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1.  Quality of life outcomes after endoscopic sinus surgery: How long is long enough? 
Determine the time interval over which quality-of-life (QOL) outcomes stabilize after endoscopic sinus surgery (ESS).
Study Design
Multi-institutional, longitudinal cohort.
Tertiary rhinology centers.
Subjects and Methods
Adults with chronic rhinosinusitis from three medical centers were asked to provide responses to the Rhinosinusitis Disability Index (RSDI) and the Chronic Sinusitis Survey (CSS) at baseline and 6 months, 12 months, and 20 months after endoscopic sinus surgery. Repeated measures and post hoc analyses were used to compare QOL scores between follow-up time points. Subgroup analyses were done in a similar fashion for patients with and without nasal polyposis, asthma, allergies, acetylsalicylic acid intolerance, depression, and prior sinus surgery
A total of 127 patients provided complete follow-up data for all three time points. Improvement in QOL scores was seen at 6 months after surgery for both the RSDI and CSS instruments. When comparing changes in mean QOL scores between all follow-up time points, there were no significant differences in either RSDI or CSS total scores (all p ≥ 0.853) or subscale scores (all p ≥ 0.251) between 6, 12, and 20 months. Each individual subgroup demonstrated stable QOL scores between 6 and 20 months follow-up, including patients with polyposis and those with ASA intolerance (all p ≥ 0.275).
At a cohort level, improvements in QOL after ESS do not appear to change between 6 and 20 months. Clinical trial designs incorporating QOL outcomes after ESS should consider the six month time frame as an appropriate primary endpoint.
PMCID: PMC2965172  PMID: 20974329
Chronic rhinosinusitis; quality of life; outcomes; longitudinal; endoscopic sinus surgery; sinusitis
2.  Quality of life before and after septoplasty and rhinoplasty 
Subjective assessment of quality of life (QOL) as an important aspect of outcomes research has received increasing importance during the past decades. QOL is measured with standardized questionnaires which had been tested with regard to reliability, validity, and sensitivity.
Surgical procedures of the nasal septum (septoplasty) and the external nose (rhinoplasty) are frequently performed. Since many years subjectively assessed results of these operations have been reported in the literature. However, validated QOL instruments were applied only for one decade. Beforehand, measurements were performed using retrospective assessment of satisfaction or visual analogue scales. Prospective application of validated disease-specific and general measuring instruments has to be demanded for future studies.
Most of the septoplasty patients as well as most of the rhinoplasty patients evaluate the operation being successful. However, a relevant number of patients is not satisfied with the result of surgery. In this context, QOL instruments have the potential to identify further factors influencing the outcome. Especially in rhinoplasty patients, special attention has to be drawn on potential psychosocial effects of the operation.
PMCID: PMC3199828  PMID: 22073110
validation; quality of life; nasal obstruction; nasal function
3.  Quality of life and surgical outcomes following laparoscopic surgery for refractory gastroesophageal reflux disease in a regional hospital 
Canadian Journal of Surgery  2012;55(1):41-45.
Gastroesophageal reflux disease (GERD) is a prevalent condition leading to poor quality of life (QOL) in patients with refractory symptoms. Laparoscopic antireflux (LAR) surgery has been shown to improve QOL, and I sought to examine the surgical and QOL outcomes associated with LAR surgery over a 3-year period at a regional hospital.
Patients were given GERD–health related quality of life (GERD-HRQL) and SF-36 questionnaires preoperatively, at 6 months and at 12 or more months after surgery. I collected data on demographic and clinical characteristics and surgical outcomes.
Of the 342 patients referred for GERD or dysphagia, 26 received LAR surgery during the study period. All 26 patients had symptoms refractory to medications; 19 had atypical symptoms and 8 had some form of chronic pain syndrome (CPS). The mean duration of surgery was 125 minutes. There were no conversions, complications, 30-day readmissions or deaths. Three patients stayed 2 days in hospital and 23 stayed overnight. One patient required esophageal dilation for persistent dysphagia. Two patients resumed medication for recurrent symptoms and 24 remained medication free. There were significant improvements in GERD–HRQL scores in all patients. Patients with CPS had no improvements in SF-36 scores, whereas patients without CPS showed significant improvement.
Excellent surgical outcomes in LAR surgery can be obtained with careful patient selection at a nonacademic regional hospital. Although GERD-HRQL improved in all patients, patients with CPS showed no improvement in general health QOL scores after LAR surgery. Careful patient counselling should be employed when offering LAR surgery to patients with CPS.
PMCID: PMC3270084  PMID: 22269301
4.  Correlations Between Endoscopy Score and Quality-of-Life Changes After Sinus Surgery 
To assess whether change in endoscopy score correlates with change in health-related quality of life (HRQOL) following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS).
