tumors. The prevalence of large-sized tumors (P < 0.003), lymph node involvement (P < 0.018), and lymphatic (P = 0.016), blood vessel (P = 0.001), and perineural invasion (P = 0.001) was significantly higher for pT2b tumors than for pT2a tumors. The rate of recurrence for pT2a cancers was significantly lower than that for pT2b cancers (P = 0.001).Median overall survival (OS) times and three-year OS of patients with a pT2b tumor were significantly worse than for patients with a pT2a tumor (P < 0.001).When patients were analyzed according to lymph node involvement, the prognosis of patients with pT2aN₁ cancers was significantly better than that of patients with pT2bN₁ (P < 0.001). Multivariate analysis indicated that the pT2 subdivision was an independent prognostic factor for OS (P = 0.006), as were pN stage, clinical stage, and recurrence.

Conclusion

Our results showed that subclassification of pT2 tumors into pT2a or pT2b was an important prognostic indicator for patients with pT2 gastric cancers who underwent curative gastrectomy. In the TNM staging system, subdivision of pT2 tumors should be undertaken routinely to detect gastric cancer patients who have a poor prognosis and to define patients more accurately in terms of their mortality after curative resection in accordance with the new 2010 AJCC TNM staging classification. This may also help as a guide to more appropriate therapy for tumors with subserosal invasion (old pT2b or new pT3).