综合性护理干预对脑梗塞恢复期患者生活质量及并发症的改善效果

目的:分析综合性护理干预对脑梗塞恢复期患者生活质量及并发症的改善效果,为临床护理脑梗塞提供参考依据.方法:选取我院收治的60例脑梗塞患者,随机分成实验组和对照组各30例,对照组实施常规护理,实验组实施综合性护理干预,对比生活质量评分、疾病不确定感评分及并发症.结果:实验组的并发症率低于对照组(P<0.05);生活质量评分高于对照组(P<0.05);疾病不确定感评分低于对照组(P<0.05).结论:综合性护理干预对脑梗塞恢复期患者生活质量具有积极影响,且可减少患者的并发症情况和疾病不确定感,值得在临床应用和推广.     

Predictors of health-related quality of life in patients with colorectal cancer

Background  

Most studies that have identified variables associated with the health-related quality of life (HRQL) of patients with colorectal cancer have been cross-sectional or included patients with other diagnoses. The objectives of this study were to identify predictors of HRQL in patients with colorectal cancer and interpret the clinical importance of the results.     

Measuring health-related quality of life in patients with venous leg ulcers

Introduction: The effect on quality of life by healing leg ulcers is not known and no validated disease-specific tool is available for measuring health-related quality of life (HRQoL) for people with venous leg ulcers. The objective of this paper was to compare four generic instruments [MOS 36-Item Short-Form Health Survey (SF-36); EuroQol (EQ); McGill Short Form Pain Questionnaire (SF-MPQ) and the Frenchay Activities Index (FAI)] used for measuring HRQoL in people with venous leg ulcers, and to offer guidance on the most appropriate tool for researchers. Methods: Two hundred and thirty-three patients with venous leg ulcers were recruited as part of a randomised controlled trial of the cost-effectiveness of community leg ulcer clinics. Subjects completed questionnaires containing the four instruments on three occasions (initial assessment, 3 and 12 months). The discriminative and evaluative properties of the four instruments were compared. Results: All four instruments were acceptable to patients, taking a mean of 19.3 (SD 6.3) min to complete. At initial assessment, the SF-MPQ had poorer discriminative properties than the other three instruments and was not able to distinguish between the different patient groups in relation to age and ulcer duration. The FAI was good at discriminating between the different patient groups (at initial assessment) in relation to age, mobility and ulcer size. At the three-month follow-up, the SF-MPQ was more responsive than the other measures and detected changes in HRQoL, whereas the EQ and SF-36 did not. At 12 months, the SF-MPQ still identified differences and the SF-36 and EQ also did at this stage. Conclusion: In the absence of a validated condition-specific tool for measuring changes in general health status for patients with venous leg ulcers, we make the following recommendations. For evaluating the outcome of interventions with a short-term follow-up (three months) in a clinical study we recommend the SF-MPQ and for 12-month follow-up in a clinical study the SF-36, with or without the SF-MPQ.     

Gender differences in health-related quality of life in patients with HIV/AIDS

Background: In studies evaluating the general US population, patients in primary care, and patients with chronic conditions, women consistently report poorer health-related quality of life (HRQoL) than men; however, studies evaluating HRQoL in patients with HIV/AIDS have not completely corroborated those findings. The objective of this study was to evaluate gender differences in HRQoL for participants in a large randomized trial comparing antiretroviral regimens. Methods: AIDS Clinical Trials Group (ACTG) 320 was a randomized, blinded, placebo-controlled trial comparing the 3-drug regimen of indinavir + zidovudine (or stavudine) + lamivudine with the 2-drug combination of zidovudine (or stavudine) + lamivudine in subjects with CD4 cell counts less than 200 cells/l and no prior treatment with protease inhibitors. Nine quality of life domains scored on 0–100 scales were assessed using the ACTG QOL 601-602 Health Survey at 3 points in the trial: baseline, 24 weeks and 40 weeks. Differences between men and women in HRQoL scores were assessed using the Wilcoxon rank-sum test and generalized estimating equation (GEE) models. Results: Overall, 202 females and 976 males were randomized to one of two treatment arms. Female participants were more likely to be black or Hispanic and tended to be younger. At baseline, females reported lower HRQoL scores than males in all of the domains except social functioning, and at week 40, women scored lower in all of the domains except overall health. In repeated measures models, women were found to score lower in all HRQoL domains except overall health, with significant differences of 3.5–6.7 points in 3 of the 9 quality of life domains: physical functioning, pain, and energy/fatigue. HRQoL scores improved for participants in the study over time and in response to potent treatment, and the improvements were similar for men and women. Conclusions: Women with HIV/AIDS report substantially poorer HRQoL than men with HIV/AIDS in several HRQoL domains. However, changes in domain scores over time and in response to treatment do not differ significantly by gender, implying that changes in domain scores may be better HRQoL outcomes to compare between HIV-infected men and women in clinical trials than mean domain scores.     

