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At least 793 records · Page 44Linked to original sources
PubMed1986

Life strain, life events, and autonomic response to a psychological stressor in patients with chronic upper abdominal pain.

The condition characterized by long-standing or intermittent upper abdominal pain despite absence of structural pathological findings was studied in 40 patients. Thirty-four control patients with long-standing, well-defined orthopedic diseases were studied in parallel together with 10 healthy controls. Fifty-five per cent of the abdominal pain patients versus 12% of the orthopedic controls had aggravation of symptoms in association with at least 1 of 14 events listed in a self-administered questionnaire. Forty per cent versus 6%, respectively, had experienced outbreak of symptoms in association with at least one of the events. Besides, they viewed themselves as living under a high time and performance pressure to a significantly higher extent than the controls. During experimentally induced stress (mental arithmetic) the increase in blood pressure and pulse rate were significantly more pronounced in the group of healthy controls than in either of the two other groups. The abdominal pain patients had the smallest increase. Calf blood flow measurements were not very informative. Plasma adrenaline and noradrenaline were measured in some of the subjects. Adrenaline concentrations were generally higher in the group of healthy controls than in either of the other two groups. It is concluded that the experience of life strain plays a role for the occurrence of symptoms in patients with chronic upper abdominal pain. They seem to have a generalized suppressed autonomic reaction to stress; this may contribute to a disturbed gastrointestinal function.

Abdomen↗
PubMed1999

[Improvement of quality of life (QOL) and life prolongation by CPT-11 + adriamycin (ADM) therapy: report of 4 cases of non-Hodgkin's lymphoma refractory to conventional chemotherapies].

CPT-11 + ADM therapy (CPT-11 40 mg/body x 2 days; Day 1 & 2, combined with ADM 20 to 60 mg/body x 1 day; Day 3) was given to four patients with relapsed and advanced non-Hodgkin's lymphoma, which was refractory to conventional chemotherapies. The symptoms of the patients at the beginning of CPT-11 + ADM therapy were fever (in two cases), dyspnea due to pleural effusion (in two), severe backache (in one), and jaundice with splenomegaly (in one). Their Karnofsky performance scales were 20 or 30%. Soon after the initiation of CPT-11 + ADM therapy, their clinical conditions improved dramatically, and they obtained a partial remission lasting 3.5 to 9 months. During the period of controlling lymphomas by this therapy, all patients had some time at home for 2 to 8 months. The adverse effects were vomiting, diarrhea, neutropenia and thrombocytopenia, but no lethal infection or hemorrhage was seen. We conclude that CPT-11 + ADM therapy is very useful for improvement of QOL and life prolongation of patients with non-Hodgkin's lymphoma, which is refractory to conventional chemotherapies and is even disseminated.

Adult↗
PubMed1999

[Evidence-based medicine and the validation of quality-of-life questionnaires: the Spanish version of the MOS-HIV questionnaire for the evaluation of the quality of life in patients infected by HIV].

BACKGROUND: To validate the Spanish version of the MOS-HIV questionnaire for measuring quality of life in HIV-infected patients. METHODS: 275 HIV-infected patients distributed in three diagnostic categories (asymptomatic, symptomatic and AIDS) and 40 blood donors as healthy controls were recruited from 23 Spanish hospitals and answered the MOS-HIV. Feasibility was assessed by analysing the mean time of administration and the percentage of patients with missing response. Internal consistency was assessed using Cronbach's alpha. A subsample of 48 stable patients completed the questionnaire on two occasions to assess test-retest reliability using the Intraclass Correlation Coefficient. Validity was assessed by calculating the area under the Receiver's Operating Characteristics (ROC) curve between patients and controls, and by correlating MOS-HIV scores with the VAS of Euroqol, the number of symptoms, the CD4+ count and viral load. RESULTS: The mean time of administration was 16 minutes and 18.9% of patients did answer the MOS-HIV with some missing response. All the scales showed high internal consistency (Cronbach's alpha = 0.78-0.89). Test-retest reliability of Physical Health (PHS) and Mental Health (MHS) Summary Scores was 0.58 y 0.85, respectively. The MOS-HIV discriminated between patients and controls (ROC = 0.77, CI = 0.69-0.85 and ROC = 0.80, CI = 0.72-0.88, for the PHS and MHS, respectively). The correlation of the scales of the MOS-HIV with the CD4+ count and viral load was low (r = -0.26 to 0.3), and with the number of symptoms and the VAS of Euroqol were moderate (r = -0.28 to -0.49 and r = 0.4 to 0.66, respectively). CONCLUSIONS: Considering evidence-based medicine principles, the Spanish version of the MOS-HIV has shown adequate feasibility, reliability and validity for its use in clinical research, but their use in clinical practice is limited because of their time of administration, the low reproducibility of some scales and the features of their scoring system.

Adolescent↗
PubMed1992

[Quality of life--demands and reality as a medical parameter versus quality of life as individual reality].

