Disease-specific health-related quality of life and its determinants in liver cirrhosis patients in Lithuania

AIM: To evaluate disease-specific quality of life (QOL) in liver cirrhosis patients and to compare it with those of a healthy population. Also an important objective was to assess whether QOL in liver cirrhosis patients differs by age and gender, by type and severity of disease. METHODS: The case group of 131 liver cirrhosis patients was selected. The control group of 262 was enrolled from a healthy population according to the scheme of case-control study. Clinical, demographic, laboratory data were collected. QOL was measured with a specific chronic liver disease questionnaire (CLDQ), which was translated and validated in Lithuanian. QOL scores were compared between groups by age, gender, type and severity of disease. Cronbach’s alpha statistics calculation was used for evaluation of internal consistency reliability. Student’s t test or ANOVA were used for evaluation hypothesis about probability equation. RESULTS: QOL was significantly lower in liver cirrhosis patients than in healthy population (59.5 ± 18.3 vs 85.3 ± 12.3, P < 0.001). The significant QOL differences between case and control groups were observed in domains of worry and abdominal symptoms, the smaller differences-in emotional functions and systematic symptom domains. Significantly worse QOL was in observed patients with increased clinical severity of the disease measured by Child-Pugh class. Age, gender and etiology of disease had an insignificant effect on QOL in cirrhotic patients. CONCLUSION: QOL was significantly impaired in all CLDQ domains in liver cirrhosis patients. Increase in severity of disease was the major factor associated with poorer QOL.

EVALUATION ON QUALITY OF LIFE FOR GYNECOLOGIC CANCER PATIENTS

Objective: To compare the quality of life (QOL) for gynecologic cancer patients with different cancer sites and to assess the impact of patients’ characteristics, disease parameters, and treatments on the subscale and overall QOL. Methods: A prospective study was conducted including 146 gynecologic cancer patients. QOL data were collected using the general Functional Assessment of Cancer Therapy (FACT- G) QOL questionnaire. Results: Advanced stage patients showed significantly poor physical well-being, emotional well-being, and functional well-being, as compared with early stage patients. QOL was reported higher in older patients (P=0.03), patients above high school education (P=0.004), and patients with help at home (P=0.009). Conclusion: Patients with later stage, multi- modality therapy, poor education, and little social support have the most significant impairments and need more support.

Patient Satisfaction with and Acceptance of Their Totally-Implanted Central Venous Catheter: Construction and First Validation of a Questionnaire

Rationale: Most cancer patients require a totally-implanted Central Venous Catheter (CVC) for their treatment. We develop and validate a French-language questionnaire dubbed QASICC (Questionnaire for Acceptance of and Satisfaction with Implanted Central Venous Catheter) assessing patient satisfaction with and acceptance of their CVC.?Method: The construction and first validation of the questionnaire was made using validated methodology consisting in four phases. Phase 1 aimed at collecting a comprehensive list of relevant items. Phase 2 consisted in converting items into questions followed by a first item selection procedure. Phase 3 tested the acceptance of the provisional module to a small number of patients. Phase 4 involved a first validation on patients to determine its psychometric characteristics.?Results: Responses to the questionnaire were collected from 215 patients. The final tool included 27 questions assessing seven dimensions: pain, contribution to the comfort of the treatment, esthetics and privacy, impact on professional activities, social and sports, impact on daily activities, local discomfort and overall satisfaction.Conclusions: This first statistical validation seems very promising and allows us to confirm the structure and the psychometric properties of the tool. Further validation studies are required on standard and specific populations in order to confirm these first results.

Literature review and analysis of the development of health outcomes assessment instruments in Chinese medicine

OBJECTIVE： To evaluate the development of health outcomes assessment instruments in Chinese medicine. METHODS： A comprehensive literature search for all published articles in China National Knowledge Infrastructure Database, Chongqing VIP Database and WANFANG Data was conducted. The studies that met the inclusion and exclusion criteria were used to extract information according to a predesigned assessment instrument. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine were identified. Of these questionnaires, 7 were generic, 12 were condition-specific and 78 were disease-specific. All instruments were suitable for adults, children, and both men and women. These instruments aimed to evaluate the health-related quality of life, signs and symptoms as well as patient satisfaction and doctor-reported outcome. However, the descriptions were poorly constructed for some of the most basic parameters, such as the domains and items, administrative mode, response options, memory recall periods, burden evaluation, format, copyright, content validity, and other properties. CONCLUSION： The instrument development for health outcomes assessment in Chinese medicine is increasing rapidly; however, there are many limitations in current methodologies and standards, and further studies are needed.

