ABSTRACT
OBJECTIVE: Our aim was to validate Spanish and Catalan versions of the Liver Disease Quality of Life questionnaire (LDQOL) for use in liver transplant patients. METHODS: The LDQOL consists of the SF-36 generic measure of health-related quality of life (HRQOL) and 12 disease-specific dimensions for liver disease patients. The Spanish and Catalan versions of the questionnaire were administered to 138 patients with a liver transplant. Cronbach's alpha coefficients (CAC) were used to test the internal consistency of disease-specific scales. Test-retest reliability was calculated using the Intraclass Correlation Coefficient (ICC) in a sub-group of 41 patients who completed the questionnaire on two occasions 1 to 2 weeks apart. Validity was analysed by determining the instrument's capacity to discriminate between patient groups classified according to years since transplant, disease etiology, and symptom severity. Ceiling and floor effects were also calculated. RESULTS: Internal consistency in the disease-specific dimensions was acceptable or good (CACs 0.60-0.97), as was test-retest reliability in all dimensions (statistically significant CCIs of 0.62-0.89), except the symptoms dimension (CCI=0.46, P<.05). Few differences were found in disease-specific dimension scores between patients classified according to number of years since transplant or etiology, but differences were found in some dimensions according to symptom severity. Moderate to severe ceiling effects were found in several disease-specific dimensions. CONCLUSIONS: The Spanish and Catalan versions of the LDQOL may be useful for measuring HRQOL in this population, though it will be important to investigate further the instrument's sensitivity to change.
Subject(s)
Liver Diseases/physiopathology , Liver Diseases/psychology , Liver Transplantation/physiology , Liver Transplantation/psychology , Quality of Life , Activities of Daily Living , Attitude to Health , Female , Health Status , Humans , Language , Liver Diseases/classification , Male , Middle Aged , Reproducibility of Results , Sexual Behavior , Sleep , Spain , Surveys and QuestionnairesABSTRACT
Objetivo : estudiar las complicaciones de la toracentesis, diagnóstica o terapéutica, en pacientes cirróticos con derrame pleural. Diseño experimental: estudio prospectivo de cohortes. Se practicó una toracentesis diagnóstica al ingreso o cuando tuvo indicación clínica y una toracentesis evacuadora a aquellos pacientes con disnea que no mejoraron con tratamiento médico. A todos los pacientes se practicó una radiografía de tórax en las 24 horas siguientes al procedimiento y un seguimiento clínico cuidadoso. Se han estudiado los factores de riesgo para presentar un neumotórax y la probabilidad actuarial de sufrir un neumotórax en el subgrupo de pacientes con toracentesis evacuadoras sucesivas. Pacientes: todos los pacientes cirróticos con derrame pleural ingresados durante un periodo de 4 años. Se incluyeron en el estudio 69 pacientes. Resultados: durante el periodo de estudio se practicaron 245 toracentesis,150 diagnósticas y 95 evacuadoras. La complicación más grave fue el neumotórax que se presentó en 10 ocasiones (4 por ciento); tras de 2 de 150 (1,3 por ciento) toracentesis diagnósticas y tras 8 de 95 (8,4 por ciento) toracentesis terapéuticas (RR, IC 95 por ciento; 6,8, 1,4132,77, p<0,01). El riesgo actuarial de sufrir neumotórax tras toracentesis evacuadoras repetidas ha sido del 7,7 por ciento, 25,3 por ciento y 34,7 por ciento tras la primera, segunda y cuarta toracentesis, respectivamente. Conclusiones : la toracentesis diagnóstica en pacientes cirróticos tiene baja morbilidad. Las toracentesis terapéuticas son un factor de riesgo para el desarrollo de un neumotórax y el riesgo aumenta con la práctica de sucesivas toracentesis. La práctica de una radiografía de tórax no está justificada tras una toracentesis diagnóstica; sin embargo, es recomendable tras una toracentesis terapéutica (AU)
Subject(s)
Middle Aged , Male , Female , Humans , Risk Factors , Paracentesis , Pleural Effusion , Prospective Studies , Hydrothorax , Liver CirrhosisSubject(s)
Alcaligenes , Bacterial Infections , Peritonitis/microbiology , Humans , Male , Middle AgedABSTRACT
OBJECTIVE: To study the complications of thoracentesis, either diagnostic or therapeutic, in cirrhotic patients with pleural effusion. EXPERIMENTAL DESIGN: A cohort prospective study. A diagnostic thoracentesis was performed at admission or when spontaneous bacterial empyema was suspected; a therapeutic thoracentesis was conducted in patients with dyspnea that did not improve with medical treatment. A chest radiography and a careful clinical follow up were performed in all patients within 24 hours after the procedure. We studied the risk factors for developing pneumothorax and the actuarial probability of pneumothorax after consecutive therapeutic thoracentesis. PATIENTS: All cirrhotic patients admitted with pleural effusion over a 4-year period. The study included 69 patients. RESULTS: During the study period, we performed 245 thoracentesis, 150 diagnostic and 95 therapeutic ones. The most severe complication was pneumothorax in 10 cases (4%), after 2 out of 150 (1.3%) diagnostic thoracentesis and after 8 out of 95 (8.4%) therapeutic thoracentesis (RR, 95% CI 6.8, 1.41-32.77, p < 0.01). The actuarial risk of pneumothorax after the first, second and fourth therapeutic thoracentesis was 7.7%, 25.3% and 34.7%, respectively. CONCLUSIONS: Diagnostic thoracentesis in cirrhotic patients is associated to a low morbidity. Therapeutic thoracentesis is a risk factor for pneumothorax and the risk increases after consecutive thoracentesis. A chest radiograph is not justified after a diagnostic thoracentesis, but should be done after a therapeutic thoracentesis.
