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DiFiglia S, Dhingra L, Georgiopoulos AM, Papia K, Sullivan E, Plachta A, Boccio C, Portenoy R, Basile M. Addressing Symptom Burden and Palliative Care Needs in Cystic Fibrosis: A Narrative Review of the Literature. Life (Basel) 2023; 13:1620. [PMID: 37629478 PMCID: PMC10455429 DOI: 10.3390/life13081620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023] Open
Abstract
Among people with cystic fibrosis (CF), illness burden is multifaceted, and symptoms may fluctuate in intensity across a lifespan. Caregivers of people with CF may also experience distressing symptoms. Recent developments in CF care, including the availability of highly effective modulator therapies (HEMTs) and new palliative care guidelines promoting palliative care screening may help alleviate symptoms. The objective of this review was to present a narrative view of the recent literature on symptom burden in CF, new screening approaches informed by the Cystic Fibrosis Foundation (CFF) palliative care guidelines, and early data from studies examining the impact of HEMTs on CF symptom burden. A review of the relevant literature was conducted using Google Scholar and PubMed. Included articles covered approaches to burden assessment in CF and other chronic illnesses, epidemiology of CF symptom burden, the impact of HEMTs on symptom burden, and the CFF palliative care guidelines. A primary palliative care model implementing the CFF guidelines was also described. Results of this review show that while recent developments in CF care have led to a reduction in physical symptoms, mental health symptoms remain prevalent. Ongoing screening and triage can ensure that physical symptoms, psychological symptoms, social needs, practical problems, and communication concerns are addressed by care teams.
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Affiliation(s)
- Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA; (S.D.); (L.D.); (R.P.)
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA; (S.D.); (L.D.); (R.P.)
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Anna M. Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA;
- Harvard Medical School, Boston, MA 02115, USA
| | - Katherine Papia
- Cystic Fibrosis Center, Northwell Health, New Hyde Park, NY 11042, USA; (K.P.); (E.S.); (C.B.)
| | - Erin Sullivan
- Cystic Fibrosis Center, Northwell Health, New Hyde Park, NY 11042, USA; (K.P.); (E.S.); (C.B.)
| | - Amy Plachta
- Cystic Fibrosis Center, Lennox Hill, New York, NY 10021, USA;
| | - Courtney Boccio
- Cystic Fibrosis Center, Northwell Health, New Hyde Park, NY 11042, USA; (K.P.); (E.S.); (C.B.)
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA; (S.D.); (L.D.); (R.P.)
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Melissa Basile
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA
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Acaster S, Mukuria C, Rowen D, Brazier JE, Wainwright CE, Quon BS, Duckers J, Quittner AL, Lou Y, Sosnay PR, McGarry LJ. Development of the Cystic Fibrosis Questionnaire-Revised-8 Dimensions: Estimating Utilities From the Cystic Fibrosis Questionnaire-Revised. Value Health 2023; 26:567-578. [PMID: 36509366 DOI: 10.1016/j.jval.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 11/09/2022] [Accepted: 12/01/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Cystic fibrosis (CF) limits survival and negatively affects health-related quality of life (HRQOL). Cost-effectiveness analysis (CEA) may be used to make reimbursement decisions for new CF treatments; nevertheless, generic utility measures used in CEA, such as EQ-5D, are insensitive to meaningful changes in lung function and HRQOL in CF. Here we develop a new, CF disease-specific, preference-based utility measure based on the adolescent/adult version of the Cystic Fibrosis Questionnaire-Revised (CFQ-R), a widely used, CF-specific, patient-reported measure of HRQOL. METHODS Blinded CFQ-R data from 4 clinical trials (NCT02347657, NCT02392234, NCT01807923, and NCT01807949) were used to identify discriminating items for a classification system using psychometric (eg, factor and Rasch) analyses. Thirty-two health states were selected for a time trade-off (TTO) exercise with a representative sample of the UK general population. TTO utilities were used to estimate a preference-based scoring algorithm by regression analysis (tobit models with robust standard errors clustered on participants with censoring at -1). RESULTS A classification system with 8 dimensions (CFQ-R-8 dimensions; physical functioning, vitality, emotion, role functioning, breathing difficulty, cough, abdominal pain, and body image) was generated. TTO was completed by 400 participants (mean age, 47.3 years; 49.8% female). Among the regression models evaluated, the tobit heteroscedastic-ordered model was preferred, with a predicted utility range from 0.236 to 1, no logical inconsistencies, and a mean absolute error of 0.032. CONCLUSION The CFQ-R-8 dimensions is the first disease-specific, preference-based scoring algorithm for CF, enabling estimation of disease-specific utilities for CEA based on the well-validated and widely used CFQ-R.
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Affiliation(s)
| | - Clara Mukuria
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, England, UK
| | - Donna Rowen
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, England, UK
| | - John E Brazier
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, England, UK
| | - Claire E Wainwright
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Bradley S Quon
- Centre for Heart Lung Innovation, St. Paul's Hospital, and Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jamie Duckers
- Department of Respiratory Medicine, Cardiff and Vale University Health Board, NHS Wales, Cardiff, Wales, UK
| | | | - Yiyue Lou
- Biostatistics, Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | - Patrick R Sosnay
- Clincal Development, Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | - Lisa J McGarry
- Health Economics and Outcomes Research, Vertex Pharmaceuticals Incorporated, Boston, MA, USA
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Abstract
Lung transplantation provides a treatment option for many individuals with advanced lung disease due to cystic fibrosis (CF). Since the first transplants for CF in the 1980s, survival has improved and the opportunity for transplant has expanded to include individuals who previously were not considered candidates for transplant. Criteria to be a transplant candidate vary significantly among transplant programs, highlighting that the engagement in more than one transplant program may be necessary. Individuals with highly resistant CF pathogens, malnutrition, osteoporosis, CF liver disease, and other comorbidities may be suitable candidates for lung transplant, or if needed, multi-organ transplant. The transplant process involves several phases, from discussion of prognosis and referral to a transplant center, to transplant evaluation, to listing, transplant surgery, and care after transplant. While the availability of highly effective CF transmembrane conductance regulator (CFTR) modulators for many individuals with CF has improved lung function and slowed progression to respiratory failure, early discussion regarding transplant as a treatment option and referral to a transplant program are critical to maximizing opportunity and optimizing patient and family experience. The decision to be evaluated for transplant and to list for transplant are distinct, and early referral may provide a treatment option that can be urgently executed if needed. Survival after transplant for CF is improving, to a median survival of approximately 10 years, and most transplant survivors enjoy significant improvement in quality of life.
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Niehammer U, Steindor M, Straßburg S, Sutharsan S, Taube C, Welsner M, Hirtz R, Stehling F. Cough suppression and HRQoL in adult people with cystic fibrosis: an unexplored correlation. Health Qual Life Outcomes 2022; 20:141. [PMID: 36203159 PMCID: PMC9535958 DOI: 10.1186/s12955-022-02053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cough suppression assessed by embarrassment about coughing has been shown in adolescents with cystic fibrosis (CF) and negatively affects health-related quality of life (HRQoL) and clinical indicators of disease severity in adolescent females. However, whether cough suppression exists in adults has been studied as little as its effects on clinical and psychological outcomes beyond adolescence. METHODS Seventy-one subjects completed the self-reported 'Cystic Fibrosis Questionnaire-Revised (CFQ-R + 14)' and a self-report questionnaire about cough suppression, health-related perspectives, and therapy adherence. The status of CF disease was quantified in terms of the percentage of predicted forced expiratory volume in one second (ppFEV1), body mass index (BMI), Pseudomonas aeruginosa, pancreatic status, and CF-related diabetes (CFRD). Additional demographic data for sex, age, graduation, employment, and marital status were assessed. RESULTS CS exists in adult CF and is associated with impaired HRQoL but not the overall CF disease status regarding BMI, ppFEV1, or health-related perspectives. Despite a higher prevalence of cough suppression in women, no effect of sex regarding either outcome measure was observed. CONCLUSION The results of this study suggest that mental health indicators have an impact on cough suppression.
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Affiliation(s)
- Ute Niehammer
- Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Mathis Steindor
- Paediatric Pulmonology and Sleep Medicine, Children's Hospital, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Svenja Straßburg
- Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Matthias Welsner
- Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Raphael Hirtz
- Paediatric Endocrinology, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Florian Stehling
- Paediatric Pulmonology and Sleep Medicine, Children's Hospital, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Setyanto D, d'Arqom A, Indiastuti DN, Qurnianingsih E, Hasanatuludhhiyah N, Izzah SN, Nasution MZ, Yusof J. Medical student acceptance on gene therapy to increase children's well-being with genetic diseases: a study in Indonesia. Future Sci OA. [PMID: 35909997 PMCID: PMC9327639 DOI: 10.2144/fsoa-2021-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
Aim: Gene therapy is expected to improve patients' quality of life. Medical students need to be aware about this technology as its application is becoming wider. Materials & methods: A web-based survey was conducted to measure the acceptance of Indonesian medical students regarding gene therapy. Results: Data from 621 valid responses showed that Indonesian medical students have little knowledge of this technology, with 34.4% of them ever heard of gene therapy. However, most of them support the approved gene therapy for health-related matters, but not on the non-health related matters. Their acceptance was determined by the sex, domicile and studentship status. Conclusion: Increasing medical students' knowledge of gene therapy is important to minimize the future conflict of gene therapy application.
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Taheri L, Mirlashari J, Modaresi M, Pederson A. Cough in adolescent with cystic fibrosis, from nightmare to COVID-19 stigma: A qualitative thematic analysis. J Pediatr Nurs 2022; 64:119-125. [PMID: 35279332 PMCID: PMC8906655 DOI: 10.1016/j.pedn.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Cough is part of the daily life of patients with Cystic fibrosis (CF) and its most common symptom. This study explored the experiences of adolescents with CF in Iran during the COVID-19 pandemic in relation to their cough. DESIGN AND METHODS In this qualitative study, we conducted 32 semi-structured interviews with 21 adolescents with CF. We analyzed the data thematically. RESULTS We identified three main themes among adolescents with CF in relation to coughing: 1. Cough is a permanent companion; 2. Coughing raises fear of double stigma; 3. Patients' individualized coping strategies to deal with coughing. Participants complained that cough interrupted daily tasks and sleep, drew unwanted attention in public places, and elicited questions about whether they were COVID-19 patients or substance users-both highly stigmatized identities. CONCLUSION Although coughing is a protective mechanism for CF patients, frequent coughing often causes major challenges, particularly during the COVID pandemic, when people were acutely sensitive and aware about coughing. During the COVID-19 pandemic, in addition to taking care of themselves and managing the disease, CF patients therefore had to also overcome issues related to social stigma and isolation. PRACTICE IMPLICATIONS Healthcare workers play an important role in increasing public awareness about CF and its symptoms, including cough. During the pandemic, healthcare workers can help reduce the stigma of coughing through public education. Healthcare workers can actively communicate with patients to identify severe and ineffective cases of cough due to exacerbation of the disease and refer them to a specialist.
