Comparison of EQ-5D and 15D instruments for assessing the health-related quality of life in cardiac surgery patients

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Tuulivoimarakentamisen edistäminen : Keinoja sujuvaan hankekehitykseen ja eri tavoitteiden yhteensovitukseen

Tuulivoimaloiden määrä Suomessa on kasvanut viimeisen vuosikymmenen aikana voimakkaasti ja tavoitteena on edelleenkin kasvattaa tuulivoiman osuutta energiantuotannosta. Tuulivoiman lisääminen edesauttaa Suomen uusiutuvan energian tavoitteiden saavuttamista. Tässä selvityksessä on tutkittu tapoja edistää tuulivoimarakentamista kolmen osakokonaisuuden kautta: tuulivoimarakentamista koskevien viranomaismenettelyiden sujuvoittaminen ja selkeyttäminen; merituulivoiman kannattavuuden parantaminen; tuulivoimarakentamisen ja aluevalvonnan yhteensovittaminen. Kukin osakokonaisuus koostuu nykytilanteen kuvauksesta sekä johtopäätöksinä esitetyistä toimenpide-ehdotuksista. Viranomaismenettelyiden sujuvoittamisehdotukset koostuvat ohjeistuksen ja toimijoiden välisen vuoropuhelun lisäämisestä sekä yksityiskohtaisemmista ehdotuksista koskien YVA-menettelyä, kaavoitusta, vaikutusten arviointia sekä eräitä muita lupa- ja lausuntomenettelyitä. Viranomaismenettelyiden osalta työssä on kiinnitetty erityistä huomiota siihen, että myös talousvyöhykkeellä edellytetyt viranomaismenettelyt on kuvattu kattavasti. Merituulivoiman kannattavuuden edistämiseksi ehdotetaan muun muassa tarkempaa selvitystä valtion takauksien hyödyntämisestä pitkäaikaisissa sähkönostosopimuksissa. Puolustusvoimien aluevalvonnan ja tuulivoiman yhteensovittamisen teknologisia mahdollisuuksia on kuvattu kattavasti. Yhteensovittamisen kehittämiseksi esitetään, että tuulivoimaloiden tarvitsemasta Puolustusvoimien hyväksynnästä säädetään lailla. Selvitykseen ei ole sisältynyt esitettyjen toimenpiteiden vaikutustenarviointi.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa. (tietokayttoon.fi) Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Tiatsididiureettien käyttö suurentaa luuntiheyttä ja pienentää murtumariskiä:järjestelmällinen kirjallisuuskatsaus ja meta-analyysi

Tiivistelmä Verenpainetaudin hoidossa käytettävät tiatsididiureetit estävät natriumin ja kloridin takaisinimeytymistä munuaisissa, jolloin natriumin, kloridin ja veden eritys virtsaan lisääntyy. Lisäksi tiatsidit vähentävät kalsiumin ja lisäävät kaliumin eritystä. Koska tiatsidit vähentävät kalsiumin eritystä, on pohdittu tiatsididiureettien suotuisaa vaikutusta luuntiheyteen ja murtumariskiin. Teimme järjestelmällisen kirjallisuuskatsauksen tiatsididiureettien vaikutuksesta luuntiheyteen ja murtumariskiin pohjautuen satunnaistettuihin ja kontrolloituihin lääketutkimuksiin. Lisäksi teimme meta-analyysin tiatsididiureettien vaikutuksesta murtumariskiin. Järjestelmällisen kirjallisuuskatsauksen perusteella tiatsididiureettien käyttäjillä luuntiheys on suurentunut verrattuna lähtötilaan tai lume-/kontrollilääkettä käyttäneisiin. Meta-analyysin perusteella tiatsidiryhmän lääkkeet pienensivät suhteellista murtumariskiä 25 prosenttia valtaosin iäkkäistä potilaista koostuneissa tutkimuksissa. Puolessa meta-analyysiin valituista tutkimuksista ei kuitenkaan käytetty Suomessa yleisimmin käytettyä hydroklooritiatsidia. Kirjallisuuskatsauksessa ja meta-analyysissä saatiin tukea oletukselle, että tiatsididiureettien käyttö suurentaa luuntiheyttä ja pienentää murtumariskiä. Verenpainetaudin hoidossa tiatsidit näyttäisivät tuovan iäkkäillä potilailla lisähyötyä murtumariskin pienenemisen muodossa. Tiatsidien tunnetut haittavaikutukset tulee huomioida hoitopäätöstä tehdessä. Koska tiatsidien murtumavaikutuksia selvittävät tutkimukset on tehty pääosin verenpainetautia sairastavilla, ei tiatsideja voida suositella normotensiivisten potilaiden murtumariskin pienentämiseen.Summary Thiazide diuretics increase bone mineral density and lower fracture risk : systematic review and meta-analysis Thiazide diuretics exert their antihypertensive effect by inhibiting the reabsorption of sodium and chloride in kidneys, leading to increases in urinary sodium, chloride and water excretion. In addition, thiazides decrease urinary calcium excretion while increasing that of potassium. Since thiazides reduce the excretion of calcium, it has been hypothesized that thiazides could exert a beneficial effect on bone mineral density and reduce the risk of fractures. We conducted a systematic review of randomized controlled trials to determine if thiazide diuretics have any beneficial effect on bone mineral density and the risk of fractures. We also performed a meta-analysis on the effect of thiazides on the risk of fractures. The systematic literature review demonstrated that the use of thiazides was associated with an increased bone mineral density. A 25% lower risk of fractures was demonstrated in the meta-analysis of the studies with mostly elderly patients. However, hydrochlorothiazide, the most widely used thiazide in Finland, was used only in half of the studies included in the meta-analysis. Thiazide diuretics are useful in the treatment of hypertension, and the lower fracture risk is an additional benefit in older patients. However, one should take into consideration the widely recognized adverse effect of thiazides before starting the treatment. Finally, since the studies reporting on thiazide use and hip fractures were conducted in hypertensive patients, the thiazides cannot be recommended to prevent fractures in normotensive individuals

