Health-related quality of life in patients with Charcot foot

Eighteen patients being treated for Charcot arthropathy of the foot or ankle completed the American Academy of Orthopaedic Surgeons (AAOS) Outcomes Instrument. Subjects rated their general health as fair to poor. Specific AAOS foot and ankle scores ranged from 15 to 46. SF-36 component scales were compared with available population controls. The SF-36 physical function and pain component scores ranged from 10.3 to 44.2 (controls, 71.9 to 84.2). The social, emotional, and mental health scores ranged from 42.5 to 61.5 (controls, 74.7 to 83.3). The results of this observational impact study reveal that Charcot foot and ankle deformity dramatically impact negatively on the lifestyle of afflicted individuals. It leads to frequent disability or premature retirement from the workforce. Pain and emotional illness do not appear to be a major component of the impact of the disease on health-related quality of life.     

Long-term functional outcome and quality of life in patients with high imperforate anus

Purpose

Anorectal malformations (ARMs) are associated with a large number of functional sequale that may affect a child's long-term quality of life (QOL). The purposes of this study were to better quantify patient functional stooling outcome and to identify how these outcomes related to the QOL in patients with high imperforate anus.

Methods

Forty-eight patients from 2 children's hospitals underwent scoring of stooling after 4 years of life. Scoring consisted of a 13-item questionnaire to assess long-term stooling habits (score range: 0-30, worst to best). These results were then correlated with a QOL survey as judged by a parent or guardian.

Result

Mean (SD) age at survey was 6.5 (1.6) years. Comparison of QOL and clinical scoring showed no signficant difference between the 2 institutions (P > .05). There was a direct correlation between the QOL and stooling score (Pearson r² = 0.827; β coefficient = 24.7, P < .001). Interestingly, functional stooling scores worsened with increasing age (Pearson r² = 0.318, P = .02). Patients with associated congenital anomalies had a high rate of poor QOL (44% in poor range; P = .001). Stooling scores decreased significantly with increasing severity/complexity of the ARM (P = .001).

Conclusion

A large number of children experience functional stooling problems, and these were directly associated with poor QOL. In contrast to previous perceptions, our study showed that stooling patterns are perceived to worsen with age. This suggests that children with ARMs need long-term follow-up and counseling.     

Long-term quality of life outcome after spondylodiscitis treatment

BACKGROUND CONTEXTSpondylodiscitis is the most common spinal infection of which the incidence has increased and the peak prevalence is between 50 and 70 years of age. Spondylodiscitis is often a complication of a distant infection. Early diagnosis can be challenging, and although improvements in diagnostic techniques and modern therapy have diminished the mortality of the disease, current literature about the outcome of spondylodiscitis is scarce.PURPOSETo evaluate the long-term clinical outcome of patients who suffered from spondylodiscitis.STUDY DESIGNA two-center cross-sectional study.PATIENT SAMPLEPatients with spondylodiscitis in two large teaching hospitals in the Netherlands between 2003 and 2017.OUTCOME MEASURESVisual Analogue Scale (VAS) for back pain, Oswestry Disability Index (ODI) for function, and Short Form 36 (SF-36) for general quality of life of spondylodiscitis patients.METHODEligible patients were identified from electronic patient databases and completed multiple patient reported outcome measures after obtaining informed consent. General demographic and clinical information (age, sex, medical history) were extracted from the patient records. SF-36 domain scores of spondylodiscitis patients were compared with a nationwide population sample.RESULTS183 patients were treated for spondylodiscitis; additional questionnaires were received from 82 patients. After a median follow-up of 63 months, the overall mortality was 28%. The mean VAS for back pain was 3.5, and the mean ODI score was 22. In all SF-36 domains a significantly lower score was found in the spondylodiscitis group compared with a normative national Dutch cohort. There was a strong correlation between back pain and ODI scores (ρ=0.81, p<.05).CONCLUSIONSOur study confirms that spondylodiscitis is a disease causing a profound impact on back pain, function and quality of life. The results suggest that chronic back pain is a debilitating problem, as it has an extensive influence on daily activities and social and psychological well-being, causing significant disability.     

Health-related quality of life of patients with diabetes and foot ulcers

Thirty-four patients with diabetes who attended a university diabetic foot clinic for treatment of a foot ulcer completed the American Academy of Orthopaedic Surgeons Musculoskeletal Outcomes Measure. The purpose of the study was to measure the impact of foot ulcers in patients with diabetes on the physical, mental, emotional, and social aspects of patients' lives. Thirty had at least a high school education. Only six were employed at the time. Nineteen were retired or disabled due to poor health. Sixteen were obese, 10 were considered overweight, and eight had a BMI within the acceptable range. Subjects had an average of four to five bodily systems affected by comorbid illness for which they were receiving treatment, some of which limited their activities. Approximately 85% of the study population required some type of ambulatory assist device or were unable to ambulate independently. The study population was significantly limited in performing all physical activities, especially those requiring use of the foot and ankle, and viewed their own health as being significantly worse than that of the general population. All stated that their foot/ankle disease interfered with their lives. Pain was not a significant component of their disability. The results of this study confirm the hypothesis that foot ulcers in patients with diabetes have a negative impact on quality of life in affected individuals.     