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Affiliation(s)
- Leila Taheri
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Jila Mirlashari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Department of OBGYN, Women's Health Research Institute, University of British Columbia, Vancouver, Canada.
| | - Mohammadreza Modaresi
- Pediatric Pulmonary Disease and Sleep Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran; Cystic Fibrosis research center, Iran CF Foundation (ICFF), Tehran, Iran.
| | - Ann Pederson
- Population Health School of Population and Public health, University of British Columbia, British Columbia, Canada.
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Caterini JE, Ratjen F, Barker AR, Williams CA, Rendall K, Schneiderman JE, Wells GD. Exercise intolerance in cystic fibrosis-the role of CFTR modulator therapies. J Cyst Fibros 2021; 21:282-292. [PMID: 34955387 DOI: 10.1016/j.jcf.2021.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/18/2021] [Accepted: 11/20/2021] [Indexed: 12/11/2022]
Abstract
Exercise intolerance is common in people with CF (pwCF), but not universal among all individuals. While associated with disease prognosis, exercise intolerance is not simply a reflection of the degree of lung disease. In people with severe CF, respiratory limitations may contribute more significantly to impaired exercise capacity than in those with mild-moderate CF. At all levels of disease severity, there are peripheral factors e.g., abnormal macro- and micro-vascular function that impair blood flow and reduce oxygen extraction, and mitochondrial defects that diminish metabolic efficiency. We discuss advances in understanding the central and peripheral mechanisms underlying exercise intolerance in pwCF. Exploring both the central and peripheral factors that contribute to exercise intolerance in CF can help inform the development of new therapeutic targets, as well as help define prognostic criteria.
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Affiliation(s)
- Jessica E Caterini
- Translational Medicine Program, SickKids Research Institute, Toronto, ON M5G 0A4, Canada; Queen's Medical School, Kingston, ON K7L 3N6, Canada
| | - Felix Ratjen
- Translational Medicine Program, SickKids Research Institute, Toronto, ON M5G 0A4, Canada; Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada; Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Alan R Barker
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter EX1 2LU, UK
| | - Craig A Williams
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter EX1 2LU, UK
| | - Kate Rendall
- Translational Medicine Program, SickKids Research Institute, Toronto, ON M5G 0A4, Canada
| | - Jane E Schneiderman
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada; Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Greg D Wells
- Translational Medicine Program, SickKids Research Institute, Toronto, ON M5G 0A4, Canada.
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8
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Quick V, Chang G. Health care provider's experiences, practices, and recommendations for interventions and screening of cystic fibrosis patients with disordered eating: A qualitative analysis. Chronic Illn 2021; 17:377-390. [PMID: 31600084 DOI: 10.1177/1742395319881182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate health care providers' perspectives on their experiences and practices with cystic fibrosis patients exhibiting disordered eating behaviors and their recommendations for interventions and screening of this population. METHODS Experienced health care providers (N = 17) were recruited from the Cystic Fibrosis Foundation listserv to participate in a semi-structured interview via phone. Two trained qualitative researchers independently coded audio-recorded interview scripts. Major themes were generated from questions inquiring health care providers' perspectives on their experiences and practices with cystic fibrosis patients exhibiting disordered eating behaviors and their recommendations for better interventions and screening of disordered eating. RESULTS The most prominent disordered eating behaviors observed by health care providers in cystic fibrosis patients were misusing pancreatic enzyme medication (53%), food restriction behaviors (47%), binge eating (29%), and skipping meals (29%). Over half (53%) of health care providers reported not having policies or procedures for disordered eating of cystic fibrosis patients. All health care providers thought it would be beneficial to have a cystic fibrosis-specific disordered eating screening tool. Recommendations by health care providers included developing a national standard protocol for cystic fibrosis disordered eating and educational training for health care providers. DISCUSSION Ongoing development of evidence-based guidelines for screening and treating disordered eating among cystic fibrosis patients is warranted including development of a cystic fibrosis-specific disordered eating screening tool.
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Affiliation(s)
- Virginia Quick
- Department of Nutritional Sciences, Rutgers University, USA
| | - Grace Chang
- Department of Nutritional Sciences, Rutgers University, USA
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9
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Gulledge A, Miller S, Mueller M. Social support and social isolation in adults with cystic fibrosis: An integrative review. J Psychosom Res 2021; 150:110607. [PMID: 34521060 DOI: 10.1016/j.jpsychores.2021.110607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/20/2021] [Accepted: 09/05/2021] [Indexed: 01/19/2023]
Abstract
Background Adults with cystic fibrosis have unique barriers that may decrease their ability to receive adequate social support and socialization, leading to social isolation. Social isolation has been correlated with negative health outcomes in other populations. In those with cystic fibrosis, social isolation may present additional physiological and psychological challenges, potentially interfering with clinical outcomes and quality of life. However, there is a lack of understanding as to how social isolation presents in this population. Methods The purpose of this integrative review is to identify and critically analyze how social support and social isolation are reported for adults with cystic fibrosis. PubMed, Scopus, and CINAHL Complete were searched for related publications, resulting in an initial yield of 1767 articles. After eligibility screening, 21 studies met the criteria for this review, which were all then critically analyzed and synthesized. Results There is a scarcity of literature focusing on social isolation and social support in this population. Reduced physical and mental health were the most commonly reported variables associated with reduced social functioning and social support. Conclusion Preliminary studies are warranted to understand how adults with cystic fibrosis experience social isolation, as well as its relationship to social support. This knowledge can guide future research focusing on physical and psychological effects of social isolation, along with interventions that facilitate socialization and support.
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Affiliation(s)
- Amy Gulledge
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street MSC 160, Room #329, Charleston, SC 29425, United States of America.
| | - Sarah Miller
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street MSC 160, Room #329, Charleston, SC 29425, United States of America.
| | - Martina Mueller
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street MSC 160, Room #329, Charleston, SC 29425, United States of America.
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Jain R, Kazmerski TM, Aitken ML, West N, Wilson A, Bozkanat KM, Montemayor K, von Berg K, Sjoberg J, Poranski M, Taylor-Cousar JL. Challenges Faced by Women with Cystic Fibrosis. Clin Chest Med 2021; 42:517-30. [PMID: 34353456 DOI: 10.1016/j.ccm.2021.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Women with cystic fibrosis (CF) face several unaddressed concerns related to their health. These areas of concern include explanations and guidance on a sex disparity in outcomes, timing of puberty, effects of contraception, prevalence of infertility and impact of pregnancy, and prevention of urinary incontinence and osteoporosis. These understudied topics leave women with numerous unanswered questions about how to manage sexual and reproductive health in the setting of CF. Because people with CF are living longer and healthier lives, there is an increasing awareness of these important aspects of care and multiple ongoing studies to address these understudied topics.
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Ciprandi R, Bonati M, Campi R, Pescini R, Castellani C. Psychological distress in adults with and without cystic fibrosis during the COVID-19 lockdown. J Cyst Fibros 2021; 20:198-204. [PMID: 33384222 DOI: 10.1016/j.jcf.2020.12.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hundreds of papers have been published on the COVID-19 pandemic, and several of them on psychological themes connected with it, but very little is so far known on how adult patients with Cystic Fibrosis (pwCFs) are coping with this dramatic event. METHODS An online questionnaire was developed according to the Italian validated COVID-19 Peritraumatic Distress Index (CPDI) and addressed to the general population (GP). A similar questionnaire, augmented with CF specific questions, targeted pwCFs. The two web-based surveys were accessible for some weeks during the lockdown mandated by the Italian government. RESULTS The CF questionnaire was completed by 712 adult pwCFs (422 females), matched for sex and age with a 1/5 ratio to GP questionnaire respondents. Mild or medium distress affected 40.2% of pwCFs and 43.9% of GP controls, severe distress 5.3% of pwCFs and 6.2% of GP controls. The level of psychological distress was not correlated with the degree of pulmonary function impairment. When symptoms of anxiety and depression, and physical manifestations were independently analyzed, the control group featured a 55% higher level of mild-moderate anxiety symptoms. Signs of psychological distress, symptoms of anxiety and depression, and physical manifestations were significantly more frequent in female pwCFs compared to males, similarly to GP. CONCLUSION Adult pwCFs seem to have equal, and in some domains, lower levels of psychological distress than GP controls. This might be sustained by lifelong experiences in coping with the demands of their chronic disease. These results may orient future psychological interventions.
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D’Angelo CM, Mrug S, Grossoehme D, Leon K, Thomas L, Troxler B. Reciprocal Links Between Physical Health and Coping Among Adolescents With Cystic Fibrosis. J Pediatr Psychol 2021; 46:231-240. [PMID: 33306793 PMCID: PMC7896275 DOI: 10.1093/jpepsy/jsaa103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Adolescents with cystic fibrosis (CF) often face a unique set of difficulties and challenges as they transition to adulthood and autonomy while also managing a progressive illness with a heavy treatment burden. Coping styles have been related to changes in physical health among youth with chronic illness more generally, but the directionality of these links has not been fully elucidated. Therefore, the objective of this study was to evaluate bidirectional links between coping styles and physical health indicators among adolescents with CF over time. METHODS Adolescents (N = 79, 54% female) recruited from inpatient and outpatient CF clinics at two sites completed questionnaires assessing secular and religious/spiritual coping styles at two time points (18 months apart, on average). Health indicators including pulmonary functioning, nutritional status, and days hospitalized were obtained from medical records. RESULTS More frequent hospitalizations predicted lower levels of adaptive secular coping over time. However, poorer pulmonary functioning predicted higher levels of positive religious/spiritual coping. The number of days hospitalized was related to adaptive secular coping and negative religious/spiritual coping. CONCLUSIONS Among youth with CF, physical health functioning is more consistent in predicting coping strategies than the reverse. Poorer pulmonary functioning appears to enhance adaptive coping over time, suggesting resilience of adolescents with CF, while more frequent hospitalizations may inhibit the use of adaptive coping strategies. Findings support the use of interventions aimed at promoting healthy coping among hospitalized adolescents with CF.
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Affiliation(s)
| | - Sylvie Mrug
- Department of Psychology, University of Alabama at Birmingham
| | | | - Kevin Leon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham School of Medicine
| | - Lacrecia Thomas
- Department of Pediatrics, Children’s of Alabama, University of Alabama at Birmingham
| | - Bradley Troxler
- Department of Pediatrics, Children’s of Alabama, University of Alabama at Birmingham
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Nakov Z, Acevski S, Velkoska V, Naceva Fushtik S, Nakov N, Tonikj Ribarska J, Trajkovikj Jolevska S. Health-related quality of life of teen/adult patients with cystic fibrosis in the Republic of North Macedonia. Maced Pharm Bull 2021. [DOI: 10.33320/10.33320/maced.pharm.bull.2021.67.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The present study investigates the Health-related quality of life of teen/adults patients with cystic fibrosis in the Republic of N. Macedonia for the first time. The main objective was to describe the health-related quality of life status of these patients with cystic fibrosis and the second objective was to investigate the connection of the current medical treatment with the analysed parameters.
