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PubMed2000

End-of-life care in the ICU: treatments provided when life support was or was not withdrawn.

STUDY OBJECTIVE: To compare and contrast use of technology, pharmacology, and physician variability in end-of-life care of ICU patients dying with or without active life support. DESIGN: Retrospective cohort study. SETTING: Two medical-surgical tertiary-care ICUs in a Canadian regional referral teaching hospital. PARTICIPANTS: One hundred seventy-four patients who died between July 1, 1996, and June 30, 1997. INTERVENTION: Data abstraction from medical records. RESULTS: Patients in whom life support was withheld or withdrawn (138 of 174, 79%) were older (65 +/- 16 years vs 55 +/- 18 years; p < 0.05 [mean +/- SD]). Once the decision to withdraw life support was made, death occurred in 4.3 h (2.1 to 6.5 h; mean [95% confidence interval]). Patients who had active life support treatment until death received more support measures including inotropic agents (36 of 36 vs 21 of 138; p < 0.05), dialysis (4 of 36 vs 2 of 138; p < 0.05), and mechanical ventilation at the time of death (36 of 36 vs 81 of 138; p < 0.05). Physician differences (> 10-fold) were detected for prescribed doses of morphine and sedative agents whether or not life support was withheld or withdrawn. The median cumulative dose of morphine prescribed during the final 12 h was larger (fivefold) in patients undergoing withdrawal of life support. No documented discussion of life support withdrawal was noted in one case. In the remaining patients, the 10 staff physicians were documented to be involved in 77% (range, 54 to 94%) of the end-of-life discussions. CONCLUSIONS: Differences were evident in technologic and pharmacologic support and in physician prescribing habits in patients for whom life support was or was not withheld or withdrawn. Substantial variability was noted in physician documentation of physician-family interactions surrounding the withdrawal of life support.

Age Factors↗
PubMed1990

[Longevity and meaning of life. Philosophical-ethical considerations of the theme 'extension of life'].

The desire for the extension of life is not one out of many desire in life, but a form of the fundamental desire for life itself. This so called 'categorical desire' is a necessary condition for the many desires in life. The question why we desire for life (and for its extension), is the question for the meaning of life. The searching for a 'natural lifespan' is meaningless when it wants to find in nature a given norm for the duration of life. It can only have meaning when it tries to formulate the conditions for the experience of life as successful and meaningful. A long tradition in philosophy and religion associates the meaning of life with the acknowledgement of its finitude and mortality and with the acceptance of death. As far as the extension of life is motivated by a fear of death and by an effort to escape from it, it is a neglect of what makes life meaningful, and of what makes it (and its extension) worthwhile to desire.

Aged↗
PubMed2006

Comparisons of life images and end-of-life attitudes between the elderly in Taiwan and New Zealand.

Rapid advances in medical technology may in the near future make "natural" aging and old age diseases the main causes of human death in affluent societies (apart from accidents). When dealing with end of life issues, medical sociology will need to focus more on life and death in seniors. Understanding the attitudes of older persons toward life and death is important for both performing end-of-life medical care and in developing end-of-life policies. Descriptive bioethical analysis of attitudes in different cultures can aid a fuller understanding of the views inside each culture and the trajectories of conflict situations within each culture. In-depth interviews were conducted with 112 senior citizens in Taiwan and with 25 senior citizens in New Zealand. All interviews were transcribed verbatim; qualitative data analysis was used to examine people's views on life and death. Their images of life and end of life attitudes were compared. Analysis of the key concepts they mentioned revealed distinctive views in life attitudes between these two groups. However, in spite of differences in culture and traditions, most life and end-of-life attitudes among elderly people in the two groups were rather similar. According to these similarities, an interpretation of these values was made within a Confucian and Taoist framework that might be applicable to non-Eastern cultures as well.

Aged↗
PubMed2005

A study of the relationships between daily life stress, self-efficacy and university student life adjustment.