Tertiary rhinology clinic
One hundred two adult patients, with and without nasal polyposis, who elected to undergo ESS and were followed for 12 ± 2 months postoperatively.
Patient characteristics and Lund-Mackay computed tomography scores were recorded preoperatively. Lund-Kennedy endoscopy scores and 2 HRQoL surveys, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS), were examined before and after surgery.
Main Outcome Measures
Postoperative changes in endoscopy score and HRQOL were examined using bivariate and multivariate analyses.
Statistically significant improvements were found in endoscopy score (p<0.001) and for all total and subscale HRQoL measures (p<0.001). After controlling for baseline status and comorbid factors, improvement in endoscopy score significantly correlated with 12 month improvement on the total RSDI (p=0.01), the physical (p=0.01) and functional (p=0.02) subscales of the RSDI, and the symptom subscale of the CSS (p=0.003), but could explain only 25.5–36.6% of the linear variation for these HRQOL improvements.
For most patients, endoscopy scores and disease specific HRQOL significantly improved after endoscopic sinus surgery. Changes in endoscopy scores explain a portion of the improvement in HRQOL. For patients with CRS, improvements in disease specific HRQoL outcomes are complex, multidimensional constructs that cannot be entirely explained by surgical changes measured by endoscopic examination.
PMCID: PMC2860109  PMID: 20403849
Endoscopic sinus surgery; endoscopy; outcomes; quality-of-life; chronic sinusitis
5.  Prospective multicenter study of quality of life before and after lower extremity vein bypass in 1404 patients with critical limb ischemia 
Patients with critical limb ischemia (CLI) have multiple comorbidities and limited life spans. The ability of infrainguinal vein bypass to improve quality of life (QoL) in patients with CLI has therefore been questioned. Prospective preoperative and postoperative QoL data for patients undergoing lower extremity vein bypass for CLI are presented.
A validated, disease-specific QoL questionnaire (VascuQoL) with activity, symptom, pain, emotional, and social domains and responses scored 1 (lowest QoL) to 7 (best QoL) was administered before surgery and at 3 and 12 months after lower extremity vein bypass for CLI. Changes in QoL at 3 and 12 months after lower extremity vein bypass and multiple predetermined variables potentially influencing QoL after lower extremity vein bypass were analyzed to determine the effect of lower extremity vein bypass on QoL in CLI patients.
A total of 1404 patients had lower extremity vein bypass for CLI at 83 centers in the United States and Canada as part of the PREVENT III clinical trial. Surveys were completed in 1296 patients at baseline, 862 patients at 3 months, and 732 patients at 12 months. The global QoL score (mean ± SD) was 2.8 ± 1.1 at baseline and was 4.7 ± 1.4 and 5.1 ± 1.4 at 3 and 12 months, respectively. Mean changes from baseline at 3 and 12 months were statistically significant (P < .0001). Improved QoL scores extended across all domains. Diabetes and the development of graft-related events were associated with decreased improvement in QoL scores, though the mean relative change from baseline remained positive.
Patients with CLI have a low QoL at baseline that is improved at 3 and 12 months after lower extremity vein bypass. QoL improvements are lower in diabetic patients and those who develop graft-related events. Successful revascularization can be expected to improve QoL in patients with CLI, with benefits that are sustained to at least 1 year.
PMCID: PMC2890307  PMID: 17098529
6.  Preoperative and Early Postoperative Quality of Life Predict Survival in Potentially Curable Patients with Esophageal Cancer 
Annals of Surgical Oncology  2009;17(1):23-30.
In patients with esophageal cancer, evidence for prognostic significance of preoperative quality of life (QoL) is limited, while the prognostic significance of postoperative QoL has not been investigated at all.
To determine whether preoperative and postoperative QoL measurements can predict survival independently from clinical and pathological factors, in patients with potentially curable esophageal adenocarcinoma.
A randomized controlled trial was performed from 1994 to 2000 in two academic medical centres, comparing transthoracic and transhiatal esophagectomy. QoL questionnaires were sent before and 3 months after surgery (Medical Outcome Study Short Form-20 and Rotterdam Symptom Checklist). Uni- and multivariate Cox regression analyses were used to examine firstly the prognostic value of preoperative QoL and several clinical factors, and secondly of postoperative QoL, several clinical factors, and pathological staging.
Out of 220 randomized patients, 199 participated in the QoL-study. In the multivariate preoperative model physical symptom scale (p = 0.021), tumor length (p = 0.034), and endosonographic T-stage (p = 0.003) were predictive for overall survival. In the postoperative multivariate analysis, social functioning (p = 0.035), pain (p = 0.026), and activity level (p = 0.037) predicted survival, besides pathological T-stage (p < 0.001) and N-stage (p < 0.001).