The survey was conducted on 31 patients by using the Cystic Fibrosis Questionnaire Revised for Health-related quality of live measurement and questions for current medical treatment.
All patients scored their digestive condition with the highest score, while the lower score was reported for social activity. The gender, the nationality and the educational level of the patients with Cystic Fibrosis had no significant impact on their perception of Health-Related Quality of Live.
The highest score for digestive condition was in positive correlation with the fact that all patients continuously used enzyme therapy. Patients who practiced physical therapy and physical activities reported high scores for physical conditions and body images. This finding point out that patient with Cystic Fibrosis should be encouraged to practice physical activity more often.
The lowest scores for life activities and treatment burden shows that this medical condition has a negative impact on the patients’ self-perception and in the execution of their daily activities.
Keywords: cystic fibrosis, Health-Related Quality of Live, digest, daily activities
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Affiliation(s)
- Zoran Nakov
- Novo Nordisk Pharma DOOEL, blvd. Oktomvriska Revolucija 18, 1000 Skopje, R.N. Macedonia
| | - Stevche Acevski
- Roche Makedonija DOOEL, str. Cyril and Methodius 7, 1000 Skopje, R.N. Macedonia
| | - Valentina Velkoska
- Faculty of Medicine, University “Goce Delchev” Shtip, str. Ljuben Ivanov 25, 2000 Shtip, R.N. Macedonia
| | - Stojka Naceva Fushtik
- University clinic for children diseases, Ss. Cyril and Methodius University in Skopje, str. Mother Tereza 47, 1000 Skopje, R.N. Macedonia
| | - Natalija Nakov
- Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, str. Mother Tereza 47, 1000 Skopje, R.N. Macedonia
| | - Jasmina Tonikj Ribarska
- Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, str. Mother Tereza 47, 1000 Skopje, R.N. Macedonia
| | - Suzana Trajkovikj Jolevska
- Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, str. Mother Tereza 47, 1000 Skopje, R.N. Macedonia
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14
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Beaufils F, Mas E, Mittaine M, Addra M, Fayon M, Delhaes L, Clouzeau H, Galode F, Lamireau T, Bui S, Enaud R. Increased Fecal Calprotectin Is Associated with Worse Gastrointestinal Symptoms and Quality of Life Scores in Children with Cystic Fibrosis. J Clin Med 2020; 9:jcm9124080. [PMID: 33348735 PMCID: PMC7766355 DOI: 10.3390/jcm9124080] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 02/06/2023] Open
Abstract
In cystic fibrosis (CF), cystic fibrosis transmembrane regulator (CFTR) dysfunction leads to digestive disorders that promote intestinal inflammation and dysbiosis enhancing gastrointestinal symptoms. In pancreatic insufficiency CF patients, both intestinal inflammation and dysbiosis, are associated with an increase in the fecal calprotectin (FC) level. However, associations between the FC level, gastrointestinal symptoms, and quality of life (QoL) remain poorly studied. We aimed to assess such associations in pancreatic insufficiency CF children. The FC level was measured in pancreatic insufficiency CF children’s stool samples. Children and their parents completed two questionnaires: The Gastrointestinal Symptoms Scales 3.0-PedsQLTM and the Quality of Life Pediatric Inventory 4.0-PedsQLTM. Lower scores indicated worse symptomatology or QoL. Thirty-seven CF children were included. A FC level above 250 µg/g was associated with worse gastrointestinal symptoms and QoL scores. The FC level was inversely correlated with several gastrointestinal scores assessed by children (i.e., Total, “Heart Burn Reflux”, “Nausea and Vomiting”, and “Gas and Bloating”). Several QoL scores were correlated with gastrointestinal scores. The FC level was weakly associated with clinical parameters. Some gastrointestinal and QoL scores were related to disease severity associated parameters. In CF, the FC level, biomarker previously related to intestinal inflammation and dysbiosis, was associated with worse digestive symptoms and QoL scores.
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Affiliation(s)
- Fabien Beaufils
- CHU Bordeaux, CRCM Pédiatrique, CIC 1401, Place Amélie Raba Léon, F-33000 Bordeaux, France; (M.F.); (L.D.); (H.C.); (F.G.); (T.L.); (S.B.); (R.E.)
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, University Bordeaux, U1045, F-33000 Bordeaux, France;
- Fédération Hospitalo-Universitaire FHU, ACRONIM, F-33000 Bordeaux, France
- Correspondence: ; Tel.: +33-5-56-79-98-24
| | - Emmanuel Mas
- CHU Toulouse, CRCM Pédiatrique, F-31300 Toulouse, France; (E.M.); (M.M.)
- INSERM, INRA, ENVT, Université de Toulouse, UPS, F-31000 Toulouse, France
- Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse, F-31300 Toulouse, France
| | - Marie Mittaine
- CHU Toulouse, CRCM Pédiatrique, F-31300 Toulouse, France; (E.M.); (M.M.)
| | - Martin Addra
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, University Bordeaux, U1045, F-33000 Bordeaux, France;
| | - Michael Fayon
- CHU Bordeaux, CRCM Pédiatrique, CIC 1401, Place Amélie Raba Léon, F-33000 Bordeaux, France; (M.F.); (L.D.); (H.C.); (F.G.); (T.L.); (S.B.); (R.E.)
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, University Bordeaux, U1045, F-33000 Bordeaux, France;
- Fédération Hospitalo-Universitaire FHU, ACRONIM, F-33000 Bordeaux, France
| | - Laurence Delhaes
- CHU Bordeaux, CRCM Pédiatrique, CIC 1401, Place Amélie Raba Léon, F-33000 Bordeaux, France; (M.F.); (L.D.); (H.C.); (F.G.); (T.L.); (S.B.); (R.E.)
- Fédération Hospitalo-Universitaire FHU, ACRONIM, F-33000 Bordeaux, France
- CHU Toulouse, CRCM Pédiatrique, F-31300 Toulouse, France; (E.M.); (M.M.)
- CHU Bordeaux, Service de Parasitologie-Mycologie, F-33000 Bordeaux, France
| | - Haude Clouzeau
- CHU Bordeaux, CRCM Pédiatrique, CIC 1401, Place Amélie Raba Léon, F-33000 Bordeaux, France; (M.F.); (L.D.); (H.C.); (F.G.); (T.L.); (S.B.); (R.E.)
- Fédération Hospitalo-Universitaire FHU, ACRONIM, F-33000 Bordeaux, France
| | - François Galode
- CHU Bordeaux, CRCM Pédiatrique, CIC 1401, Place Amélie Raba Léon, F-33000 Bordeaux, France; (M.F.); (L.D.); (H.C.); (F.G.); (T.L.); (S.B.); (R.E.)
- Fédération Hospitalo-Universitaire FHU, ACRONIM, F-33000 Bordeaux, France
| | - Thierry Lamireau
- CHU Bordeaux, CRCM Pédiatrique, CIC 1401, Place Amélie Raba Léon, F-33000 Bordeaux, France; (M.F.); (L.D.); (H.C.); (F.G.); (T.L.); (S.B.); (R.E.)
- Fédération Hospitalo-Universitaire FHU, ACRONIM, F-33000 Bordeaux, France
| | - Stéphanie Bui
- CHU Bordeaux, CRCM Pédiatrique, CIC 1401, Place Amélie Raba Léon, F-33000 Bordeaux, France; (M.F.); (L.D.); (H.C.); (F.G.); (T.L.); (S.B.); (R.E.)
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, University Bordeaux, U1045, F-33000 Bordeaux, France;
- Fédération Hospitalo-Universitaire FHU, ACRONIM, F-33000 Bordeaux, France
| | - Raphaël Enaud
- CHU Bordeaux, CRCM Pédiatrique, CIC 1401, Place Amélie Raba Léon, F-33000 Bordeaux, France; (M.F.); (L.D.); (H.C.); (F.G.); (T.L.); (S.B.); (R.E.)
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, University Bordeaux, U1045, F-33000 Bordeaux, France;
- Fédération Hospitalo-Universitaire FHU, ACRONIM, F-33000 Bordeaux, France
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Coffey N, O' Leary F, Burke F, Roberts A, Hayes M. Periodontal and oral health status of people with Cystic Fibrosis: a systematic review. J Dent 2020; 103:103509. [PMID: 33129998 DOI: 10.1016/j.jdent.2020.103509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES People with Cystic Fibrosis (PWCF) may be presumed to be at lower risk of periodontal disease due to long term antibiotic use but this has not been comprehensively investigated. The oral hygiene and periodontal status of PWCF in comparison to the general population is not well established. The objective of this systematic review was to critically evaluate the literature on periodontal and oral hygiene status in PWCF to see if this group are at increased risk of periodontal disease (gingivitis or periodontitis). DATA SOURCES 5 databases were searched: Scopus, MEDLINE, Embase, Cochrane Library and Web of Science. STUDY SELECTION The search resulted in 614 publications from databases with one more publication identified by searching bibliographies. 13 studies were included in the qualitative analysis. CONCLUSIONS The majority of studies showed better oral hygiene, with lower levels of gingivitis and plaque among people with Cystic Fibrosis (PWCF) than controls. Interestingly, despite this, many studies showed that PWCF had higher levels of dental calculus. Three studies found there was no difference in Oral Hygiene between PWCF and controls. One study found that PWCF aged between 6 and 9.5 years had increased levels of clinical gingivitis, and one study showed that PWCF with gingivitis had more bleeding on probing than people without CF. The vast majority of PWCF examined were children- only five studies included people over 18 years, and only one looked exclusively at adults. There is a need for further study into the periodontal health of PWCF- particularly those over the age of 18. CLINICAL SIGNIFICANCE There are currently no guidelines referring to oral care in PWCF. Studies have suggested that the oral cavity acts as a reservoir of bacteria which may colonise the lungs. If PWCF are at increased risk of periodontal disease, they should attend for regular screenings to facilitate early detection.
