Background and aims: Cognitive impairments associated with aging and dementia are major sources of neuropsychiatric symptoms (NPs) and deterioration in quality of life (QoL). Preventive measures to both reduce disease and improve QoL in those affected are increasingly targeting individuals with mild cognitive impairment (MCI) at early disease stage. However, NPs and QoL outcomes are too commonly overlooked in intervention trials. The purpose of this study was to test the effects of physical and cognitive training on NPs and QoL in MCI.

Methods: Baseline data from an MCI court (N = 93, mean age 74.9 ± 4.7) enrolled in the Train the Brain (TtB) study were collected. Subjects were randomized in two groups: a group participated to a cognitive and physical training program, while the other sticked to usual standard care. Both groups underwent a follow-up re-evaluation after 7 months from baseline. NPs were assessed using the Neuropsychiatric Inventory (NPI) and QoL was assessed using Quality of Life-Alzheimer's Disease (QOL-AD) scale.

Results: After 7 months of training, training group exhibited a significant reduction of NPs and a significant increase in QOL-AD with respect to no-training group (p = 0.0155, p = 0.0013, respectively). Our preliminary results suggest that a combined training can reduce NPs and improve QoL.

Conclusions: Measuring QoL outcomes is a potentially important factor in ensuring that a person with cognitive deficits can 'live well' with pathology. Future data from non-pharmacological interventions, with a larger sample and a longer follow-up period, could confirm the results and the possible implications for such prevention strategies for early cognitive decline.

Goal-based training such as task practice combined with aerobic training (AT) has been suggested to improve motor performance and neuroplasticity for people with Parkinson's Disease (PwPD); however, its effect on clinical outcomes is unclear. Therefore, the main aim was to investigate the effects of task-oriented circuit training combined with AT (TOCT-AT) on balance and gait in PwPD. The secondary aim was to investigate the effects of TOCT-AT on functional mobility, balance confidence, disease severity, and quality of life. Twenty-six PwPD were randomly assigned to either to the experimental group (n = 14) or the control group (n = 12). The control group received AT, while the experimental group received TOCT-AT three times a week for 8 weeks. The main outcomes were the Berg Balance Scale (BBS), Postural Stability Test (PST), Limits of Stability Test (LOS), Pull Test (PT), Six Minute Walk Test (6MWT), Timed Up and Go Test (TUG), Activities-specific Balance Confidence Scale (ABC), Unified Parkinson's Disease Rating Scale (UPDRS), and eight-item Parkinson's Disease Questionnaire (PDQ-8) were secondary outcomes. After intervention, between-group comparisons showed that the experimental group significantly improved more than the control group in all outcomes (p < 0.05). Additionally, both groups significantly improved in BBS, 6MWT, TUG, ABC, UPDRS-II, UPDRS-III, UPDRS total, and PDQ-8 (p < 0.05), while only the experimental group significantly improved in PST, LOS, and PT (p < 0.001). This study suggest that TOCT-AT could improve balance and gait performance, which could also be positively translated into functional mobility, balance confidence, disease severity, and quality of life in PwPD.

Background and aims: Obesity is an increasing problem in patients after total knee replacement. The aim of this study was to investigate whether a weight loss intervention before primary total knee replacement would improve quality of life, knee function, mobility, and body composition 1 year after surgery.

Material and methods: Patients scheduled for total knee replacement due to osteoarthritis of the knee and obesity were randomized to a control group receiving standard care or to an intervention group receiving 8-week low-energy diet before total knee replacement. Patient-reported quality of life, 6-Min Walk Test, and body composition by dual-energy X-ray absorptiometry were assessed before intervention for the diet group, and within 1 week preoperatively for both groups, and the changes in outcome from baseline to 1 year after total knee replacement were compared between groups. The number of participants was lower than planned, which might introduce a type-2 error and underestimate the trend for a better outcome after weight loss.

Results: The analyses are based on a total of 76 patients, 38 in each group. This study showed major improvement in both study groups in quality of life and knee function, though no statistically significant differences between the groups were observed 1 year after total knee replacement. The average weight loss after 8-week preoperative intervention was 10.7 kg and consisted of a 6.7 kg reduction in fat mass. One year after total knee replacement, the participants in the diet group managed to maintain the weight reduction, whereas there was no change in the control group.

Conclusion: The results suggest that it is feasible and safe to implement an intensive weight loss program shortly before total knee replacement. The preoperative intervention resulted in a 10% body weight loss, improved body composition, lower cardiovascular risk factors, and sustained s-leptin.

Introduction: Alopecia areata (AA) is a disfiguring disease with substantial psychological burden. No studies explore the efficacy of pharmacotherapy through health-related quality of life (HRQoL) using both disease-specific and generic quality of life (QoL) instruments. We present the first study to elicit health utility from patients with AA and to evaluate the efficacy of cyclosporin in relation to HRQoL using both measures.

