The effect of treatment on quality of life in psoriasis patients

Psoriasis is a chronic skin disease with substantial impact on patients' social and relational ways of living and subsequently on their quality of life. The aim of this study was to evaluate the health-related quality of life (HRQoL) of patients with moderate to severe psoriasis treated with short contact dithranol treatment, UVB phototherapy or inpatient dithranol treatment. HRQoL was evaluated in an open randomized multicentre study by appliance of the Dutch short form of the Sickness Impact Profile and the Psoriasis Disability Index; 250 patients were included. Successful short contact dithranol treatment and UVB phototherapy both led to a comparable improvement in HRQoL immediately after treatment until the end of the follow-up (maximum 1 year). Inpatients experienced a more impaired HRQoL and showed no significant improvement in HRQoL directly following treatment. At the end of the study HRQoL became comparable for all treatment groups.All three treatments led to substantial improvement in HRQoL; however, patients treated by short contact treatment or UVB showed a better HRQoL than inpatients.     

On mouse and man: neutrophil gelatinase associated lipocalin is not involved in apoptosis or acute response

Neutrophil gelatinase-associated lipocalin (NGAL) is a siderphore binding molecule present in the specific granules of neutrophils and induced in a variety of epithelial cells during inflammation. Its mouse orthologue, 24p3, is also an acute phase protein synthesized in the liver and adipose tissue during inflammation. 24p3 has recently been implicated in apoptosis of myeloid cells. We investigated whether similar features are characteristics of NGAL. First, isolated normal myeloid bone marrow cells were incubated with NGAL for 6 and 24 hr and analyzed for apoptosis by annexin V binding and by propidium iodide labeling. We found no indication that NGAL induces significant apoptosis in myeloid cells. Second, a human sepsis model where normal volunteers were given endotoxin 2 ng/kg intravenously, showed no evidence that NGAL is an acute phase protein. The plasma level of NGAL reflected the number of circulating neutrophils and was completely different from the kinetics of C-reactive protein. We thus conclude that major differences exist between mouse and man with regards to the role of this lipocalin in myelopoiesis and inflammation.     

The bone-anchored hearing aid: quality-of-life assessment

OBJECTIVES: To assess the impact of a bone-anchored hearing aid (BAHA) on the quality of life (QOL) of adults and to test the hypothesis that a BAHA improves QOL because otorrhea and/or skin irritations decrease. DESIGN: Prospective postal-based questionnaire study using validated health-related QOL instruments, combined with hearing-aid-related questions. PATIENTS AND METHODS: The study included 56 consecutive adult patients with acquired conductive or mixed hearing loss who were scheduled for BAHA implantation at the University Medical Centre Nijmegen, Nijmegen, the Netherlands. All 56 patients completed the 36-Item Short-Form Health Survey (SF-36), the EuroQol-5D (EQ-5D), and the Hearing Handicap and Disability Inventory (HHDI); 36 patients had been using an air-conduction hearing aid (ACHA) and 20 patients a conventional bone-conduction hearing aid (CBHA). Questionnaires were filled out before surgery and after 6 months of experience with the BAHA. RESULTS: In the SF-36 group, there was significant improvement in the scores of the mental health domain (P =.02). When the SF-36 patients were classified according to previous hearing aid, there was no statistically significant change in the scores in any of the domains. In the EQ-5D group and in its ACHA and CBHA subgroups, there were no important differences in the results before and after the patients received their BAHAs. In the HHDI group, the handicap and disability scales showed significant improvement (P<.01) irrespective of the type of previously worn hearing aid. CONCLUSIONS: Overall, generic health-related QOL was not influenced significantly by the use of a BAHA according to the SF-36 and the EQ-5D. The more disease-specific scales (HHDI) did show improved QOL with a BAHA.     

Cancer recurrence after total laryngectomy: treatment options, survival, and complications

BACKGROUND: A follow-up schedule to detect asymptomatic cancer recurrence is offered to all patients with laryngeal cancer. In this study, the therapeutic options, prognosis, and morbidity of patients with total laryngectomy, who were found to have cancer recurrence during this follow-up schedule were determined. METHODS: Patients who had undergone a total laryngectomy between January 1, 1990, and January 1, 2000, and had cancer recurrence were included. Data from this group were analyzed retrospectively. RESULTS: The prognosis was poor after the development of cancer recurrence. Curative therapy could only be offered to 27.5% of these patients. Only 5% of the patients were disease free at the end of the study period. Many patients with cancer recurrence needed interventions. A large proportion of them had complications. CONCLUSIONS: The follow-up schedule offered to patients after total laryngectomy should put greater emphasis on care than on early detection of cancer recurrence.     