PURPOSE: This correlation study was undertaken to examine the relationships between daily life stress, self-efficacy and university student life adjustment and to analyze the self-efficacy affecting that university student life adjustment. METHODS: 265 university students were recruited from several participating required undergraduate classes. They were surveyed as the subject of this study. Data collection was conducted through the use of questionnaires. RESULTS: The university life adjustment level showed a maximum score of 9 with the mean score 5.22. A negative correlation was found between daily life stress and university life adjustment. Also, there was positively correlation between self-efficacy and university life adjustment. Self-efficacy and daily life stress accounted for 23% of the variance in university student life adjustment. CONCLUSION: According to the results, self-efficacy is a useful concept in helping overall university life adjustment. Therefore, university student consultation office or nurse should consider the program based on self efficacy in order to help university students to better adapt to university life.

Adaptation, Psychological↗
PubMed1993

[Life control, the core of being healthy. Theoretical-empirical definition of the concept "life control"].

In this article the concept 'life control' is being analysed and defined. A need to define the concept 'life control' emerged during a research that deat with a human being's descriptions being healthy. 'Life control' turned out to be the central category and the main concept organising the whole data. The data were collected by focused interviews (N = 60). Those interviewed represented five different styles of 'life control'. One of these styles that were discovered in the research was chosen as the basis of the conceptual analysis. This style was characterised by 'laissez faire' attitude towards life. Hybrid model was used as the theoretical frame of reference in the conceptual analysis. Thorough study of Finnish and foreign literature about 'life control' leads into an explicit definition of 'life control' describing the data collected by focused interviews: 'Life control' is an individual's basic belief concerning the possibilities to control the course of human life and the extent of this control. An individual either controls his/her life quite independently and completely or only to a certain extent, or it is controlled by factors beyond the influence of a human being. The definition of the 'life control' -concept in the sense that it displays basic beliefs should be examined by studying people's way of thinking with the help of interviews, essays, questionnaires or analysis of autobiographies.

Attitude to Health↗
PubMed2004

Life experiences of people who stutter, and the perceived impact of stuttering on quality of life: personal accounts of South African individuals.

UNLABELLED: The purpose of the study was to investigate the life experiences of a group of South African adults who stutter and the impact of stuttering on their quality of life. Participants were 16 adults with a mean age of 28.9 and ranging from 20 to 59 years. Methods involved individual interviews designed to explore the life domains of education; social life; employment; speech therapy; family and marital life; and identity, beliefs and emotional issues. Main findings of the study indicated that the majority of participants perceived their stuttering to have impacted on their academic performance at school, and relationships with teachers and classmates. Although their stuttering was not perceived to adversely influence their ability to establish friendships, people generally reacted negatively to their stuttering. Many felt that their stuttering did not have an adverse effect on their choice of occupation, ability to obtain work, and relationships with managers and co-workers, although it was perceived to influence their work performance and hamper their chances for promotion. Although the majority viewed their speech therapy experiences as being negative; more than half the sample believed that speech therapy had, nevertheless exerted a positive effect on their quality of life. Overall, stuttering did not appear to have influenced participants' family and marital life. Most participants felt that stuttering had affected their self-esteem and self-image, and had evoked strong emotions within them. Findings are taken to suggest the need to incorporate subjective feelings about stuttering into the clinical practice of speech-language therapy; to provide information and coping strategies for teachers and employers; and for further research. EDUCATIONAL OBJECTIVES: After completing this activity, the reader will be able to: (1) describe and explain the perceived impact of stuttering on quality of life in terms of education; social life; employment; speech therapy; family and marital life; and identity, beliefs and emotional issues; (2) to interpret and utilize the subjective meanings that individuals attach to their stuttering to improve stuttering treatment, counseling and research.

Achievement↗
PubMed2004

Clinical holistic medicine: induction of spontaneous remission of cancer by recovery of the human character and the purpose of life (the life mission).