Literature review and analysis of the application of health outcome assessment instruments in Chinese medicine

OBJECTIVE： To evaluate the application of health assessment instruments in Chinese medicine. METHODS： According to a pre-defined search strategy, a comprehensive literature search for all articles published in China National Knowledge Infrastructure databases was conducted. The resulting articles that met the defined inclusion and exclusion criteria were used for analysis. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine have been used in fundamental and theoretical research, and 14 of these were also used in 29 clinical trials that were randomized controlled trials, or descriptive or cross-sectional studies. In 2 152 Chinese medicine-based studies that used instruments in their methodology, more than 150 questionnaires were identified. Among the identified questionnaires, 51 were used in more than 10 articles （0.5%）. Most of these instruments were developed in Western countries and few studies （4%） used the instrument as the primary evidence for their conclusions. CONCLUSION： Usage of instruments for health outcome assessment in Chinese medicine is increasing rapidly; however, current limitations include selection rationale, result interpretation and standardization, which must be addressed accordingly.

Evaluation of Depression and Quality of Life in Patients With Psoriasis

Objective:To measure the prevalence of depression in patients with psoriasis and to evaluate the relationship between the severity of psoriasis and depression and its effect on patients’quality of life.Methods:A total of 154 patients with a confirmed diagnosis of psoriasis were assessed to determine the severity of psoriasis based on the psoriasis area and severity index score,presence,and severity of depression using the patient health questionnaire 9,and quality of life using the dermatology life quality index 10.Pearson correlation coefficient was used to demonstrate the relationship between continuous variables with 95%confidence intervals(CIs);P<0.00001 was taken to indicate statistical significance.Results:The severity of psoriasis was mild in 36.36%of patients,moderate in 25.97%,severe in 32.47%,and very severe in 5.20%.Of the 154 patients,139(90.3%)had depression;the severity of depression was mild in most affected patients(46.7%)and severe in 2.6%of patients.Psoriasis had a moderate effect on the quality of life in 37.01%of patients and a very large effect in 33.77%of patients.The severity of psoriasis was positively correlated with depression(Pearson correlation coefficient,r=0.42,P<0.00001,95%CI:0.28–0.54)and quality of life(r=0.43,P<0.00001,95%CI:0.29–0.55).Conclusion:Depression is a common comorbidity in patients with psoriasis.The severity of psoriasis is positively correlated with the severity of depression and is associated with poor quality of life.

癌症患者生活质量调查表的编制及试测

随着癌症患者生存期的延长，癌症患者生活质量（ＱＯＬ）研究越来越引起人们的关注。因此，在引进、修订国外有关ＱＯＬ问卷（量表）的同时，编制、评估我国自己的ＱＯＬ问卷将有助于我国在这一年轻领域的研究工作。本文简介了中国癌症化疗患者生活质量调查问卷（ＱＬＱ－ＣＣＣ）的编制、试测及应用情况，初步研究结果表明ＱＬＱ－ＣＣＣ在评价中国癌症化疗患者ＱＯＬ时具有可靠、有效、灵敏及实用等特点。但尚需通过进一步调查研究来验证其有效性及实用性。最后，文章指出我们在该领域研究工作中存在的一些问题及今后努力方向。

结直肠癌术后中医生存质量量表条目池的建立及初步筛选

目的建立结直肠癌术后中医生存质量量表的条目池,并进行初步筛选。方法在中华文化背景和中医理论指导下,利用病历系统回顾研究、访谈法、中医证候条目、EORTC QLQ-CR38、理论结构模型分别提取条目,形成初选条目池。通过调查法进行条目筛选和条目优化,以专家征询会形式确立条目池。结果确立的条目池由70条条目组成,并形成预调查量表。结论条目池的提取保证了软指标的可靠性和科学性,同时具备中医特色。

综合医院神经内科门诊患者抑郁症状群及生活质量调查

目的运用抑郁症状群筛选工具,调查综合医院神经内科门诊患者抑郁症状群的检出率;探讨神经内科门诊伴有抑郁症状群患者的生活质量。方法使用中文版患者健康问卷(patient health questionnaire,PHQ)的抑郁症状群分量表(PHQ-9)及健康状况调查问卷(the short form-36 health survey,SF-36)对综合医院神经内科门诊患者进行调查。共收集有效问卷306份。分析了患者抑郁症状群与生活质量的相关性。结果存在抑郁症状群患者有149例(占受调查人群的48.7%)。具有抑郁症状群的神经内科门诊患者SF-36各维度评分低于不伴有抑郁症状群患者。SF-36各维度评分与PHQ-9评分呈负相关,具有统计学意义(r值:-0.182～-0.839,P≤0.001)。结论在综合医院神经内科门诊就诊者中,抑郁症状群检出率较高,这类患者生活质量较差。