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Affiliation(s)
- Niamh Coffey
- Department of Restorative Dentistry, Cork University Dental School and Hospital, University College Cork, T12 E8YV, Ireland.
| | - Fiona O' Leary
- Department of Restorative Dentistry, Cork University Dental School and Hospital, University College Cork, T12 E8YV, Ireland
| | - Francis Burke
- Department of Restorative Dentistry, Cork University Dental School and Hospital, University College Cork, T12 E8YV, Ireland
| | - Anthony Roberts
- Department of Restorative Dentistry, Cork University Dental School and Hospital, University College Cork, T12 E8YV, Ireland
| | - Martina Hayes
- Department of Restorative Dentistry, Cork University Dental School and Hospital, University College Cork, T12 E8YV, Ireland
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Nakov Z, Naceva Fushtikj S, Acevski S, Tonic Ribarska J, Trajkovic Jolevska S. Social aspect as a part of HRQoL in patients with cystic fibrosis in Republic of North Macedonia. Maced Pharm Bull 2020. [DOI: 10.33320/maced.pharm.bull.2020.66.03.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Zoran Nakov
- Novo Nordisk Pharma DOOEL, st. Nikola Kljusev 11, 1000 Skopje, Republic of North Macedonia
| | - Stojka Naceva Fushtikj
- University clinic for children diseases, Ss. Cyril and Methodius University, Mother Tereza 17, 1000 Skopje, Republic of North Macedonia
| | - Stevce Acevski
- Alakloid AD, blvd. Aleksandar Makedonski 12, 1000 Skopje, Republic of North Macedonia
| | - Jasmina Tonic Ribarska
- Faculty of Pharmacy, Ss. Cyril and Methodius University, Mother Tereza 47, 1000 Skopje, Republic of North Macedonia
| | - Suzana Trajkovic Jolevska
- Faculty of Pharmacy, Ss. Cyril and Methodius University, Mother Tereza 47, 1000 Skopje, Republic of North Macedonia
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17
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Pilewski JM. Lung Transplantation for Cystic Fibrosis. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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Gao J, Arden M, Hoo ZH, Wildman M. Understanding patient activation and adherence to nebuliser treatment in adults with cystic fibrosis: responses to the UK version of PAM-13 and a think aloud study. BMC Health Serv Res 2019; 19:420. [PMID: 31234848 PMCID: PMC6591841 DOI: 10.1186/s12913-019-4260-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient activation refers to patients' knowledge, skills, and confidence in self-managing health conditions. In large cross-sectional studies, individuals with higher patient activation are observed to have better health outcomes with the assumption that they are more engaged in health self-management. However, the association between patient activation and objectively measured self-care indicators in individuals can be inconsistent. This research investigated the role of patient activation as measured by the UK Patient Activation Measure (PAM-13) in adults with Cystic Fibrosis (CF). The aims were twofold: to explore how adults with CF interpret and respond to the PAM-13; and to investigate the association between PAM-13 and objectively measured nebuliser adherence in UK adults with CF. METHODS This article describes two studies which examined the PAM-13 from different perspectives. Study 1 comprised 'think aloud' interviews with 15 adults with CF. The data were analysed using an a priori coding framework. Study 2 examined the association between PAM-13 and objectively measured nebuliser adherence in 57 adults with CF. RESULTS Study 1 showed that adults with CF encountered several difficulties while completing the PAM-13. The difficulties were related to understanding how to interpret aspects of CF in order to respond (i.e., control over the condition, ability to exercise) and item wording. Some adults with CF responded to the PAM-13 in an optimistic way in relation to what they thought they should do rather than what they actually do. These findings were echoed by the results of Study 2, which showed that PAM-13 scores were not significantly correlated with objective medication adherence in a different sample. This article synthesises the results of both studies, providing insights into influences and associations of patient activation as measured by the UK PAM-13 in adults with CF. CONCLUSIONS There were some significant difficulties created by the wording of the UK PAM-13 for adults with CF. This may partly explain the finding that PAM-13 scores were not related to objectively measured nebuliser adherence in this study. The UK PAM-13 would benefit from further research to verify its validity and reliability in different patient populations against objective measures of behaviour rather than simply self-report.
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Affiliation(s)
- Jie Gao
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK.
| | - Madelynne Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - Zhe Hui Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, Sheffield, UK
| | - Martin Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, Sheffield, UK
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19
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Tomaszek L, Dębska G, Cepuch G, Kulpa M, Pawlik L, Broniatowska E. Evaluation of quality of life predictors in adolescents and young adults with cystic fibrosis. Heart Lung 2019; 48:159-165. [DOI: 10.1016/j.hrtlng.2018.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 08/15/2018] [Accepted: 08/17/2018] [Indexed: 12/15/2022]
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20
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Vadagam P, Kamal KM, Covvey JR, Giannetti V, Mukherjee K. Cost-Effectiveness and Budget Impact of Lumacaftor/Ivacaftor in the Treatment of Cystic Fibrosis. J Manag Care Spec Pharm 2018; 24:987-997. [PMID: 30247102 PMCID: PMC10397671 DOI: 10.18553/jmcp.2018.24.10.987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a chronic, progressive, genetic disease affecting more than 30,000 people in the United States and 70,000 people globally. The goals of treatment are to slow disease progression, reduce pulmonary exacerbations, relieve chronic symptoms, and improve the patient's quality of life. Lumacaftor/ivacaftor is a new therapy for CF that has demonstrated good clinical outcomes, including improved absolute percentage predicted forced expiratory volume in 1 second (FEV1%). However, given the high cost of therapy, there is a need to evaluate the overall value of lumacaftor/ivacaftor in CF management. OBJECTIVES To (a) conduct a cost-effectiveness analysis (CEA) of lumacaftor/ivacaftor to understand the overall effectiveness of the drug compared with its costs and (b) conduct a budget impact analysis (BIA) to understand the potential financial effect of introducing a new drug in a health plan. METHODS Two static decision models were developed using Microsoft Excel to evaluate the cost-effectiveness and budget impact of lumacaftor/ivacaftor over a 1-year time frame from a payer perspective. Model inputs included drug costs (wholesale acquisition costs), drug monitoring schedules (package inserts), drug monitoring costs (Centers for Medicare & Medicaid physician fee schedule and published literature), FEV1% predicted and pulmonary exacerbation values (clinical trials), and cost to treat pulmonary exacerbations (published literature). The outcomes in the CEA included total cost of therapy; average cost-effectiveness ratio (ACER), defined as cost per FEV1% predicted; and incremental cost-effectiveness ratio (ICER), defined as the difference in the ratio of cost per FEV1% predicted of lumacaftor/ivacaftor and placebo. Outcomes in the BIA included total budget impact; cost per member per month (PMPM), defined as total budget impact per hypothetical plan population; and cost per treated member per month (PTMPM), defined as total budget impact per target CF population. All costs were adjusted to 2016 dollars, and one-way sensitivity analyses were conducted to test the model robustness given uncertainty in model inputs and study assumptions. RESULTS The annual cost of therapy per patient for lumacaftor/ivacaftor was $379,780. The ACER for lumacaftor/ivacaftor was $151,912, while the ICER for lumacaftor/ivacaftor compared with placebo was $95,016 per FEV1% predicted. The annual total budget impact due to the inclusion of lumacaftor/ivacaftor on the health plan formulary was $266,046. The PMPM cost was $0.02 and the PTMPM cost was $6.21. CONCLUSIONS In patients with CF, lumacaftor/ivacaftor has demonstrated better clinical effectiveness compared with placebo alongside an increased drug acquisition cost. However, the therapy may be a viable alternative to existing standard therapy over a short time horizon. Health care payers, both private and public, need to evaluate the cost-effectiveness and the financial effect when considering expansion of new drug coverage in CF management. DISCLOSURES No outside funding supported this study. Covvey and Kamal have received research funding from Novartis Pharmaceuticals. Covvey, Giannetti, and Kamal have received research funding from the College of Psychiatric and Neurologic Pharmacists. Kamal serves as a consultant to the Lynx Group (Cranbury, NJ) and Manticore Consulting Group (Scottsdale, AZ). Mukherjee has nothing to disclose. A related poster abstract was presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting; March 27-30, 2017; Denver, CO.
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Affiliation(s)
- Pratyusha Vadagam
- 1 Division of Pharmaceutical, Administrative and Social Sciences, Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania
| | - Khalid M Kamal
- 1 Division of Pharmaceutical, Administrative and Social Sciences, Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania
| | - Jordan R Covvey
- 1 Division of Pharmaceutical, Administrative and Social Sciences, Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania
| | - Vincent Giannetti
- 1 Division of Pharmaceutical, Administrative and Social Sciences, Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania
| | - Kumar Mukherjee
- 2 Pharmacy Practice, Philadelphia College of Osteopathic Medicine, Suwanee, Georgia
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Rodriguez-Miguelez P, Lee N, Tucker MA, Csányi G, McKie KT, Forseen C, Harris RA. Sildenafil improves vascular endothelial function in patients with cystic fibrosis. Am J Physiol Heart Circ Physiol 2018; 315:H1486-H1494. [PMID: 30168731 PMCID: PMC6297813 DOI: 10.1152/ajpheart.00301.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 12/19/2022]
Abstract
Cystic fibrosis (CF), characterized by defective CFTR function, is associated with multiple systemic complications, including vascular dysfunction. Sildenafil, a phosphodiesterase type 5 inhibitor, not only enhances nitric oxide (NO) metabolism but has been shown to improve CFTR functionality as well. Thus, sildenafil has been proposed as a therapy to improve vascular health in CF; however, its potential therapeutic role has yet to be determined. We sought to investigate the effect of sildenafil on endothelial function in patients with CF. Patients with CF completed a randomized, double-blind, placebo-controlled, crossover study with an acute dose of sildenafil (50 mg) or placebo followed by a 4-wk open-label extension with sildenafil (20 mg/day). Flow-mediated dilation (FMD) was used to evaluate endothelial function before and after treatments. In addition, phosphorylated endothelial NO synthase (pNOS3) and total NOS3 protein expression was determined from endothelial cells that were exposed to plasma from the patients before and after 4 wk of sildenafil treatment. No changes ( P ≥ 0.110) in endothelial function were observed after the acute dose of sildenafil. However, FMD significantly ( P = 0.029) increased after 4 wk of treatment (∆FMD: 1.5 ± 2.2%). Moreover, pNOS3 protein expression significantly ( P = 0.013) increased after 4 wk of treatment (∆pNOS3: 0.31 ± 0.39 arbitrary units) and was associated ( r = 0.593, P = 0.033) with the change in FMD. These data suggest that 4 wk of sildenafil treatment can improve vascular endothelial function in patients with CF, likely through an increase in NOS3 phosphorylation. NEW & NOTEWORTHY Findings from the present study demonstrate, for the first time, significant improvement of endothelial function in patients with cystic fibrosis treated with sildenafil that is associated with greater phosphorylation of endothelial nitric oxide synthase. These results support the use of sildenafil as a potential novel therapy for this patient population.
