Showing papers on "Quality of life published in 1990"

Quality-of-life changes and hearing impairment. A randomized trial.

Abstract: Objective To assess whether hearing aids improve the quality of life of elderly persons with hearing loss. Setting Primary care clinics at a Bureau of Veterans Affairs hospital. Patients One hundred and ninety-four elderly veterans who were identified as being hearing impaired from a screening survey involving 771 consecutive clinic patients. Of the original 194, 188 (97%) completed the trial. Intervention Subjects were randomly assigned to either receive a hearing aid (n = 95) or join a waiting list (n = 99). MAIN ENDPOINTS: A comprehensive battery of disease-specific and generic quality-of-life measures were administered at baseline, 6 weeks, and 4 months. Measurements and main results Persons assigned to the two groups were similar in age, ethnicity, education, marital status, occupation, and comorbid diseases. At baseline, 82% of subjects reported adverse effects on quality of life due to hearing impairment, and 24% were depressed. At follow-up, a significant change in score improvements for social and emotional function (34.0; 95% CI, 27.3 to 40.8; P less than 0.0001), communication function (24.2; CI, 17.2 to 31.2; P less than 0.0001), cognitive function (0.28; CI, 0.08 to 0.48; P = 0.008), and depression (0.80; CI, 0.09 to 1.51; P = 0.03) was seen in subjects who received hearing aids compared with those assigned to the waiting list. Six drop-outs (three per group), no crossovers, and no significant changes in cointerventions were seen. Average, self-reported, daily aid use in the hearing aid group was 8 hours. Conclusion Hearing loss is associated with important adverse effects on the quality of life of elderly persons, effects which are reversible with hearing aids.

Development of a quality of life index for patients with cancer.

Abstract: This study developed an instrument to measure the quality of life (QOL) of patients with cancer that would account for individual values, as well as satisfaction. The sample consisted of patients with breast cancer (n = 111) listed in the tumor registry of a major hospital. Ferrans and Power's Quality of Life Index (QLI) was modified based on an extensive review of the oncology literature, which supported content validity. The findings supported the internal consistency reliability of the entire QLI (alpha = 0.95) and of the four subscales: health and functioning, socioeconomic, psychological/spiritual, and family (alphas = 0.90, 0.84, 0.93, and 0.66, respectively). Support for concurrent validity was provided by a strong correlation (r = 0.80) between the QLI and a measure of satisfaction with life. Support for construct validity was provided by significantly higher mean QOL scores for subjects who had less pain, less depression, and were coping better with stress, using the known group technique. The positive results obtained from this assessment and the fact that many patients can complete the QLI independently are important variables to consider when health professionals are selecting instruments for research and practice.

The quality of life of hemodialysis recipients treated with recombinant human erythropoietin. Cooperative Multicenter EPO Clinical Trial Group.

Abstract: Initial clinical trials with recombinant human erythropoietin provided evidence of a quality-of-life benefit for patients with anemic end-stage renal disease who received maintenance hemodialysis. As part of a phase III clinical trial of recombinant human erythropoietin, the quality of life of patients was systematically assessed. More than 300 patients at nine dialysis centers were evaluated. A statistically significant improvement was established between baseline and second follow-up on most objective and subjective quality-of-life parameters, including energy and activity level, functional ability, sleep and eating behavior, disease symptoms, health status, satisfaction with health, sex life, well-being, psychological affect, life satisfaction, and happiness. No change was observed in ability to work or employment status. We conclude that, in addition to substantial improvement in hematologic parameters, recombinant human erythropoietin greatly enhances the quality of life of anemic patients who receive maintenance hemodialysis.

"The Göteborg quality of life instrument"--an assessment of well-being and symptoms among men born 1913 and 1923. Methods and validity.

Abstract: "The Goteborg quality of life instrument" (GQL-instrument) has been used to assess the quality of life of men born in 1913 and 1923. On a population basis, it was possible to show that the well-being variables were stable over time and that excellent well-being showed a great variation. A high level of well-being was common in variables such as family and housing but more uncommon in variables such as fitness, vision, hearing and memory. Symptoms were often significantly related to biomedical variables such as body mass index, blood pressure, lung function, blood lipids, fasting blood sugar and fasting insulin. The GQL-instrument seems to provide a reliable and stable assessment of well-being and symptoms and is useful both as a descriptive tool, and as a help in evaluating treatment, and it also has predictive power.

