Monitoring health care from the patient's point of view

Poor quality of life in patients with and without frailty: co-prevalence and prognostic implications in patients undergoing percutaneous coronary interventions and cardiac catheterization

AIMS

We hypothesize that poor quality of life (QOL) is highly prevalent in frail older adults and is associated with worse prognosis.

METHODS AND RESULTS

Predismissal standardized tests for frailty and QOL were prospectively administered to patients included in two cohorts. In Cohort 1, 629 patients ≥65 years who underwent percutaneous coronary intervention (PCI) from 2005 to 2008, frailty (Fried criteria), and QOL [SF-36 and Seattle Angina Questionnaires (SAQ)] were ascertained. Cohort 2 included 921 patients ≥55 years who underwent cardiac catheterization (535 had PCI) from 2014 to 2018 and frailty was determined by Rockwood criteria and QOL by single-item, self-reported health questionnaire. In Cohort 1, 19% were frail and 20% patients in Cohort 2 were frail with a frailty index >0.30. The median SAQ for physical limitation (58.9 vs. 82.2, P < 0.001), physical (29.5 vs. 43.9, P < 0.001), and mental (49.2 vs. 57.4, P < 0.001) component scores of SF-36 in Cohort 1 were lower and self-rating of fair/poor health (56% vs 18%, P < 0.001) in Cohort 2 was significantly higher in frail patients. As compared to patients without frailty, frail patients were five times more likely (59% vs. 11%, P < 0.001) in Cohort 1 and seven times more likely (56% vs. 8%) in Cohort 2 to be classified with poor QOL. Age- and gender-adjusted 3-year all-cause death and death or myocardial infarction (MI) was significantly higher for patients undergoing PCI with frailty; [hazard ratio (95% confidence interval) death, 4.20 (2.63-6.68, P < 0.001) and death or MI hazard ratio (HR) 2.72 (1.91-3.87, P < 0.001)] and with poor QOL [HR death 2.47 (1.59-3.84, P < 0.001)] and death or MI 1.61 (1.16-2.24, P < 0.001). There was no significant interaction between frailty and QOL (P = 0.64) and only modest attenuation was observed when considered together indicating their independent prognostic influence.

CONCLUSION

In elderly patients undergoing cardiac catheterization or PCI, poor QOL is seen more frequently in frail patients. Both frailty and poor QOL had significant and independent association with long-term survival.

Comprehensive Geriatric Assessment in the Management of Older Patients With Cardiovascular Disease

Cardiovascular disease (CVD) disproportionately affects older adults. It is expected that by 2030, one in five people in the United States will be older than 65 years. Individuals with CVD now live longer due, in part, to current prevention and treatment approaches. Addressing the needs of older individuals requires inclusion and assessment of frailty, multimorbidity, depression, quality of life, and cognition. Despite the conceptual relevance and prognostic importance of these factors, they are seldom formally evaluated in clinical practice. Further, although these constructs coexist with traditional cardiovascular risk factors, their exact prevalence and prognostic impact remain largely unknown. Development of the right decision tools, which include these variables, can facilitate patient-centered care for older adults. These gaps in knowledge hinder optimal care use and underscore the need to rigorously evaluate the optimal constructs for providing care to older adults. In this review, we describe available tools to examine the prognostic role of age-related factors in patients with CVD.

The birth satisfaction scale

PURPOSE

The purpose of this paper is to develop a psychometric scale--the birth satisfaction scale (BSS)--for assessing women's birth perceptions.

DESIGN/METHODOLOGY/APPROACH

Literature review and transcribed research-based perceived birth satisfaction and dissatisfaction expression statements were converted into a scored questionnaire.

FINDINGS

Three overarching themes were identified: service provision (home assessment, birth environment, support, relationships with health care professionals); personal attributes (ability to cope during labour, feeling in control, childbirth preparation, relationship with baby); and stress experienced during labour (distress, obstetric injuries, receiving sufficient medical care, obstetric intervention, pain, long labour and baby's health).

