Showing papers on "Quality of life published in 1988"

Quality of Life 4 Years After Stroke

Abstract: The quality of life for 46 stroke survivors under the age of 65 years in a stroke register was studied 4 years after their first stroke. A questionnaire covering four domains of life (working conditions, activities at home, family relationships, and leisure time activities) was used for investigation of the quality of life. The results showed that in spite of a good recovery in terms of discharge from the hospital, activities of daily living, and return to work, the quality of life of most patients (83%) had not been restored to the prestroke level. Deterioration among the several domains of life ranged from 39% to 80%, the lowest being in the domain of activities at home and the highest in the domain of leisure time activities. Hemispheral localization of the lesion, paresis, coordination disturbances, and especially subjective tendency to depression were highly correlated with a deterioration in the quality of life. Dependence in activities of daily living and an inability to return to work were also associated with the lack of restoration. Our results suggest that much more attention should be paid to the quality of life of stroke patients.

Quality of life following intensive care.

Abstract: Evaluations of intensive care have largely focused on survival, cost, or functional status; however, these may not be the only outcomes of interest to patients, families, and health care providers. Quality of life is an important consideration in evaluating intensive care because it influences decisions about the use of life-sustaining treatment. A study was conducted to assess the quality of life of survivors of intensive care to determine the relationship of perceived quality of life to other outcomes of intensive care. Patients at least 55 years old who received medical intensive care during 1983 (n=69) were interviewed to determine social characteristics, functional status, psychological well-being, and their perceived quality of life using a new 11-item Perceived Quality of Life scale. Functional status correlated only moderately with perceived quality of life (r=0.49, p=0.0001). Objective measures of patients’ material and social resources did not predict satisfaction. To evaluate outcome adequately, it is necessary to assess perceptions of life quality from patients who have received life-sustaining treatment.

Estimating the quality of life in a clinical trial of patients with metastatic lung cancer using the Karnofsky performance status and the Functional Living Index--Cancer.

Abstract: Serial assessments of Karnofsky performance status (KPS) and of the Functional Living Index--Cancer (FLIC) have been used to estimate the quality of life (QOL) of patients in a prospective, randomized trial of supportive care versus supportive care given with combination chemotherapy to patients with metastatic non-small cell lung cancer. There was a good correlation between KPS and FLIC scores at study entry, thus confirming results originally reported using the FLIC. However, a number of unexpected problems were encountered in data collection and quality control with this QOL assessment instrument. This made it impossible to look for differences in treatment effect on QOL in this clinical trial. It is believed that QOL assessment should be an integral part of cancer clinical trials; however, investigators must acknowledge the difficulties in collecting this type of data. The development of new instruments and the refinement of old ones will facilitate the collection of data for this important aspect of clinical trials research.

Psychosocial correlates of cancer survival: a subsequent report 3 to 8 years after cancer diagnosis.

Abstract: Professional and public interest in possible relationships between psychosocial factors and disease outcome continues to increase. Published research in this area, however, is marked by contradictory results. Positive relationships between a variety of psychosocial factors and length of survival from cancer are reported, but other studies uncover no such associations. In a previously reported prospective investigation of 359 patients with newly diagnosed malignant diseases, we found no relationship between clinical outcome and any psychosocial factor studied. We have continued to observe these patients, who are now up to 8 years post-diagnosis, and report here additional data on their disease outcomes as they relate to psychosocial factors assessed at diagnosis. Two groups of patients were studied: 204 patients with advanced, prognostically poor malignant disease at diagnosis; and 155 patients with intermediate or high-risk melanoma or breast cancer. Shortly after diagnosis, patients completed a self-report questionnaire that assessed seven psychosocial factors previously reported to predict longevity in the general population. Factors included social ties and marital history, job satisfaction, use of psychotropic drugs, general life satisfaction, subjective view of adult health, hopelessness, and perception of amount of adjustment required to cope with the new diagnosis. Clinical factors--performance status and extent of disease at diagnosis--predicted clinical outcome. No psychosocial factor consistently was associated with length of survival or remission. Results of additional exploratory analyses also are reported.

Yea-saying and mood-of-the-day effects in self-reported quality of life

Abstract: This paper focuses on some of the complications that may arise from errors of measurement in quality of life (QOL) scales based on self-report. It is argued that systematic errors as well as random errors (specifically in the shape of mood-of-the-day effects) will tend to suppress, mask or “wash out” statistical associations between “objective”, sociologically relevant, indicators of well-being and self-reported quality of life. Results from a Norwegian sample of middle-aged and old participants in a health screening operation (N=610) are reported. The findings indicate that response acquiescence (“yea-saying”) may be a source of systematic error even in balanced QOL-scales, and that this bias may lead one to underestimate QOL among the well-educated and overestimate it among older respondents. Utilizing over-time data we are able to show that self-reported QOL appears particularly vulnerable to mood-of-the-day effects among younger females. Implications for sociological research on subjective well-being are pointed out.

