Posterior laryngitis: a study of persisting symptoms and health-related quality of life.

Posterior laryngitis is a common cause of chronic cough, hoarseness, voice fatigue and throat pain. The aim of the present study was to examine how patients with posterior laryngitis have been examined, treated and followed up, and to assess their present health-related quality of life (HRQOL). Patients treated for posterior laryngitis at consultation at the ear-, nose- and throat clinic during 2000-2008 were contacted by mail. The letter contained questionnaires addressing the current symptoms and medication, and the HRQOL 36-item short-form questionnaire (SF-36). Medical records were scrutinized. One hundred and twenty-two patients with verified signs and symptoms of posterior laryngitis were included. Forty percent of the patients had been treated for acid-related symptoms prior to consultation. The most common symptoms at the time of consultation were the sensation of hoarseness (women 40 %, men 37 %), globus (women 35 %, men 33 %) and cough (women 33 %, men 26 %). The most frequent diagnosis was gastro-oesophageal reflux disease. Ninety percent of the women and 92 % of the men were treated with proton pump inhibitors (PPIs). At the time of study, 63 % of the patients still had symptoms. The results of the SF-36 questionnaire showed significantly lower HRQOL for women. Patients with posterior laryngitis present varying symptoms, and are often not adequately treated or followed up. When PPI treatment fails, other aetiologies of their complaints, such as visceral hypersensitivity, weakly gaseous acid reflux or non-acid reflux are not considered. Symptoms from posterior laryngitis have a negative impact on the HRQOL for women

Posterior laryngitis: a disease with different aetiologies affecting health-related quality of life:a prospective case–control study

Background: Laryngo-pharyngeal reflux (LPR) is assumed to be the most common cause of posterior laryngitis (PL). Since LPR is found in healthy subjects, and PL patients are not improved by acid-reducing therapy, other aetiologies to PL must be considered. The aims of this study in PL were to investigate the prevalence of acid reflux in the proximal oesophagus and functional gastrointestinal symptoms, to analyse motilin levels in plasma, and to assess health-related quality of life (HRQOL) before and after treatment. Methods: Forty-six patients (26 women), with verified PL, median age 55 (IQR 41–68) years, were referred to oesophago-gastro-duodenoscopy and 24-h pH monitoring. Plasma motilin was analysed. The 36-item Short-Form questionnaire was completed at inclusion and at follow-up after 43±14 months, when also the Visual Analogue Scale for Irritable Bowel Syndrome was completed. Values were compared to controls. Treatment and relief of symptoms were noted from medical records. Results: Thirty-four percent had proximal acid reflux and 40% showed signs of distal reflux. Ninety-four percent received acid-reducing treatment, with total relief of symptoms in 17%. Patients with reflux symptoms had lower plasma motilin levels compared to patients without reflux symptoms (p = 0.021). The HRQOL was impaired at inclusion, but improved over time. Patients, especially men, had more functional gastrointestinal symptoms than controls. Conclusions: This study indicates that a minority of patients with PL has LPR and is cured by acid-reducing therapy. Disturbed plasma motilin levels and presence of functional gastrointestinal symptoms are found in PL. The impaired HRQOL improves over time

The Impact of Advanced Home Care on Health-related Quality of Life Reports in the end of life from palliative care patients with cancer