RESEARCH LIMITATIONS/IMPLICATIONS

Women construct their birth experience differently. Views are directed by personal beliefs, reactions, emotions and reflections, which alter in relation to mood, humour, disposition, frame of mind and company kept. Nevertheless, healthcare professionals can use BSS to assess women's birth satisfaction and dissatisfaction. Scores measure their service quality experiences.

SOCIAL IMPLICATIONS

Scores provide a global measure of care that women perceived they received during labour.

ORIGINALITY/VALUE

Finding out more about what causes birth satisfaction and dissatisfaction helps maternity care professionals improve intra-natal care standards and allocate resources effectively. An attempt has been made to capture birth satisfaction's generalised meaning and incorporate it into an evidence-based measuring tool.

Damage caused by Wegener's granulomatosis and its treatment: Prospective data from the Wegener's Granulomatosis Etanercept Trial (WGET)

OBJECTIVE

To analyze damage occurring in patients with Wegener's granulomatosis (WG) enrolled in the WG Etanercept Trial (WGET) and to correlate that damage with disease activity, adverse events, and quality of life.

METHODS

The Vasculitis Damage Index (VDI) was applied to all 180 patients at trial entry and every 6 months throughout the trial. Items of damage were analyzed by presumed etiology (i.e., secondary to WG, to therapy, or both) and time of occurrence. Spearman's rank correlation coefficients were calculated between VDI scores and the Birmingham Vasculitis Activity Score for WG (BVAS/WG), frequency of flares, number of adverse events, and the patients' quality-of-life assessments.

RESULTS

The mean VDI score was 1.3 at the study enrollment and 1.8 at the end of the trial. This increase was due to damage that occurred despite (or because of) therapy, including visual impairment, hearing loss, nasal blockade, pulmonary fibrosis, hypertension, renal insufficiency, peripheral neuropathy, gonadal failure, and diabetes mellitus. Only 11% of the enrolled patients had not sustained a single VDI item after 1 year of enrollment. When adjusted for baseline VDI, the baseline BVAS/WG correlated moderately well with the VDI score at 1 year (r = 0.20, P = 0.015). Increases in adjusted VDI scores also correlated with the number of adverse events, particularly among patients with limited WG (P = 0.06).

CONCLUSION

Damage from both active disease and its treatment remain important problems for patients with WG. Despite the dramatic improvements in patient survival achieved over the last several decades, only a few patients with WG emerge from a period of active disease without sustaining some damage from the disease itself, its treatment, or both. An important measure of future therapeutic approaches will be their ability to reduce the damage accrued over time.

Investigating Patient Satisfaction as an Outcome for Ultrasound-Guided Breast Procedures

An investigation of patient satisfaction with ultrasound-guided breast procedures (fine needle biopsy and cyst aspiration) was performed. The research was designed around a proposed imaging loop added to the Health Related Quality of Life model. A patient questionnaire, devised to assess three areas of the imaging loop—preanalytical, postanalytical, and overall satisfaction with the procedure—was administered. Results show a population of patients satisfied with these invasive procedures. Study patients' satisfaction levels were comparable with those of control subjects. Procedure anxiety was identified as a patient perception, but did not hamper level of satisfaction. Study patients also reported that ultrasound-guided breast procedures contributed to a perception of favorable overall health and gave a high level of patient satisfaction.

An analysis of the concept 'patient satisfaction' as it relates to contemporary nursing care

Patient satisfaction has become an established indicator of the quality of health care yet, despite the abundance of measurement surveys reported in the literature, there are few theoretical underpinnings for this important concept. An analysis of the concept of patient satisfaction, specifically as it relates to contemporary nursing care, provides an excellent vantage point to more closely examine this key measure of health care quality. A review of pertinent literature is presented, followed by examination of the uses of the concept in professional literature as well as more general sources. Defining attributes cited throughout the literature are identified along with the concept's antecedents and consequences. Empirical referents, definitions, and measurements are also presented. The analysis concludes with re-examination of some of the assumptions underlying patient satisfaction literature in general, and thoughts regarding the significance of patient satisfaction with nursing care in particular. Suggestions for future inquiry are offered.