延续护理对中晚期肝癌介入治疗后患者生活质量的影响

目的:探讨分析延续护理对中晚期肝癌介入治疗后患者生活质量的影响,并观测其应用的效果。方法:选取2016年3月至2017年8月在本院接受介入治疗的中晚期肝癌患者130例,随机分为对照组和观察组,每组65例,对照组采用一般护理方法进行护理,观察组采用延续护理的方法进行干预,比较观察两组患者护理后生活质量和护理满意度的效果。结果:预后过程中患者对运用不同护理方法后的满意度进行统计学分析,观察组患者满意明显高于对照组,满意度分别为86.15%与63.08%,差异显著(P<0.05),具有统计学意义。结论:延续护理应用于介入治疗的中晚期肝癌的患者有效的改善了患者的身心健康,提高了患者的生活质量,值得推广应用。

Quality of life in end stage renal disease patients

AIM： To understand factors associated with quality of life （QOL）, examine types of QOL instruments, and determine need for further improvements in QOL assessment.METHODS： The method used databases （Pubmed, Google scholar） and a bibliographic search using key words QOL, end stage renal disease, Hemodialysis, Peritoneal dialysis, instruments to measure QOL, patients and qualitative/quantitative analysis published during 1990 to June 2014. Each article was assessed for sample size, demographics of participants, study design and type of QOL instruments used. We used WHO defnition of QOL. RESULTS： For this review, 109 articles were screened, out of which 65 articles were selected. Out of 65 articles, there were 19 reports/reviews and 12 question-naire manuals. Of the 34 studies, 82% were quantita-tive while only 18% were qualitative. QOL instruments measured several phenomenon such as physical/psychological health, effects and burdens of kidney dis-ease, social support etc. those are associated with QOL. Few studies looked at spiritual beliefs, cultural beliefs, personal concerns, as per the WHO defnition. Telemedicine and Palliative care have now been successfully used however QOL instruments seldom addressed those in the articles reviewed. Also noticed was that longitudinal studies were rarely conducted. Existing QOL instruments only partially measure QOL. This may limit validity of predictive power of QOL. CONCLUSION： Culture and disease specific QOL in-struments that assess patients’ objective and subjective experiences covering most aspects of QOL are urgently needed.

Reliability and validity of Chinese version of a tool to assess the quality of life in idiopathic pulmonary fibrosis in patients with interstitial lung disease

Objective:This paper aims to determine the reliability and validity of the Chinese version of a tool that assesses the quality of life in idiopathic pulmonary fibrosis(cATAQ-IPF)in patients with interstitial lung disease(ILD).Methods:We used the process of scale introduction to establish cATAQ-IPF.The content validity of the scale was evaluated by six experts.A total of 92 patients with ILD completed the cATAQ-IPF,St.George's respiratory questionnaire(SGRQ),and The Medical Research Council dyspnoea scale at the baseline,and 15 patients completed cATAQ-IPF at the follow-up period 2 weeks later.Thus,yielding data were used to assess various psychometric properties of cATAQ-IPE Intraclass correlation coefficient(ICC),Cronbach'sαcoefficient,content validity index(CVI),item-level CVI(I-CVI),Pearson's coefficients,criterion-relation validity,and known-group validity were used for data analysis.Results:The cATAQ-IPF showed excellent test-retest reliability(ICC=0.95),except for the therapy domain(Cronbach'sα=0.60)and acceptable internal consistency(Cronbach'sα=0.96 for the total).The scale-level CVI was 0.80,and the I-CVI was in the range of 0.78-1.00.The total cATAQ-IPF score was strongly correlated with the SGRQ total score(r=0.71,P<0.01).The cATAQ-IPF score of patients with ILD was 250.74±47.39,and that of patients with IPF was 287.90±22.56.Patients with IPF possessed considerable impairments in health-related quality of life according to the cATAQ-IPF score(t=4.94,P<0.01).Conclusions:The cATAQ-IPF is a reliable and valid instrument for the evaluation of quality of life of Chinese patients with various forms of ILD.