In the present paper the first large consecutive series of potentially curable esophageal cancer patients is presented in whom prospectively collected QoL data before and after potentially curative surgical resection were used to predict survival. Both preoperative (physical symptoms) and postoperative (social functioning, pain, and activity level) QoL subscales are independent predictors of survival in potentially curable patients with esophageal adenocarcinoma.
PMCID: PMC2805800  PMID: 19830496
7.  Prospective nonrandomized comparison of quality of life and recurrence between high ligation and stripping and radiofrequency ablation for varicose veins 
Varicose veins are a major problem worldwide and improvement in quality of life (QoL) is the ultimate goal after treatment of this benign disease. However QoL is highly dependent on personal and social factors. This study compares high ligation and stripping (HS) and radiofrequency ablation (RFA) in terms of QoL and recurrence in Korea.
A retrospective analysis of prospectively collected data between August 2006 and October 2008 was performed for patients undergoing HS and RFA at a single institution. QoL was assessed with a questionnaire preoperatively, at 3 months postoperatively and annually thereafter. Recurrence was assessed by Duplex ultrasound annually after surgery.
A total of 272 patients completed the questionnaire at 3 months. Among these patients, 155 patients returned for their annual follow-up. There were no significant differences between HS and RFA in global QoL scores, although RFA showed less pain. However, paresthesia rates were also higher after RFA. Recurrence rates were similar between the two modalities, although technical failures were more common after RFA.
Overall QoL and recurrence rates were similar between the two modalities. The benefits of RFA do not seem to be enough to overcome the higher costs of HS in Korea.
PMCID: PMC3539110  PMID: 23323236
Varicose veins; Radiofrequency catheter ablation; Recurrence; Quality of life
8.  Visual function and quality of life following vitrectomy and epiretinal membrane peel surgery 
To investigate the effect of epiretinal membrane (ERM) peel on patients' health related quality of life (HR‐QOL) and to explore the association between self reported HR‐QOL and conventional measures of visual function.
The National Eye Institute 25 Item Visual Function Questionnaire (VFQ‐25) and the 36 Item Short‐Form Health Survey (SF‐36) were self administered by 20 patients before and 4 months following surgery. Preoperative and postoperative data collected included logMAR near and distant visual acuity (VA), contrast sensitivity, and metamorphopsia. Questionnaire scores were compared preoperatively and postoperatively and their correlation with traditional methods of visual function evaluation analysed.
Postoperatively there was no significant improvement in mean logMAR VA. However, eight (40%) subjects improved by two or more ETDRS lines and nine eyes (45%) reached a final VA of 6/18 or better. Metamorphopsia decreased significantly (p = 0.019) and there was significant improvement in VFQ‐25 mean scores for the general vision (p = 0.03), distance activities (p = 0.05), and composite score (p = 0.03). Baseline binocular VA was significantly correlated with baseline VFQ‐25 composite score (r = 0.631, p = 0.004).
ERM surgery appears to improve patients' subjective perception of visual function as indicated by higher composite scores in VFQ‐25 and improved metamorphopsia in the absence of significant improvement in mean logMAR VA.
PMCID: PMC1857048  PMID: 16421185
epiretinal membrane
9.  A Prospective Evaluation of Short-Term Health-Related Quality of Life in Patients Undergoing Anterior Skull Base Surgery 
Skull Base  2010;20(1):27-33.
We evaluated the health-related quality of life (QOL) of patients undergoing anterior skull base tumor resection. The Anterior Skull Base Surgery QOL questionnaire, a disease-specific multidimensional instrument dedicated to this population, was used to collect and prospectively analyze demographic, medical, and QOL data on 48 patients. Thirty-nine patients completed the questionnaire preoperatively and at 6 and 12 months postoperatively. Seventeen patients (44%) had malignant histology and 22 (56%) had benign tumors. The overall QOL score decreased significantly at 6 months postoperatively (p < 0.05) and improved significantly at 12 months postoperatively (p < 0.04). The emotional domain improved significantly at 12 months postoperatively compared with the preoperative scores (p < 0.03). Patients with malignant tumors had lower scores at 6 months postoperatively compared with patients with benign lesions (p < 0.002), although the scores for both groups at 12 months postoperatively were similar. Adjuvant radiation therapy was associated with a poor QOL (p < 0.005). The results of this prospective study show that the overall deteriorated QOL of patients after anterior skull base tumor resection returns to baseline by 1 year after surgery. Histology and radiotherapy are significant predictors of health-related QOL in this population.
PMCID: PMC2853063  PMID: 20592855
Craniofacial resection; cranial base; subcranial approach; cancer
10.  Quality of life among patients receiving palliative care in South Africa and Uganda: a multi-centred study 
Quality of life (QOL) is a core outcome of palliative care, yet in African settings there is a lack of evidence on patients' levels of QOL. We aimed to describe QOL among patients with incurable, progressive disease receiving palliative care in South Africa and Uganda, to compare QOL in cancer and HIV, to determine how domains of QOL correlate with overall QOL, and compare levels of QOL in this population with those in other studies using the same tool.