正颌外科患者健康相关生命质量评价的初步研究

目的:通过问卷调查评估正颌患者治疗过程中健康相关生命质量指数的变化,初步探讨正颌外科治疗对正颌患者健康相关生命质量状况的影响,为今后正颌治疗提供一定的参考依据。方法:于正颌外科治疗安放矫治器前(T1)-正颌外科手术前1周(T2)-正颌外科术后正畸完成后1周(T3),采用改良的正颌患者生命质量问卷(Health-related quality of life,HRQOL)对58例正颌患者进行问卷调查,PEMS3.1软件包对正颌治疗三阶段四因子分及HRQOL总分进行统计分析。结果:HRQOL总分及颜面、口颌功能、社交因子分T3阶段明显低于T1、T2(P<0.01),正颌治疗后患者HRQOL改善明显,但自我关注因子分改变未见统计学差异;T1～T2,各因子未见统计学差异。结论:正颌外科治疗能明显改善正颌患者的健康相关生命质量水平,但患者自我关注水平不随身体、心理和社交生活质量的改善而降低,在临床治疗中要合理引导患者的审美观和心理状态,以达到更好的治疗结果。

起搏参数调整对老年起搏器植入患者生活质量影响的研究

目的探讨起搏参数调整对老年起搏器植入患者生活质量的影响。方法80例接受永久起搏治疗的患者，男性41例，女性39例，年龄65-86（70．5±11．5）岁。随访期间采用常规心电图、动态心电图、超声心动图、6min步行测距、生活质量评分等指标，观察起搏系统干预前后的疗效、心功能分级和生活质量变化。结果随访期内实施起搏系统干预共168次，其中调整AVD27例、调整起搏频率19例、调整感知性能14例、改变起搏模式8例、起搏故障探查术6例、VVI改DDD8例，3例起搏器介导性心动过速被纠治。优化起搏系统前后，“起搏患者生活质量测评”分值提高，差异有统计学意义（P〈0．05）。结论优化起搏系统可确保起搏治疗高效、安全，显著提高患者生活质量。起搏系统优化应坚持提高随访效率、个体化原则。

简明幸福与生活质量满意度问卷在中国精神障碍患者中的信效度

目的:引进简明幸福与生活质量满意度问卷(Quality of Life Enjoyment and Satisfaction Ques-tionnaire,Short Form,Q-LES-Q-SF),评估其在中国精神障碍患者中的信效度和适用性。方法:在山东省精神卫生中心2007年7月-2008年1月的门诊和住院患者中,按照就诊或住院的先后顺序,选取385例符合《ICD-10精神与行为障碍分类》诊断标准的精神分裂症(n=193)和心境障碍患者(n=192);按1∶2的比例选取与其相匹配的健康对照者196例。对所有对象进行Q-LES-Q-SF初次测评,30天后进行重测,对原始测评结果进行信度分析。以世界卫生组织生活质量量表(World Health Organization Quality of Life,WHO-QOL-100)为效标变量评价患者和健康对照者效标效度并进行区分效度分析。结果:信度分析显示量表的Cronbacnα系数为0.920,重测信度为0.785。总量表评分与WHOQOL-100总分及6个领域和24个方面均具有较高的相关性(心境障碍,r=0.22～0.71;精神分裂症,r=0.24～0.70;健康对照,r=0.17～0.73;Ps<0.01)。精神分裂症组和心境障碍组患者的幸福与生活质量满意度总分及各条目分均低于健康对照组[如总分,(46.42±8.36)vs.(54.34±8.11),(46.20±10.12)vs.(54.34±8.11),Ps<0.01]。结论:简明幸福与生活质量满意度问卷在中国精神障碍患者中有较好的信效度,适用于精神障碍患者生活质量的量化评估。

先天性心脏病患儿及父母生存质量研究现状

先天性心脏病(CHD)给家庭和社会带来了沉重的经济和社会负担。生存质量(QOL)可用来评估疾病疗效和社会功能恢复情况。文章介绍CHD患儿和父母的QOL国内外研究现状和对应量表特点,讨论在我国CHD领域开展QOL研究面临的困难、可以采取的措施和此项工作的应用前景。