Psychological well-being before and after growth hormone treatment in adults with growth hormone deficiency.

Abstract: The effect of recombinant-DNA human growth hormone treatment on psychological well-being and quality of life was studied in adults with GH deficiency (GHD). 24 adults who satisfied strict criteria for GHD took part in a double-blind, placebo-controlled, 6-month trial. Quality of life assessments were performed at entry, 1 and 6 months by means of self-rating questionnaires. This study reports significantly lower scores on quality of life assessment in the GH-deficient patients at entry compared with matched controls, indicating that this population may be psychologically compromised. Preliminary analysis of treatment results shows that after 6 months, those patients receiving active treatment experienced less perceived illness than the placebo group. Significant psychological improvements were noted in the patients' perception of their energy level and mood.

Quality-of-Life Changes and Hearing Impairment

Abstract: Objective:To assess whether hearing aids improve the quality of life of elderly persons with hearing loss. Setting:Primary care clinics at a Bureau of Veterans Affairs hospital. Patients:O...

Can the Spitzer Quality of Life Index help to reduce prognostic uncertainty in terminal care

Abstract: Data from an on-going trial of co-ordinating care for terminally ill cancer patients are used to investigate whether the Spitzer Quality of Life (QL) Index can be used to reduce prognostic uncertainty in terminal care. Four questions are addressed. First, can doctors and nurses distinguish between patients with a prognosis of more or less than 1 year? Second, do the medical and nursing staff differ in their ability to estimate prognosis? Third, are there differences in the length of life remaining between groups of patients with different QL Index scores? Fourth, how well does the QL Index predict the likelihood of individual patients dying within 6 months of assessment? Doctors and nurses assigned between 17 and 25% of patients to the wrong prognostic group and were as likely to over-estimate as to under-estimate life expectancy. Medical and nursing staff did not differ in their ability to make prognostic judgements. Patients with a low QL Index score were more likely to die within 6 months than those with higher scores, but scores on the Index were not strong predictors of 6-month survival in individual patients. The Index is not accurate enough to be used to predict what sort of treatment terminally ill patients will require in the future and for how long. Nevertheless, it may prove valuable for those planning services for terminally ill cancer patients who require information on the levels of need in a population.

Outcomes of Lower Extremity Amputations

Abstract: In an effort to identify variables that could be used to predict outcomes of amputation, a cohort of 97 veteran amputees with a median age of 64 years who underwent 155 lower extremity procedures during 1984 was followed for 15 months. A high incidence of postoperative complication, revision, and mortality with poor quality of life confirm the serious prognosis of these individuals. Regression analyses indicated that peripheral vascular disease and prolonged preoperative hospitalization were associated with complications. Preoperative gangrene and peripheral vascular disease were associated with the need for revision. Complications, a low body mass index, and multiple diseases were related to death. Those with multiple diseases and extensive atherosclerosis were less likely to walk. Ability to perform activities of daily living was the most important predictor of quality of life. Patients at higher risk for these adverse outcomes need to be identified early in their hospital stay. The involvement of the patient or his or her surrogate in decisions regarding the course of treatment and the level of amputation is essential.

Quality of life as a function of HIV classification.

Abstract: The purpose of this research was to identify variables related to life quality for persons with Human Immunodeficiency Virus Infection and to ascertain if life quality differs according to the classifications of a positive serologic test for HIV antibodies (HIV+), AIDS-related complex (ARC), and Acquired Immunodeficiency Syndrome (AIDS). A convenience sampling technique was used to obtain subjects from AIDS support groups and affiliated agencies in a major southwest urban area. Ninety-five HIV-infected subjects completed a demographic data sheet, the Sickness Impact Profile (SIP), and the Symptom Distress Scale (SDS). The majority of subjects (59%) listed AIDS as their category of diagnosis, 25% were HIV+ only and 16% identified ARC as their disease classification. Subjects had SIP and SDS scores which indicated HIV-infection significantly affected their quality of life. Multivariate results indicated that quality of life indicators varied as a function of HIV classification. HIV-infection had the greatest disruption in psychosocial aspects of life. The impact of HIV-infection (both physical and psychosocial) was greatest in subjects with ARC and least among subjects who were HIV+ only.

