ABSTRACT
Measuring Health Related Quality of Life has become more and more important in evaluating patients with peripheral arterial disease. This prospective longitudinal survey aimed to investigate health related quality of life over time in patients with peripheral arterial disease (PAD) undergoing percutaneous transluminal angioplasty (PTA) between December 2005 and June 2008. Health Related Quality of life was assessed using the Claudication Scale (CLAU-S) and EQ5D and the Sense of Coherence Scale was used to estimate the patients' sense of coherence. The findings of this study shows that the total CLAU-S score was improved both at one-month follow-up (p < 0.0001) and one-year follow-up (p < 0.0001) compared to baseline. There were significant differences regarding all five dimensions: every day life, pain, social life, illness-specific fears and psychological wellbeing. The EQ5D computed by index improved significantly both at one-month follow-up (p = 0.0006) and one-year follow-up (p = 0.0019) compared to baseline. Differences were found between the groups with low and moderate sense of coherence (p = 0.0169) as well as between the groups with low and high sense of coherence (p = 0.0208) regarding health related quality of life (HRQoL). This study showed that PTA improves HRQoL among individuals suffering from PAD and that the effect is sustainable over time. For more accurate results, a disease-specific instrument should be used to evaluate HRQoL.
Subject(s)
Angioplasty , Peripheral Arterial Disease/psychology , Quality of Life , Adaptation, Psychological , Aged , Aged, 80 and over , Angioplasty/psychology , Female , Follow-Up Studies , Health Status Indicators , Humans , Male , Middle Aged , Pain Measurement , Peripheral Arterial Disease/therapy , Prognosis , Prospective Studies , Psychometrics , Statistics as Topic , Statistics, Nonparametric , Stress, Psychological , Surveys and Questionnaires , Time FactorsABSTRACT
BACKGROUND: Appendectomy has been the treatment for acute appendicitis for over 120 years. Antibiotic treatment has occasionally been used in small uncontrolled studies, instead of operation, but this alternative has never before been tried in a multicenter randomized trial. PATIENTS AND METHODS: Male patients, 18-50 years of age, admitted to six different hospitals in Sweden between 1996 and 1999 were enrolled in the study. No women were enrolled by decision of the local ethics committee. If appendectomy was planned, patients were asked to participate, and those who agreed were randomized either to surgery or to antibiotic therapy. Patients randomized to surgery were operated on with open surgery or laparoscopically. Those randomized to antibiotic therapy were treated intravenously for 2 days, followed by oral treatment for 10 days. If symptoms did not resolve within 24 hours, an appendectomy was performed. Participants were monitored at the end of 1 week, 6 weeks, and 1 year. RESULTS: During the study period 252 men participated, 124 in the surgery group and 128 in the antibiotic group. The frequency of appendicitis was 97% in the surgery group and 5% had a perforated appendix. The complication rate was 14% in the surgery group. In the antibiotic group 86% improved without surgery; 18 patients were operated on within 24 hours, and the diagnosis of acute appendicitis was confirmed in all but one patient, and he was suffering from terminal ileitis. There were seven patients (5%) with a perforated appendix in this group. The rate of recurrence of symptoms of appendicitis among the 111 patients treated with antibiotics was 14% during the 1-year follow-up. CONCLUSIONS: Acute non-perforated appendicitis can be treated successfully with antibiotics. However, there is a risk of recurrence in cases of acute appendicitis, and this risk should be compared with the risk of complications after appendectomy.