养阴润肠方治疗慢性传输型便秘32例

目的观察养阴润肠方治疗慢性传输型便秘临床疗效。方法符合纳入标准的32例慢性传输型便秘患者,使用养阴润肠方治疗3个疗程,每个疗程7d,分别记录治疗前、2个疗程后、3个疗程后、停药1个月后便秘患者生活质量自评量表(patient assessment of constipation quality of life questionnaire,PAC-QOL)评分及Cleveland便秘评分。结果治疗结束时治愈17例,显效8例,有效4例,无效3例,总有效率为90.6%。治疗前后PAC-QOL比较,在治疗2个疗程后、3个疗程后、停药1个月后,生理积分、担忧度积分、满意度积分、总分均显著减少(P<0.01);3个疗程后、停药1个月后,心理积分显著减少(P<0.01);与治疗前比较,治疗2个疗程后、3个疗程后、停药1个月后Cleveland评分均显著减少(P<0.01)。结论养阴润肠方治疗慢性传输型便秘在全身整体性调节和提高生活质量等方面疗效确切。

家庭护理干预对终末期血液透析患者临床效果研究

目的:分析和研究家庭护理干预对终末期血液透析患者临床效果。方法:选取区人民医院、中心医院自2011年5月-2012年11月期间共同收治的50例维持性血液透析患者,随机分成A、B两组,每组各25例,A组为家庭护理干预组,对终末期血液透析患者采用家庭护理干预,即实验组,B组为血液透析患者组,给予基本护理,即对照组。分别采用疾病知识知晓率调查表、肾脏疾病生活质量量表对两组患者的实际情况进行全面评估。结果:经疾病知识知晓率调查表分析,A组患者对透析充分性、饮食与营养、用药、运动、自我保护及内瘘护理方面的了解程度明显高于B组,P<0.05具有统计学意义。经肾脏疾病生活质量量表分析,A组患者的肾病影响、肾病负担、工作状态、性功能、社会支持、体能影响、疼痛方面、健康行为、自护技巧、社会活动等十项指标的合格率均大于B组,P<0.05具有统计学意义。结论:家庭护理干预对终末期血液透析患者的治疗尤为重要,值得推广。

左旋多巴联合恩他卡朋治疗帕金森病对患者认知功能及生活质量的影响

目的探讨左旋多巴联合恩他卡朋治疗帕金森病对患者认知功能及生活质量的影响。方法将99例帕金森病患者按随机数字表法分观察组(50例)和对照组(49例)。对照组予以左旋多巴治疗,观察组予以左旋多巴联合恩他卡朋治疗,观察16周。比较两组的疗效,治疗前及治疗16周患者运动功能、认知功能、生活质量、睡眠质量、抗氧化应激反应情况,不良反应发生状况。结果(1)观察组总有效率为96.0%,对照组为81.63%,观察组显著高于对照组(P<0.05)。(2)治疗后两组运动功能、认知功能评分均显著改善(P<0.01),观察组帕金森氏病综合评分量表-Ⅲ评分显著低于对照组(P<0.01),简易智力状态检查量表评分显著高于对照组(P<0.01)。(3)治疗后两组抗氧化应激反应情况均显著改善(P<0.01),观察组血清胱抑素C、白细胞介素-1β水平显著低于对照组(P<0.01),血清超氧化物歧化酶水平显著高于对照组(P<0.01)。(4)治疗后两组生活质量及睡眠质量均显著改善(P<0.01),观察组帕金森患者生活质量问卷评分显著低于对照组(P<0.01),帕金森病睡眠量表评分显著高于对照组(P<0.01)。(5)观察组不良反应总发生率为18.0%,对照组为38.8%,观察组显著低于对照组(P<0.05)。结论左旋多巴联合恩他卡朋治疗帕金森病临床疗效显著,能有效改善患者的运动功能及认知功能,缓解氧化应激反应,提高生活质量及睡眠质量,减轻左旋多巴引起的不良反应。