The recovery of the human character and purpose of life with consciousness-based medicine seems to be able to induce spontaneous remissions in several diseases. On two different occasions, we observed breast tumors reduced to less than half their original diameters (clinically judged) during a holistic session, when working with the patients in accordance with the holistic process theory of healing, the life mission theory, and the theory of human character. One tumor was histologically diagnosed as malign breast cancer prior to the session, while the other was under examination. As both patients had the affected regions of the breast surgically removed immediately after the session, we are unable to determine if they were actually healed by the holistic treatment. We find it extremely interesting that the size of a tumor can be reduced dramatically within a few hours of holistic treatment, when the patient is highly motivated for personal development. The reduction of tumor size is in accordance with the holistic view that many types of cancer are caused by emotional and existential disturbances. From a holistic perspective, cancer can be understood as a simple disturbance of the cells, arising from the tissue holding on to a trauma with strong emotional content. This is called "a blockage", where the function of the cells is changed from their original function in the tissue to a function of holding emotions. The reduction of the tumor in the two cases happened when old painful emotions were identified in the tissues, in and around the tumor, and processed into understanding; when the patients finally did let go of negative beliefs and attitudes that had kept the feeling(s) repressed to that part of the body, the tumor first softened and then disappeared, presumably by apoptosis. We believe that the consciousness-based/holistic medical toolbox has a serious additional offer to cancer patients, and we will therefore strongly encourage the scientific society to explore these new possibilities. Our holistic medical research meets both ethical dilemmas and practical difficulties, as it obviously is important for the research in induced spontaneous remissions that surgery and chemotherapy is not used before it is absolutely necessary. On the other hand, is it important for the patient"s survival that they receive any well-documented treatment as soon as possible. An additional aspect for the patient who is able to cure her own cancer is that she is much less likely to get cancer again and much better prepared to deal with other diseases and challenges in life. Knowing that one can fight even cancer gives a strong belief in life and the need to improve quality of life. The high incidence of secondary cancers and the physical and emotional wounds from the biomedical treatment seem to justify a focus on prevention and additional holistic treatment modules. To support the patient in learning the mastery of coherence of body and life, using the crisis of cancer to recover the human character and the purpose of life, seems turning a personal potential disaster into the greatest gift of all. When it comes down to it, life is not just about surviving; what is more important is to live fully, to learn from the great challenges of life, and to obtain the optimal quality of life while being here.

Character↗
PubMed1996

Effects of long workhours on life-style, stress and quality of life among intermediate Japanese managers.

OBJECTIVES: In accordance with international coordination of labor conditions a Japanese campaign advocating less work finally got under way recently in the form of work-reducing policies of the government to prevent occupational and stress-related diseases. However, long workhours among intermediate managers, who are key persons in most organizations in Japanese industry, are still considered to be prevalent. This study was conducted to examine the workhours of intermediate managers and clarify the effects of long workhours on the life-style, subjective stress, and subjective quality of life among them. METHODS: Questionnaires were administered concerning workhours, life-styles, subjective stress, and subjective quality of life to 3870 heads of a division or a section and 2666 foremen in 110 firms in Japan. RESULTS: The prevalence of > or = 10 workhours was 69.7% for the divisional or sectional heads and 53.2% for the foremen. Long workhours had significant effects on the managers' life-style, such as sleeping pattern and regularity of daily life and meals. The divisional or sectional managers with long workhours perceived higher stress [odds ratio (OR) 2.51, 95% confidence interval (95% CI) 2.17-2.90] and lower quality of life (OR 1.17, 95% CI 1.02-1.36) than those who worked relatively short hours. The foremen with long workhours perceived higher stress (OR 2.35, 95% CI 2.01-2.75) and lower quality of life (OR 1.26, 95% CI 1.08-1.46) than those who worked relatively short hours. CONCLUSIONS: Long workhours may be associated with poorer life-style, higher stress, and lower quality of life among managers at the intermediate level.

Administrative Personnel↗
PubMed2005

Life expectancy--a commentary on this life table variable.

In 1992, I wrote an article on a method of modifying the Decennial US Life Table to accommodate any pattern of excess mortality expressed in terms of excess death rate (EDR), for the specific purpose of calculating the reduced life expectancy, e. I believe this was the first article published in the Journal of Insurance Medicine (JIM) that dealt specifically with life expectancy as an index of survival and risk appraisal, never used in the classification of extra mortality risk in applicants for life insurance. In this commentary, I discuss the 1989-91 US Decennial Life Table in detail. I link the subject matter of the 1992 article with several more recent articles that also focus on the utility of life expectancy in underwriting structured settlement annuities and preparing reports on life expectancy for an attorney in a tort case. A few references are given for further reading on life table methodology and its use in the most accurate estimate of life expectancy, given the inherent limitations of the life table and the limited duration of follow-up studies.