ABSTRACT The aim of the present work was to compare patients with advanced cancer receiving specialized palliative home care with those receiving conventional care. A hospital-based advanced home care programme was initiated, in order to enable patients to remain at home for a longer period and to choose to die at home. The allocation to advanced home care (AHC) or conventional care (CC) was performed according to the patients’ preferences. This intervention offered an opportunity to investigate the effect of AHC and to describe the HRQL of patients with a progressive, life-threatening disease. A prospective longitudinal comparative study was performed. The two groups of patients (AHC and CC) were compared and the main outcome variables were place of death, time spent in institution or at home, and the patients’ HRQL. The latter was assessed monthly by using self-reported questionnaires, including the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), the Impact of Event Scale (IES), five questions about social support and two items concerning general well-being. The AHC patients spent more time outside the hospital and more died at home compared with patients in the CC group. Compared with the CC patients, patients who chose the AHC programme had lived longer with their cancer diagnosis, had a shorter survival period after study enrolment, and had poorer performance status. A marked, but gradual deterioration was seen during the patients’ last three months of life. A more rapid increase in problems was observed between two and one month before death regarding Physical, Cognitive and Social function, as well as Fatigue. The mean scores for Pain, Nausea/Vomiting, Sleeping problems, Diarrhoea and Financial impact were stable over time. Patients who dropped out of the study after filling in the first questionnaire after inclusion had a less favourable prognosis, with regard to both clinical variables and HRQL data. This pattern was not found from patients dropping out of the study during the last two months before death. The palliative intervention with AHC proved successful. Dying at home is strongly associated with the patients’ preference to do so. The results indicate that patients are reluctant to accept home care until necessary due to the severity of functioning impairments and symptom burden. It is important to be aware of the high level of symptoms in the patients’ last three months of life. Symptom assessment using standardised questionnaires may enhance the focus on symptom management. Results from HRQL studies must be interpreted with care due to non-random attrition. This is less evident close to death

How the final Swedish clinical exam prepares the nursing students for their future challenges-qualitative analysis

The national clinical final examination (NCFE) plays an important role in order to measure the level of knowledge and performance of nursing students. Our findings indicate that the design of the NCFE is beneficial for the students’ clinical reasoning and problem solution in the caring situation. The aim of this study was to investigate the experiences of the NCFE from lecturers who corrected the written part examination. A further aim was to study the lectures and the RN during observation in the bedside part of the examination. The NCFE is divided into two parts: a theoretical (written) part and a practical (bedside) part. In nursing education it is essential to assess nursing competencies for the future professional role such as the assessment of clinical competence that has become central to evaluate what outcomes are assessed. In addition, it provides a valuable approach to measure the level of knowledge and performance of nursing students. Future development of the NCFE is necessary regarding the degree to which the examination meets learning objectives and educational results

Place of death : hospital-based advanced home care versus conventional care - A prospective study in palliative cancer care

The purpose of this prospective nonrandomized study was to evaluate time spent at home, place of death and differences in sociodemographic and medical characteristics of patients, with cancer in palliative stage, receiving either hospital-based advanced home care (AHC), including 24-hour service by a multidisciplinary palliative care team or conventional hospital care (CC). Recruitment to the AHC group and to the study was a two-step procedure. The patients were assigned to either hospital-based AHC or CC according to their preferences. Following this, the patients were asked to participate in the study. Patients were eligible for the study if they had malignant disease, were older than 18 years and had a survival expectancy of 2-12 months. A total of 297 patients entered the study and 280 died during the study period of two and a half years, 117 in the AHC group and 163 in the CC group. Significantly more patients died at home in the AHC group (45%) compared with the CC group (10%). Preference for and referral to hospital-based AHC were not related to sociodemographic or medical characteristics. However, death at home was associated with living together with someone. Advanced hospital-based home care targeting seriously ill cancer patients with a wish to remain at home enable a substantial number of patients to die in the place they desire

Lack of concealment may lead to selection bias in cluster randomized trials of palliative care

Comprehensive palliative care programs are often implemented on a community level, and to evaluate such interventions, randomization by cluster (community) may be the only feasible method. In trials randomizing individual subjects, the importance of proper concealment has been stressed, In cluster randomized trials, however, concealment of individual patient allocation is often impossible. The following risk of selection bias has been given little attention. In the present study, comparing palliative care to conventional care, community health care districts were defined as clusters and randomized. The patients' treatment assignment was determined by the allocation of the cluster in which they resided, and hence predictable by their address. A biased selection based on practical considerations related to patients' diagnoses and hospital departments was suspected. To explore this, cancer diagnoses were grouped according to local tradition for sharing of treatment responsibility among hospital departments. A significant difference between trial arms in distribution of these groups was revealed and strongly supported our suspicion. The finding carries an important message to future researchers: when using cluster randomization, any evidence of selection bias should be carefully checked and reported