The quality of life in adult survivors of allogeneic bone marrow transplantation: correlates and comparison with matched renal transplant recipients

Abstract: Research on the quality of life (QOL) following bone marrow transplantation has been hampered by assessment of a limited range of QOL domains as well as by a failure to assess relevant comparison groups. The QOL of adult survivors (n=29) of allogeneic BMT (mean of 51 months post-BMT) drawn from two BMT centers was assessed. QOL was also assessed in a sample of renal transplantation (RT) patients (n=29) matched with BMT patients with regard to age, sex, and time since transplant. Results indicated few differences between the BMT and RT groups across a broad range of QOL domains. Overall, neither group reported what might be considered a "normal" QOL. Multivariate analysis of the correlates of post-BMT QOL revealed that (1) less education, increased dosage of total-body irradiation during pre-BMT conditioning, and an older age at BMT were all associated with poorer status on several measures of post-BMT QOL; (2) time post-BMT was unrelated to post-BMT QOL; and (3) post-BMT affective status was more difficult to predict than post-BMT health or functional status. It was concluded that, while results indicate an acceptable post-BMT QOL, further research is necessary to identify means by which post-BMT QOL can be improved.

Quality of life after intensive care.

Abstract: Summary An important aspect of effectiveness of intensive care services is change in the quality of life of survivors after critical illness. A questionnaire was compiled using established methods for assessment of quality of life and sent to all known survivors of a regional intensive care unit. Each patient's quality of life was then quantified using disability categories. The results show that patients with a good premorbid quality of life suffered a significant decline after critical illness. Similar important decreases in quality of life were found in younger patients and trauma victims. Quality of life may be a valuable consideration in determining the appropriateness of intensive care management.

Disease and symptom severity, functional status, and quality of life in chronic bronchitis and emphysema (CBE).

Abstract: A path analysis model examined interrelationships among variables significantly associated with chronic dyspnea in chronic bronchitis and emphysema (CBE) and the relative influence of these variables on each other and on functional status and quality of life. Results from the 45 adults (mean age, 61) with moderate CBE disease severity showed that dyspnea severity has a sizable effect on functional status and quality of life. Disease severity was more strongly related to functional status than to quality of life. Depression and mastery had the strongest total effects on quality of life. Dyspnea severity had strong but separate effects on functional status and quality of life. From these preliminary results, it is suggested that a direct focus on psychologic interventions to ameliorate depression and improve mastery is likely to improve quality of life with some resultant positive effect on functional status.

Quality of life and rehabilitation differences among four end-stage renal disease therapy groups.

Abstract: This study investigates the quality of life of patients on alternative therapies for end-stage renal disease. The quality of life of 766 patients who experienced one of the following therapies for at least one year are compared: a successful transplant performed in the 1970's (N = 82), a successful transplant performed in 1980-1984 (N = 91), in-center hemodialysis (N = 83, 8 centers), and continuous ambulatory peritoneal dialyses (CAPD) (N = 510, 185 centers). All patients were aged 19-56 and nondiabetic. Survey questionnaires were administered containing measures of physical, emotional and social well-being, vocational rehabilitation, and sexual adjustment. Case-mix differences were controlled, insofar as possible, with an Analysis of Covariance; adjusted means were compared. Findings indicate that the quality of life for successful transplant patients exceeds that of both dialysis groups for almost all variables (p less than 0.05 for 9/11 measures). This advantage persists when transplant patients are compared to dialysis patients who have experienced no prior, failed therapies.

Quality of life following liver transplantation: a preliminary report.

Abstract: Although the quality of life attained after heart transplantation has been assessed, there is no equivalent information for recipients of liver grafts in this country. In this paper we report a cross-sectional survey of 81 adult patients in the Cambridge/King's College Hospital joint programme using the Nottingham Health Profile which is a validated measurement of the quality of life. The results show the quality of life to be high, and broadly similar to the levels expected in the general population. The data suggest an increase in the problems related to physical mobility (two-fold) and a reduction in problems of emotional reaction (a halving).