Drug therapy for heart failure in older patients —what do they want？

Chronic heart failure （CHF） is predominantly seen in older patients, and therefore real life medicine often requires the extrapolation of findings from trials conducted in much younger populations. Prescribing patterns and potential benefits in the elderly are heavily influenced by polypharmacy and co-morbid pathologies. Increasing longevity may become less relevant in the frail elderly, whereas improving quality of life （QoL） often becomes priority; the onus being on improving wellbeing, maintaining independence for longer, and delaying institution- alisation. Specific studies evaluating elderly patients with CHF are lacking and little is known regarding the tolerability and side-effect profile of evidence based drug therapies in this population. There has been recent interest on the impact of heart rate in patients with symptomatic CHF. Ivabradine, with selective heart rate lowering capabilities, is of benefit in patients with CHF and left ventricular systolic dysfunction in sinus rhythm, resulting in reduction of heart failure hospitalisation and cardiovascular death. This manuscript will focus on CHF and the older patient and will discuss the impact of heart rate, drug therapies and tolerability. It will also highlight the tmmet need for specific studies that focus on patient-centred study end points rather than mortality targets that characterise most therapeutic trials. An on-going study evalu- ating the impact of ivabradine on QoL that presents a unique opportunity to evaluate the tolerability and impact of an established therapy on a wide range of real life, older patients with CHF will be discussed.

Impact of body mass index and gender on quality of life in patients with gastroesophageal reflux disease

AIM： To investigate the symptom presentation and quality of life in obese Chinese patients with gastro- esophageal reflux disease （GERD）. MKTHODS： Data from patients diagnosed with GERD according to the Montreal definition, were collected between January 2009 to March 2010. The enrolled patients were assigned to the normal [body mass in- dex （BMI） 〈 25 kg/m2], overweight （25-30 kg/m2）, and obese （BMI 〉 30 kg/m2） groups. General demographic data, endoscopic findings, and quality of life of the three groups of patients were analyzed and compared.and 15 patients were classified in the normal, over- weight, and obese, respectively. There was significantly more erosive esophagitis （73.3% vs 64.3% vs 39.2%, P = 0.002）, hiatal hernia （60% vs 33.9% vs 16.7%, P = 0.001）, and males （73.3% vs 73.2% vs 32.4%, P = 0.001） in the obese cases. The severity and frequency of heartburn, not acid regurgitation, was positively cor- related with BMI, with a significant association in men, but not in women. Obese patients were prone to have low quality of life scores, with obese women having the lowest scores for mental health. CONCLUSION： In patients with GERD, obese men had the most severe endoscopic and clinical presenta- tion. Obese women had the poorest mental health.

Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia

Diamantis G, Scarpa M, Castoro C, Ancona E and Battaglia G designed the research; Diamantis G, Scarpa M, Bocus P, Realdon S and Castoro C performed the research; Castoro C, Ancona E and Battaglia G contributed analytic tools; Diamantis G, Scarpa M, Bocus P, Realdon S and Castoro C analyzed the data; Diamantis G and Scarpa M wrote the paper; all authors revised and approved the final version of the manuscript.

Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction

AIM:To compare postoperative quality of life (QOL) in patients with gastric cancer treated by esophagogastrostomy reconstruction after proximal gastrectomy.METHODS: QOL assessments that included functional outcomes (a 24-item survey about treatment-specific symptoms) and health perception (Spitzer QOL Index) were performed in 149 patients with gastric cancer in the upper third of the stomach, who had received proximal gastrectomy with additional esophagogastrostomy.RESULTS: Fifty-four patients underwent reconstruction by esophagogastric anterior wall end-to-side anastomosis combined with pyloroplasty (EA group); 45 patients had reconstruction by esophagogastric posterior wall end-to-side anastomosis (EP group); and 50 patients had reconstruction by esophagogastric end-to-end anastomosis (EE group). The EA group showed the best postoperative QOL, such as recovery of body weight, less discomfort after meals, and less heart burn or belching at 6 and 24 mo postoperatively. However, the survival rates, surgical results and Spitzer QOL index were similar among the three groups.CONCLUSION: Postoperative QOL was better in the EA than EP or EE group. To improve QOL after proximal gastrectomy for upper third gastric cancer, the EA procedure using a stapler is safe and feasible for esophagogastrostomy.

Quality of life and palliative care needs of elderly patients with advanced heart failure

Objective To examine the quality of life and palliative care needs of elderly patients with advanced heart failure （HF）. Methods This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Patients who were aged 65 or over, diagnosed with HF of New York Heart Association Class III or IV symptoms, and mentally sound were eligible to the study. The Edmonton Symptom Assessment Scale, the overall quality of life single item scale, and the McQill Quality of Life Questionnaire （MQoL）, were used for measurement. Multi- ple regression analysis was performed to determine factors for predicting quality of life. Results A convenience sample of 112 patients was recruited. Their age was 81.5 ± 8.5 years. The three most distressing symptoms reported by the patients were tiredness （5.96 ± 2.78）, drowsiness （5.47± 2.93）, and shortness of breath （5.34 ± 2.96）. Their mean overall quality of life single item scale score was 4.72 ± 2.06 out of 10. The mean MQoL physical subscale score was the lowest （4.20 ± 1.767）, whereas their mean psychological subscale was the highest （7.14 ±2.39）. However, in a multivariate analysis model, quality of life was significantly associated with existential wellbeing, physical wellbeing, psychological wellbeing and educational level. Conclusions The findings highlight that spiritual concerns are significant palliative care needs among elderly patients with advanced HF, in addition to symptom management. This is in line with the argument that palliative care that places great emphasis on holistic care should be integrated to the care of this group of patients.