Current concepts of Charcot foot in diabetic patients

The Charcot foot is an uncommon complication of neuropathy in diabetes. It is a disabling and devastating condition. The etiology of the Charcot foot is unknown, but it is characterized by acute inflammation with collapse of the foot and/or the ankle. Although the cause of this potentially debilitating condition is not known, it is generally accepted that the components of neuropathy that lead to foot complications must exist. When it is not detected early, a severe deformity will result in a secondary ulceration, infection, and amputation. Immobilization in the early stages is the key for success, but severe deformity may still develop. When severe deformity is present, bracing may be attempted but often patients will need surgical intervention. Good success has been shown with internal and external fixation. In patients with concomitant osteomyelitis, severe deformity, and/or soft tissue infection, a high amputation may be the best treatment of choice.     

Long-term outcome and quality of life after nonaneurysmal subarachnoid hemorrhage

Purpose  

Nonaneurysmal subarachnoid hemorrhage (SAH) is an uncommon form of SAH. As nonaneurysmal SAH is often concentrated around the pons and midbrain, the term perimesencephalic SAH (pmSAH) is widely accepted to describe this entity, though there are patients with a more widespread distribution of subarachnoid blood (non-pmSAH). The outcome of pmSAH is commonly regarded as good, although often outcome is not analyzed using standardized tools of outcome measurement. In this study we focused on the patient’s quality of life after nonaneurysmal SAH.     

Long-term follow-up and quality of life in patients with intracranial germinoma

Intracranial germinomas are fairly rare tumors occurring mostly in children or young adults with a comparatively good prognosis. Radiation is the preferred treatment of choice for this diagnosis. It has been thoroughly studied to what extent radiation doses and fields can be limited in order to avoid side effects in these young patients. The role of chemotherapy remains unclear, whereas surgery is limited to biopsy for proof of histology. Regarding the good overall survival rate, quality of life is a significant aspect to consider in these patients. We present a single institution analysis of patients with intracranial germinoma and analyze the long-term outcome with special regard to quality of life. Thirty-three patients with intracranial germinomas were analyzed by chart review, telephone interview, and neurological assessment. Additionally, a survey on quality of life was performed. The 10-year overall survival rate was 82.1 % at a mean follow-up of 141 (22–306)?months. Three quarters (76 %) of the patients reached a favorable neurological outcome on the Modified Rankin Scale (mRS 0–2). However, the self-reported quality of life was significantly worse in germinoma patients compared with a healthy control group (p?<?0.001). Surgical resection of the tumor led to no improvement regarding overall survival, neurological outcome, and quality of life. In terms of cognitive functioning, patients with tumor resection were significantly more impaired than biopsied patients (p?=?0.04). Although germinomas are efficiently treatable tumors, the restrictions in quality of life in these often young patients are considerable, including financial difficulties. There seems no justification for tumor resection in newly diagnosed cases suspicious for germinoma as the cognitive outcome is worse than in biopsied patients, and there is no effect on overall survival.     

Long-term disease-specific quality of life in children and adolescent patients with ARM

BackgroundThe main aim of the present study was to investigate how fecal incontinence might influence different aspects of quality of life (QOL) in children and adolescents with anorectal malformations (ARMs). We considered both the influence of fecal incontinence at time 1 of the study and the influence of fecal incontinence at time 2 (4 years later) on QOL measured at time 2.MethodsA total of 175 parents from the Italian Parents' and Patients' Association for Anorectal Malformations completed a questionnaire about fecal incontinence in their children at time 1 of the study. Four years later, 97 of these parents completed the Hirschsprung Disease/Anorectal Malformation Quality of Life questionnaire. Patient ages ranged from 4 to 17 years. Quality of life areas from the Hirschsprung Disease/Anorectal Malformation Quality of Life questionnaire were considered as outcome variables in a hierarchical regression analyses where fecal incontinence at time 1 and at time 2 served as predictors.ResultsThe principal findings indicated that fecal incontinence at time 2 significantly predicted constipating diet, presence of diarrhea, urinary continence, social functioning, emotional functioning, body image, and physical symptoms, also when severity of the malformation was taken into account.ConclusionsIt is extremely important that pediatric surgeons continue to promote effective bowel management programs and that they work with other specialists and support associations to offer emotional and psychological support to patients with ARM and their families.     

Long-term outcome and quality of life of patients requiring prolonged mechanical ventilation after cardiac surgery.