The quality of life scale: A preliminary study with chronic pain patients

Abstract: In order to examine the impact of chronic pain on a patient's perceived life quality, a self-report instrument measuring quality of life was developed and administered to a sample (N=393) of chronic pain patients. The Quality of Life Scale (QOLS) defined quality of life as the degree to which a patient perceives several key psychosocial life areas as satisfying or fulfilling. A psychometric analysis of the QOLS showed it to be internally consistent, highly reliable across time, and representative of a single construct. Preliminary validity investigations determined that the QOLS shared variance with measures of psychological distress, pain-related disability, and pain description. These correlations were consistent with the definition of the construct. Although this initial study is promising, further research on the QOLS is needed.

Quality of life in chronically mentally ill patients in day treatment

Abstract: A structured assessment instrument, the Quality of Life Interview, was used to explain the quality of life of seventy patients with chronic psychiatric illness attending a day treatment programme. The interview was found to have acceptable psychometric properties. Factors that best predicted the quality of life of these patients included the number of re-admissions in the last year, frequency of family contacts, satisfaction with social life, psychiatric health and adult education. The theoretical implications and potential clinical benefits of these findings for chronic psychiatric patients are discussed.

The Oxford-Manchester study of dialysis patients. Age, risk factors and treatment method in relation to quality of life.

Abstract: A retrospective study of 159 patients who started Haemodialysis (HD) or Continuous Ambulatory Peritoneal Dialysis (CAPD), between 1981 and 1984 was carried out in two UK Renal Units. An extension of the study was carried out in one unit during 1985, gathering data on 30 patients aged greater than 65. The aim was to assess whether age, medical or social risk factors, or treatment method, affected perceived quality of life. Assessment was by standardised self-report questionnaire. The overall life satisfaction, measured on Cantril's ladder scale, showed no significant difference between dialysis patients and a normal population. On a quality of life semantic differential scale CAPD patients scored significantly better than HD patients. Satisfaction with sexual relationships showed marked deterioration in all age groups, but this did not seem to affect reported satisfaction with marriage. Those aged greater than 65 scored significantly better than younger patients on dialysis stress scales, and were generally more satisfied with life. When the study population was sub-divided into four groups, by age (less than or greater than 60) and presence or absence of additional factors, were seen to be those least satisfied with life on several different assessment scales.

Social and family integration of hemiplegic elderly patients 1 year after stroke.

Abstract: We interviewed 120 elderly hemiplegic patients 1 year after their acute stroke to assess cognitive impairment using the Mini-Mental State Examination, functional autonomy using the Barthel Index, mood disorders using the Hamilton Rating Depression Scale, and social integration using the Social Functioning Exam. Of the 76 patients admitted to this study, eight (12.1% of those testable) had significant cognitive impairment, 41 (53.9%) were functionally self-sufficient, 27 (35.5%) showed depressive symptoms, and 44 (57.9%) had problems in social and family integration. We suggest that a complete rehabilitation program aimed at producing a good quality of life for elderly hemiplegic patients should take into account all these aspects of human existence.

Quality of life in schizophrenia

Abstract: Skantze K, Malm U, Dencker SJ, May PRA. Quality of life in schizophrenia.The strong move from inpatient treatment to community care for chronic schizophrenic patients made it urgent to investigate their quality of life and living conditions in the community. This paper describes 61 schizophrenic outpatients' own view of their quality of life, obtained through the Quality of Life Self-Report (QLS-100). This new method includes a semistruetured interview, dealing with satisfaction and dissatisfaction as reported in the QLS-100. The self-reported quality of life is reviewed in relation to facts about the patients' standard of living, housing, sex, age, and survival time in the community. The quality of life of schizophrenic patients is also presented in comparison with a contrast group of university students. The outcome indicates that it is neither possible nor adequate to infer a person's quality of life from his standard of living, but that quality of life should be evaluated by the person himself. The ar...

Applications of global statistics in analysing quality of life data.