A cross-sectional survey was conducted using the Missoula Vitas Quality of Life Index (MVQOLI), a 26-item QOL questionnaire with five subscales (Function, Symptom, Interpersonal, Well being, Transcendent) covering physical, social, psychological and spiritual domains and one global QOL item. One item in each subscale assesses the subjective importance of the domain on a score from 1 (least important) to 5 (most important), used to weight the contribution of the subscale towards the Total QOL score. The tool was translated into 6 languages and administered to consecutively recruited patients at four facilities in South Africa and one in Uganda.
285 patients were recruited, with a mean age of 40.1; 197 (69.1%) were female. Patients' primary diagnoses were HIV (80.7%), cancer (17.9%) and other conditions (1.4%). The mean global QOL score was 2.81 (possible range 0 (worst) to 5 (best)); mean Total score 17.32 (possible range 0 to 30). Patients scored most poorly on Function (mean 0.21), followed by Well being (2.59), Symptoms (5.38), Transcendent (5.50), Interpersonal (9.53) (possible range for subscale scores -30 to 30). Most important to patients were: close relationships (mean 4.13), feeling at peace (4.12), sense of meaning in life (4.10), being active (3.84), physical comfort (2.58). Cancer patients were predominantly recruited at three of the sites; hence comparison with HIV-infected patients was restricted to these sites. HIV+ patients (n = 115) scored significantly worse than cancer patients (n = 50) on Well being (Z = -2.778, p = 0.005), Transcendence (Z = -2.693, p = 0.007) and Total QOL (Z = -2.564, p = 0.01). Global QOL score was most weakly correlated with Total QOL (r = 0.37) and the Transcendent subscale was most highly correlated (r = 0.77) (both p < 0.001). Patients receiving palliative care in South Africa and Uganda exhibited significantly poorer QOL compared to similar populations in the USA.
Feeling at peace and having a sense of meaning in life were more important to patients than being active or physical comfort, and spiritual wellbeing correlated most highly with overall QOL. It is therefore vital to identify and meet the psychological and spiritual care needs of patients, as well as to assess and treat pain and other symptoms. Our finding that patients scored most poorly on the Function domain warrants further research.
PMCID: PMC3094195  PMID: 21477274
11.  Endoscopic septoplasty: The open book method 
The advent of endoscopes has revolutionized rhinology and the traditional headlight based surgeries have largely been replaced by endoscopes. Septoplasty for deviated nasal septum or Sluder’s neuralgia have been conventionally performed with the aid of headlight. This can be technically challenging as visualization of the nasal cavity, particularly the posterior portion is rather limited as the procedure is performed via the nostrils. In addition, with headlights for illumination, teaching this procedure can be difficult as only the surgeon who is wearing the headlights has direct vision of the surgical field.
Endoscopic septoplasty is an accepted alternative to traditional headlight approach to septoplasty. This approach provides a direct-targeted route to the anatomic deformity, improved visualization, and magnification of the surgical field. Our experience in endoscopic septoplasty is highlighted in this paper, excluding septoplasties performed as part of exposure to the sinuses. We use the open book method that to best of our knowledge has not been described in literature before.
PMCID: PMC3450244  PMID: 23120731
Endoscopic septoplasty; deviated nasal septum
12.  The Reliability and Validity of the Persian Version of Sinonasal Outcome Test 22 (Snot 22) Questionnaires 
The quality of life (QOL) is an important indicator for disease-severity classification and outcome measurement in obtaining treatment sinonasal diseases. The sinonasal outcome test 22 (SNOT 22) questionnaire has been introduced as the best specific sinonasal instrument for QOL measurement.
To prepare a valid and reliable Persian language version of SNOT 22 questionnaire.
Patients and Methods
After forward and backward translation of the original version of SNOT 22 questionnaire from English to Persian, a group of patients with nasal septal deviation who need septal surgery and another group of healthy volunteers answered the Persian version of the questionnaire. The responsiveness rate, validity (Pearson correlations and differential validity) and reliability (internal consistency and test-retest reliability) of the 22 items of the questionnaire was calculated. P value < 0.05 was considered significant.
Thirty adults with nasal septal deviation need surgical correction and 30 healthy volunteers were included (mean age 30.4 ± 7.1 vs. 33 ± 6.7, P value = 0.148). The questionnaire was introduced to subjects two times with a two-week-period gap. Total responsiveness rate for 22 items was more than 97%. The total Cronbach's Alfa coefficient was 0.898 (ranging 0.890-0.903). The Pearson correlations were 0.85 and 0.96 for patients and healthy volunteers, respectively. The mean total score were 25.6 ± 13.3 (range 6-52) and 7.6 ± 9.1 (range 0-45) in patients and healthy volunteers, respectively (P < 0.0001). The subscales scores were also significantly different between two groups.