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Affiliation(s)
| | - Nichole Lee
- Georgia Prevention Institute, Augusta University , Augusta, Georgia
| | - Matthew A Tucker
- Georgia Prevention Institute, Augusta University , Augusta, Georgia
| | - Gábor Csányi
- Vascular Biology Center, Augusta University , Augusta, Georgia
| | | | - Caralee Forseen
- Pulmonary and Critical Care Medicine, Augusta University , Augusta, Georgia
| | - Ryan A Harris
- Georgia Prevention Institute, Augusta University , Augusta, Georgia
- Sport and Exercise Science Research Institute, Ulster University, Jordanstown, Northern Ireland, United Kingdom
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Gancz DW, Cunha MT, Leone C, Rodrigues JC, Adde FV. Quality of life amongst adolescents and young adults with cystic fibrosis: correlations with clinical outcomes. Clinics (Sao Paulo) 2018; 73:e427. [PMID: 30365823 PMCID: PMC6172978 DOI: 10.6061/clinics/2017/e427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/13/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The current study sought to evaluate the quality of life of young patients with cystic fibrosis and correlate these results with the clinical parameters indicative of disease severity. METHODS This cross-sectional study applied the validated Portuguese version of a cystic fibrosis specific quality of life questionnaire to clinically stable patients aged 14 to 21 years old. The correlations between the questionnaire domain scores and forced expiratory volume in one second (FEV1) values, the Shwachman-Kulczycki score, and body mass index were assessed, and correlations were considered as significant when p<0.05. RESULTS A total of 31 patients (11 females; 16.4±2.3 years old) were evaluated, and the median scores on the questionnaire domains ranged from 66.7 to 100. A significant correlation was found between body mass index and the weight (r=0.43, p=0.016) and the eating questionnaire domains (r=0.44, p=0.013); between FEV1 and the physical (r=0.53, p=0.002) and treatment burden (r=0.41, p=0.023) domains; and between the Shwachman-Kulczycki score and the physical (r=0.39, p=0.03), health (r=0.41, p=0.023), and role (r=0.37, p=0.041) domains. A significant difference was found amongst patients with FEV1 values above or below 60% of the predicted value with regard to the role and health domains. No differences in the scores were found according to gender. CONCLUSIONS The current cystic fibrosis specific quality of life questionnaire scores exhibited wide variability across all domains; however, they indicated a relatively satisfactory quality of life amongst the patients studied. Certain domains exhibited significant correlations with clinical parameters; thus, this instrument has consistent associations with clinical outcomes.
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Affiliation(s)
- Daniela W Gancz
- Unidade de Pneumologia Pediatrica, Instituto da Crianca, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Maristela T Cunha
- Servico de Fisioterapia, Instituto da Crianca, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Claudio Leone
- Departamento de Saude Materno Infantil, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Joaquim C Rodrigues
- Unidade de Pneumologia Pediatrica, Instituto da Crianca, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, BR
| | - Fabíola V Adde
- Unidade de Pneumologia Pediatrica, Instituto da Crianca, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, BR
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Abstract
Gender differences in chronic respiratory disease, including cystic fibrosis and non-cystic fibrosis bronchiectasis are clinically apparent and of increasing importance. Differences in disease prevalence, severity and outcome are all described, however, the precise cause of the gender dichotomy and their associated underlying mechanisms have been poorly characterised. A lack of dedicated clinical and epidemiological research focused in this area has led to a paucity of data and therefore a lack of understanding of its key drivers. Diagnosis, disease pathogenesis and treatment response are all complex but important aspects of bronchiectasis with an evident gender bias. Broadening our understanding of the interplay between microbiology, host physiology and the environment in the context of chronic lung diseases, such as bronchiectasis, is critical to unravelling mechanisms driving the observed gender differences. In this review, epidemiological, biological and environmental evidence related to gender in bronchiectasis is summarised. This illustrates gender differences as a “real issue” with the objective of mapping out a future framework upon which a gender-tailored medical approach may be incorporated into the diagnosis, monitoring and treatment of bronchiectasis. CF and non-CF bronchiectasis are complex multifactorial chronic pulmonary diseases demonstrating gender differences in their prevalence, severity and infections, some of which are attributable to sex hormoneshttp://ow.ly/beDf30jseK4
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Affiliation(s)
- Celine Vidaillac
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Valerie F L Yong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Tavleen K Jaggi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Min-Min Soh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Aguiar KCA, Marson FAL, Gomez CCS, Pereira MC, Paschoal IA, Ribeiro AF, Ribeiro JD. Physical performance, quality of life and sexual satisfaction evaluation in adults with cystic fibrosis: An unexplored correlation. Rev Port Pneumol (2006) 2017; 23:179-192. [PMID: 28438512 DOI: 10.1016/j.rppnen.2017.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/23/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Quality of life (QOL), sexual satisfaction (SS) and physical performance have been assessed in the management of numerous chronic diseases. METHODS In this study, the following tests and surveys were applied: (i) QOL questionnaire [Cystic Fibrosis Questionnaire (CFQ)]; (ii) SS questionnaire (SSQ) [female sexual quotient (FSQ) and male sexual quotient (MSQ)]; (iii) 6-minute walk test (6MWT). Spearman's correlation was used for comparison between the data; the Mann-Whitney test was applied to analyze the difference between genders. A total of 52 adult patients with CF were included in this study. RESULTS There was a positive correlation between CFQ domains and SSQ questions. The CFQ showed a positive correlation with peripheral oxygen saturation of hemoglobin (SpO2) and the distance walked in the 6MWT, and a negative correlation with the Borg scale. The SSQ showed positive correlation with the distance walked and a negative correlation with the Borg scale. For some markers evaluated in the 6MWT, there was sometimes association with the evaluated domains and questions. Male patients showed better scores in the emotional CFQ domain, better performance in SSQ and physical performance. CONCLUSIONS There was a correlation between CFQ, SSQ and 6MWT in CF. Finally; we believe that QOL surveys should assess the domain "sexuality" as well as physical performance tests.
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Affiliation(s)
- K C A Aguiar
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - F A L Marson
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil; Department of Medical Genetics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
| | - C C S Gomez
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - M C Pereira
- Department of Medical Clinic, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - I A Paschoal
- Department of Medical Clinic, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - A F Ribeiro
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - J D Ribeiro
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
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Askew K, Bamford J, Hudson N, Moratelli J, Miller R, Anderson A, Doe S, Bourke SJ. Current characteristics, challenges and coping strategies of young people with cystic fibrosis as they transition to adulthood. Clin Med (Lond) 2017; 17:121-125. [PMID: 28365620 PMCID: PMC6297616 DOI: 10.7861/clinmedicine.17-2-121] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study provides detailed data on the current characteristics, perceptions and outcomes of 45 young people with cystic fibrosis (CF) as they transition into adulthood. Although many had severe disease, they generally coped well, found attendance at a transition clinic helpful and welcomed the increased independence of an adult healthcare environment. Levels of psychological distress were low with only 15.6% having anxiety and 6.7% depression. The main psychological coping strategy used was optimistic acceptance. Overall, most remained stable after transfer but 33% had some decline in lung function and 9% in nutritional status, requiring intensification of treatment. They had high levels of satisfaction with their relationships and life situations and 76% were in employment or education. These results are encouraging and as life expectancy improves, young adults with CF are coping well with transition into adulthood.
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Affiliation(s)
| | - Jade Bamford
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | | | | | | | - Simon Doe
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Burke DG, Fouhy F, Harrison MJ, Rea MC, Cotter PD, O'Sullivan O, Stanton C, Hill C, Shanahan F, Plant BJ, Ross RP. The altered gut microbiota in adults with cystic fibrosis. BMC Microbiol 2017; 17:58. [PMID: 28279152 PMCID: PMC5345154 DOI: 10.1186/s12866-017-0968-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 03/03/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cystic Fibrosis (CF) is an autosomal recessive disease that affects the function of a number of organs, principally the lungs, but also the gastrointestinal tract. The manifestations of cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction in the gastrointestinal tract, as well as frequent antibiotic exposure, undoubtedly disrupts the gut microbiota. To analyse the effects of CF and its management on the microbiome, we compared the gut microbiota of 43 individuals with CF during a period of stability, to that of 69 non-CF controls using 454-pyrosequencing of the 16S rRNA gene. The impact of clinical parameters, including antibiotic therapy, on the results was also assessed. RESULTS The CF-associated microbiome had reduced microbial diversity, an increase in Firmicutes and a reduction in Bacteroidetes compared to the non-CF controls. While the greatest number of differences in taxonomic abundances of the intestinal microbiota was observed between individuals with CF and the healthy controls, gut microbiota differences were also reported between people with CF when grouped by clinical parameters including % predicted FEV1 (measure of lung dysfunction) and the number of intravenous (IV) antibiotic courses in the previous 12 months. Notably, CF individuals presenting with severe lung dysfunction (% predicted FEV1 ≤ 40%) had significantly (p < 0.05) reduced gut microbiota diversity relative to those presenting with mild or moderate dysfunction. A significant negative correlation (-0.383, Simpson's Diversity Index) was also observed between the number of IV antibiotic courses and gut microbiota diversity. CONCLUSIONS This is one of the largest single-centre studies on gut microbiota in stable adults with CF and demonstrates the significantly altered gut microbiota, including reduced microbial diversity seen in CF patients compared to healthy controls. The data show the impact that CF and it's management have on gut microbiota, presenting the opportunity to develop CF specific probiotics to minimise microbiota alterations.
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Affiliation(s)
- D G Burke
- Teagasc Food Research Centre, Moorepark, Fermoy, Co, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - F Fouhy
- Teagasc Food Research Centre, Moorepark, Fermoy, Co, Cork, Ireland
| | - M J Harrison
- HRB Clinical Research Facility, University College Cork, Cork, Ireland.,Cork Cystic Fibrosis Centre, University College Cork, Cork University Hospital, Wilton, Cork, Ireland
| | - M C Rea
- Teagasc Food Research Centre, Moorepark, Fermoy, Co, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - P D Cotter
- Teagasc Food Research Centre, Moorepark, Fermoy, Co, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - O O'Sullivan
- Teagasc Food Research Centre, Moorepark, Fermoy, Co, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - C Stanton
- Teagasc Food Research Centre, Moorepark, Fermoy, Co, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - C Hill
- APC Microbiome Institute, University College Cork, Cork, Ireland.,School of Microbiology, University College Cork, Cork, Ireland
| | - F Shanahan
- APC Microbiome Institute, University College Cork, Cork, Ireland.,Department of Medicine, University College Cork, National University of Ireland, Cork, Ireland
| | - B J Plant
- APC Microbiome Institute, University College Cork, Cork, Ireland.,HRB Clinical Research Facility, University College Cork, Cork, Ireland.,Cork Cystic Fibrosis Centre, University College Cork, Cork University Hospital, Wilton, Cork, Ireland.,Department of Medicine, University College Cork, National University of Ireland, Cork, Ireland
| | - R P Ross
- APC Microbiome Institute, University College Cork, Cork, Ireland. .,College of Science, Engineering and Food Science (SEFS), University College Cork, Cork, Ireland.
