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      Impact of chronic Immune Thrombocytopenic Purpura (ITP) on health-related quality of life: a conceptual model starting with the patient perspective

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          Abstract

          Background

          Immune thrombocytopenic purpura (ITP), a condition characterized by autoimmune-mediated platelet destruction and suboptimal platelet production, is associated with symptoms such as bruising, epistaxis, menorrhagia, mucosal bleeding from the gastrointestinal and urinary tracts and, rarely central nervous system bleeding. The aim of this research is to develop a conceptual model to describe the impact of ITP and its treatment on patients' health-related quality of life (HRQoL).

          Methods

          A literature search and focus groups with adult ITP patients were conducted to identify areas of HRQoL affected by ITP. Published literature was reviewed to identify key HRQoL issues and existing questionnaires used to assess HRQoL. Focus group transcripts were reviewed, and common themes were extracted by grouping conceptual categories that described the impact on HRQoL.

          Results

          The literature synthesis and themes from the focus group data suggest that decreased platelet counts, disease symptoms, and treatment side effects influence multiple domains of HRQoL for ITP patients. Key areas affected by ITP and its treatments include emotional and functional health, work life, social and leisure activities, and reproductive health.

          Conclusion

          ITP affects various areas of HRQoL. This conceptual model will help inform the evaluation of therapeutic strategies for ITP.

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          Most cited references61

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          Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes.

          Our model proposes a taxonomy or classification scheme for different measures of health outcome. We divide these outcomes into five levels: biological and physiological factors, symptoms, functioning, general health perceptions, and overall quality of life. In addition to classifying these outcome measures, we propose specific causal relationships between them that link traditional clinical variables to measures of HRQL. As one moves from left to right in the model, one moves outward from the cell to the individual to the interaction of the individual as a member of society. The concepts at each level are increasingly integrated and increasingly difficult to define and measure. AT each level, there are an increasing number of inputs that cannot be controlled by clinicians or the health care system as it is traditionally defined.
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            Immune thrombocytopenic purpura.

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              Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications.

              Splenectomy has been a standard treatment for adult patients with idiopathic thrombocytopenic purpura (ITP) for more than 50 years. However, the durability of responses, the ability to predict who will respond, and the frequency of surgical complications with splenectomy all remain uncertain. To better interpret current knowledge we systematically identified and reviewed all 135 case series, 1966 to 2004, that described 15 or more consecutive patients who had splenectomy for ITP and that had data for 1 of these 3 outcomes. Complete response was defined as a normal platelet count following splenectomy and for the duration of follow-up with no additional treatment. Forty-seven case series reported complete response in 1731 (66%) of 2623 adult patients with follow-up for 1 to 153 months; complete response rates did not correlate with duration of follow-up (r = -0.103, P = .49). None of 12 preoperative characteristics that have been reported consistently predicted response to splenectomy. Mortality was 1.0% (48 of 4955 patients) with laparotomy and 0.2% (3 of 1301 patients) with laparoscopy. Complication rates were 12.9% (318 of 2465) with laparotomy and 9.6% (88 of 921 patients) with laparoscopic splenectomy. Although the risk of surgery is an important consideration, splenectomy provides a high frequency of durable responses for adult patients with ITP.
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                Author and article information

                Journal
                Health Qual Life Outcomes
                Health and Quality of Life Outcomes
                BioMed Central
                1477-7525
                2008
                8 February 2008
                : 6
                : 13
                Affiliations
                [1 ]Health Outcomes Solutions, P.O. Box 2343; Winter Park, Florida 32790, USA
                [2 ]Amgen, Inc., One Amgen Center Drive; Thousand Oaks, CA 91320-1799, USA
                [3 ]ICON Clinical Research, Lifecycle Sciences Group, 188 Embarcadero, Suite 200; San Francisco, CA 94105, USA
                [4 ]Evanston Northwestern Healthcare and Northwestern University Medical School, 1001 University Place, Suite 100; Evanston IL 60201, USA
                [5 ]John Hopkins University, 624 North Broadway; Baltimore, MD 21205, USA
                [6 ]Phase V Technologies, Inc., 20 Walnut Street; Wellesley Hills, MA 02481, USA
                [7 ]New York Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street; New York, NY 10021, USA
                [8 ]University of Oklahoma Health Sciences Center, P.O. Box 26901; Oklahoma City, OK 73190, USA
                [9 ]The Scripps Research Institute, 10550 N Torrey Pines Road; La Jolla, CA 92037, USA
                [10 ]University of Nebraska at Kearney, Copeland Hall 120B; Kearney, NE 68849, USA
                Article
                1477-7525-6-13
                10.1186/1477-7525-6-13
                2275726
                18261217
                21ceda99-2d22-4600-8c29-a3c6ed07eb77
                Copyright © 2008 Mathias et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 October 2007
                : 8 February 2008
                Categories
                Research

                Health & Social care
                Health & Social care

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