An unusual case of fatty liver in a patient with desmoid tumor

A desmoid tumor,also known as aggressive fibromatosis,is a rare benign neoplasm that arises from fascial or musculoaponeurotic tissues.It can occur in any anatomical location,most commonly the abdominal wall,shoulder girdle and retroperitoneum.The typical clinical presentation is a painless mass with a slow and progressive invasion of contiguous structures.It is associated with a high local recurrence rate after resection.Many issues regarding the optimal treatment of desmoid tumors remain controversial.Aggressive surgical resection with a wide margin(2-3 cm) remains the gold standard treatment with regard to preserving quality of life.Radiotherapy alone has been shown to be effective for the control of unresectable or recurrent lesions.Desmoid tumors tend to be locally infiltrative,therefore,the fields must be generous to prevent marginal recurrence.The radiation dose appropriate for treating desmoid tumors remains controversial.We present a 25-year-old Caucasian man with local recurrence of a desmoid tumor after repeated surgical resection,treated with radiotherapy.The patient achieved complete tumor regression at 4 mo after radiotherapy,and he is clinically free of disease at 12 mo after the end of treatment,with an acceptable quality of life.The patient developed short bowel syndrome as a complication of second surgical resection.Consequently,radiotherapy might have worsened an already present malabsorption and so led to steatohepatitis.

Analysis of the psychological conditions and related factors of breast cancer patients

Sufferers of breast cancer are often plagued by various psychological problems. Mastectomy, which has a serious influence on the female sex characteristics, can bring about especially serious psychological problems. These problems affect not only the patients’ quality of life but also the beginning, development, and end of the disease. This paper reviewed the relationships between the patients’ personal factors, the disease itself, treatment factors, and other socio-psychological factors and psychological conditions so as to provide new ideas for the psychological intervention on breast cancer patients, comprehensive clinical diagnosis and treatment, and prevention and cure.

The Quality of Life of Chinese Middle-Aged Male Patients with Gastric Carcinoma After Total Gastrectomy and Nursing Intervention

OBJECTIVE The purpose of this study was to evaluate the quality of life （QOL） in Chinese middle-aged male patients with gastric carcinoma after total gastrectomy, to investigate the factors affecting their QOL, and to Study the effectiveness of nursing intervention.METHODS Structured questionnaire （EORTC QLQ-C30） was used among 162 middle-aged male patients after total gastrectomy （the patients finished the whole process of chemotherapy, and returned home, and society） for data collection and reevaluate the patients＇ aualitv of life with 2 months nursing intervention.RESULTS The patient＇s quality of life was related to their education level, economic condition, family support, and pathological staging. This study showed that patients got higher scores in Functional scales （except for CF）, and lower scores in Symptom scales and single items （except for FI） after receiving intervention than before it was received before.CONCLUSION The study revealed that the QOL in middleaged male patients after total gastrectomy was worse when there was inadequate attention. After implementing pertinent nursing intervention implementing, patients＇ mental attitude and negative behavior were improved, and their QOL was enhanced after returning home and into society.

Analysis of results of two kinds of hemi-pelvic arthroplasty after wide resection of pelvic tumors

Objective The Patients with pelvic tumors were treated with tumor resection,hemi-pelvic allografting or artificial hemi-pelvic replacement for the improvement of their life quality.Methods Seven cases of pelvic tumor were treated with wide resection and hemi-pelvic allografting,and 35 cases with resection of pelvic tumors and artificial hemi-pelvic replacement.Results These 42 cases were all successfully operated upon without operative mortality.The results of long term following-up of 2.5 to 12 years(mean 5.4 years)showed that the increased and satisfactory functional recovery(50.0%).Conclusion Hemi-pelvic allografting or artificial hemi-pelvic replacement after wide resection of pelvic tumors can improve the survival rate of patients,as well as reconstruction of the pelvis and the hip joint with satisfactory function.

