Patrick Phillips

Patient-reported outcome measures in patients with peripheral arterial disease: a systematic review of psychometric properties.

BackgroundPeripheral arterial disease (PAD) is generally associated with considerable morbidity and reduced quality of life. Patient-reported outcome measures (PROMs) provide important information about the burden of disease and impact of treatment in affected patients.ObjectivesThe objective of the review was to identify and appraise studies reporting the psychometric evaluation of PROMs administered to a specified population of patients with PAD with a view to recommending suitable PROMs.MethodsA systematic review of peer-reviewed English language articles was undertaken to identify primary studies reporting psychometric properties of PROMs in English-speaking patients with various stages of PAD. Comprehensive searches were completed up until January 2015. Study selection, data extraction and quality assessment were undertaken independently by at least two researchers. Findings were presented as tabular and narrative summaries based on accepted guidance.ResultsPsychometric evaluation of 6 generic and 7 condition-specific PROMs reported in 14 studies contributed data to the review. The frequently reported measure was the SF-36 (n = 11 studies); others included the Walking Impairment Questionnaire (n = 8 studies), EQ-5D (n = 5 studies) and the Vascular Quality of Life Questionnaire (n = 3 studies). Studies included a diverse PAD population and varied in methodology, including approach to validation of PROMs.ConclusionsVarious PROMs have been validated in patients with PAD but no study provided evidence of a full psychometric evaluation in the patient population. Careful selection is required to identify reliable and valid PROMs to use in clinical and research settings.

Themes that Determine Quality of Life in Patients with Peripheral Arterial Disease: A Systematic Review

ObjectivesThe aim of this study was to identify domains that determine quality of life in patients with peripheral arterial disease and find the patient-reported outcome measures that can examine the identified themes.MethodsA systematic review of all the main six databases was undertaken to identify primary qualitative studies reporting on the health and/or quality of life of patients with peripheral arterial disease. The quality of studies was assessed using the Critical Appraisal Skills Program criteria. Findings from the included studies were analysed using framework analysis methodology. The identified themes were mapped against the items/domains of validated patient-reported outcome measures used in patients with peripheral arterial disease.ResultsThe systematic review identified eight papers that fulfilled the inclusion criteria. The included papers reported the views of 186 patients with peripheral arterial disease including patients with intermittent claudication, critical ischaemia and amputation secondary to peripheral arterial disease. The overall quality of the included studies was good based on Critical Appraisal Skills Program criteria. Framework analysis identified 35 themes that were divided into six main groups: symptoms, impact on physical functioning, impact on social functioning, psychological impact, financial impact and process of care. The best-fit generic and disease-specific patient-reported outcome measures were the Nottingham Health Profile and the Vascular Quality of Life Questionnaire, respectively. None of the patient-reported outcome measures covered all the themes important to patients with peripheral arterial disease.DiscussionThe findings from the review identified the important domains that affect patients living with peripheral arterial disease. None of the current generic and disease-specific patient-reported outcome measures provide a comprehensive measure for all themes that impact the daily living of patients with peripheral arterial disease.

A systematic review of qualitative research into people's experiences of living with venous leg ulcers

AIM To systematically identify, evaluate and synthesize qualitative research that examined the symptoms and health-related quality of life themes that are important from the perspective of patients with venous leg ulceration. BACKGROUND Venous leg ulceration is a common chronic condition; the symptoms and associated treatments have a negative effect on health-related quality of life. Qualitative research methods can provide insight into the personal experiences of patients with venous leg ulceration. DESIGN Qualitative evidence synthesis (using framework synthesis). DATA SOURCES Multiple electronic databases including MEDLINE, EMBASE, PsycINFO and CINAHL were comprehensively searched from inception to November 2015. REVIEW METHODS Systematic identification, quality assessment and synthesis of existing qualitative research were performed; framework synthesis was conducted on included studies. An inductive approach was used and emergent themes were identified. The final stage in the synthesis involved the development of new interpretations. RESULTS Thirteen studies met the inclusion criteria; the overall quality of the included studies was good. Four overarching themes were identified; physical impact, psychological impact, social impact and treatment and, in these, further subthemes were identified. Ulcer and treatment-related pain, as well as odour and exudate appeared to have significant and direct negative effects on quality of life, with additional and cumulative effects on sleep, mobility and mood. CONCLUSION The themes identified in this review should be considered by professionals providing services, care and treatment for venous leg ulcer patients and in the selection, or development, of patient-reported outcome measures for use with this population.