Abstract: Quality of life (QOL) instruments usually consist of a number of components, each of which deals specifically with a particular functionally related dysfunction. In a clinical trial whose primary aim is the evaluation of the treatment by means of QOL instruments, analysis of each of the components usually consists of either univariate analysis of variance (ANOVA) or some non-parametric methods. This multiple testing approach can produce an increase in false positive findings. One attempt to correct for this is the Bonferroni adjustment. Another approach is to apply global statistics (parametric or non-parametric) for the null hypothesis of no treatment difference versus the alternative hypothesis that one treatment is uniformly better than the other for QOL instruments as a whole. Data from a randomized double-blind trial of 111 congestive heart failure patients, which involved four QOL instruments, were analysed with univariate ANOVA, Bonferroni adjustment, parametric and non-parametric global statistics. The global statistics complemented the univariate methods and made the presentation of QOL data very effective. I recommend the general use of global statistics in analysis of QOL data.

Quality of life after heart transplantation in patients assigned to double- or triple-drug therapy.

Abstract: The purpose of this study was to compare the quality of life after heart transplantation for patients treated with cyclosporine and azathioprine (double therapy) versus cyclosporine, azathioprine, and corticosteroids (triple therapy). This study was based on a randomized, prospective trial and was focused on patients from ages 17 to 57 years at 1-year after transplantation. Patients who received double therapy showed advantages on 10 of 11 measures of quality of life. Significant differences were found on measures of anxiety, sexual activity, physical well-being, and financial well-being. Patients who received double-drug therapy reported a lower frequency and less distress from the side effects of immunosuppression; a higher proportion of double-drug therapy patients had returned to full-time employment. In addition double-therapy patients were better able to control body mass. These features may explain why double-drug therapy patients reported a higher quality of life, and in the long term, could be important from a cost benefit analysis.

Is quality of life affecting survival? The study of men born in 1913.

Abstract: In this study the prognostic significance of a set of quality of life measures was tested with regard to mortality regardless of its cause, cardiovascular mortality, cancer mortality and mortality from other causes. From the population register of Gothenburg, Sweden, a sample was drawn consisting of one third of all 60-year-old men. The 945 men who met the criteria were invited to a medical examination. Information on the occurrence of 30 symptoms and 15 measures of well-being was obtained by questionnaire. Mortality data were obtained through official registers, death certificates and medical records. Of the symptoms at 60, breathlessness, cough, depression, bad appetite and feeling cold, all were significantly related to mortality during 15 years of follow-up. Of the well-being variables, the same was true of perceived health, physical fitness and appetite. This means that the quality of life has a strong bearing not only on the present life situation for these men but also for their future health.

Quality of Life in Adults with Insulin-Dependent Diabetes Mellitus

Abstract: Conventional measures of psychiatric or medical morbidity do not adequately reflect the consequences of chronic illness. Quality of life refers to a more comprehensive assessment of the impact of illness. Uncomplicated insulin-dependent diabetes is usually associated with mild reported reduction in quality of life. Increased depressive and anxiety disorders have been reported in individuals with insulin-dependent diabetes mellitus, particularly in association with more severe medical complications and low social support. The potential benefits of intensive treatment approaches must be weighed against adverse effects on the quality of life.

The effect of percutaneous transluminal coronary angioplasty on quality of life.

Abstract: The purpose of this study is to examine the effect of percutaneous transluminal coronary angioplasty (PTCA) on quality of life. Secondary purposes are to determine if there is an improvement in state anxiety and physical functioning after PTCA. Data on quality of life in these patients will provide physicians, nurses and other health professionals with a basis to help the angioplasty patient adjust after the procedure. This information will add to the present body of knowledge, serve as a basis for patient education and guide further research. In addition, data on the subjective perception of quality of life may provide an additional index of success or failure of therapy. Subjects scheduled for elective PTCA were mailed a study packet containing three questionnaires. Prior to their admission to the hospital for a scheduled PTCA, subjects completed the Quality of Life Index (QLI), Spielberger's State-Trait Anxiety Inventory and the Physical Functioning Questionnaire. Demographic data were collected from subjects' medical records. Six weeks after a successful PTCA, a second study packet was mailed to subjects. Twenty subjects participated in the study. The majority were employed, Caucasian males with multivessel coronary artery disease and had complained of symptoms less than three months. Paired t-tests demonstrated improvement in the (1) health and functioning subscale (p = less than 0.034), (2) decrease in state anxiety (p = less than 0.030), and (3) increase (p = less than 0.000) in perceived physical functioning. In addition, an inverse relationship was demonstrated between state anxiety and quality of life (r = -0.70, p = 0.000).(ABSTRACT TRUNCATED AT 250 WORDS)