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Kazmerski TM, Weiner DJ, Matisko J, Schachner D, Lerch W, May C, Maurer SH. Advance care planning in adolescents with cystic fibrosis: A quality improvement project. Pediatr Pulmonol 2016; 51:1304-1310. [PMID: 27749020 DOI: 10.1002/ppul.23559] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/28/2016] [Accepted: 08/09/2016] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Advance care planning (ACP), though recommended, has not been studied in adolescents with cystic fibrosis (CF). This quality improvement project engaged adolescents with advanced CF disease in ACP and assessed patient and CF provider attitudes and preferences regarding ACP discussions and tools. MATERIALS AND METHODS Patients ≤22 years with advanced CF (FEV1 ≤40% predicted, >2 pulmonary exacerbations requiring IV antibiotics in 1 year, and/or use of home oxygen or non-invasive ventilation) were referred to the pediatric palliative care team (PC). After establishing rapport, ACP was discussed using Voicing My CHOiCES™: An Advanced Care Planning Guide (VMC). Patients completed a survey assessing attitudes and preferences around ACP. PC also led a training session for CF providers around ACP and VMC and provider attitudes were assessed via a pre- and post-training survey. RESULTS Twelve patients (mean age 17.9 ± 2.2 years) reviewed VMC and completed the ACP survey. The majority (83%) found ACP helpful. None felt it was harmful. All found VMC easy to understand and 90% felt it was appropriate for patients with CF. Of participating CF providers (pre-training, n = 6; post-training, n = 7), 83% found ACP worthwhile, but desired more training in this area. All found the training session useful and felt VMC was appropriate for patients with CF. DISCUSSION Adolescents with advanced CF disease felt ACP was a positive experience and not harmful. CF providers valued ACP, but desired more training. Both patients and providers felt that VMC was a useful, disease-appropriate tool. Pediatr Pulmonol. 2016;51:1304-1310. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Traci M Kazmerski
- Children's Hospital of Pittsburgh of UPMC, Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daniel J Weiner
- Children's Hospital of Pittsburgh of UPMC, Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Janice Matisko
- Children's Hospital of Pittsburgh of UPMC, Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Diane Schachner
- Children's Hospital of Pittsburgh of UPMC, Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Whitney Lerch
- Children's Hospital of Pittsburgh of UPMC, Supportive Care Program, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Carol May
- Children's Hospital of Pittsburgh of UPMC, Supportive Care Program, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Scott H Maurer
- Children's Hospital of Pittsburgh of UPMC, Supportive Care Program, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Le Gal C, Vandervelde L, Poncin W, Reychler G. [Impact of physical exercise in cystic fibrosis patients: A systematic review]. Rev Mal Respir 2016; 33:573-82. [PMID: 27209116 DOI: 10.1016/j.rmr.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/20/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Beneficial effects of physical exercise have been previously demonstrated in patients with chronic obstructive pulmonary disease. The aim of this systematic review was to summarize the evidence supporting physical exercise to improve on lung function, exercise capacity and quality of life in cystic fibrosis patients. METHODS Medline database was used to search clinical studies from 2000 to 2015. We also analyzed the bibliographic section of the included studies, in order to identify additional references. RESULTS A total of 17 studies were identified. A great disparity was found in the results of the different studies. No systematic benefit was found on lung function, exercise capacity or quality of life. No relationship between the type of program and the benefits achieved was observed. CONCLUSIONS Evidence that physical exercise benefits lung function, exercise capacity and quality of life in cystic fibrosis patient is inconsistent and evidence does not support a particular standardized program for all patients.
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Affiliation(s)
- C Le Gal
- Département de kinésithérapie, Parnasse-ISEI, 1200 Bruxelles, Belgique
| | - L Vandervelde
- Département de kinésithérapie, Parnasse-ISEI, 1200 Bruxelles, Belgique
| | - W Poncin
- Service de pneumologie, cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgique
| | - G Reychler
- Département de kinésithérapie, Parnasse-ISEI, 1200 Bruxelles, Belgique; Service de pneumologie, cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgique; Service de médecine physique et réadaptation, cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgique; Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et dermatologie, université catholique de Louvain, 1200 Bruxelles, Belgique.
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Hoo Z, Daniels T, Wildman M, Teare M, Bradley J. Airway clearance techniques used by people with cystic fibrosis in the UK. Physiotherapy 2015; 101:340-8. [DOI: 10.1016/j.physio.2015.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 01/11/2015] [Indexed: 11/26/2022]
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Borawska-Kowalczyk U, Bodnar R, Meszaros A, Sands D. Comparison of health-related quality of life among children with cystic fibrosis and their parents in two Eastern European countries. J Cyst Fibros 2015; 14:798-804. [DOI: 10.1016/j.jcf.2015.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/22/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
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Burge AT, Holland AE, Sherburn M, Wilson J, Cox NS, Rasekaba TM, McAleer R, Morton JM, Button BM. Prevalence and impact of urinary incontinence in men with cystic fibrosis. Physiotherapy 2015; 101:166-70. [DOI: 10.1016/j.physio.2014.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 11/04/2014] [Indexed: 01/23/2023]
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Kazmerski TM, Miller E, Abebe KZ, Matisko J, Schachner D, Spahr J. Patient Knowledge and Clinic Attendance in Adolescent Patients with Cystic Fibrosis. Pediatric Allergy, Immunology, and Pulmonology 2015. [DOI: 10.1089/ped.2014.0475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Traci M. Kazmerski
- Children's Hospital of Pittsburgh of University of Pennsylvania Medical Center, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Children's Hospital of Pittsburgh of University of Pennsylvania Medical Center, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kaleab Z. Abebe
- Center for Research on Health Care Data Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Janice Matisko
- Children's Hospital of Pittsburgh of University of Pennsylvania Medical Center, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Diane Schachner
- Children's Hospital of Pittsburgh of University of Pennsylvania Medical Center, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jonathan Spahr
- Children's Hospital of Pittsburgh of University of Pennsylvania Medical Center, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Abstract
OBJECTIVES The insights that people with cystic fibrosis have concerning their health are important given that aspects of health-related quality of life (HRQoL) are independent predictors of survival and a decrease in lung function is associated with a decrease in HRQoL over time. Cross-sectional data suggest that key variables, other than lung function, are also associated with HRQoL--although study results are equivocal. This work evaluates the relationship between these key demographic and clinical variables and HRQoL longitudinally. DESIGN Longitudinal observational study. Observations were obtained at seven time points: approximately every 2 years over a 12-year period. SETTING Large adult cystic fibrosis centre in the UK. PARTICIPANTS 234 participants aged 14-48 years at recruitment. OUTCOME MEASURE Nine domains of HRQoL (Cystic Fibrosis Quality of Life Questionnaire) in relation to demographic (age, gender) and clinical measures (forced expiratory volume in 1 s, (FEV1)% predicted, body mass index (BMI), cystic fibrosis-related diabetes, Burkholderia cepacia complex, totally implantable vascular access device, nutritional and transplant status). RESULTS A total of 770 patient assessments were obtained for 234 patients. The results of random coefficients modelling indicated that demographic and clinical variables were identified as being significant for HRQoL over time. In addition to lung function, transplant status, age, having a totally implantable vascular access device, cystic fibrosis-related diabetes, BMI and B. cepacia complex impacted on many HRQoL domains longitudinally. Gender was important for the domain of body image. CONCLUSIONS Demographic and changes in clinical variables were independently associated with a change in HRQoL over time. Compared with these longitudinal data, cross-sectional data are inadequate when evaluating the relationships between HRQoL domains and key demographic and clinical variables, as they fail to recognise the full impact of the CF disease trajectory and its treatments on quality of life.
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Affiliation(s)
- Janice Abbott
- School of Psychology, University of Central Lancashire, Preston, UK
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Mc Hugh R, Mc Feeters D, Boyda D, O’Neill S. Coping styles in adults with cystic fibrosis: implications for emotional and social quality of life. PSYCHOL HEALTH MED 2015; 21:102-12. [DOI: 10.1080/13548506.2015.1020317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Habib AR, Manji J, Wilcox PG, Javer AR, Buxton JA, Quon BS. A Systematic Review of Factors Associated with Health-Related Quality of Life in Adolescents and Adults with Cystic Fibrosis. Ann Am Thorac Soc 2015; 12:420-8. [DOI: 10.1513/annalsats.201408-393oc] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dębska G, Mazurek H. Factors related to changes in the quality of life among Polish adolescents and adults with cystic fibrosis over a 1-year period. Patient Prefer Adherence 2015; 9:1763-70. [PMID: 26719679 PMCID: PMC4689266 DOI: 10.2147/ppa.s88385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the effects of clinical factors, physical activity, and sociodemographic variables on 1-year changes in health-related quality of life (HRQoL) in Polish adolescents and adults with cystic fibrosis (CF). METHOD The study included 67 subjects with CF (mean age 21.1±5.1 years; range 14-37 years; 34 males and 33 females). The Cystic Fibrosis Quality of Life Questionnaire was used at baseline and after 1 year. Lung function data, body weight, and body height were extracted from medical records. Clinical assessment was performed with the Shwachman-Kulczycki scale. RESULTS The highest scores in both HRQoL examinations came from the domains of physical and social functioning, and the lowest from future concerns, body image, and career concerns. No significant changes of Cystic Fibrosis Quality of Life Questionnaire scores were documented over a period of 1 year. Patients with better baseline spirometry results more frequently reported an improvement in the treatment issues (subjects with FEV1 >50% of predicted, P=0.020) and in the career concerns (patients with FVC >50% of predicted, P=0.039). The improvement in the career concerns also depended upon daily physical activity (P=0.024), which was shown to modulate future concerns (P=0.032), along with place of residence and living conditions (P=0.003). Moreover, the time elapsed from the last pulmonary exacerbation was related to the change in social functioning (P=0.026). CONCLUSION When planning treatment, attention should be paid to interventions which may improve HRQoL. Systematic chronic therapy improves lung function, related to treatment issues and career concerns. Maintaining good physical condition and activity may positively influence future and career concerns. Special attention must be devoted to patients living in rural areas and enduring difficult living conditions, as they are especially vulnerable to deterioration in future concerns.