Quality of life of lung cancer patients in a randomized clinical trial evaluated by a psychosocial well-being questionnaire.

Abstract: The quality of life of patients treated with radiotherapy and chemotherapy for non-small cell lung cancer is compared in a randomized study. A standardized questionnaire composed of 12 questions covering psychosocial well-being (10 question index), and global quality of life evaluation (2 questions) was used to evaluate the patient's quality of life. Data were collected before treatment was started and at 7 different occasions up to 52 weeks after the beginning of the first treatment. The psychosocial well- being index and the 2 global questions were found to have a high degree of validity in a previous study. Two weeks after the start of treatment, the psychosocial well-being index for patients receiving radiotherapy was significantly higher than for patients treated by cytostatic drugs. This observation was confirmed by the 2 global questions. No differences in the quality of life were detected in the follow-up period (6–52 weeks).

Quality of Life After Kidney Transplantation. A Prospective, Randomized Comparison of Cyclosporine and Conventional Immunosuppressive Therapy

Abstract: The aim of this research is to compare the quality of life after kidney transplantation for patients treated with cyclosporine versus conventional immunosuppressive therapy. This evaluation assumes particular importance given the high cost of cyclosporine, the resistance of the government to cover these costs, and the absence in some series (including this one) of significant differences in patient and kidney survival. This study is based on a randomized, stratified, prospective trial and concentrates on nondiabetic patients from ages 19 to 56 at 1-year posttransplant. Patients on cyclosporine show significant advantages in physical, emotional, and social well-being. Differences for 5 out of 10 indicators of quality of life were significant at the P less than or equal to .05 level. Significant differences are found on health satisfaction, happiness measures, indices of overall life satisfaction and well-being, perceived adjustment of the family, and female (not male) vocational rehabilitation. The fewer number of episodes of rejection and infection are, in part, responsible for these advantages in quality of life for cyclosporine patients.

Rehabilitation after heart transplantation: the Australian experience.

Abstract: This study was designed to assess aspects of the quality of life and rehabilitation of heart transplant recipients who had transplantations at St Vincent's Hospital, New South Wales, Australia, between February 1984 and March 1987 Factors determining return to full-time employment were delineated A questionnaire was sent to 51 recipients The response rate was 92% The questionnaire measured employment status and satisfaction with family, social, marital, and sexual life Financial status, exercise ability, and participation in daily activities were also assessed Analysis showed that 53% of recipients had returned to either full-time or part-time employment, home duties, or full-time study A further 28% were receiving a pension, 9% had chosen voluntary retirement, 6% were receiving unemployment benefits, and 4% were getting paid leave Ability to exercise was improved for 77% of recipients and remained the same for another 14% Financial status was unchanged for 45% and improved for 17% Thirty-eight percent believed that they were worse off financially Ratings of social, family, and marital life showed nearly complete or complete satisfaction in most cases Satisfaction with sex life was less favorable Comparison of the group who had returned to full-time employment with the group receiving a pension identified two variables of work status--length of time since transplantation and employment status before transplantation There were also some differences between the two groups on quality of life ratings

Quality of life post-myocardial infarction: effects of a transtelephonic coronary intervention system.

Abstract: The impact of an outpatient, risk-management system, including a transtelephonic electrocardiographic monitor and lidocaine injector, on the quality of life in post-myocardial infarction patients was examined. Patients (n = 238) were assigned randomly to either the system or to standard medical care (control). Quality of life was defined in terms of psychological status, return to work, and social functioning. Relative to control patients, system patients showed a significant decrease in concerns about physical functioning and symptoms, and, over time, reported less depressive affect. At 9-month follow-up, control patients were more than twice as likely to be in the range of clinical depression. Patients' perceptions of their ability to manage a recurrence of cardiac symptoms appeared to be related inversely to depressive affect. Moreover, a larger percentage of system patients (92%) had returned to work by the 9-month follow-up, compared with control patients (76%). There were, however, no significant differences between groups in the degree of impairment in social interaction. Overall, these results indicate that the use of a "system" encouraging patient participation in treatment can significantly improve qualify of life after a myocardial infarction.