Adolescent↗
PubMedDate not supplied

Changes in health status and quality of life and the impact of uncertainty in patients who survive life-threatening arrhythmias.

OBJECTIVE: The purpose of this study was to describe the changes in perception of health status and quality of life from before treatment to 6 months after and the impact of uncertainty on these variables in survivors of life-threatening arrhythmia. DESIGN AND SETTING: A descriptive correlational design at a large urban teaching hospital. MEASURES: We measured health status, quality of life, and uncertainty before treatment and 6 months after a life-threatening arrhythmia. RESULTS: Survivors included 66 men and 15 women, 41 of whom received pharmacologic therapy and 36 of whom received an implantable cardioverter defibrillator (ICD), completed the Medical Outcomes Survey (SF-36), Ferrans and Powers Quality of Life Index (QLI), and the Mishel Uncertainty in Illness Scale (MUIS-C) before treatment and 6 months after. There were significant improvements in the mental and physical health composite summaries as measured by the SF36 (P <.01). Conversely, there were significant reductions in the overall score and specifically in socioeconomic and psychological/spiritual quality of life domains as measured by the QLI (P <.05). An increased perception of uncertainty was related to decreased perception of health status and quality of life at both measurement times, with higher correlations 6 months later. CONCLUSIONS: Survivors demonstrated improvements in perceived health status, although this did not appear to translate into improvements in the subjective domains of quality of life. The overall quality of life and the domains of psychological/spiritual state and socioeconomic status were lower 6 months after a life-threatening arrhythmia. Uncertainty had a significant impact on these perceptions, identifying an area for nursing interventions.

Adaptation, Psychological↗
PubMed2001

The use of life review to enhance quality of life of people living with AIDS: a feasibility study.

People living with AIDS (PLWA) are confronted with uncertainty and their own mortality at an earlier than expected age. Life review, an intervention that has the potential to increase life satisfaction in the elderly experiencing transition points in their lives, may have a similar effect when used with PLWA. Therefore, the purpose of this feasibility study was to explore the use of life review in a sample of 20 PLWA through a randomized controlled trial of its effectiveness in decreasing depressive symptoms and in increasing self esteem, quality of life, and purpose in life. Compared to the control group, the treatment group had an improved overall quality of life and self-esteem over 12 months, less depressive symptoms over 12 months, and a greater purpose in life at 3 months. The effects that were seen were mainly small to medium effects. The findings from this feasibility study suggest the potential value of life review to enhance quality of life, purpose in life, and self-esteem, and to decrease depressive symptoms in PLWA. Further research is needed with a larger sample and with other groups such as PLWA experiencing virologic failure.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Appropriate time frames for data collection in quality of life research among cancer patients at the end of life.

Longitudinal research has been recommended as the most appropriate research design to ensure the validity of quality of life assessments. However, high attrition and non-random missing data in quality of life studies for terminal cancer patients raise questions about generalizability of the study, and at worst they may jeopardize interpretation of the results. Appropriate time frames for eliciting information directly from terminal cancer patients can ensure the internal and external validity of quality of life research in end-of-life care, allow health care professionals to detect sensitively the effects of end-of-life care within the shortest intervention period, and make comparisons across studies possible. From a review of the literature, it is recommended that the appropriate time frame for interviewing terminal cancer patients about their quality of life be a weekly assessment schedule based on the following factors: (a) the median survival of terminal cancer patients enrolling in a hospice/palliative care program is approximately 30 days and there are substantial number of patients who die in each week; (b) at the final weeks of life, quality of life and symptoms of some terminal cancer patients change dramatically; and (c) the shortest intervention period that is likely to give a clinically significant effect of end-of-life care management is 1 week after the enrollment in end-of-life care.

Humans↗
PubMed1997

General life satisfaction and domain-specific quality of life in chronic schizophrenic patients.