Patient-reported outcomes in coronary artery disease : the relationship between the standard, disease-specific set by the International Consortium for Health Outcomes Measurement (ICHOM) and the generic health-related quality of life instrument 15D

Background Patient-reported outcome (PRO) instruments measure health gains, including changes in health-related quality of life (HRQoL). Previous studies have assessed the reliability and relationship of multiple HRQoL instruments in search of the optimal instrument for feasible measurement of PROs. Although the 15D instrument was shown to have the best sensitivity and construct validity among cardiac patients, it is unknown how well it captures relevant disease-specific information scores compared to instruments included in the International Consortium for Health Outcomes Measurement (ICHOM) standard set. The aim of this study was to investigate whether the disease-specific PRO instruments and a generic HRQoL instrument capture disease related symptoms in coronary artery disease (CAD) patients. Methods Health status and HRQoL were assessed with the instruments included in the ICHOM standard set: Seattle Angina Questionnaire short-form (SAQ-7), Rose Dyspnea Scale (RDS), two-item Patient Health Questionnaire (PHQ-2), and with the 15D HRQoL instrument at baseline and 1 year from the treatment in a university hospital setting. Spearman correlation and explanatory factor analysis were used to assess the relationship of baseline scores and 1-year change in scores of 297 patients. Results At baseline, the overall 15D score and SAQ-physical limitation (SAQ-PL), 15D "breathing" and SAQ-PL, as well as "breathing" and RDS showed moderately strong correlations. The factor interpreted to reflect "Breathing-related physical activity", based on high loadings of "breathing", RDS, SAQ-PL, "mobility", "vitality", and "usual activities", explained 19.2% of the total variance. Correlations between 1-year changes in scores were fair. The factor of "Breathing-related physical activity", with significant loading of RDS, SAQ-PL, "breathing, "usual activities", "vitality", "sexual activity", "mobility", and disease-specific quality of life explained 20.5% of the total variance in 1-year change in scores. The correlation of angina frequency measured by SAQ-7 and the 15D instrument was poor. Conclusions The 15D detects dyspnea and depression similarly to RDS and PHQ-2 but not angina similarly to the SAQ-7. This may call for supplementing the 15D instrument with a disease-specific instrument when studying CAD patients.Peer reviewe

Agreement between patient- and physician-reported CCS scores.

Agreement between patient- and physician-reported CCS scores.</p

Characteristics of the study population.

The primary aim of revascularization in stable coronary artery disease (CAD) is symptom relief. The severity of symptoms is usually evaluated by the physician, not by the patient. We examined the agreement between physician- and patient-reported Canadian Cardiovascular Society (CCS) scores among patients scheduled for elective coronary angiography in a cross-sectional study. Patients (n = 650) and cardiologists evaluated the severity of angina symptoms by filling the CCS questionnaire before coronary angiography. Patients were divided into those without CAD (stenosis diameter 50%, n = 205). CAD patients were further divided into three groups according to disease severity (single-, double- or triple-vessel disease). The mean age of the patients was 67.6 (9.9) years and 50.6% were women. In 51.8% (95% CI 44.5%–59.0%) of patients with CAD and 51.9% (95% CI 47.0%–56.8%) of those without, physician- and patient reported CCS scores agreed. The physician reported better CCS scores in 33.9% (95% CI 27.6%–40.7%) of patients with CAD and 36.2% (95% CI 31.8%–41.0%) of patients without CAD. The proportions of full or partial agreement between physician- and patient reported CCS scores were similar across the CAD severity groups. To summarize, we observed a significant discrepancy between the physician- and patient-reported symptom severity in patients with or without CAD scheduled for angiography. The physician underestimated the symptoms in third of the cases. Thus, patient-reported symptom severity, rather than physician’s evaluation, should be the cornerstone of treatment decisions.</div

Patient- and physician-reported CCS scores.

Statistical significances: * p<0.05, ** p<0.01, and *** p<0.001 for patient- vs. physician-reported CCS.</p

The CCS questionnaire.