Importance of frailty and comorbidity in elderly patients with severe aortic stenosis

The progressive aging of the population has risen awareness and concern about the impact of geriatric syndromes on both clinical outcomes and health-related quality of life in elderly patients, as well as issues regarding the rising economic burden associated with healthcare. Recent studies have demonstrated frailty and other geriatric syndromes such as functionality, dependency and comorbidity can identify the most vulnerable patients, thus allowing to better estimate the individual prognosis in terms of disability, readmission and mortality. Such information should also be considered in the decision making process, ensuring the benefit derived from each treatment in each patient, optimizing the resources and avoiding futility.

Pharmaceutical Care of the Patients Suffering from Depression

Depression is the most present mental disorders with a very expensive treatment costs. Due to the high prevalence of depression in Bosnia and Herzegovina and high work load of psychiatrists, patients that suffer from depression are often marginalised, stigmatised and inadequately treated. Therefore, a pharmacist can influence an adequate selection of a therapy through an interdisciplinary approach and pharmaceutical care and alos provide patient monitoring, counselling about side effects and interactions of the prescribed drugs, which will in the end improve the quality of life for patients that suffer from depression. The aim of this work was to establish the influence of pharmaceutical care on the outcome of the quality of life and the pharmacological treatment of patients suffering from depression. Results showed that the involvement of pharmacist in a multidisciplinary approach to the treatment of depression lead to improvement of the effect of therapy and increased quality of life.

Improvements in quality of life in septuagenarians versus octogenarians undergoing trans-catheter aortic valve replacement

Background Very elderly patients represent a distinct patient group in clinical setting in terms of a decision for trans-catheter aortic valve replacement （TAVR） when one considers the potential improvement in the quality of life （QoL） on one hand and the benefit to risk ratio on the other. This study aimed to compare functional and QoL outcomes of TAVR between octogenarians and septuagenarians. Methods This prospective cohort study included 136 elderly patients （70 to 89 years of age）, who tmderwent Wansfemoral TAVR due to degenerative aortic stenosis. Patients were allocated into one of the following age groups： septuagenarians （n = 67） and octogenarians （n = 69）. Preoperative and early postoperative clinical parameteT：s were recorded. In addition, QoL of the patients was evaluated using SF-36 questionnaire preoperatively and six month postoperatively. Results Groups were similar in terms of early postoperative mortality and morbidity parameters. The mean New York Heart Association （NYHA） class improved after TAVR in both groups. In addition, all SF-36 norm-based scale and SF-36 summary scale scores improved significantly in both groups during the postoperative period. Postoperatively, physical functioning, general health and physical component summary scores were significantly better in the septuagenarian group （P = 0.02, 0.01, 0.03, respectively）. ConcLusion Although the improvement in the QoL in terms of physical health was more marked in septuagenarians than in octogenarians, substantial benefits on the QoL and particularly on mental health seem to justify re-consideration of TAVR indications in the very elderly.

老年髋关节置换术应用不同麻醉方式的价值探析

目的探讨老年髋关节置换术应用不同麻醉方式的价值。方法回顾2016年1月—2017年2月84例老年髋关节置换术患者并分组。对照组用全麻方式,研究组用腰硬联合麻醉方式。比较两组老年髋关节置换术麻醉优良率;麻醉起效时间、麻醉后心率、血压变化;麻醉不良事件出现率。结果研究组老年髋关节置换术麻醉优良率高于对照组,P<0.05;研究组麻醉起效时间、麻醉后心率、血压变化优于对照组,P<0.05;研究组麻醉不良事件出现率低于对照组,P<0.05。结论老年髋关节置换术应用腰硬联合麻醉的价值高,可更快起效,稳定生命体征,减少并发症发生,安全和可行性高。

Effect of modified Taohongsiwu decoction on patients with chemotherapy-induced hand-foot syndrome

OBJECTIVE:To observe the effect of the Traditional Chinese Medicine,modified Taohongsiwu decoction,versus pyridoxine on patients with hand-foot syndrome(HFS)from capecitabine,sorafenib,and gefitinib chemotherapy for gastric,lung,breast,colon,or rectal cancer.Also,to compare quality of life of patients in each group.METHODS:Patients were assigned randomly to group A or B.Group A was given modifiedTaohongsiwu decoction to soak hands and feet for 30 min,once daily.Group B was given 100 mg pyridoxine orally,twice daily.After a 2-week treatment,thetherapeutic effect was assessed by observing three major symptoms,including pain,ulceration,and muscular atrophy.This was assessed with the HFS-14 questionnaire.RESULTS:Significant differences were observed between the two groups in pain relief,and improvement of daily life,walking,and interpersonal communication(P<0.01).No significant differences in driving ability or interpersonal relationships were found.After 2 weeks,the effective rate was 88.3%in group A,which was significantly higher than the50%in group B(P=0.00).CONCLUSION:Modified Taohongsiwu decoction is effective in the treatment of patients with HFS.It improves patients'quality of life according to the HFS-14.

