Quality of life among parents of children with autistic disorder: A sample from the Arab world

BackgroundA growing body of research has sought to examine issues associated with the Quality of Life (QoL) of parents of children with Autistic Disorder. However, no studies have examined the QoL of Arab parents whose parenting experience is expected to be substantially different from that of their western counterparts. Therefore, the purposes of this study were: (1) to examine differences in the QoL between fathers and mothers of children with Autistic Disorder in a sample from an Arab country, and (2) to examine the psychosocial correlates of the QoL of Arab parents of children with Autistic Disorder.MethodsSelf-administered questionnaires on parents’ QoL, stress, coping strategies, and demographic characteristics were completed by 184 parents of children with Autistic Disorder. The participants were recruited using the convenience sampling design.ResultsFathers and mothers of children with Autistic Disorder showed no significant differences in their physical, psychological, social, and environmental health. Further, both parents showed almost similar bivariate correlations between the reported QoL levels and their parenting stress, coping strategies, and demographic characteristics.ConclusionThis is the first study to examine the QoL of parents of children with Autistic Disorder in the Arab world and, in doing so, it highlighted the distinct lack of research in this area. The QoL of Arab parents of children with Autistic Disorder crosses lines with their stress levels, coping strategies, demographic characteristics, and to some extent their cultural context.     

Validity of standard gamble estimated quality of life in acute venous thrombosis

Introduction

The standard gamble is considered the ‘gold standard’ technique for measuring quality of life. We recently used the standard gamble to estimate quality of life in acute venous thrombosis, and found unexpected variability in the responses. The current study aimed to explore the reasons for variability by comparing the standard gamble technique in patients with acute venous thrombosis to other quality of life measurement tools.

Materials and Methods

Thrombosis clinic patients treated for venous thrombosis were eligible to participate. Patients evaluated their current health state by performing a standard gamble interview, reporting on a visual analogue scale, completing the SF-36 and disease specific questionnaires (PEmb-Qol and VEINES-QOL/Sym). Validity was assessed by correlating the standard gamble utilities with the other methods. Test-retest reliability, responsiveness and acceptability were also assessed.

Results

Forty-four patients were interviewed, with 16 attending for a repeat interview. The median standard gamble utility was 0.97 (0.84-1.0), SF-6D 0.64 (0.59 - 0.80) and visual analogue score 70 (60 - 80). Participants with pulmonary embolism had lower standard gamble estimates than those with deep vein thrombosis. There was good discriminant validity in that the standard gamble estimates were not associated with risk taking behavior, negative outlook, sex or education. Test-retest reliability with the standard gamble was moderate and there was evidence of a ceiling effect.

Conclusions

Standard gamble utilities are higher than other methods of measuring quality of life in venous thrombosis. The choice of utility values adopted in studies will impact on future economic studies.     

家庭肠内营养对改善晚期胃癌患者生活质量的应用价值

目的研究家庭肠内营养（HEN）对晚期胃癌患者改善生活质量的意义。方法回顾性分析浙江省人民医院胃肠外科2010年6月1日至2012年6月1日连续收治的60例无法手术切除及复发转移的晚期胃癌患者的病历资料,根据是否进行HEN分为肠内营养（EN）组（25例）和对照组（35例）。EN组营养支持方式包括经空肠造瘘管EN、经鼻胃肠管完全或部分EN;对照组中存在胃癌伴梗阻的患者进行全肠外营养（TPN）,其余患者完全经口饮食。在持续1年的随访过程中,分别于第1、3、6和12月进行Kamofsky评分和Spitzer指数测定。第6月时行EORTCQLQ—c30评分。全组患者均接受FLOFOX4方案（奥沙利铂、四氢叶酸钙、氟尿嘧啶）静脉化疗。结果两组患者在基线资料方面差异无统计学意义。1年随访期间,两组共有53例患者死亡,其中EN组21例,对照组32例。KamoHky评分结果显示,EN组在第3、6、12月的评分结果分别为平均57．4、39．6和28．2,明显优于对照组的平均45．3、29．2和20．1（分别为P=0．041、P=0．012和P=0．015）。Spitzer评分结果显示,EN组在第3、6、12月的评分结果分别为5．12、4．04和2．54,也明显优于对照组的4．32、3．21和1．97（分别为P=0．048、P=0．035和P=0．024）。EROTCQLQ-30评分结果显示,EN组在功能量表方面同样均明显优于对照组（均P〈0．05）,“呼吸费力”、“疼痛”和“疲劳”阳性症状较对照组轻（分别为P=0．025、P=0．044和P=0．016）;但“腹泻”症状较对照组明显（P=0．047）。结论HEN作为一项营养干预措施,能在有限的生存期内改善晚期胃癌患者的生活质量。     