Subjective quality of life (QOL) has often been assessed through questionnaires or structured interviews focusing on the person's satisfaction with various life domains. In particular, most QOL instruments for psychiatric patients are based on this concept. We report on a study casting some doubts on the rationale of this approach. We investigated the QOL of 48 chronic schizophrenic outpatients with a long-term disease history (at least 20 years) using a German version of the Lancashire QOL Profile. The interrelations between general life satisfaction, satisfaction with specific life domains, psychological well-being and psychopathology were studied using correlation analysis and multiple linear regression. Of the life domains assessed, only two, namely social relations and health, contributed significantly to the patients' general life satisfaction, while the others (including work, leisure, family relations and housing) did not. The subscales on psychological well-being (self-esteem, affective state) as well as psychopathology were found to be more closely associated with general life satisfaction than almost all life domains considered. The findings are discussed with regard to the specific situation of the group of patients investigated. They give indications that the life domain approach to measuring QOL has its limitations, in particular when applied to patients having adapted to a very restricted everyday life.

Adult↗
PubMed1996

Quality of life in dialysis patients. A spanish multicentre study. Spanish Cooperative Renal Patients Quality of Life Study Group.

The aim of this study was to evaluate the quality of life in patients on chronic dialysis and to research the influence of various factors related to treatment and ESRD on quality of life. The cross-sectional study was carried out nationally and 1013 randomly selected stable patients on dialysis were evaluated. The evaluation of quality of life was by the Karnofsky Scale (KS) and the Sickness Impact Profile (SIP). Both questionnaires were self-reported. Co-morbidity was evaluated according to the Friedman Comorbidity Index. Adjusted quality of life scores for case-mix differences of several groups of patients were compared. Twenty-six per cent of the patients showed severe quality of life restriction on the Global Score of SIP (score > or = 20) and 31% on the KS (score < or = 60). The partial categories of the SIP that were more affected were work, recreation and pastimes, home management, and sleep and rest. No significant differences were found relating to dialysis technique, dialysis solution, or dialyser membrane. Greater haemoglobin concentrations were related to better quality of life scores on Physical Dimension and Global Score of SIP. Advanced age and Comorbidity Index were related to worse quality of life scores. We conclude that 25% of the patients showed an important effect of the disease on their quality of life. An increase in haemoglobin was related to better quality of life in dialysis patients. Advanced age and co-morbidity both adversely affected quality of life.

Adult↗
PubMed1994

Alveolar-arterial oxygen gradients before extracorporeal life support for severe pediatric respiratory failure: improved outcome for extracorporeal life support-managed patients?

OBJECTIVE: Recent reports have described the usefulness of the alveolar-arterial oxygen tension difference (P[A-a]O2) in predicting mortality in children with acute respiratory failure managed with mechanical ventilation. We reviewed our experience with extracorporeal life support for acute pediatric respiratory failure and specifically examined P(A-a)O2 measurements during the 24 hrs before extracorporeal life support to determine if defined cutoffs established with conventional mechanical ventilation were applicable to extracorporeal life-support survival. DESIGN: Retrospective, case-series chart review. SETTING: A university tertiary medical center. PATIENTS: Infants and children (n = 36), one month to 18 yrs of age, with severe life-threatening respiratory failure who were believed to have failed conventional mechanical ventilatory support. INTERVENTIONS: Veno-venous or veno-arterial extracorporeal life support. MEASUREMENTS AND MAIN RESULTS: From 1982 to 1992, we managed 36 pediatric patients with severe respiratory failure using extracorporeal life support. We identified 28 patients who had P(A-a)O2 values of > 400 torr (> 53.3 kPa) for the 24-hr time period before placement on bypass. At the time of bypass initiation, all blood gas and mechanical ventilator parameters except PaCO2 showed trends of worsening pulmonary function, compared with measurements done 24 hrs before bypass initiation. Oxygenation-related variables showed statistically significant worsening trends when measured 24 hrs before bypass, compared with the time of bypass: P(A-a)O2 539 vs. 582 torr (71.9 vs. 77.6 kPa), p < .01; PaO2/FIO2 ratio 70 vs. 57 torr (9.3 vs. 7.6 kPa), p < .05; oxygenation index 32 vs. 47 cm H2O/torr, p < .01; and FIO2 0.94 vs. 0.98, p < .05. Sixty-one percent of extracorporeal life support-managed patients (17 of 28) survived their life-threatening respiratory illness to be discharged home. CONCLUSIONS: Based on previous reports of the utility of P(A-a)O2 measurements to predict mortality, our preliminary evidence suggests that extracorporeal life support results in 62% survival for pediatric respiratory failure patients predicted to have no chance of survival using conventional mechanical ventilation. Prospective, randomized trials of children with severe acute respiratory failure managed with mechanical ventilation vs. extracorporeal life support may be indicated.