乌鲁木齐市老年结核患者健康相关生命质量评价

目的 了解乌鲁木齐市老年结核病患者的生命质量状况。方法 选取2016年4月 - 2017年4月乌鲁木齐市204名60岁以上确诊结核病人,根据年龄、性别、民族1∶2匹配对照组,采用SF - 36量表进行问卷调查并收集两组基本信息,采用统计分析系统SAS 9.4软件对数据进行多重线性回归分析影响老年结核病患者生命质量的因素。结果 SF - 36量表各维度评分显示除BP维度（z = 1.064,P = 0.288）外,其余维度及PCS、MCS、总评分上2组差异均有统计学意义（P＜0.05)。单因素分析,性别、文化程度、退休前职业、婚姻状况、个人收入、独居、饮酒、吸烟、体育锻炼、糖尿病史和冠心病史对老年结核患者的生命质量有不同程度的影响。多重线性回归显示个人收入会影响BP和MH维度（F = 4.38,P = 0.038和F = 7.60,P = 0.006）,独居是GH的影响因素（与配偶居住F = 9.29,P = 0.003;与子女居住F = 5.92,P = 0.016）,吸烟会影响RE、MCS和总评分（F = 4.89,P = 0.028;F = 8.71,P = 0.004和F = 7.21,P = 0.008）,冠心病史是PF、RP的影响因素（F = 9.01,P = 0.003;F = 5.74,P = 0.018）,而体育锻炼会影响PF、PCS及总评分（F = 29.09,P＜0.001;F = 8.62,P = 0.004;F = 6.50,P = 0.012）。结论 老年肺结核患者的健康相关生命质量较低,相关因素的改善有助于提高老年肺结核患者的生命质量。     

The impact of denial on health-related quality of life in patients with HIV

Background/purpose

The purpose of this study was to examine the influence of denial coping on quality of life (QOL) over time among individuals living with HIV, as denial has been understudied as a coping strategy within the literature on HIV/AIDS.

Methods

In a sample of 65 adult men and women, we used multilevel linear modeling to test trajectories of change in physical and mental health-related QOL across baseline, 3, 6, and 12?months, including denial as a predictor and gender as a moderator.

Results

The use of denial coping was associated with lower physical and mental health-related QOL at baseline. Denial coping predicted an increase in QOL over time, though QOL remained low in those who practiced denial coping. Men??s baseline mental health-related QOL was more negatively affected by denial coping than women??s. Women tended to increase in QOL more slowly over time compared to men.

Conclusion

Reliance on denial as a coping strategy is associated with poorer physical and mental health-related QOL in an HIV-positive population, though participants who engaged in denial also displayed more rapid improvement in their QOL over time. Men and women displayed different rates of improvement in QOL, indicating a need for gender-based treatment approaches. Future research should examine the complex role of denial on change in QOL.     