Isolated lung transplantation: a review of problems and guide to anaesthesia

Abstract: Some recipients of isolated, orthotopic lung transplants have now survived to leave hospital with greatly improved quality of life. Inevitably, the successful demonstration of the feasibility of these operations means that transplant centres throughout the world may wish to participate in a lung transplant programme. The indications and preparations for, and some of the implications of, these operations are discussed and some of the relevant literature, pertaining to perioperative anaesthetic management, reviewed. Successful transplantation has vindicated the policy that anaesthesia for these patients can be managed with methods conventional for pulmonary resection, and without resort to cardiopulmonary bypass. Key operative points highlighted, and management factors, based on practical experience, are suggested to provide guidelines for the benefit of those anaesthetists who may be involved in lung transplantation.

Measurement of the quality of life in congestive heart failure-Influence of drug therapy.

Abstract: In cardiovascular diseases such as hypertension, drug therapy may improve survival and the drug of choice is the one that interferes least with health-related well-being, otherwise known as the quality of life. However, in angina, and possibly congestive heart failure, a drug may improve well-being but not survival. In this instance, the measurement of the quality of life is the endpoint in any therapeutic intervention. When selecting dimensions of quality of life and the methods to measure these dimensions, the key issue is the detection of a response to treatment during the trial. The sensitivity of a variety of methods appropriate to hypertension, angina, and congestive heart failure are considered. Overall, the quality of life should be assessed by double-blind, randomized, controlled trials, with a health index included to take account of any mortality and morbidity that occurs during the trial. Validity and repeatability of measures are most important, both within populations and across cultures. Observer bias must be avoided.

Presidential address: does adjuvant radiotherapy have a role in the postmastectomy management of patients with operable breast cancer-revisited

Abstract: About 2 decades ago, "routine" adjunctive postmastectomy radiotherapy, especially for axillary node-positive patients, was the norm and uncriticized standard against which adequate treatment was measured in most centers. With the advent of cyclic, aggressive, multi-agent chemotherapy and anti-hormones used as adjuvants, especially within the last decade, there has been tremendous reduction in patients referred to the radiation oncologist for consideration of adjunctive postmastectomy radiotherapy. This presentation will attempt to define a role for radiotherapy in at least selected subsets of patients who undergo modified radical mastectomy, based upon published series in the literature. Breast cancer is a protean disease and deserves a multidisciplinary approach to evaluation and treatment. "Routine" adjunctive postmastectomy radiotherapy for all patients with operable breast cancer obviously is not indicated, but there appear to be groups of patients who benefit from radiotherapy, both from the standpoint of disease-free survival and improved quality of life, and … in very narrow subsets, absolute survival. In some of these subsets the benefit clinically may be greater than that resulting from chemotherapy or anti-hormone therapy, although, because of sample size, falling short of statistical verification. In response to the posed question, while this remains a controversial issue, there appears to be a role for selective adjunctive postmastectomy radiotherapy in specific subsets of patients, and physicians administering adjunctive breast cancer therapy with sweeping applications of chemotherapy or anti-hormones alone do not appear to be offering their patients optimal therapy.

Assessment of quality of life: a medical imperative.

Abstract: In caring for patients with chronic illness, particularly those chronic illnesses for which there are a number of comparably effective therapies as regards biomedical outcomes, important additional considerations include the assessment of the quality of life by the measurement of physical symptoms, general well-being, and emotional, intellectual, and social functioning.

Association between job stress and perceived quality of life.

Abstract: Professionals in the area of health promotion have been aware for some time of the negative effects of job stress on worker quality of life. This study examined the relationship between job stress and quality of life (QOL) indicators for university faculty and administrators as well as the potential buffering effects of selected variables on these relationships. The principal QOL indicators were considered to be job and life satisfaction and psychophysiological symptoms. The moderating variables of percentage of body fat, maximum oxygen consumption, self-esteem, physical self-esteem, overall social support, and supervisor support were examined for their ability to buffer the effects of job stress on the QOL indicators. Life and job satisfaction and psychophysiological symptoms were found to be significantly related to job stress. Self-esteem, body cathexis, overall social support, supervisor support, and maximum oxygen consumption were found to moderate the effects of job stress on QOL indicators...

Quality of life in treated head and neck cancer patients

Abstract: Sixty-Seven patients with head and neck cancer have been studied with respect to their quality of life after their treatment. The Grogono Woodgate index was used to evaluate their quality of life, the quality of life of patients treated for laryngeal cancer was excellent, even if they underwent total laryngectomy. On the contrary, however, patients who had hypopharyngeal cancer and had undergone a pharyngolaryngoesophagectomy had the lowest indices. As for patients with an oral cancer, their indices were high if the cancer was being controlled by radiotherapy.