Adolescent↗
PubMed2004

Quality of life, life satisfaction and happiness in shift- and non-shiftworkers.

OBJECTIVE: To investigate the quality of life, life satisfaction, happiness and demands of work in workers with different work schedules. METHODS: The survey was carried out on professional workers in social care. Some were shiftworkers whose schedule included night shifts (N=311), some were shiftworkers without night shifts (N=207) and some were non-shiftworkers (N=1,210). Surveys were mailed and the response rate was 86%. For the purpose of this study several variables were selected from the Survey: The Quality of Life Profile, which measures importance, satisfaction, control and opportunities in nine domains of life plus measures of happiness, life satisfaction and demands of work. RESULTS: While both groups of shiftworkers, compared to non-shiftworkers, reported needing more physical effort to complete their work, and reported 'being' more physically tired, no differences were found in reports of overall happiness, life satisfaction or total quality of life. However, night-shiftworkers reported greater percentage of time unhappy than the other two groups of workers. In analyses of the quality of life, night-shiftworkers were less satisfied with domains of spiritual 'being' and physical and community 'belonging' than day-shiftworkers and non-shiftworkers. They also reported having fewer opportunities to improve their physical 'being', leisure, and personal growth than the other two groups. CONCLUSIONS: Quality of life in specific domains in night-shiftworkers was rated worse than in other groups of workers. Domain-based quality of life assessment gives more information regarding the particular needs of workers than overall or global measures of well-being.

Adult↗
PubMed1996

Objective life circumstances and life satisfaction: results from the course of homelessness study.

Relations between objective life circumstances and life satisfaction were examined using structural equation modeling of two waves of data obtained from homeless and mentally ill homeless participants (N = 298) in the Course of Homelessness Study (COH). Cross-sectional analyses revealed that objective indexes of life quality were primarily associated with domain-specific, rather than general, life satisfaction. Results could not be attributed to the covariation of life satisfaction with other indexes of subjective well-being (i.e., psychological symptoms and perceived self-mastery). In addition, significant direct ("causal") cross-lagged effects were found linking initial objective housing status with subsequent income and subsequent satisfaction with housing. By contrast, neither life satisfaction nor any other index of subjective well-being exerted a direct impact on subsequent life quality as assessed by objective indexes. Finally, we found no support for previous claims that perceived self-mastery mediates the impact of objective life circumstances on subsequent life satisfaction. Findings are discussed with reference to the utility of a hierarchical model of life satisfaction that incorporates domain-specific, as well as global, satisfaction.

Adult↗
PubMed1996

Quality of life as an outcome measure in nursing research. "May you have a long and healthy life".

Quality of life has emerged as an important concept and outcome in health and health care. Policy-makers, researchers, clinicians, and the public at large consider perceived quality of life to be an important dimension of the health of a population or an individual. The nature of nursing is such that many of its anticipated outcomes relate to improvement in the quality of life of individuals and populations. There continues to be debate about the actual definition of quality of life, and a concept that is difficult to define will naturally pose challenges to measurement. This has not impeded the proliferation of quality-of-life instruments, since the concept is recognized as an increasingly important clinical and research outcome. Progress has been made in clarifying and operationalizing the concept. We propose a conceptual viewpoint that separates what quality of life is from what contributes to quality of life. This will assist nurse researchers planning to use quality of life as an outcome in evaluating nursing interventions. In clinical or research situations, for the purposes of measurement, an operational definition of quality of life stems from a definition of health. From this is drawn a definition of health-related quality of life (HRQL). For the purpose of outcome measurement, the operational definition relates to the domains important to the study population and the particular health intervention under study. Issues that arise in the measurement of HRQL are also presented.

Humans↗