Methods: Participants with moderate to severe AA from a placebo-controlled randomized trial investigating cyclosporin were administered the generic preference-based HRQoL instrument, Assessment of Quality of Life-8D (AQoL-8D) and the disease-specific HRQoL instrument, Alopecia Areata Symptom Impact Scale (AASIS). HRQoL was measured at each study visit and compared to baseline.

Results: A number of 32 participants were analyzed. The mean health utility was 0.748. At 3 months, the cyclosporin group had trends for greater improvement in HRQoL across 6 of 8 AQoL-8D dimensions and 5 of 7 AASIS symptom domains compared to placebo. HRQoL was lower than Australian population norms across 6 of 8 AQoL-8D dimensions.

Conclusions: Patients with AA had a mean health utility of 0.748. Treatment with cyclosporin 4 mg/kg/d for 3 months resulted in trends for improvement of HRQoL across multiple dimensions in both disease-specific and generic measures. Capsule summary The mean health utility for patients with AA was 0.748. Patients with alopecia areata have impaired health-related quality of life across 6 of 8 AQoL-8D dimensions compared to population norms. Treatment with oral cyclosporin for moderate to severe AA resulted in trends for improvement in QoL across multiple dimensions.

Background: The interleukin 5 (IL-5) pathway is an important component in the pathophysiology of severe eosinophilic asthma. Mepolizumab is a monoclonal antibody that targets the IL-5 pathway. Clinical trials showed efficacy of Mepolizumab in patients with severe eosinophilic asthma. However, reports on experience with treatment in a real-world cohort are limited.

Objectives: Evaluation of the efficacy and safety of Mepolizumab for treatment of severe eosinophilic asthma in a real-world cohort of patients.

Methods: A clinical prospective observational trial included all patients >18 years treated with Mepolizumab between March 2016 to March 2019 at Rabin Medical Center. The composite primary outcome measures evaluated: increase in FEV1 by≥ 200 ml and/or decrease in exacerbation rate of ≥50% and/or cessation of oral corticosteroids (OCS) treatment or ≥50% decrease in dosage. Also evaluated: blood eosinophil count, adverse events and quality of life.

Results: Of 61 patients, 50 (82.0%) achieved the primary outcome. The number of patients who suffered from frequent exacerbations decreased from 52 (85.2%) to 8 (13.1%) (p < 0.001). Twenty-two patients (68%) stopped OCS treatment or received >50% reduced dosage (p < 0.001). Mean FEV1 increased from 1.72 ± 0.78 liters to 1.87 ± 0.85 liters (p = 0.043). Response to therapy was seen within six months. Forty-nine patients (80%) reported an improvement in quality of life (p < 0.001). Only minor adverse events were reported.

Conclusion: Treatment with mepolizumab was well tolerated and significantly lowered the exacerbation rate and OCS dependence in a real-world cohort of severe eosinophilic asthma patients. Response to therapy was within six months and treatment effect was sustained over time.

The aim of this study was to assess the effectiveness of a dog-assisted therapy intervention to enhance quality of life in persons with dementia institutionalized in a public care home and to study its effect on the use of psychotropic medications. A dog-assisted therapy intervention was designed, in which 34 residents of a public care home in Cuenca (Spain) participated. The participants were assigned to two groups, an experimental and a control group. The program consisted of one 50-min session per week during 9 months. Analysis of covariance (ANCOVA) was used to compare post-training values between groups, using baseline values as covariates. Our findings do seem to support the hypothesis that Animal-Assisted Therapy may contribute to enhancing quality of life for residents in an aged care home. However, aspects such as the format, time, and content of the sessions as well as their possibilities of reducing psychotropic medication require more research.

Introduction: The addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery (CRS) improves recurrence-free (RFS) and overall survival (OS) in patients with FIGO stage III ovarian cancer. We evaluated the effect of HIPEC on patient's health-related quality of life (HRQoL) in the OVHIPEC trial.

Materials and methods: OVHIPEC was a multicentre, open-label, randomized phase III trial for patients with stage III ovarian cancer. Patients were randomly assigned (1:1) to receive interval CRS with or without HIPEC with cisplatin. HRQoL was assessed using the EORTC QLQ-C30, and the ovarian (QLQ-OV28) and colorectal cancer (QLQ-CR38) modules. HRQoL questionnaires were administered at baseline, after surgery, after end of treatment, and every three months thereafter. HRQoL was a secondary endpoint, with the prespecified focus on the QLQ-C30 summary score and symptom scores on fatigue, neuropathy and gastro-intestinal symptoms. HRQoL was analysed using linear and non-linear mixed effect models.