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Affiliation(s)
- Grażyna Dębska
- Faculty of Health and Medical Studies, Andrzej Frycz Modrzewski Krakow University, Krakow
- Correspondence: Grażyna Dębska, Faculty of Health and Medical Studies, Andrzej Frycz Modrzewski Krakow University, Herlinga-Grudzińskiego 1, 30-705 Krakow, Poland, Tel +48 12 252 4520, Fax +48 12 252 4523, Email
| | - Henryk Mazurek
- Department of Pneumonology and Cystic Fibrosis, National Tuberculosis and Lung Diseases Research Institute, Rabka, Poland
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Bodnar R, Kadar L, Holics K, Ujhelyi R, Kovacs L, Bolbas K, Szekely G, Gyurkovits K, Solyom E, Meszaros A. Factors influencing quality of life and disease severity in Hungarian children and young adults with cystic fibrosis. Ital J Pediatr 2014; 40:50. [PMID: 24887479 PMCID: PMC4068701 DOI: 10.1186/1824-7288-40-50] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 05/28/2014] [Indexed: 12/28/2022] Open
Abstract
Background The aim of our study was to evaluate factors affecting cystic fibrosis (CF) patients’ health-related quality of life (HRQoL) and to assess the level of agreement on HRQol between children and their parents. Methods Fifty-nine patients (mean age: 14.03 ± 4.81 years) from 5 Hungarian CF centres completed the survey. HRQoL was measured using The Cystic Fibrosis Questionnaire-Revised (CFQ-R). Parents were asked to fill out a questionnaire about their smoking habits, educational level and history of chronic illness. Disease severity was assessed using the physician-reported Shwachman-Kulczycki (SK) score system. Spirometry, Body Mass Index (BMI) percentile (pc), hospitalisation and Pseudomonas aeruginosa (PA) infection were examined as physiologic parameters of CF, and the impact of these factors on HRQoL was assessed. A multivariate regression analysis was performed to identify the most important factors affecting HRQoL. The level of significance was set to 0.05. Results Passive smoking and parental educational level and chronic diseases status did not have a significant impact on the patients’ HRQoL (p > 0.05). Significantly lower SK scores and spirometry values were found in low BMI pc patients (p < 0.001), in hospitalised (p < 0.01) and in PA-infected patients (p < 0.01), than in the adequate-weight, non-hospitalised and PA culture-negative subgroup. Lower CFQ-R scores were detected in hospitalised patients than in non-hospitalised patients in their Physical functioning domain. PA-infected patients had HRQoL scores that were significantly worse in the Body image (p < 0.01) and Respiratory symptoms (p < 0.05) domains than the PA culture-negative patients. Patients with a low BMI pc (<25th BMI pc) had significantly lower scores in the Eating, Body image and Treatment burden domains, than the adequate-weight patients (>25th BMI pc) (p < 0.01). A strong child–parent agreement was found in the Physical functioning domain (r = 0.77, p < 0.01). Conclusions Passive smoking, parental educational level and chronic diseases of parents do not affect the HRQoL of CF patients. In contrast, hospitalisation, PA infection and malnutrition have a significant and negative impact on patients’ HRQoL and the clinical severity of the disease. Parents and children were consistent in their scoring of symptoms and behaviours that were observable.
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Affiliation(s)
- Reka Bodnar
- Department of Pharmacy Administration, Semmelweis University, Hogyes Endre u, 7-9, 1092 Budapest, Hungary.
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Platten MJ, Newman E, Quayle E. Self-esteem and its relationship to mental health and quality of life in adults with cystic fibrosis. J Clin Psychol Med Settings 2014; 20:392-9. [PMID: 23264083 DOI: 10.1007/s10880-012-9346-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Research from the general population indicates an important role for self-esteem in mental health, but limited research in this area exists in the cystic fibrosis (CF) literature. This study aimed to explore the predictive value of self-esteem and health-related quality of life (HRQoL) in mental health symptoms in adults with CF. Seventy-four participants, recruited online, completed the Clinical Outcomes in Routine Evaluation-Outcome Measure 34 (CORE-OM), Rosenberg Self-esteem Scale and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Comparably high levels of self-esteem were found, but HRQoL was lower than previous research. Thirty percent of participants scored within the clinical range for mental health difficulty. Hierarchical regression, controlling for gender, explored the value of four CFQ-R subscales (physical, social, emotional and role functioning) and self-esteem in predicting CORE-OM total score. Gender accounted for 8.2% of the variance in mental health scores while the five independent variables accounted for a further 73.0% of variance. Of the five variables, CFQ-R emotional functioning and self-esteem were significant predictors of mental health symptoms. Results are discussed in relation to clinical implications and potential uses for internet technologies to promote socialisation.
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Affiliation(s)
- Melanie Jane Platten
- Department of Psychological Services and Research, Dumfries & Galloway NHS Health Board, Nithbank, Dumfries, DG1 2SA, Scotland, UK.
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Dill EJ, Dawson R, Sellers DE, Robinson WM, Sawicki GS. Longitudinal trends in health-related quality of life in adults with cystic fibrosis. Chest 2014; 144:981-989. [PMID: 23670667 DOI: 10.1378/chest.12-1404] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Health-related quality-of-life (HRQOL) measures have been used as patient-reported outcomes in clinical trials in cystic fibrosis (CF), but there are limited data on HRQOL changes over time in adults with CF. METHODS The Project on Adult Care in Cystic Fibrosis, a prospective, longitudinal panel study of 333 adults with CF at 10 CF centers in the United States, administered a disease-specific HRQOL measure, the Cystic Fibrosis Questionnaire-Revised (CFQ-R), seven times over 21 months. The CFQ-R assesses both physical and psychosocial domains of health. Growth curve regression models were developed for each CFQ-R domain, adjusting for demographic and clinical characteristics. RESULTS Between 205 and 303 adults completed surveys (response rate, 70%-93%). Mean age at baseline was 33 years (range, 19-64 years); mean FEV1 % predicted was 59.8% (SD, 22%). Over the 21 months of follow-up, lung function, frequency of pulmonary exacerbations, and nutritional indices were associated with physical CFQ-R domain scores. There were no significant population trends over time in the physical domain scores; however, there were population time trends in three psychosocial domains: treatment burden (+8.9 points/y), emotional functioning (+3.2 points/y), and social functioning (-2.4 points/y). Individual variation in both physical and psychosocial subscales was seen over 21 months. CONCLUSIONS In a longitudinal multicenter population of adults with CF, clinical variables such as FEV1, exacerbation frequency, and weight were correlated with related CFQ-R subscales. For the population as a whole, the physical domains of CFQ-R, such as respiratory symptoms, were stable. In contrast, population changes in several psychosocial domains of CFQ-R suggest that differentiating between the physical and the psychosocial trajectories in health among adults with CF is critical in evaluating patient-reported outcomes.
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Affiliation(s)
- Edward J Dill
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ree Dawson
- Frontier Science and Technology Research Foundation, Boston, MA
| | - Deborah E Sellers
- Center for Applied Ethics, Education Development Center, Inc, Newton, MA
| | - Walter M Robinson
- Center for Applied Ethics, Education Development Center, Inc, Newton, MA
| | - Gregory S Sawicki
- Division of Respiratory Diseases, Children's Hospital, Boston, Harvard Medical School, Boston, MA.
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Shoff SM, Tluczek A, Laxova A, Farrell PM, Lai HJ. Nutritional status is associated with health-related quality of life in children with cystic fibrosis aged 9-19 years. J Cyst Fibros 2013; 12:746-53. [PMID: 23410621 PMCID: PMC3683079 DOI: 10.1016/j.jcf.2013.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 11/29/2012] [Accepted: 01/11/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND The impact of improved nutritional status on health-related quality of life (HRQOL) is unknown for children with cystic fibrosis (CF). METHODS Associations between nutritional status and HRQOL were examined over 2 years in 95 children, aged 9-19 years, who were followed in the Wisconsin Newborn Screening Project. HRQOL was assessed using the Cystic Fibrosis Questionnaire (CFQ). Associations between height z-score (HtZ), BMI z-score (BMIZ) and seven CFQ dimensions were evaluated. RESULTS Mean values of at least 80 were observed for all CFQ dimensions except respiratory symptoms and treatment burden. Treatment burden was significantly worse in patients with meconium ileus (57) compared to pancreatic insufficient (65) and sufficient (78) subjects, p<0.0001. HtZ and BMIZ were positively associated with physical functioning and body image (p<0.05). CONCLUSIONS Better nutritional status was associated with increased HRQOL scores. Early diagnosis through newborn screening and improved nutrition provides an opportunity to enhance quality of life and body image perception.
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Affiliation(s)
- Suzanne M Shoff
- University of Wisconsin College of Agriculture and Life Sciences, Department of Nutritional Sciences, 1415 Linden Drive, Madison, WI 53706, USA; University of Wisconsin School of Nursing, K6/346 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792, USA; University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, K4/922 Clinical Sciences Center, 600 Highland Ave., Madison, WI 53792, USA; University of Wisconsin School of Medicine and Public Health, Departments of Pediatrics and Population Health Sciences, WARF Building, Room 756, 610 Walnut St., Madison, WI 53726, USA
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Wright KF, Bryant LD, Morley S, Hewison J, Duff AJA, Peckham D. Presenting life with cystic fibrosis: a Q-methodological approach to developing balanced, experience-based prenatal screening information. Health Expect 2013; 18:1349-62. [PMID: 23910894 DOI: 10.1111/hex.12113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is one of the most common life-threatening genetically inherited conditions and prenatal screening for CF is available in many countries. Genetic counsellors and other health professionals are expected to provide information about the condition in a way that facilitates personal decision making. Knowing what information to deliver about complex genetic conditions to support informed screening decisions can be challenging for health professionals. OBJECTIVE To solicit views from those with personal experience with CF on which aspects of the condition they consider most important to include in prenatal screening materials. METHODS Q-methodology; an approach to systematically explore variations in viewpoint that combines factor analytic techniques with qualitative approaches to pattern interpretation. SETTING AND PARTICIPANTS Twelve adults with CF and 18 parents of affected children were recruited from a regional centre in the UK. RESULTS Five distinct viewpoints on the items most and least important to include in screening information were identified: Factor 1 the normality of life with CF and increasing life expectancy; Factor 2 the hardships and reduced lifespan. Factor 3 medical interventions and the importance of societal support. Factor 4 longer-term consequences of CF. Factor 5 the ability to adjust to the condition. DISCUSSION The identification of five different views on what represented the most and least important information to include about CF highlights the challenge of portraying a complex genetic condition in a balanced and accurate manner. Novel ways in which Q-methodology findings can be used to meet this challenge are presented.
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Affiliation(s)
| | - Louise D Bryant
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Stephen Morley
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Abstract
Based on Moos and Holahan’s “Coping With Chronic Illness and Disability” model, we examined the contribution of medical impairment, illness perception, sense of coherence (SOC), relationship with the professional team, and adherence to treatment to the psychosocial adaptation (social adjustment and life satisfaction) of young adults with cystic fibrosis (CF). We also examined adherence, an important goal in and of itself for patients with CF. Seventy-one participants completed the following questionnaires: Social Adjustment, Life Satisfaction, Perceived Illness Severity, SOC, Relationship With Team, and Compliance. The legal criteria for medical impairment were also examined. Findings indicate that female patients and patients with high SOC reported better psychosocial adaptation. Participants with more severe medical impairments reported higher levels of adherence, and those who perceived their illness to be less severe reported lower levels of adherence and greater satisfaction in life. Relationship with the team was found to contribute to social adjustment. Psychosocial adaptation is associated with internal and external resources, but not necessarily with adherence to treatment. The rehabilitation counselor’s role is, therefore, to help adults with CF bridge between the contrasting dimensions of their lives, namely adherence to strict treatment protocols and psychosocial adaptation.