Screening for second primary lung cancer after treatment of laryngeal cancer

OBJECTIVES/HYPOTHESIS: As a result of smoking, patients who have received curative treatment for laryngeal cancer run a high risk of developing lung cancer. Therefore, these patients enter a screening program that aims to detect lung cancer at an asymptomatic stage. The study evaluated whether screening for lung cancer by means of regular chest x-ray examinations contributed to prolonging survival. STUDY DESIGN: A longitudinal follow-up study was performed to analyze the survival of patients who had received curative treatment for squamous cell laryngeal cancer and developed lung cancer during the follow-up period. METHODS: Patients with lung cancer were divided into two groups: 1) patients with asymptomatic screen-detected lung cancer and 2) patients with complaints indicating lung cancer, whose tumor was detected in the interval between screening examinations by chest x-ray films. RESULTS: In the complete group of patients with laryngeal cancer, no prognostic factors could be identified for developing lung cancer. There was no prolongation of survival in the screen-detected asymptomatic lung cancer patients. The median survival of both groups was 56 months (P =.57). The date of detection of the lung cancer was clearly brought forward by screening; a difference of 8 months was found between the median detection date of the two groups (P <.001). There was no difference in tumor-specific mortality between the two groups. CONCLUSION: Screening by chest x-ray examination to detect lung cancer in an asymptomatic stage after curative treatment for squamous cell laryngeal cancer does not improve survival for patients who develop lung cancer.     

Prognostic impact of hs‐CRP and IL‐6 in patients with persistent atrial fibrillation treated with electrical cardioversion

Objective. The aim of this study was to assess the role of inflammatory processes in the development of atrial fibrillation (AF) and the prognostic impact of inflammatory markers in predicting long‐term risk of AF recurrence after electrical cardioversion (CV). Methods. High‐sensitivity C‐reactive protein (hs‐CRP) and interleukin‐6 (IL‐6) were measured in 56 patients with persistent AF (lasting mean 128 days (range 14–960), mean age 65 years (34–84)), 19 healthy volunteers and 19 patients with permanent AF. Patients with persistent AF underwent CV. Blood samples were taken prior to CV and after 1, 30 and 180 days. Results. The immediate success rate of CV was 88?%, while the total recurrence rate after 180 days was 68?%. Patients with permanent AF had significantly higher levels of hs‐CRP and IL‐6 than patients with persistent AF (p = 0.0011, p<0.001). Patients in sinus rhythm (SR) after 180 days had significantly lower baseline hs‐CRP (1.25?mg/L (0.5–2.4) versus 2.0?mg/L (0.9–3.3), p<0.001) and IL‐6 (1.96?pg/mL (1.35–2.7) versus 2.75?pg/mL (1.55–3.62), p<0.001) than patients with recurrent AF. Baseline IL‐6 was the only independent predictor of recurrent AF (p = 0.04) in a multivariate Cox analysis. Patients in the lowest hs‐CRP quartile (<0.8?mg/L) had significantly lower AF recurrence rates after 180 days (50?% versus 74?% in the other three quartiles combined; p = 0.0069). Conclusion. Patients with AF had elevated levels of inflammatory markers. Low hs‐CRP and IL‐6 prior to CV are associated with a lower risk of AF recurrence after CV.     

Frequency vs. intensity: which should be used as anchors for self-report instruments?

ABSTRACT: BACKGROUND: The aim of the present study was to investigate the usability of verbal rating scale anchors in patients suffering from a depressive episode and whether differences between frequency or intensity scales could be determined. Frequency and intensity terms were evaluated concerning their interindividual congruency, intraindividual stability across time, and distinguishability of adjacent terms. METHODS: In a longitudinal design, 44 patients (age M=39.1, SD=15.2, 68.2% female) with a depressive disorder filled out several established questionnaires (e.g. BDI or SCL-90) and questionnaires containing frequency and intensity terms which should be indicated by the percentage of time or intensity that is reflected by each term at two different measuring times within one week. Data analysis contained t-tests for paired samples and effect sizes d according to Cohen. RESULTS: Intensity terms showed weaker intraindividual stability across time as compared to frequency terms. Participants were able to reliably distinguish four frequency and intensity terms at both measuring times. Overall congruency between patients was larger for intensity terms in comparison to frequency terms. CONCLUSIONS: The present results indicate that both frequency and intensity terms can be applied as verbal anchors for clinical self-report scales. However, if longitudinal assessment is intended, our results indicate that frequency terms should be used as they showed slightly greater stability across time. Generally, the present study suggests that no more than four different verbal anchors should be used together in rating scales as especially older patients and those with low lexical experience would not be able to reasonably differentiate more than these.