欧洲五维健康量表(EQ-5D)中文版应用介绍

  目的  了解上海市老年人健康相关生命质量及其影响因素,为提高老年人生存质量提供参考依据。  方法  收集上海市2013年第五次国家卫生服务调查数据,对上海市17个区县11 103名老年人的健康相关生命质量及其影响因素进行分析。  结果  上海市11 103名老年人中,欧洲五维健康量表（EQ-5D）健康描述系统行动能力、自我照顾能力、日常活动能力、疼痛或不舒服、焦虑或抑郁5个维度均没有任何困难者8 136人（73.28 %）,有极度困难者16人（0.14 %）。上海市老年人EQ-5D量表视觉模拟标尺（EQ-VAS）得分为0～100分,25 %分位数为70分,中位数为80分,75%分位数为85分。多因素分位数回归分析结果显示,婚姻状况已婚和丧偶、每天吸烟、饮酒 ≥ 1次/周、体育锻炼 ≥ 1次/周和1年内进行健康体检的EQ-VAS得分Q₅老年人得分较高,年龄 ≥ 70岁和患慢性病的EQ-VAS得分Q₅老年人得分较低;婚姻状况已婚和丧偶、饮酒 ≥ 1次/周、体育锻炼 ≥ 1次/周和1年内进行健康体检的EQ-VAS得分Q₂₅老年人得分较高,农业户口、年龄 ≥ 70岁、患慢性病和体育锻炼 < 1次/周的EQ-VAS得分Q₂₅老年人得分较低;女性、饮酒 ≥ 1次/周和体育锻炼 ≥ 3次/周的EQ-VAS得分Q₅₀老年人得分较高,年龄 ≥ 70岁和患慢性病的EQ-VAS得分Q₅₀老年人得分较低;婚姻状况已婚、离异和丧偶的EQ-VAS得分Q₇₅老年人得分较高,年龄 ≥ 70岁和患慢性病的EQ-VAS得分Q₇₅老年人得分较低;农业户口和患慢性病的EQ-VAS得分Q₉₅老年人得分较低。  结论  上海市老年人健康相关生命质量较好,户籍类型、年龄、婚姻状况、是否患慢性病、吸烟情况、饮酒情况、体育锻炼和1年内是否进行健康体检是该地区老年人健康相关生命质量的主要影响因素。     

Factors associated with health-related quality of life among hemodialysis patients in the DOPPS

Objective To identify modifiable factors associated with health-related quality of life (HRQOL) among chronic hemodialysis patients. Methods Analysis of baseline data of 9,526 hemodialysis patients from seven countries enrolled in phase I of the Dialysis Outcomes and Practice Patterns Study (DOPPS). Using the Kidney Disease Quality of Life Short Form (KDQOL-SF^TM), we determined scores for 8 generic scale summaries derived from these scales, i.e., the physical component summary [PCS] and mental component summary [MCS], and 11 kidney disease- targeted scales. Regression models were used to adjust for differences in comorbidities and sociodemographic and treatment factors. The Benjamini–Hochberg procedure was used to correct P-values for multiple comparisons. Results Unemployment and psychiatric disease were independently and significantly associated with lower scores for all generic and several kidney disease-targeted HRQOL measures. Several other comorbidities, lower educational level, lower income, and hypoalbuminemia were also independently and significantly associated with lower scores of PCS and/or MCS and several generic and kidney disease-targeted scales. Hemodialysis by catheter was associated with significantly lower PCS scores, partially explained by the correlation with covariates. Conclusion Associations of poorer HRQOL with preventable or controllable factors support a greater focus on psychosocial and medical interventions to improve the well-being of hemodialysis patients. An erratum to this article can be found at     

护理干预对急性心肌梗死患者PCI术前后生活质量的影响

目的分析护理干预对急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）手术前后生活质量的影响。方法将十堰市东风公司茅箭医院收治的120例AMI患者随机分为2组,即观察组60例,对照组60例。行PCI术治疗前后,对照组患者行常规护理措施,观察组患者在常规护理的基础上行系统化的护理干预措施,包括术前心理护理、健康宣教、基础准备;术后并发症护理包括功能康复及指导、社会支持。于2组患者入院时,行PCI术前1d及行PCI术后7～10d,采用生活质量综合评定量表（GQOLI-74）对2组患者的生活质量进行评估。同时,观察并统计2组患者术后心绞痛的发作次数、术后并发症的发生率及住院时间。结果、入院时,2组患者在平均躯体功能、社会功能、心理功能、物质生活状态4个维度得分比较上,差异无统计学意义（P〉0．05）;PCI术前1d及PCI术后7—10d,观察组患者4个维度得分均高于对照组（P〈0．01）。同时,观察组患者的术后平均心绞痛发作次数低于对照组,平均住院时间短于对照组（P〈0．01）。结论AMI患者行PCI术治疗前后,采取有效的护理干预能有效提高患者的生活质量。     

