We assessed the quality of life of 859 patients undergoing dialysis or transplantation, with the goal of ascertaining whether objective and subjective measures of the quality of life were influenced by case mix or treatment. We found that 79.1 per cent of the transplant recipients were able to function at nearly normal levels, as compared with between 47.5 and 59.1 per cent of the patients treated with dialysis (depending on the type). Nearly 75 per cent of the transplant recipients were able to work, as compared with between 24.7 and 59.3 per cent of the patients undergoing dialysis. On three subjective measures (life satisfaction, well-being, and psychological affect) transplant recipients had a higher quality of life than patients on dialysis. Among the patients treated with dialysis, those undergoing treatment at home had the highest quality of life. All quality-of-life differences were found to persist even after the patient case mix had been controlled statistically. Finally, the quality of life of transplant recipients compared well with that of the general population, but despite favorable subjective assessments, patients undergoing dialysis did not work or function at the same level as people in the general population.

From the standpoint of cost-effectiveness, interferon-alpha therapy for 6 or 12 months may be justified in patients with chronic hepatitis C. The possible exception is patients older than 60 years of age.

The subject of stimulant treatment for patients with neurobehavioural sequelae of traumatic brain injury (TBI) has received a good deal of recent attention, although there have to date been no controlled studies published. This is a description of 15 TBI patients who received treatment with the psychostimulant methylphenidate, in a double-blind, placebo-controlled cross-over study, with behavioural and neuropsychological ratings. Three subjects remained on the drug for a year after the acute study, and were subsequently studied in a double-blind, placebo-controlled reversal. The results support the idea that at least some symptomatic improvement may be gained from low-dose stimulant treatment, although the statistical analysis of the data was compromised by the occurrence of carryover effects from one drug condition to another. This, in itself, is an interesting discovery, because such effects have never been observed in stimulant studies of other patient groups. There are clear implications for the design of further studies in this area. The long-term effects of methylphenidate treatment were not at all impressive, however. Although the findings presented below may be subject to differing interpretation, it is conceivable that stimulants act to advance the course of cortical recovery following TBI.

No abstract