Results: In total, 245 patients were randomized. One-hundred-ninety-seven patients (80%) completed at least one questionnaire. No significant difference over time in the QLQ-C30 summary scores was observed between the study arms (p-values for linear and non-linear growth: p > 0.133). The pattern over time for fatigue, neuropathy and gastro-intestinal symptoms did not significantly differ between treatment arms.

Conclusion: The addition of HIPEC to interval CRS does not negatively impact HRQoL in patients with stage III ovarian cancer who are treated with interval CRS due to the extent of disease. These HRQoL results, together with the improvement in RFS and OS, support the viability of HIPEC as an important treatment option in this patient population. CLINICALTRIALS.

Gov number: NCT00426257.

Eudract number: 2006-003466-34.

Objective: To investigate whether graded motor imagery (GMI) is effective for reducing phantom limb pain (PLP) in people who have undergone limb amputations.

Design: A single-blinded randomised, controlled trial.

Setting: Physiotherapy out-patient departments in three secondary level hospitals in Cape Town, South Africa.

Participants: Twenty-one adults (≥18 years) who had undergone unilateral upper or lower limb amputations and had self-reported PLP persisting beyond three months.

Interventions: A 6-week GMI programme was compared to routine physiotherapy. The study outcomes were evaluated at baseline, 6 weeks, 3 months and 6 months.

Outcome measures: The pain severity scale of the Brief Pain Inventory (BPI) was used to assess the primary outcome - PLP. The pain interference scale of the BPI and the EuroQol EQ-5D-5L were used to assess the secondary outcomes - pain interference with function and health-related quality of life (HRQoL) respectively.

Results: The participants in the experimental group had significantly greater improvements in pain than the control group at 6 weeks and 6 months. Further, the participants in the experimental group had significantly greater improvements than the control group in pain interference at all follow-up points. There was no between-group difference in HRQoL.

Conclusion: The results of the current study suggest that GMI is better than routine physiotherapy for reducing PLP. Based on the significant reduction in PLP and pain interference within the participants who received GMI, and the ease of application, GMI may be a viable treatment for treating PLP in people who have undergone limb amputations.

Clinical trial registration number: (PACTR201701001979279).

Objectives: There is a lack of evidence concerning the efficacy of oral corticosteroids (OCS) as a postoperative treatment for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The objective of our study was to determine the short-term additive benefit of postoperative OCS in CRSwNP patients.

Methods: We prospectively randomized CRSwNP patients who were treated by endoscopic sinus surgery. All patients were resistant to maximum medical treatment according to European position paper on rhinosinusitis and nasal polyps 2012 guidelines. Treatment group received postoperative OCS in descending doses plus nasal douching over a period of 4 weeks, whereas the control group received only nasal douching. The efficacy of OCS was determined by a total 5 item symptoms score (T5SS), polyp size score, Barcelona Smell Test 24 and Medical Outcome Study Short Form-36 questionnaire for quality of life (QoL).

Results: Of the 70 enrolled patients, 35 were in the treatment group and 35 in the control group. After 4 weeks of follow-up, patients from both groups improved in T5SS, QoL, endoscopic findings (except for crusts that increased in both) and sense of smell, without significant differences between OCS and control groups.

Conclusion: Postoperative OCS as an add-on treatment for CRSwNP patients does not improve sinonasal and QoL outcomes; thus, they should not be routinely recommended.

Level of evidence: Ib Laryngoscope, 2019.

Introduction: Pain, depression, and anxiety are prominent symptoms that frequently co-occur, causing significant debilitation and frequent primary care visits. This paper examines the acceptability of telecare and self-management modules in managing these conditions in a randomized trial.

Methods: The Comprehensive Management of Mood and Physical Symptoms (CAMMPS) trial compared an automated symptom management (ASM) plus self-management intervention with a comprehensive symptom management (CSM) intervention that added telecare facilitation of enhanced services. Data from the CAMMPS trial were analysed to compare the acceptability of these two interventions as indicated by utilization and patient satisfaction surveys.

Results: The mean number of automated reports completed was similar between the CSM and ASM groups (14.5 vs 14.0). Responses designated with clinically relevant "red alerts" (i.e. patient reports warranting an expedited nurse contact) were more frequent in the CSM group (10.2 vs 8.3). The CSM and ASM groups completed a similar number of the nine self-management modules (6.3 vs 5.8). The mean helpfulness score across all modules was higher in the CSM group than in the ASM group (1.8 vs 1.5; p = .003). The most common feedback suggestion from the ASM group was to have more personal interaction, while participants from both groups commonly suggested technical improvements or requests for more flexible timing of calls.

Discussion: Participants generally found both interventions satisfactory, with a trend in satisfaction data suggesting that patients tended to find the CSM intervention more helpful.