光动力疗法治疗酒渣鼻的疗效

目的观察光动力疗法（photodynamictherapy,PI）T）治疗不同类型酒渣鼻的疗效及其安全性。并与外用10％磺胺醋酰钠、5％硫磺复合霜剂的疗效对比,确定两种治疗方法的优劣。方法酒渣鼻患者43例,随机分为2组,其中23例为PDT组,20例为外用药组。PDT组每7～10d行PDT治疗1次,共治疗3次;外用药组每日用药治疗2次。连续30d。治疗前后拍照片存档,医师根据照片单盲评价症状改薄程度,皮损减轻60％以上视为治疗有效;患者自我记录不良反应,并评价其严承程度;治疗前后要求患者填写皮肤病生活质量指标量表,评价生活质量改善程度。结果PDT组治疗1个月后,总有效牢为65％,其中丘疹脓疱型患者有效率为71％,红斑毛细血管扩张型患者有效,卒为50％;外用药组治疗总有效率为35％。PDT组和外用药组治疗总有效率差异有统计学意义（P％0．05）。PI）T组患者生活质量改善程度优于外用药组;PDT治疗和外用药治疗均没有不可逆性不良反应产生。结论PDT治疗酒渣鼻安全有效,可明显改善患者生活质量,出现的不良反应少且可逆。     

Cost and logistics of implementing a tissue-based American College of Surgeons/Association of Program Directors in Surgery surgical skills curriculum for general surgery residents of all clinical years

Background

The cost and logistics of deploying the American College of Surgeons (ACS)/Association of Program Directors in Surgery (APDS) National Technical Skills Curriculum across all training years are not known. This information is essential for residency programs choosing to adopt similar curricula.

Methods

A task force evaluated the authors' institution's existing simulation curriculum and enhanced it by implementing the ACS/APDS modules. A 35-module curriculum was administered to 35 general surgery residents across all 5 clinical years. The costs and logistics were noted, and resident satisfaction was assessed.

Results

The annual operational cost was $110,300 ($3,150 per resident). Cost per module, per resident was $940 for the cadaveric module compared with $220 and $240 for dry simulation and animal tissue–based modules, respectively. Resident satisfaction improved from 2.45 to 4.78 on a 5-point, Likert-type scale after implementing the ACS/APDS modules.

Conclusions

The ACS/APDS skills curriculum was implemented successfully across all clinical years. Cadaveric modules were the most expensive. Animal and dry simulation modules were equivalent in cost. The addition of tissue-based modules was associated with high satisfaction.     

Is NSQIP Pediatric review representative of total institutional experience for children undergoing appendectomy?

Background/purpose

NSQIP Pediatric (NSQIP-P) is a robust quality improvement effort. A limitation of the NSQIP process lies in capturing a small proportion of the total case volume. This study examines whether appendectomies captured by NSQIP-P are concordant with all appendectomies, the most commonly captured procedure in 2011.

Methods

We compared case mix and 30-day outcomes between children undergoing an appendectomy who were included in NSQIP (n = 80) and children not captured by NSQIP (n = 276) during 2011 at a tertiary referral children’s hospital. A single surgical case reviewer reviewed all cases using NSQIP-P methodology.

Results

NSQIP-P captured 80 of a total of 356 appendectomies (22%). The case mix was similar between NSQIP and non-NSQIP groups (e.g., 31% of each group had complicated appendicitis). Outcomes were also similar; post-operative occurrences, readmissions and return to the operation room occurred at rates of 7.5% vs. 7.6%, 5% vs. 4.7%, and 3.8% vs. 4.3% respectively.

Conclusion

Although NSQIP-P captured a minority of the total patient population that had an appendectomy, the case mix and outcomes were similar. Our results offer reassurance that NSQIP-P data are representative of the larger population for this procedure. Whether this concordance exists for procedures less commonly performed is unknown and a focus of ongoing work.     

Optimal resources for children's surgical care

We will discuss a new initiative of the American College of Surgeons and the American Pediatric Surgical Association to prospectively define optimal resource standards for children’s surgical care.