The Persian version of SNOT 22 questionnaire is a valid and reliable instrument for accessing sinonasal diseases in Persian-speaking people.
PMCID: PMC3838650  PMID: 24349728
Quality of Life; Nasal Septal; Questionnaires
13.  A 5-Year Audit of Rhinology Procedures Carried Out in a District General Hospital 
Although there has been many studies quoting ENT and rhinology complications, there have been none looking at the complication rates of one department with a single specialist rhinologist over a 5-year period.
Over a 5-year period between 1998 and 2002, the number of operative procedures undertaken in the ENT department in a busy district general hospital was collected in a prospective manner.
A total of 10,768 ENT procedures were undertaken in the department which comprised four consultants and associated junior staff (SpRs/SASs/SHOs); 2507 of these procedures were rhinology cases. There were 39 recorded complications following nasal surgery, giving an overall rhinology complication rate of 1.56%. This included 12 postoperative nose bleeds (0.48%), 5 cases of infection following septal surgery (0.56%), 7 cases of septal perforation (0.75%) and various minor functional endoscopic sinus surgery (FESS) complications (2.17%). These figures are either below or within the quoted literature rates. There were no major complications or deaths recorded following nasal surgery.
These results compare favourably with those of other studies.
PMCID: PMC2173183  PMID: 17999825
Audit; Rhinology; District general hospital
14.  Instruments for Estimation of Health-Related Quality of Life in Patients with Skull Base Neoplasms 
Skull Base  2010;20(1):5-10.
With advances in treatment of patients with tumors of the skull base and associated improvement in length of survival, the need for assessment of quality of life (QOL) is becoming increasingly apparent. A thorough assessment of QOL, including functional, physical, social, and emotional status, as well as disease-specific symptoms, allows for comparison of treatments and informs treatment decisions. In addition, it allows for problems following intervention to be identified and addressed, thereby assisting patients in their pursuits of returning to their normal activities and level of functioning. Although health care providers and researchers are increasingly aware of the need to assess patients' QOL, few standardized measures exist with which to perform a comprehensive assessment of QOL in patients with skull base neoplasms. Further research is needed, including prospective trials using reliable and valid measures tapping various aspects of QOL and specific symptoms unique to patients with tumors of the skull base.
PMCID: PMC2853060  PMID: 20592851
Skull base tumor; quality of life
15.  Visual and non-visual factors associated with patient satisfaction and quality of life in LASIK 
Eye  2011;25(9):1194-1201.
The aim of this study was to determine how laser in situkeratomileusis (LASIK) affects quality of life (QOL) and to identify factors that may affect satisfaction after LASIK.
A total of 104 patients with a mean age of 29±6, treated with LASIK for myopia and astigmatism, were enrolled in a prospective study. High (90%) and low (10%) contrast visual acuity (CVA) were measured under photopic and scotopic conditions before surgery and at 3 months later. A multidimensional QOL scale (Institute for Eye Research multidimensional QOL scale), which assesses psychological characteristics, personality traits, cosmesis, frequency, and tolerance to disturbing visual and ocular symptoms, and overall satisfaction with vision correction, was also used. Paired rank tests were used to compare preoperative and postoperative vision and QOL scores. Correlations and a multiple linear regression were used to describe the relationship between CVA, QOL, and satisfaction after LASIK.
Significant postoperative changes included increased satisfaction following LASIK (P<0.001), reduced frequency of visual and ocular symptoms (P<0.001), and change in psychological characteristics (P=0.033). The change in satisfaction with LASIK can be predicted by a combination of preoperative satisfaction, postoperative frequency of disturbing visual and ocular symptoms, postoperative mean spherical equivalent, and postoperative scotopic high CVA (R 2=0.725, P<0.05).
Satisfaction with LASIK is related to visual function, preoperative expectations, psychological characteristics, and uncorrected CVA achieved. An increased sense of subjective well-being, adaptability, and self-efficacy was evident after LASIK. Patients reported a more optimistic attitude to life and increase perceived QOL after surgery.
PMCID: PMC3178233  PMID: 21720417
quality of life; vision performance; LASIK; psychological characteristics; satisfaction
16.  Digestive tract reconstruction pattern as a determining factor in postgastrectomy quality of life 
Postgastrectomy quality of life (QoL) is affected by various symptoms, and compared with the preoperative baseline QoL, is typically impaired for the first 6 mo after surgery. Thereafter, improvement to a stable QoL is observed at approximately 12 mo postoperatively. We consider the digestive tract reconstruction pattern to be a determining factor in postgastrectomy QoL among gastric cancer patients, and believe it requires further discussion. Proximal gastrectomy is associated with the worst postoperative QoL among gastrectomy procedures and should be performed cautiously. The trend of better QoL provided by the pouch procedure of total gastrectomy requires further robust support. Whether the use of Billroth-I gastroduodenostomy or Roux-en-Y gastrojejunostomy for distal gastrectomy is optimal remains controversial, but Roux-en-Y gastrojejunostomy is likely to be preferable.