OBJECTIVES: To study the long-term survival and quality of life of patients with a complicated post-operative course after cardiac surgery requiring prolonged (>or=7 days) mechanical ventilation (MV), since they represent a heavy burden on hospital resources and their outcome has never been adequately evaluated. METHODS: Out of 4827 consecutive cardiac surgical patients, 148 (3%) required prolonged post-operative MV: their hospital course was analysed and factors affecting prolonged MV and mortality were identified using multivariate analysis. Long-term survival was assessed using Cox proportional hazard method. Long-term (36+/-12 months) follow-up information was collected and quality of life was assessed by an ad hoc questionnaire. RESULTS: Overall mortality in the study group was 45.3 versus 2% in the control population (P<0.0001). Predictors of death in the prolonged MV group were age (odds ratio, OR 1.049) and diabetes (OR 3.459). Long-term survival was significantly worse in those patients who were extubated after 21 days: 88.9 versus 70.9% at 1 year (P=0.03) and 80.9 versus 64.5% at 5 years (P=0.05). Mild or no limitation in daily living was referred by 69% of the survivors. CONCLUSIONS: The hospital mortality of patients requiring prolonged MV is high. The long-term survival of patients who are weaned from MV after 21 days is significantly lower. The great majority of the survivors can enjoy a good quality of life.     

重症急性胰腺炎远期疗效及健康相关生命质量分析

目的评估重症急性胰腺炎（severe acute pancreatitis,SAP）患者的远期疗效及健康相关生命质量,分析其影响因素。方法回顾性分析2003年1月至12月出院的98例SAP患者相关病历资料,应用SF-36量表及自制问卷表进行自评式调查,观察其健康相关生命质量及远期疗效。并与普通人群健康相关生命质量进行比较,作相关影响因素的单因素方差分析。自制问卷表单独分析。结果98例SAP患者中,病历资料完整59例,死亡2例,不能完成量表1例,无应答6例,收回有效问卷50例,应答率89．8％。SF-36量表生理功能、生理职能、情感职能、身体疼痛、活力、精神健康、社会功能和总体健康8个维度的得分分别为：（83±15）分、（62±42）分、（69±36）分、（80．4-15）分、（69±19）分、（72±15）分、（75±18）分和（65±18）分。与普通人群比较,生理职能和社会功能两项与普通人群间差异有统计学意义（P〈0．05）。其余6项与普通人群差异无统计学意义（P〉0．05）。影响生理健康总分的变量有治疗方式、住院时间、住院费用造成的经济负担。影响心理健康总分的变量有性别和住院费用造成的经济负担。结论SAP患者的健康相关生命质量与普通人群相近,远期疗效及生命质量良好,其影响因素主要有性别、治疗方法、住院时间及经济状况。     

Long-term outcome and quality of life after thymectomy for myasthenia gravis.

OBJECTIVE: The authors identify criteria suitable to predict long-term clinical improvement and evaluate quality of life after thymectomy for myasthenia. DESIGN: Retrospective analysis with long-term follow-up (mean 92 months) was conducted for 86 patients and questionnaire interviews were performed for 65 patients who underwent thymectomy between 1976 and 1993. MAIN OUTCOME MEASURES: The authors used the Osserman Score and the European Organization for Research and Treatment of Cancer quality-of-life questionnaire. RESULTS: After thymectomy, lasting benefits were achieved predominantly by patients with moderate and severe myasthenia, and this association was significant (p < 0.001) in both bivariable and multiple analyses. No correlation was observed between outcome and thymic pathology, patient age or gender, duration of disease, preoperative plasmapheresis, and medication. Restitution to normal was complete at most recent follow-up as to physical status, working ability, and cognitive and social functions, but some emotional and vegetative deficits remained. CONCLUSION: Future patient selection for thymectomy should-apart from those with suspected thymoma-concentrate on patients with moderate and severe myasthenia unresponsive to conservative management.     

Relationships among subjective patient-reported outcome,quality of life,and objective gait characteristics using wearable foot inertial-sensor assessment in foot–ankle patients

European Journal of Orthopaedic Surgery & Traumatology - This study aimed to determine the relationships between subjective validated patient-reported outcomes and health-related quality of...     

Imaging of the Charcot foot

Charcot foot is a serious problem that causes considerable morbidity and may lead to limb loss. Arriving at a definitive diagnosis can be challenging. Given the progressive, destructive nature of Charcot's arthropathy, this delay can result advancing deformity, ulceration, infection, and place the limb at risk for amputation. Although clinical signs and symptoms and historical information are crucial, this article focuses on the imaging modalities that can aid practitioners in arriving at an early diagnosis, and how to differentiate Charcot's arthropathy from osteomyelitis of the feet.     

神经性糖尿病足疼痛患者健康相关生活质量的研究进展

综述了神经性糖尿病足患者疼痛的原因、健康相关生活质量研究现状以及疼痛对健康相关生活质量的影响和干预措施,旨在为相关研究及临床实践提供参考,改善神经性糖尿病足疼痛患者的生活质量。     

The diagnosis of Charcot foot

Charcot foot is a rapidly progressive disease process occurring in those with peripheral neuropathy. The disease is frequently misdiagnosed resulting in a delay of appropriate treatment, worsening the outcome. We present the hallmarks for diagnosis of Charcot foot based on the clinical examination and imaging studies. We provide a simple algorithm based on evidence and experience for the investigation of the foot when Charcot arthropathy is suspected. Additionally, we propose a new classification that accounts for the degree of complications in the Charcot joint. This new system considers deformity, ulceration, and osteomyelitis, which may help to predict amputation.