The primary aim of revascularization in stable coronary artery disease (CAD) is symptom relief. The severity of symptoms is usually evaluated by the physician, not by the patient. We examined the agreement between physician- and patient-reported Canadian Cardiovascular Society (CCS) scores among patients scheduled for elective coronary angiography in a cross-sectional study. Patients (n = 650) and cardiologists evaluated the severity of angina symptoms by filling the CCS questionnaire before coronary angiography. Patients were divided into those without CAD (stenosis diameter 50%, n = 205). CAD patients were further divided into three groups according to disease severity (single-, double- or triple-vessel disease). The mean age of the patients was 67.6 (9.9) years and 50.6% were women. In 51.8% (95% CI 44.5%–59.0%) of patients with CAD and 51.9% (95% CI 47.0%–56.8%) of those without, physician- and patient reported CCS scores agreed. The physician reported better CCS scores in 33.9% (95% CI 27.6%–40.7%) of patients with CAD and 36.2% (95% CI 31.8%–41.0%) of patients without CAD. The proportions of full or partial agreement between physician- and patient reported CCS scores were similar across the CAD severity groups. To summarize, we observed a significant discrepancy between the physician- and patient-reported symptom severity in patients with or without CAD scheduled for angiography. The physician underestimated the symptoms in third of the cases. Thus, patient-reported symptom severity, rather than physician’s evaluation, should be the cornerstone of treatment decisions.</div

The effect of hydroxychloroquine on cholesterol metabolism in statin treated patients after myocardial infarction

Background and aims: To evaluate the effect of hydroxychloroquine (HCQ) on serum and lipoprotein lipids and serum biomarkers of cholesterol synthesis and absorption in myocardial infarction patients with a high-dose statin. Methods: Myocardial infarction patients (n = 59) with a constant statin dose were randomized to receive hydroxychloroquine 300 mg (n = 31) or placebo (n = 28) daily for six months and followed up for one year. Results: Statin reduced total-c (−26 ± 22% in hydroxychloroquine and −28 ± 19% in placebo group, P = 0.931), LDL-c (−38 ± 26% vs. −44 ± 23%, respectively, P = 0.299), and cholesterol synthesis biomarkers zymostenol, desmosterol, and lathosterol ratios from baseline to one year (e.g., serum lathosterol ratio −17 ± 45% vs. −15 ± 41%, respectively, P < 0.001 for both, P = 0.623 between groups). Compensatorily, cholesterol absorption increased during the intervention (e.g., serum campesterol ratio 125 ± 90% vs. 113 ± 72%, respectively, P < 0.001 for both, P = 0.488 between groups). Hydroxychloroquine did not affect cholesterol concentrations or cholesterol absorption. It prevented the statin-induced increase in cholesterol precursor, desmosterol ratio, from six months to one year in the hydroxychloroquine group (P = 0.007 at one year compared to placebo). Conclusions: Combined with a high-dose statin, hydroxychloroquine had no additional effect on serum cholesterol concentration or cholesterol absorption. However, the findings suggest that hydroxychloroquine interferes with lanosterol synthesis, and thereafter, it temporarily interferes with the cholesterol synthesis pathway, best seen in halting the increase of the desmosterol ratio.Trial Registration ClinicalTrials.gov Identifier: NCT02648464

The effect of hydroxychloroquine on cholesterol metabolism in statin treated patients after myocardial infarction

Background and aims: To evaluate the effect of hydroxychloroquine (HCQ) on serum and lipoprotein lipids and serum biomarkers of cholesterol synthesis and absorption in myocardial infarction patients with a high-dose statin. Methods: Myocardial infarction patients (n = 59) with a constant statin dose were randomized to receive hydroxychloroquine 300 mg (n = 31) or placebo (n = 28) daily for six months and followed up for one year. Results: Statin reduced total-c (-26 +/- 22% in hydroxychloroquine and-28 +/- 19% in placebo group, P = 0.931), LDL-c (-38 +/- 26% vs.-44 +/- 23%, respectively, P = 0.299), and cholesterol synthesis biomarkers zymostenol, desmosterol, and lathosterol ratios from baseline to one year (e.g., serum lathosterol ratio-17 +/- 45% vs.-15 +/- 41%, respectively, P < 0.001 for both, P = 0.623 between groups). Compensatorily, cholesterol absorption increased during the intervention (e.g., serum campesterol ratio 125 +/- 90% vs. 113 +/- 72%, respectively, P < 0.001 for both, P = 0.488 between groups). Hydroxychloroquine did not affect cholesterol concentrations or cholesterol absorption. It prevented the statin-induced increase in cholesterol precursor, desmosterol ratio, from six months to one year in the hydroxychloroquine group (P = 0.007 at one year compared to placebo). Conclusions: Combined with a high-dose statin, hydroxychloroquine had no additional effect on serum cholesterol concentration or cholesterol absorption. However, the findings suggest that hydroxychloroquine interferes with lanosterol synthesis, and thereafter, it temporarily interferes with the cholesterol synthesis pathway, best seen in halting the increase of the desmosterol ratio. Trial Registration ClinicalTrials.gov Identifier: NCT02648464.Peer reviewe