PMCID: PMC3886029  PMID: 24415891
Gastric cancer; Gastrectomy; Quality of life; Reconstruction; Digestive tract
17.  Effect of lung cancer surgery on quality of life 
Thorax  2005;60(3):234-238.
Background: Health related quality of life (HRQOL) after surgery is important, although very limited data are available on the QOL after lung cancer surgery.
Methods: The effect of surgery on HRQOL was assessed in a prospective study of 110 patients undergoing potentially curative lung cancer surgery at Papworth Hospital, 30% of whom had borderline lung function as judged by forced expiratory volume in 1 second. All patients completed the EORTC QLQ-C30 and LC13 lung cancer module before surgery and again at 1, 3 and 6 months postoperatively.
Results: On average, patients had high levels of functioning and low levels of symptoms. Global QOL had deteriorated significantly 1 month after surgery (p = 0.001) but had returned to preoperative levels by 3 months (p = 0.93). Symptoms had worsened significantly at 1 month after surgery but had returned to baseline levels by 6 months. Low values on the preoperative HRQOL scales were not significantly associated with poor surgical outcome. However, patients with low preoperative HRQOL functioning scales and high preoperative symptom scores were more likely to have poor postoperative (6 months) QOL. The only lung function measurement to show a marginally statistically significant association with quality of life at 6 months after surgery was percentage predicted carbon monoxide transfer factor (TLCO).
Conclusion: Although surgery had short term negative effects on quality of life, by 6 months HRQOL had returned to preoperative values. Patients with low HRQOL functioning scales, high preoperative symptom scores, and preoperative percentage predicted TLCO may be associated with worse postoperative HRQOL.
PMCID: PMC1747338  PMID: 15741442
18.  Time trends of chest pain symptoms and health related quality of life in coronary artery disease 
There is at present a lack of knowledge of time trends in health related quality of life (HRQL) in common patients with coronary artery disease (CAD) treated in ordinary care. The objective of this study is to assess and compare time trends of health related quality of life (HRQL) and chest pain in patients with coronary artery disease.
253 consecutive CAD patients in Stockholm County, Sweden – 197 males/56 females; 60 ± 8 years – were followed during two years. Perceived chest pain symptoms and three global assessments of HRQL were assessed at baseline, after one and after two years. EuroQol-5 dimension (EQ-5D) with a predefined focus on function and symptoms; the broader tapping global estimates of HRQL; EuroQol VAS (EQ-VAS) and Cardiac Health Profile (CHP) were used. Chest pain was ranked according to Canadian Cardiovascular Society (CCS). Change in HRQL was analysed by a repeated measurements ANOVA and chest pain symptoms were analysed by Friedman non-parametric ANOVA.
Perceived chest pain decreased during the two years (p < 0.00022); CCS 0: 41–51%; CCS 1: 19–15%; CCS 2: 31–27%; CCS 3: 5–4% and CCS 4: 4–2%. By contrast, HRQL did not change: EQ-5D: 0.76 (CI 0.73–0.79) -0.78 (CI 0.75–0.81), EQ-VAS: 0.68 (CI 0.66–0.71)-0.68 (CI 0.65–0.71) and CHP: 0.66 (CI 0.64–0.69) -0.66 (CI 0.64–0.69).
HRQL did not increase despite a reduction in the severity of chest pain during two years. This implies that the major part of HRQL in these consecutive ordinary patients with CAD is unresponsive to change in chest pain symptoms.
PMCID: PMC1821316  PMID: 17341296
19.  Impact of invasive bladder cancer and orthotopic urinary diversion on general health-related quality of life: An SF-36 survey 
Molecular and Clinical Oncology  2013;1(4):758-762.