Systematic review of patient-reported outcome measures in patients with varicose veins

Varicose veins can affect quality of life. Patient‐reported outcome measures (PROMs) provide a direct report from the patient about the impact of the disease without interpretation from clinicians or anyone else. The aim of this study was to examine the quality of the psychometric evidence for PROMs used in patients with varicose veins.

Systematic review of carotid artery procedures and the volume–outcome relationship in Europe

Hospitals that conduct more procedures on the carotid arteries may achieve better outcomes. In the context of ongoing reconfiguration of UK vascular services, this systematic review was conducted to evaluate the relationship between the volume of carotid procedures and outcomes, including mortality and stroke.

Systematic Review of Carotid Artery Procedures and the Volume-Outcome Relationship in Europe

Study design: This study was a search of studies that reported the effect of hospital or clinician volume on carotid endarterectomy (CEA) and stenting (CAS) outcomes restricted to European populations using MEDLINE, Embase, the Cochrane Library, Science Citation Index, and CINAHL from December 2014 to June 2016. Key findings: Eleven eligible studies were identified (233,411 participants): 5 from the UK, 2 from Sweden, 1 each from Germany, Finland, and Italy, and a combinedGerman,Austrian, andSwiss population. Two large studies (179,736patients) suggested an inverse relationshipbetweenhospital volumeandmortalityandcombinedmortality andstroke followingCEA.An inverse relationshipwasalso identifiedby2of3 small studiesofCEA.Theevidencewas lessclear for CAS;multiple analyses in three studiesdidnot identify convincingevidenceof anassociation. Limiteddata areavailableon the relationshipbetweenclinician volume and outcome in CAS. Conclusion: The evidence from the largest and highest-quality studies included in this review support the centralization of CEA. Commentary: Althoughmany studies have showna correlationbetweenhospital procedure volumeandoutcomes,manyhave also shown that themore important factor is thevolumeof the individual surgeonor interventionalist. Thisassociationmakes senseparticularly forCEA,where itwouldnotbesurprising that an outstanding vascular surgeon performing these operations at a small hospital where no one else performs CEAs obtained excellent results. Itmay be that the large-volumehospitalsdrawexcellentsurgeonsandthehospital itselfhas little impactonoutcomes.Theothervariable thathasbeenshowntohavea strong impact on CEA outcomes is the specialist performing the surgery. Several past studies have shown that vascular surgeons have better outcomes than general surgeons or neurosurgeons when performing CEA. The results of the current study are not surprising, but the plea for centralization of CEAsmakes senseonly if the surgeons at aparticular hospital havebeen shown toobtainexcellent results. On the otherhand, itmaybedifficult to expect a surgeon, especially a board-certified vascular surgeon, to tell patients to travel 2 hours, or even to go across town, to a hospital that doesmore CEAs than his or her hospital does, when that individual has tracked his or her own results andmet accepted standards in terms of low stroke andmortality rates.

Hysterectomy With Radiotherapy or Chemotherapy or Both for Women With Locally Advanced Cervical Cancer

BACKGROUND Cervical cancer is a common cancer in women younger than 65 years and the most common cause of death from gynecological cancers worldwide. The introduction of screening programs has internationally contributed to early identification of cervical cancer in Europe and the United States. Tumors are being identified and staged at International Federation of Gynecology and Obstetrics (FIGO) IA1 and treated by removal of affected tissue using local cervical treatments or total hysterectomy. Tumors identified at FIGO stages IA2 to IB1 are commonly treated with radical hysterectomy with pelvic lymphadenectomy or chemoradiotherapy. In contrast, later stage cervical cancer, locally advanced FIGO stages IB2 to III, where there is significant likelihood of lymph node metastases, the consensus is to treat nonsurgically, using combination chemoradiotherapy. This has implications in developing countries, such that (1) cervical cancer is often not discovered until it has progressed and has locally advanced because of inadequate screening and (2) treatment choices are limited, particularly by lack of access to radiotherapy. In this context, hysterectomy is frequently performed in combination with chemotherapy, although its effectiveness in reducing mortality is uncertain. In addition, chemotherapy, radiotherapy, and surgery are different in terms of risks and burdens associated with treatment in the short, medium, and long terms. For nurses discussing treatment options with patients, it would be valuable to have information about risks and benefits associated with each treatment and combination of these treatments. For these reasons, there is a need to assess the effectiveness of hysterectomy as a treatment for locally advanced cervical cancer in combination with other therapies for outcomes including survival, adverse events, and quality of life.

Systematic review assessing the measurement properties of patient-reported outcomes for venous leg ulcers

A variety of instruments have been used to assess outcomes for patients with venous leg ulcers. This study sought to identify, evaluate and recommend the most appropriate patient‐reported outcome measures (PROMs) for English‐speaking patients with venous leg ulcers.