Comparison of health-related quality of life measures in chronic obstructive pulmonary disease

<p>Abstract</p> <p>Background</p> <p>The aims of this study were: (1) to compare the discriminative ability of a disease-specific instrument, the St. George's Respiratory Questionnaire (SGRQ) to generic instruments (i.e., EQ-5D and SF-36); and (2), to evaluate the strength of associations among clinical and health-related quality of life (HRQL) measures in chronic obstructive pulmonary disease (COPD).</p> <p>Methods</p> <p>We analyzed data collected from 120 COPD patients in a Veterans Affairs hospital. Patients self-completed two generic HRQL measures (EQ-5D and SF-36) and the disease-specific SGRQ. The ability of the summary scores of these HRQL measures to discriminate COPD disease severity based on Global Obstructive Lung Disease (GOLD) stage was assessed using relative efficiency ratios (REs). Strength of correlation was used to further evaluate associations between clinical and HRQL measures.</p> <p>Results</p> <p>Mean total scores for PCS-36, EQ-VAS and SGRQ were significantly lower for the more severe stages of COPD (<it>p </it>< 0.05). Using SGRQ total score as reference, the summary scores of the generic measures (PCS-36, MCS-36, EQ index, and EQ-VAS) all had REs of <1. SGRQ exhibited a stronger correlation with clinical measures than the generic summary scores. For instance, SGRQ was moderately correlated with FEV₁(<it>r </it>= 0.43), while generic summary scores had trivial levels of correlation with FEV₁(<it>r </it>< 0.2).</p> <p>Conclusions</p> <p>The SGRQ demonstrated greater ability to discriminate among different levels of severity stages of COPD than generic measures of health, suggestive that SGRQ may provide COPD studies with greater statistical power than EQ-5D and SF-36 summary scores to capture meaningful differences in clinical severity.</p

Quality of life in metastatic pancreatic cancer patients receiving liposomal irinotecan plus 5-fluorouracil and leucovorin

Abstract Background The NAPOLI-1 study (NCT01494506) reported that liposomal irinotecan plus 5-fluorouracil and leucovorin (nal-IRI+5-FU/LV) improved overall survival vs 5-FU/LV with manageable toxicity in patients with metastatic pancreatic adenocarcinoma previously treated with gemcitabine-based therapy. Yet, clinicians need treatment strategies that also maintain the patient's health-related quality of life (HRQOL). Here, we report the HRQOL data. Methods Patients completed the European Organisation for Research and Treatment of Cancer QOL core questionnaire C30 (EORTC QLQ-C30) at baseline, every 6 weeks, and at 30 days after discontinuation of study treatment. Patient-reported outcomes (PROs) were scored according to EORTC guidelines. nal-IRI+5-FU/LV HRQOL was compared with 5-FU/LV. The PRO population comprised intent-to-treat patients who completed baseline and at least one subsequent assessment on the EORTC QLQ-C30. Data were also analysed for missingness. Results Of 236 patients in the intent-to-treat population, 128 (54.2%) comprised the PRO population (71 in the nal-IRI+5-FU/LV arm; 57 the in 5-FU/LV arm). Of the remaining 108 patients (45.8%) not included in the PRO population, most progressed rapidly, making participation difficult. Median change from baseline was ≤10 points at weeks 6 and 12 in global health status or functional and symptom scale scores, except for fatigue, which deteriorated by 11.1 points with nal-IRI+5-FU/LV but did not change vs 5-FU/LV. The proportion of patients whose HRQOL improved or deteriorated was not significantly different between the arms. Conclusion In the NAPOLI-1 study, HRQOL was maintained with nal-IRI+5-FU/LV in patients with metastatic pancreatic adenocarcinoma previously treated with a gemcitabine-based regimen, while survival was significantly extended

Economic Analysis of Alvimopan for Prevention and Management of Postoperative Ileus