Bladder cancer is a common type of genitourinary cancer, and radical cystectomy with urinary diversion is considered to be the most effective local treatment for invasive bladder cancer. In order to assess the functional results and health-related quality of life (QOL) in bladder cancer patients with an orthotopic neobladder, and to provide a reasonable basis for the evaluation of urinary diversion in situ, we conducted a study on 96 neobladder patients. In December, 2011, questionnaires were mailed to 96 patients that had undergone urinary diversion surgery between January, 2007 and December, 2009. The questionnaire included the validated health-related QOL questionnaire and the MOS 36-item Short-Form Health Survey (SF-36). We compared the functional results between patients with an orthotopic neobladder and those with other types of urinary diversion at 6, 12 and 24 months after surgery. Data from 82 patients (54 with orthotopic and 28 with non-orthotopic urinary diversion) were included in the analysis. The SF-36 patient scores following orthotopic urinary diversion were significantly higher than those following non-orthotopic urinary diversion. The majority of patients with orthotopic urinary diversion considered themselves as healthy and their scores of total health were higher compared to those of patients with non-orthotopic urinary diversion. However, there were no differences in the scores of physical functioning between patients with orthotopic and those with non-orthotopic urinary diversion. Our findings regarding health-related QOL and the frequency of complications in the orthotopic and the non-orthotopic urinary diversion groups were similar. However, the mental health of patients with orthotopic urinary diversion was more easily restored compared to that of patients with non-orthotopic urinary diversion, which reduced their overall recovery time.
PMCID: PMC3915709  PMID: 24649242
bladder neoplasms; orthotopic; urinary diversion; quality of life; SF-36 general health survey
20.  The improvement of quality of life in patients treated with bariatric surgery in Korea 
Bariatric surgery is considered an efficient treatment for severe obesity, but postoperative complications and psychosocial problems may impact quality of life (QoL). Although QoL is an important aspect of bariatric surgery, few studies have evaluated the changes in QoL. We examined whether severely obese patients who had undergone bariatric surgery had better QoL compared with severely obese adults who had not undergone bariatric surgery in Korea.
Data were obtained from 78 participants in two groups; bariatric surgery group (n = 53) and nonsurgery group (n = 25). EuroQoL-5D (EQ-5D), the impact of weight on quality of life-lite (IWQoL-lite) and the obesity-related psychosocial problem scale (OP-scale) were used to assess the improvement of QoL.
A total of 78 patients completed the QoL forms as part of their surgical consultation. In the EQ-5D, the changes of EQ-5D 3 level and EQ-5D visual analogue scale in the surgery group was 0.174 and 24.6 versus 0.017 and 17.8 in the nonsurgery group (P = 0.197 and P = 0.179). The changes of IWQoL-lite and OP-scale were significantly improved after bariatric surgery. In the IWQoL-lite, the mean changes in the surgery group was 33.4 versus 14.3 points in the nonsurgery group (P = 0.000). In the OP-scale, the mean changes in the surgery group patients scored 39.3 versus 9.0 points in the nonsurgery group (P = 0.000).
We demonstrated significant improvement of QoL observed after bariatric surgery compared to nonsurgical procedure. The results of this comparative study favor bariatric surgery for the treatment of severe obesity.
PMCID: PMC3594640  PMID: 23486845
Bariatric surgery; Obesity; Quality of life
21.  Improvement in visual function and quality of life following a blindness prevention surgery program in a rural area of Eastern China 
The aim of this study was to assess the changes in visual function (VF) and quality of life (QOL) among patients following blindness prevention surgery in a rural area of Eastern China. The prospective study selected cataract patients via mobile eye screening camps. VF and QOL questionnaires originally developed by Fletcher et al were completed prior to and 6 months after surgery. Small-incision cataract surgery (SICS) with posterior chamber intraocular lens (IOL) implantation was performed on patients by a blindness prevention surgery group. The VF and QOL scores of 178 cataract patients preoperatively were 48.58±31.18 and 65.97±26.77, respectively. The scores decreased in proportion to decreasing vision status. The VF and QOL scale scores were significantly correlated with the vision grade of the patient (rVF=−17.2093, t=−10.87, P<0.001, rQOL=−13.1399, t=−8.87, P<0.001) and age (rVF=−0.6505, t=−3.87, P<0.001, rQOL=− 0.3309, t=−2.10, P=0.037). A total of 131 patients responded to the second survey, VF and QOL scores increased significantly over a six-month postoperative period (VF=83.21±16.40, P<0.001; QOL=86.53±16.33, P<0.001). The VF scale scores were correlated with the grade of vision and residence area, the QOL scale scores were correlated with the grade of vision and gender. The VF and QOL of patients were significantly improved by performing SICS with posterior chamber IOL implantation collectively in a short period in rural areas of Eastern China. It is important to follow-up cataract patients postoperatively as untreated complications of the surgery may affect the stability of VF and QOL postoperatively.
PMCID: PMC3702720  PMID: 23837062
prevent blindness; quality of life; visual function; cataract; surgery
22.  Cross-cultural development of an EORTC questionnaire to assess health-related quality of life in patients with testicular cancer: the EORTC QLQ-TC26 
Quality of Life Research  2012;22(2):369-378.
Testicular cancer (TC) is the most common cancer in young men, and its incidence is increasing. The low mortality rate makes quality of life (QOL) an important issue in this patient group. This study aimed to develop a supplementary module of the EORTC QLQ-C30 questionnaire to assess TC-specific aspects of QOL.