Evaluation of psychosocial aspects in a breast preservation trial.

Abstract: The aim of a controlled clinical trial is usually to compare the efficacy of an innovative treatment with that of an established standard therapy. In cancer clinical trials the survival time of patients, i. e., the time from entry into the trial until death or recurrence, is the most important end point. This variable gives an objective description of what happens to the patient. However, both the disease and the treatment also have a subjective impact on the patient. To combine both objective and subjective viewpoints for a comprehensive appreciation of treatment effects we must take psychosocial factors into consideration — the latter are commonly referred to as the “quality of life” (QOL).

International travel amongst patients on chronic anticoagulation therapy.

Abstract: The travel habits of a group of patients on anticoagulants after heart valve replacements with mechanical prostheses have been investigated. In spite of their advanced mean age (63 at follow-up) more than half of the patients (55%) thought that they could travel without problems. Of those who had been travelling 56% had been to a foreign country. Only 5% had check-ups of prothrombin time when staying abroad. The adoption of the International Normalized Ratio for prothrombin control, patient education and international agreements making it easier to have check-ups of prothrombin time, can result in more patients on anticoagulants, for different reasons, to travel, thus increasing their quality of life.

Treating the hearing-impaired in a standard chemical dependence unit.

Abstract: Treatment of deaf chemical-dependent patients is considered difficult except in special facilities. We summarize the treatment of three such patients in a standard chemical dependence unit. The deaf patients were involved completely in the unit, with as few concessions as possible made to their deafness. One of the three deaf patients achieved complete sobriety through treatment. However, it was thought that all patients had gained in quality of life and productivity. We recommend techniques to modify standard facilities when specialized programs for deaf patients are unavailable.

Effect of treatment on the quality of life in hypertension and congestive heart failure.

Abstract: The objective in the treatment of hypertension is to preserve the quality of life. Most patients with hypertension do not have any impairment to their quality of life and the objective of treatment is to preserve this well-being. The results of trials in Europe and in the USA are discussed in this communication. At entry to the European trials, younger men appeared to have a better quality of life than older hypertensive men but older hypertensive women appeared, in some respects, to have a better quality of life than younger women. Following treatment the younger patients, aged less than 60 years, appeared to improve most with captopril and did not improve with methyldopa. However, in contrast, the elderly patients appeared to improve with both methyldopa and captopril. A large American trial confirmed that in white working men with hypertension the quality of life was best with treatment with captopril, least good with methyldopa and intermediate with propranolol. With congestive heart failure there are very few studies on the quality of life that can be discussed. However, Lipkin and Poole-Wilson did review the changes in exercise capacity with different drugs employed for the treatment of congestive heart failure. They assessed 16 trials that included the New York Heart Association Classification as an outcome. The reviewers did not consider that the inotropic agents improved exercise capacity. They considered that some of the trials supported a benefit from vasodilator treatment and that the four trials which assessed angiotensin-converting enzyme inhibitor therapy all showed an improvement in exercise capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

Quality of life following cerebral bypass surgery.

Abstract: Information available for nurses on counseling cerebral bypass patients regarding the outcomes of surgery is limited. In order to assess the impact of surgery on the patient's quality of life, a questionnaire was mailed to a sample of cerebral bypass patients who were at least three months postoperative and had suffered an ischemic event prior to surgery. Objective and subjective indicators were used to assess quality of life. Objective measures included type and frequency of symptoms most often associated with ischemic events, as well as return to work status. Subjective aspects included an overall assessment of life satisfaction as measured by the Cantril Self Anchoring Scale and satisfaction with these related domains of life: family, social, sex and occupation. Perceptions of body image were also examined. One hundred and two questionnaires were analyzed. Results indicated that for patients who were working before surgery, return to work was significant (p less than .0001). The signs and symptoms most often associated with an ischemic event were identified and overall, the number of reported symptoms was significantly decreased (p less than .0001) after surgery. In addition, an analysis of variance (ANOVA) with repeated measures indicated that patients viewed present and future life as better than life prior to surgery. Patients also reported greater satisfaction with family life (p less than .0001) and body image (p less than .01) following surgery. This information will be useful to nurses in diagnosing and counseling patients with stroke symptoms as well as in developing a comprehensive plan of care for patients who may undergo cerebral bypass surgery.