Objective:
To review quality of life (QOL) instruments for chronic limb-threatening ischemia (CLTI) patients and informal carers, and their use in QOL and cost-utility analysis (CUA) studies.
Background:
CLTI is a global health problem with significant morbidity affecting patients and informal carers. QOL is increasingly measured for holistic outcomes assessment and CUA. However, measurement instruments in CLTI are poorly understood.
Methods:
MEDLINE, EMBASE, PsycINFO, CINAHL, COSMIN, PROQOLID, CEA registry, and NHS EED databases were searched for all English language studies up to May 2021. Features of instruments, evidence of measurement property appraisal, and trends in use were assessed. Prospective protocol registration (Open Science Framework: https://doi.org/10.17605/OSF.IO/KNG9U).
Results:
A total of 146 studies on QOL instruments (n=43), QOL outcomes (n=97), and CUA (n=9) were included. Four disease-specific QOL instruments are available for lower extremity arterial disease (intermittent claudication or CLTI). VascuQoL-25 and VascuQoL-6 have been used in CLTI. There is no CLTI-specific instrument. Of 14 generic instruments, SF-36, EQ-5D-3L, NHP, and WHOQOL-BREF were most common. Studies reporting partial measurement property appraisal favored VascuQoL-25, VascuQoL-6, and SF-36. Feasibility considerations include mode of administration and responder burden. None of 4 available carer-specific instruments have been used in CLTI. Since 1992, the number of QOL studies has increased considerably, but CUA studies are scarce. Informal carers have not been assessed.
Conclusions:
This review provides a comprehensive reference for QOL measurement in CLTI that helps end-users with instrument selection, use, and interpretation. However, a CLTI-specific instrument is needed. There is an opportunity to benefit society through future CUA studies and evaluation of QOL in informal carers.
Ureteric stone position can limit the use of extracorporeal shock wave lithotripsy due to imaging difficulties. Ureteric lithotripsy overcomes this problem. The holmium laser has proven to be safe and effective in clearing urinary stone burdens of a variety of sizes, sites and compositions in this cohort of patients.
Intra‐arterial temazepam injection by intravenous drug abusers may be associated with vascular and metabolic complications. Patients generally present with severe pain, mottling and swelling of the limb. This can progress to tissue loss. The pathophysiology is not clearly defined, but may include direct vascular injury, as well as rhabdomyolysis. This is illustrated by two cases that presented to The Geelong and St Vincent's Hospitals, Victoria, Australia, resulting in compartment syndromes, limb ischaemia and rhabdomyolysis. Treatment consists of reducing intracompartmental pressure, attempts to re‐establish blood flow by either pharmacological or surgical methods and supportive care. Compartment syndromes and ischaemia may take hours to develop, so that prolonged observation is indicated. Evidence of raised intracompartmental pressure or limb ischaemia warrants early and aggressive intervention in order to prevent or minimize the limb‐ and life‐threatening consequences of intra‐arterial injection of temazepam.
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