Questionnaire development was conducted according to guidelines from the EORTC Quality of Life Group. Phase I comprised generation of QOL issues relevant to TC patients through a literature search and interviews with patients and experts. Phase II included operationalization and assessment of item relevance. In phase III, items were pre-tested in a cross-cultural sample to assess issues such as understandability and intrusiveness of items.
In phase I and II, an initial list of 69 QOL issues possibly relevant to TC patients was refined through patient and expert interviews. The remaining 37 issues were operationalized into items and assessed for relevance and priority in an expert sample (n = 28) and a patient sample (n = 62) from Austria, Canada and the Netherlands. After revision of the item list, 26 items were considered eligible for pre-testing in phase III, in which 156 patients from Australia, Austria, Italy and Spain participated. All items passed criteria for pre-testing, thus forming the new EORTC QLQ-TC26.
The newly developed EORTC QLQ-TC26 is now available in several languages to assess QOL in TC patients receiving treatment and in TC survivors. Phase IV of questionnaire development will comprise international field testing, including extensive analysis of psychometric characteristics of the EORTC QLQ-TC26.
PMCID: PMC3576569  PMID: 22407356
Testicular cancer; Quality of life; Questionnaire; eortc qlq-tc26
23.  Diagnostic tools in Rhinology EAACI position paper 
This EAACI Task Force document aims at providing the readers with a comprehensive and complete overview of the currently available tools for diagnosis of nasal and sino-nasal disease. We have tried to logically order the different important issues related to history taking, clinical examination and additional investigative tools for evaluation of the severity of sinonasal disease into a consensus document. A panel of European experts in the field of Rhinology has contributed to this consensus document on Diagnostic Tools in Rhinology.
PMCID: PMC3294630  PMID: 22410181
24.  Will cardiac surgery improve my quality of life? 
Netherlands Heart Journal  2007;15(2):51-54.
The intention of this study is to analyse the correlation between a visual analogue scale (VAS) and the most common preoperative comorbidity and cardiac variables in patients undergoing elective cardiac surgery. This VAS is simple, easy to register and can be used as a global measurement of quality of life (QOL).
Preoperative assessment of QOL in 1351 patients, 979 men and 372 women, with a mean age of 64.5±10.5 (18-88), undergoing elective cardiac surgery between January 2003 and December 2005. QOL was measured by the EuroQol questionnaire.
The mean VAS was 58.7±20.9, range 3 to 100. Univariate analysis showed a difference for sex (p=0.000), and NYHA (p=0.009) between patients with an isolated CABG and those with a combined revascularisation (p=0.05). Stepwise logistic regression analysis identified female gender (p=0.00), NYHA (p=0.00) and valve disease (p=0.03) as independent variables for a low QOL. The correlation between NYHA and QOL was low (r=-0.09, p=0.003).
The clinical consequence is that using this simple VAS we can identify patients with a good QOL. If these patients present for high-risk surgery, with a better quality of life as primary indication, more extended counselling regarding their QOL is recommended. (Neth Heart J 2007;15:51-4.17612660)
PMCID: PMC1847756  PMID: 17612660
myocardial revascularisation; angina pectoris; quality of life; follow-up
25.  Enhanced patient reported outcome measurement suitable for head and neck cancer follow-up clinics 
Head & Neck Oncology  2012;4:32.
The ‘Worse-Stable-Better’ (W-S-B) question was introduced to capture patient-perceived change in University of Washington Quality of Life (UW-QOL) domains.
202 head and neck cancer patients in remission prospectively completed UW-QOL and Patients Concerns Inventory (PCI). For each UW-QOL domain, patients indicated whether over the last month things had worsened (W), remained stable (S) or were better (B).
202 patients at 448 attendances selected 1752 PCI items they wanted to discuss in consultation, and 58% (1024/1752) of these were not covered by the UW-QOL. UW-QOL algorithms highlighted another 440 significant problems that the patient did not want to discuss (i.e. the corresponding items on the PCI were not selected).
After making allowance for UW-QOL algorithms to identify 'significant problems' and PCI selection of corresponding issues for discussion there remained clear residual and notable variation in W-S-B responses, in particular to identify patients with significant problems that were getting worse, and patients without significant problems that wanted to discuss issues that were getting worse. Changes in mean UW-QOL scores were notably lower for those getting worse on the W-S-B question, typically by 10 or more units a magnitude that suggests clinically important changes in score.
The W-S-B question adds little questionnaire burden and could help to better identify patients who might benefit from intervention. The results of this study suggest that the UW-QOL with the W-S-B modification should be used together with the PCI to allow optimal identification of issues for patient-clinician discussion during routine outpatient clinics.
PMCID: PMC3448513  PMID: 22695251
Health-related quality of life; Head and neck cancer; UW-QOL; Patients Concerns Inventory; Unmet needs

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