Adolescent health-related quality of life and perceived satisfaction with life

Purpose: To explore the relationship between perceived satisfaction with life and health-related quality of life (HRQOL) in a state-wide sample of 13–18-year-old adolescents (n=4914) in South Carolina, USA. Methods: Questions were added to the self-report Centers for Disease Control (CDC) Youth Risk Behavior Survey (YRBS) asking about perceived life satisfaction in six domains (self, family, friends, living environment, school, and overall) and HRQOL (self-rated health; and the number of poor physical health days, poor mental days, and activity limitation days during the past 30 days). Results: Adjusted logistic regression analyses and multivariate models constructed separately revealed that self-rated health, poor physical days (past 30 days), poor mental health days (past 30 days), and activity limitation days (past 30 days) were significantly related (p < 0.05) to reduced life satisfaction, regardless of race or gender. Moreover, as the number of reported poor health days increased, the greater the odds of reporting life dissatisfaction. Conclusions: This is the first study to document the relationship between poor physical health and perceived life satisfaction. This adds to the mounting evidence that life satisfaction is related to a variety of adolescent health behaviors and that life satisfaction may add additional information in longitudinal databases that track adolescent health because it appears to be related to HRQOL.     

Validation of the EQ-5D quality of life instrument in patients after myocardial infarction

Background: We assessed cross-sectional validity of EQ-5D after myocardial infarction (MI). Methods: We compared EQ-5D, SF-36, quality of life After MI (QLMI), and Canadian Cardiovascular Society Anginal Classification (CCSG) scores. Correlation and regression techniques were used to assess convergent validity. SF-36 and alternate Rand-36 scoring were compared. CCSG class was used to evaluate discriminative validity and clinical difference in health state scores. Results: Of 99 patients: mean age 64; median 176.5 days post-MI; 80% had one MI; 74% were CCSG I. 1/3 to 1/2 reported mobility, self-care, pain, and emotional difficulties on EQ-5D. Median health state was 0.73. EQ-5D and SF-36 (or Rand-36) strongly correlate in overall health (0.75), emotional health (0.75), pain (0.68), and activity/ functional (0.5–0.63). EQ-5D and QLMI strongly correlate in activities/ self esteem (0.56), emotional health (0.64), anxiety/depression – restriction (0.53), and overall health (0.5–0.57). EQ-5D self-care correlates weakly with all domains. Domain scores from each general instrument contributed to each other’s overall health score (adjusted R² 0.61–0.69) and to disease specific score (0.45 adjusted R²). EQ-5D discriminates among CCSG classes (p < 0.000). Physicians detected a 0.16 difference in health state scores. Conclusion: The EQ-5D provides valid general HrQOL measurement post-MI.     

Clinical correlates of health-related quality of life among opioid-dependent patients

Purpose  

Previous work suggests that opioid users have lower health-related quality of life (HRQOL) than patients with more prevalent chronic illnesses such as hypertension or diabetes. Although comparisons with population norms are informative, studies of the correlates of HRQOL for opioid users are needed to plan clinical services.     

The prognostic value of health-related quality of life in patients with Chagas heart disease

Quality of Life Research - To verify the prognostic value of health-related quality of life (HRQoL) and the differences in HRQoL and clinical variables between groups of Chagas heart disease (CHD)...     

Association between patient education and health-related quality of life in patients with Parkinson's disease

BACKGROUND: Providing patients with disease- and treatment-related information is an important role of medical staff and is now reimbursed in Japan by the national health insurance system under the rubric 'patient education'. Evaluation of the effectiveness of patient education programs is necessary to ensure that limited health care resources are used efficiently. OBJECTIVE: The objective is to determine whether educating patients with Parkinson's disease (PD) is related to better health-related quality of life (HRQOL). DESIGN: A cross-sectional study was conducted. SETTING: Members of the Japan Association of Patients with Parkinson's disease were randomly selected. PARTICIPANTS: A total of 1200 patients with PD were asked to fill in written questionnaires and replies from 762 (63.5%) were analyzed. MEASUREMENTS: The questionnaire inquired about clinical characteristics, comorbidity, symptoms of PD, complications of therapy, HRQOL, and patient education. SF-36 was used to assess HRQOL. The section on patient education comprised one question each on patient-perceived satisfaction with information provided on (1) disease condition and pathophysiology, (2) effectiveness of drug therapy, (3) adverse drug reactions, (4) publicly available financial and social resources, and (5) rehabilitation and daily activities. Patient education score was defined as the sum of the individual scores for these five questions. The relationships between scores on the SF-36 subscales and the patient education score were examined. RESULTS: More satisfaction with patient education was associated with higher scores in all SF-36 subscales except physical functioning and bodily pain. The difference in score between the most satisfied and the least satisfied patients ranged from 8.4 points on the subscales of general health and 16.7 points on the subscale of role limitation due to emotional problems. CONCLUSION: The conclusion that patient education is associated with better HRQOL in patients with PD is drawn.     