Effect of Liandouqingmai Recipe on life quality and vascular endothelial injury in patients with coronary heart disease

OBJECTIVE:To observe the effects of Liandouqingmai Recipe on life quality and vascular endothelial injury in patients with coronary heart disease.METHODS:Capitalized 101 patients with coronary heart disease were randomly divided into a treatment group(n=45) treated with Liandouqingmai Recipe and a standard treatment group(control group,n=56).A normal group of 16 healthy persons was additionally set up.Changes in ET-1 and NO levels were measured and Seatle Angina Questionnaire(SAQ) was adopted in studying life quality before and after treatment for two weeks.The data were analyzed with SPSS 16.0 statistic software.RESULTS:The average level of ET-1 in the normal group was lower and NO higher than that of patients with coronary heart disease.There was no significant difference in the average level of ET-1 and NO and in the scores of SAQ [physical limitation(PL),pngina stability(AS),apngina frequency(AF),treatment satisfaction(TS) and disease perception(DP)] between the two groups before treatment(P>0.05).But after treatment,the scores of SAQ(PL,AS,AF,TS,DP) and NO level were higher than those in the control group,and ET-1 average level in the treatment group was lower than that in the control group.The negative relations between PL and ET-1 and between AF and ET-1 were found in this study.CONCLUSION:Liandouqingmai Recipe can raise scores of SAQ and NO level and decline ET level in patients with coronary heart disease on the basis of convertional standard treatment,thus improving vascular endothelial function and life quality.Life quality is related to vascular endothelial function.

Curative effect of acupuncture on quality of life in patient with depression： a clinical randomized single-blind placebo-controlled study

OBJECTIVE:To evaluate the effect of acupuncture on the quality of life in patients with depression by clinical randomized single-blind placebo-controlled study.METHODS:one hundred and sixty-three cases of depression according with the inclusion criteria were randomly divided into a group of acupuncture dredging liver and regulating flow of theosophy(group 1),a group of acupoint shallow stab(group 2)and a group of non-acupoint shallow stab(group 3)at 1∶1∶1 ratio,and treated with acu-puncture,moxibustion,and intradermal embedding of needle,twice a week,for a total of 12 weeks.Scale of Quality of Life(SF-36)was used to measure the scores at four different time points and evaluate the effect of acupuncture on the quality of life of the patients with depression.RESULTS:At each time point after treatment,in scores of the 8 items,physical function,physical role,bodily pain,general physical condition,energy,social function,emotional function and mental health there were statistically significant differences among the 3 groups(P<0.0125).CONCLUSION:Acupuncture can effectively improve the quality of life of patients with depression.

Development of a disease-specific health-related quality of life questionnaire for patients with post-stroke spasticity

OBJECTIVE： This study was designed to develop a disease-specific health-related quality of life （HR-QOL） measure for patients with post-stroke spasticity. METHODS; Based on responses from 20 patients with post-stroke spasticity and an extensive literature search, items potentially used to measure these patients＇ recovery status were identified and the Apoplexy Spastic-Paralysis Questionnaire （ASPQ） was formed. A sample of 106 patients was then tested twice using the ASPQ, the Self-rating Depression Scale （SDS） and the Stroke-specific Quality of Life （SS-QOL）. Clinicians also examined all the patients using the Ashworth Scale （AS）. Inter- nal reliability was assessed using Cronbach＇s coeffi- cient a, while construct validity was determined us- ing principal component analysis （PCA）. Empirical validity was evaluated between patients with de- pression and those without depression by single factor analysis. Sensitivity was examined by calcu- lating the Spearman correlation coefficient be- tween the changes in scores of the ASPQ, the AS and the SS-QOL. RESULTS： The ASPQ had adequate internal consis- tency reliability （a=0.874） and sensitivity, with sig- nificant correlations between the changes in scores of the AS, the SS-QOL and the ASPQ, with three do- mains. In a construct validity test, six factors were extracted; the overall variance explained by all fac- tors was 72.6%. For empirical validity, mean values of 19 items and 3 domains were all higher in the de- pressive patients than in the non-depressive pa- tients. CONCLUSION： The ASPQ is a reliable and valid self-rating scale for measuring the HR-QOL in pa- tients with post-stroke spasticity.