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Affiliation(s)
| | | | - Asher Barak
- Sheba Medical Center, The Edmond and Lili Safra Children’s Hospital, The Pediatric Pulmonology Unit, Israel
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Abstract
This paper describes the prevalence of eating disorders and disordered eating behaviors, the reasons why these practices are endorsed, and the potential consequences in youths and young adults with selected diet-related chronic health conditions (DRCHCs) and provides recommendations for eating disorder prevention interventions and research efforts. Although it remains unclear whether the prevalence of eating disorders is higher in those with DRCHCs compared with the general population, overall findings suggest that young people with DRCHCs may be at risk of endorsing disordered eating behaviors that may lead to diagnosis of an eating disorder and other health problems over the course of their treatment. Thus, health care providers should be aware that young people with DRCHCs may be at risk of eating disorders and carefully monitor psychological changes and the use of unhealthy weight control methods. It is also important to develop and evaluate theory-based interventions and disease-specific eating disorder risk screening tools that are effective in halting the progression of eating disorders and negative health outcomes in young people with chronic health conditions.
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Affiliation(s)
- Virginia M. Quick
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Epidemiology, Statistics, and Prevention Research, NIH, DHHS, Bethesda, MD
| | | | - Dianne Neumark-Sztainer
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
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Bodnár R, Holics K, Ujhelyi R, Kádár L, Kovács L, Bolbás K, Székely G, Gyurkovits K, Sólyom E, Mészáros Á. Quality of life in Hungarian patients with cystic fibrosis. Orv Hetil 2013; 154:784-91. [DOI: 10.1556/oh.2013.29612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: Cystic fibrosis is a progressive multisystemic disease which affects the quality of life of patients. Aim: The aim of the study was to evaluate quality of life in Hungarian patients with cystic fibrosis. Methods: Validated Hungarian translation of The Cystic Fibrosis Questionnaire – Revised was used to measure quality of life. Clinical severity was determined on the basis of Shwachman–Kulczycki score. Lung function was measured using spirometry. Results: 59 patients were included from five centres in Hungary. The relationships between 8–13 year-old children self-report and parent proxy report was 0.77 (p<0.001) in physical functioning, 0.07 (p<0.001) in emotional functioning, 0.51 (p<0.001) in eating, 0.21 (p<0.001) in treatment burden, 0.54 (p<0.001) in body image, 0.49 (p<0.001) in respiratory symptoms and 0.40 (p<0.001) in digestive symptoms domains. Conclusions: In contrast to physical domains weak correlations were observed between answers obtained from children and their parents in psychosocial domains. The perception of both patients and their parents should be assessed when measuring quality of life in paediatric patients with cystic fibrosis. Orv. Hetil., 2013, 154, 784–791.
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Affiliation(s)
- Réka Bodnár
- Semmelweis Egyetem Egyetemi Gyógyszertár Gyógyszerügyi Szervezési Intézet Budapest Üllői út 86. 1089
| | - Klára Holics
- Heim Pál Gyermekkórház Mucoviscidosis Szakrendelés Budapest
| | - Rita Ujhelyi
- Heim Pál Gyermekkórház Mucoviscidosis Szakrendelés Budapest
| | - László Kádár
- Tüdőgyógyintézet Törökbálint Gyermekosztály Törökbálint
| | - Lajos Kovács
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest
| | - Katalin Bolbás
- Kaposi Mór Oktató Kórház Gyermek-tüdőgyógyászati és Gyermekrehabilitációs Egység Mosdós
| | - Gyöngyi Székely
- Kaposi Mór Oktató Kórház Gyermek-tüdőgyógyászati és Gyermekrehabilitációs Egység Mosdós
| | - Kálmán Gyurkovits
- Kaposi Mór Oktató Kórház Gyermek-tüdőgyógyászati és Gyermekrehabilitációs Egység Mosdós
| | - Enikő Sólyom
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Velkey László Gyermek-egészségügyi Központ Miskolc
| | - Ágnes Mészáros
- Semmelweis Egyetem Egyetemi Gyógyszertár Gyógyszerügyi Szervezési Intézet Budapest Üllői út 86. 1089
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Tluczek A, Becker T, Grieve A, Laxova A, Rock MJ, Gershan WM, Green CG, Farrell PM. Health-related quality of life in children and adolescents with cystic fibrosis: convergent validity with parent-reports and objective measures of pulmonary health. J Dev Behav Pediatr 2013; 34:252-61. [PMID: 23669872 DOI: 10.1097/DBP.0b013e3182905646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examined the convergent validity of health-related quality of life (HRQOL) reported by patients with cystic fibrosis compared with their parents' reports and objective pulmonary measures across 3 time points. METHODS Ninety-two children (8-13 years) and adolescents (14-18 years) with cystic fibrosis and their parents completed Cystic Fibrosis Questionnaires to examine concordance with Wisconsin chest x-ray (WCXR) scores and pulmonary function tests, for example, forced expiratory volume at 1 second (FEV1), and parent-child/adolescent concordance across multiple HRQOL domains. Concordance was analyzed relative to patient age and gender. RESULTS Parent-reports were closely aligned with WCXR scores, whereas patient reports were more closely aligned with FEV1. Adolescents and parents of both age groups had more HRQOL domains concordant with pulmonary health measures than did child self-reports. Parent-child concordance was inversely related to child age, particularly with male adolescents. Children generally reported better HRQOL than parents. Male adolescents and their parents were more likely to have significantly discordant HRQOL scores than female adolescents and their parents. Male and female adolescents reported higher HRQOL than their parents reported for all but vitality and health perception domains. Younger male children showed concordance with their parents on 5 of 7 domains. CONCLUSIONS Parent-child/adolescent discordance on HRQOL was consistent with normative child development expectations. Findings underscore the value of enlisting perspectives from parents as well as children regarding HRQOL.
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Bouka A, Tiede H, Liebich L, Dumitrascu R, Hecker C, Reichenberger F, Mayer K, Seeger W, Schulz R. Quality of life in clinically stable adult cystic fibrosis out-patients: Associations with daytime sleepiness and sleep quality. Respir Med 2012; 106:1244-9. [DOI: 10.1016/j.rmed.2012.06.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/03/2012] [Accepted: 06/10/2012] [Indexed: 11/20/2022]
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Salek MS, Jones S, Rezaie M, Davies C, Mills R, Ketchell RI. Do patient-reported outcomes have a role in the management of patients with cystic fibrosis? Front Pharmacol 2012; 3:38. [PMID: 22416231 PMCID: PMC3298894 DOI: 10.3389/fphar.2012.00038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 02/21/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is a rapidly growing area of expertise and the most commonly used patient-reported outcome (PRO). The impact of cystic fibrosis (CF) on HRQoL is liable to be great, making CF patients ideal candidates for the application of HRQoL instruments. The aims of this study were to assess the affect of CF on HRQoL, to ascertain the reliability and validity of the United Kingdom Sickness Impact Profile (UKSIP) and the Cystic Fibrosis Quality of Life Questionnaire (CFQoL) in the adult CF population, and to examine their role in the management of patients. METHODS Seventy participants were recruited from the All Wales Adult Cystic Fibrosis Centre at Llandough Hospital, UK. There were two stages to the study: self-report of the UKSIP and CFQoL; and completion of the same two questionnaires 7-10 days later. RESULTS The areas of HRQoL most impaired by CF were employment and concerns regarding the future. The UKSIP and CFQoL showed high internal consistency (rα = 0.89-0.93) and test-retest reliability (r(s) = 0.57-0.94, p < 0.005) in the CF population. Validity was variable with the UKSIP showing discrimination across socio-demographic factors, whilst the CFQoL showed increased sensitivity to clinical variables. Many parameters influenced patient-reported HRQoL, with the greatest correlations seen with the Borg score (p < 0.005). The use of a HRQoL instrument in CF annual reviews is recommended to provide holistic patient care. The results of this study underpin the value of HRQoL as a patient-reported outcome measure in the management of adult CF.
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Affiliation(s)
- M Sam Salek
- Centre for Socioeconomic Research, Cardiff University Cardiff, UK
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Ashish A, Shaw M, McShane J, Ledson MJ, Walshaw MJ. Health-related quality of life in Cystic Fibrosis patients infected with transmissible Pseudomonas aeruginosa strains: cohort study. JRSM Short Rep 2012; 3:12. [PMID: 22393473 PMCID: PMC3291422 DOI: 10.1258/shorts.2011.011119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives To assess the impact on health-related quality of life (HRQoL) in adult cystic fibrosis (CF) patients of chronic infection with the Liverpool Epidemic Strain (LES) of Pseudomonas aeruginosa (Psa). Design Cohort study. Participants Adult CF patients attending a single CF centre. Setting Outpatient clinic. Main outcome measures HRQoL measures of adult CF patients chronically infected with LES and Psa strains measured by CFQ-UK. Results Patients infected by transmissible Psa strains had worse physical functioning, respiratory symptoms, treatment burden, vitality, role, health perception and emotion than those with unique Psa strains (P < 0.01), and significantly poorer physical functioning, respiratory symptoms, treatment burden, body image, weight, role, and emotion than those without any Psa infection (P < 0.05). Furthermore, in a matched cohort of 39 patients, those with LES infection reported significantly worse physical functioning, treatment burden, respiratory symptoms and health perception than those with unique Psa infection (P < 0.02). Conclusion Chronic infection with transmissible Psa strains, particularly LES, confers a worse quality of life in adult CF patients. Coupled with the established poorer clinical outcome, this reinforces the need to prevent the spread of such strains in CF community.
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Affiliation(s)
- Abdul Ashish
- Liverpool Heart and Chest Hospital , Thomas Drive, Liverpool L14 3PE , UK
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Gage LA. What deficits in sexual and reproductive health knowledge exist among women with cystic fibrosis? A systematic review. Health Soc Work 2012; 37:29-36. [PMID: 22908479 DOI: 10.1093/hsw/hls003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The life span of patients with cystic fibrosis (CF) continues to extend due to advances in treatments and care. The rate of pregnancy for female patients with CF has also continued to rise. The purpose of this study was to systematically review the available literature on female patients with CF and their knowledge of sexual and reproductive health. A priori, the research question was posed: What deficits in sexual and reproductive health knowledge exist among women with cystic fibrosis? Three broad areas of knowledge lacking in female patients with CF were identified: physiological, genetic, and psychosocial. The results imply female patients with CF are not equipped with adequate information for the decision-making process involved in sexual and reproductive choices. Social workers play an important and dynamic role on the multidisciplinary CF care team and can improve the quality of life for women with CF by addressing the psychosocial processes associated with the disease. Because of social work's important role in the holistic care approach to CF and other chronic and debilitating illnesses, social work literature should focus greater attention on these issues.
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Affiliation(s)
- L Ashley Gage
- School of Social Work, University of Missouri, Columbia, OH 65211, USA.
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