Oral health-related quality of life of patients after heart transplantation and those with heart failure is associated with general health-related quality of life: a cross-sectional study

Quality of Life Research - The aim of this cross-sectional study was to examine the oral health-related quality of life (OHRQoL) in patients after heart transplantation (HTx) and those with heart...     

Long-term health-related quality of life after surgery in patients with chronic thromboembolic pulmonary hypertension

Quality of Life Research - To assess the dynamic of various health-related quality of life (HRQoL) parameters 3&nbsp;years after pulmonary thromboendarterectomy (PTE), and to identify factors...     

The relationship between insomnia and health-related quality of life in patients with chronic illness

OBJECTIVES: To determine the association between insomnia and health-related quality of life (HRQOL) in patients with chronic illness after accounting for the effects of depression, anxiety, and medical comorbidities. STUDY DESIGN: We used a cross-sectional analysis of Medical Outcomes Study (MOS) data. POPULATION: The sample consisted of 3445 patients who completed a self-administered questionnaire and who were given a diagnosis of 1 or more of 5 chronic medical and psychiatric conditions by an MOS clinician. Patients were recruited from the offices of clinicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry in 3 US cities. OUTCOMES MEASURED: Outcomes were sleep items, health-related quality of life as measured by the Medical Outcomes Study Short Form Health Survey (SF-36), chronic medical comorbidity, depression, and anxiety. Insomnia was defined as the complaint of difficulty initiating or maintaining sleep. RESULTS: Insomnia was severe in 16% and mild in 34% of study patients. Patients with insomnia demonstrated significant global decrements in HRQOL. Differences between patients with mild insomnia versus no insomnia showed small to medium decrements across SF-36 subscales ranging from 4.1 to 9.3 points (on a scale of 0 to 100); the corresponding decrements for severe insomnia (versus no insomnia) ranged from 12.0 to 23.9 points. CONCLUSIONS: Insomnia is independently associated with worsened HRQOL to almost the same extent as chronic conditions such as congestive heart failure and clinical depression.     

Counseling interventions delivered in women with breast cancer to improve health-related quality of life: a systematic review

Background

Higher survival rates for breast cancer patients have led to concerns in dealing with short- and long-term side effects. The most common complications are impairment of shoulder functions, pain, lymphedema, and dysesthesia of the injured arm; psychological consequences concern: emotional distress, anxiety, and depression, thereby, deeply impacting/affecting daily living activity, and health-related quality of life.

Objective

To perform a systematic review for assessing the efficacy or effectiveness of interventions aiming at improving health-related quality of life, return to daily activity, and correct lifestyles among breast cancer patients.

Methods

A literature search was conducted in December 2016 using the databases PubMed and Scopus. Search terms included: (counseling) AND (breast cancer) AND (quality of life). Articles on counseling interventions to improve quality of life, physical and psychological outcomes were included.

Results

Thirty-five articles met the inclusion criteria. The interventions were grouped in five main areas: concerning lifestyle counseling interventions, related to combined interventions (physical activity and nutritional counseling), physical therapy, peer counseling, multidisciplinary approach, included psychological, psycho-educational interventions, and cognitive-behavior therapy (CBT). Exercise counseling as well as physical therapy are effective to improve shoulder mobility, healing wounds, and limb strength. Psychological therapies such as psychoeducation and CBT may help to realize a social and psychological rehabilitation.

Conclusion

A multidisciplinary approach can help in sustaining and restoring impaired physical, psychosocial, and occupational outcomes of breast cancer patients.