男性2型糖尿病患者血糖水平及其对性生活质量的影响

目的分析血糖水平对男性2型糖尿病患者性生活质量的影响,为2型糖尿病患者的临床诊疗提供指导。方法2018年12月至2019年8月期间,将佛山市妇幼保健院内分泌科收治的128例2型糖尿病男性患者作为观察组,同期选择110例健康男性体检者作为对照组。比较两组受检者的总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、体重指数(BMI)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbAIc)、性欲、性交频率、射精时间>12 min、射精快感、性生活满意度;采用抑郁自评工具(PHQ-9)和简化国际勃起功能指数评分(IIEF-5)量表评估并比较两组受检者性功能的差异。结果两组受检者的TG、HDL-C水平比较,差异均无统计学意义(P>0.05);观察组患者的TC、LDL-C、BMI、FPG、2 hPG、HbAIc水平及PHQ-9评分[(5.43±1.32)mmol/L、(2.98±1.20)mmol/L、(27.48±2.73)kg/m2、(9.66±2.42)mmol/L、(14.65±7.52)mmol/L、(8.45±2.50)%、(8.23±5.37)分]明显高于对照组[(4.12±0.61)mmol/L、(2.21±0.90)mmol/L、(23.97±3.71)kg/m^2、(6.41±0.47)mmol/L、(13.63±0.80)mmol/L、(4.42±2.51)%、(7.08±4.75)分],而IIEF-5评分为(18.80±1.30)分,明显低于对照组的(24.47±1.32)分,差异均有统计学意义(P<0.05);观察组患者的性欲高、性交频率、射精时间>12 min、射精快感强烈、性生活满意度[7.81%、(1.58±1.52)次/月、2.35%,0.78%、4.69%]明显低于对照组[43.68%、(2.98±1.56)次/月、13.63%、44.55%、39.09%],差异均有统计学意义(P<0.05)。结论男性2型糖尿病患者的FPG、2hPG等血糖指标明显升高,IIEF-5评分显著降低,而PHQ-9评分明显上升。同时,其性欲、性交频率、射精时间等性生活质量降低明显,长期良好的血糖控制有助于性功能的恢复。

影响慢性心力衰竭病人家属生活质量的相关因素研究

[目的]探讨影响慢性心力衰竭病人家属生活质量的相关因素。[方法]采用问卷的方法对128例慢性心力衰竭病人的家属进行调查。数据分析采用构成比描述、Spear-man单因素相关分析。[结果]疾病的诊断、体能状况、知情的状况以及家属文化程度、经济状况等与慢性心力衰竭病人家属生活质量具有相关性。[结论]慢性心力衰竭病人家属的生活质量受病人疾病诊断、体能状况、知情的程度及家属文化程度、经济状况等因素的影响。

前臂皮瓣与股前外侧皮瓣修复舌癌术后缺损的供区主观满意度比较

目的比较游离前臂皮瓣(FRFF)及股前外侧皮瓣(ALTF)用于舌癌术后缺损重建的供区主观满意度。方法选取2011年8月—2014年10月间在天津市口腔医院和北京大学口腔医院接受FRFF或ALTF重建的121例原发性舌鳞状细胞癌患者为调查对象。2016年10月—2017年1月间采用自制供区病态特异性问卷评估患者主观满意度(包括供区感觉、运动障碍、外观、社交活动及生存质量的总体影响5个方面)。结果 121例中有34例因肿瘤或其他疾病死亡,2例因皮瓣重建术后复发而被剔除,11例失联,最终74例患者完成问卷,FRFF组39例,ALTF组35例。调查结果显示,ALTF组在供区感觉、外观、对总体生存质量的影响及量表总分均高于FRFF组(P<0.05)。2组在运动障碍及社交活动两方面的得分相似(P>0.05)。结论 ALTF具有更好的供区病态,对患者总体生存质量的不良影响较小,满意度较高。

绵阳地区HIV/AIDS抗病毒治疗依从性及生活质量现状调查研究

目的 通过调查绵阳地区艾滋病病毒感染者/艾滋病(AIDS)病人(HIV/AIDS)治疗依从性及生活质量现状,分析影响因素,为制定提高病人依从性的政策和方法提供参考。方法 选择2016年5月至2019年5月绵阳市12个县市区(园区、科学城)年龄范围为18~60岁建档并正在接受高效联合抗反转录病毒治疗(HAART)的HIV/AIDS病人,收集病人社会人口学特征及AIDS治疗依从性自我效能量表(HIV-ASES)、世界卫生组织艾滋病生存质量测量简表(WHOQOL-HIV BREF)评分,分析影响病人治疗依从性及生活质量的高危因素。结果 该研究共回收有效问卷1 600份,HIV-ASES结果显示近一个月内治疗依从率为67.19%(1 600/1 659)。对治疗依从率进行logistic多因素回归,非医学专业和未采取方法提醒用药会降低治疗依从率,且结果差异有统计学意义(P<0.05)。治疗持续时间、年龄和文化程度会影响病人的生活质量得分,且差异有统计学意义(P<0.05)。结论 非医学专业和未采取方法提醒用药史是影响HIV/AIDS病人治疗依从率的独立危险因素;治疗持续时间、年龄、文化程度是影响HIV/AIDS病人生活质量得分的高危因素;HIV/AIDS病人治疗依从率和生活质量均较低,因此加强对病人提醒、督导,提高全民文化水平,对HIV/AIDS早期发现及时治疗并坚持服药,可提高病人服药依从性和生活质量。