Objective: To determine whether alvimopan for prevention of post-operative ileus (POI) among patients undergoing small- or large-bowel resection via laparotomy is associated with lower total costs compared to standard post-operative care. Methods: We constructed a formal decision model from the healthcare system perspective. Clinical outcomes (time to discharge order written [DCO], post-operative nasogastric tube insertion, POI-related readmission within 7 days, nausea and vomiting) were obtained from meta-analyses of published studies. Cost inputs included drugs, nursing labor, readmission, and hospitalization. Costs were assessed by determining the net cost of alvimopan use and subsequent reduction in length of stay (LOS). Sensitivity analyses and a scenario analysis were conducted. Results: The costs for alvimopan were $570 based on an average of 9.5 doses. Given the 18.4-hour mean reduction in DCO, the use of alvimopan reduced hospitalization costs by$2,021. The mean difference in overall cost of care was $1,168 (95$-437 to $5,879), favoring the use of alvimopan. In sensitivity analyses, the association of alvimopan with lower costs was robust to several changes in key parameters including the cost and number of doses of alvimopan, DCO, readmission rates, and hospitalization cost. In scenario analyses, alvimopan use yielded a cost saving of$897 when no difference in readmission rates was assumed and a net cost of $278 when no difference in Touchette DR et al. Economic Analysis of Alvimopan for POI Page 4 of 27 DCO was assumed. In the scenario analysis using data from a study that did not enforce opioid use, alvimopan resulted in a cost-saving of$65 per patient. Conclusion: For the base case, alvimopan was cost-saving for prevention of POI among patients undergoing bowel resection via laparotomy, although these potential cost-savings were highly dependent on a difference in DCO. This finding is not applicable to the less-invasive laparoscopic surgical approach for which quality data on alvimopan use are lacking. Limitations of this analysis included the use of DCO as a proxy for LOS and difficulty interpreting study results due to inconsistent reporting and conduct of the clinical trials evaluating alvimopan

Comparison of structural changes in fully delithiated Li-x[Ni1/3Co1/3Mn1/3]O-2 and Li-x[Ni0.33Co0.33Mn0.30Mg0.04]O1.96F0.04 cathodes (x=0) upon thermal annealing

This study compared the structural changes in Lix [Ni13 Co13 Mn13] O2 and Lix [Ni0.33 Co0.33 Mn0.3 Mg0.04] O1.96 F0.04 cathodes (x=0) occurring after full delithiation and subsequent heat-treatment at 200, 300, and 400°C using X-ray diffraction (XRD), transmission electron microscopy, and X-ray absorption spectra (XAS). In both cathodes, XRD patterns at x=0 showed a layered O3 -type structure (CdCl2), but subsequent thermal annealing led to a similar structure decomposition to a Co3 O4 -type spinel and possible new O3- Ni13 Mn13 O2+δ -type layered phases. However, the XAS spectra clearly showed that the Lix [Ni0.33 Co0.33 Mn0.3 Mg0.04] O1.96 F0.04 exhibited much improved structural stability, showing a suppression of the phase decomposition to spinel Co3 O4, as evidenced by a decrease in the FT peak intensity of corner-shared CoO6 octahedra at ∼3.2 &Aring;.close2

Effects of Chewing Exerciser on the Recovery of Masticatory Function Recovery after Orthognathic Surgery: A Single-Center Randomized Clinical Trial, a Preliminary Study

Background and Objectives: The aim of this study was to evaluate the effects of the chewing exerciser (CE) on the functional recovery of the masticatory muscles after orthognathic surgery. Material and Methods: This randomized clinical trial was conducted in patients undergoing bimaxillary orthognathic surgery including bilateral sagittal split ramus osteotomy. Postoperative physiotherapy (PT) was performed for 3 weeks starting 3 weeks after the surgery. The patients were randomly divided into two groups: control (Con) (conventional PT) group and CE group (use of CE in addition to conventional PT). The masticatory function was evaluated based on three standards: bite force (BF), amount of mouth opening (MO), and surface electromyography (sEMG) of the anterior temporal muscle (TA), masseter muscle (MM), sternocleidomastoid muscle, and anterior belly of digastric muscle before, 3 weeks (before PT) and 6 weeks after the surgery (after PT). Results: Finally, 22 subjects participated in this study: 10 patients for Con group and 12 patients for CE group. In both groups, the BF, which was reduced significantly after the surgery, recovered after the PT similar to that before the surgery. In both groups, the MO was also significantly reduced by the surgery. However, it did not recover as much, as it was before the surgery after applying the PT. There was no difference in BF and MO between the two groups. All muscles did not show significant changes in sEMG by surgery and PT at both resting and clenching states. Conclusion: Applying CE as a PT after orthognathic surgery did not cause any harmful side effects. In both groups, the weakened muscle activity after orthognathic surgery (OGS) was adequately restored 6 weeks after the surgery. However, CE did not offer a statistically significant benefit to the masticatory function in the recovery process after OGS