Quality of life (QL) is a term, whose definition extends beyond scientific methods. Even the most accurate description will only be able to represent a part of the reality due to the proviso of only a limited view. For that reason the abandonment of this term, described as "utopical" and "principally remaining in dissent", was called for. This could be countered by the possibilities to use QL as a therapeutic aim, as well as an aid towards finding an individual indication. Alone the demand staged by QL, to take the individuality seriously, and to be the motor for patient oriented medicine, make this term valuable. The definition itself will remain a called instruments have been developed and tuned, their evaluation has not yet been concluded. The acceptance of QL-registration within clinical studies is low, since the individual integration of values compared to the biometric difficulties can hardly be generalized. The aims of QL-research are: the individual focus on the field of projection of QL; a motivation-oriented mode of record; the involvement of QL-registration in form of information and accompaniment; adequate modular techniques including dialogical methods (nondirective interviews); the establishment of a QL-anamnesis towards an extension of the clinical picture; the observance of a possible conflict of roles, the danger of linguistic inaccuracies and misunderstandings, the consideration of a person's privacy.

Ethics, Medical↗
PubMed1992

Quality of life on antihypertensive therapy: a double-blind trial comparing quality of life on pinacidil and nifedipine in combination with a thiazide diuretic. European Pinacidil Study Group.

The quality of life (QL) was evaluated in a 6 month double-blind trial in six European countries. Patients with a sustained supine diastolic blood pressure (SDBP), phase V, of 95 mm Hg or more on bendrofluazide, 5 mg daily (or an equivalent dose of a thiazide diuretic) were randomised to additional pinacidil (n = 127), 25 mg up to 100 mg daily, or nifedipine (n = 130), 20 mg up to 80 mg daily. The treatment groups were similar at entry for QL scores, average DBP of 103 +/- 6 (SD) mm Hg, and average age of 56 +/- 10 (SD) years. Eighteen patients on pinacidil and 12 on nifedipine withdrew due to side effects, such as oedema (both drugs) and flushing (nifedipine). The maximum antihypertensive effect was achieved within 6 weeks and maintained, resulting in a significant fall in SDBP of 13.7 mm Hg on pinacidil and 15.5 mm Hg on nifedipine at the end of the trial. There was no significant difference in the antihypertensive effect. The target SDBP was achieved in 57% of pinacidil-and 63% of nifedipine-treated patients. The average number of symptomatic complaints fell in both groups, with significant decreases in the reporting of blurred vision and headaches on nifedipine. Complaints of growth of body and facial hair increased on pinacidil but there were no significant between-drug comparisons with respect to side effects. In measures of psychological well being, patients on pinacidil showed a significant (p less than 0.05) improvement in total and cognitive function scores compared to nifedipine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

The meaning of quality of life for bone marrow transplant survivors. Part 2. Improving quality of life for bone marrow transplant survivors.

Surviving bone marrow transplant (BMT) represents a major victory against malignant disease but also creates challenges of survivorship for patients and the professionals who care for them. Part 2 of this report presents the findings of a qualitative study (N = 119) related to improving quality of life (QOL) for BMT survivors. Results are shared based on BMT survivors' perceptions of (a) what makes QOL better, (b) what makes QOL worse, and (c) what doctors or nurses could do to enhance QOL. The findings of the study have been useful in constructing a quantitative instrument to measure QOL in BMT and in understanding the conceptual basis of QOL for the BMT population. Nursing interventions can improve the QOL for the BMT patient across all phases of the transplant process and long-term issues related to survival.

Bone Marrow Transplantation↗
PubMed1992

The meaning of quality of life for bone marrow transplant survivors. Part 1. The impact of bone marrow transplant on quality of life.

Quality of life (QOL) is an important concept in cancer nursing and has particular significance for bone marrow transplant (BMT). BMT survivors are faced with the demands of acute transplant symptoms as well as chronic illness demands posttransplant. The purpose of this study was to explore the concept of QOL for BMT survivors and to gain understanding of nursing interventions that may improve QOL in this population. The conceptual framework for this study was derived from the model of QOL developed by Ferrell, Grant, and Padilla (1989) that depicts the QOL domains of physical well-being, psychological well-being, social concerns, and spiritual well-being. This qualitative study consisted of a one-time interview of 119 BMT survivors using six open-ended questions. The items were based on previous research of the authors and content validity was established by a panel of BMT experts. Content analysis was performed on verbatim written responses to six questions regarding BMT and QOL. Part one of this two-part report provides analysis based on the questions regarding the meaning of QOL to BMT survivors and the impact of BMT on QOL.

Adult↗
PubMed1991

An innovative method of teaching Advanced Cardiac-Life Support, or why Cosmic Osmo may someday save your life.

A demonstration and discussion of the effectiveness of an animated and interactive simulation of cardiac and/or respiratory arrest with tools to allow the user to reverse the fatal course of events. The simulation is designed to reinforce and teach the American Heart Association's course in Advanced Cardiac Life Support (ACLS). Using an animated interactive simulation allows the student to rehearse various critical events without assembling all the components typically used in the ACLS course "MegaCode." The simulation is written in a commercial authoring shell made by Authorware, Inc, and currently runs on an Apple Macintosh II platform. Cosmic Osmo (Activision) is an animated and interactive exploration game based in Hypercard that allows the user to explore and control the game by clicking on various switchs, buttons, objects, even telephones. The interactive spirit of this program has been carried over to the ACLS tutorial.

Cardiopulmonary Resuscitation↗
PubMed1991

How is life treating you? Quality of life: a model for cancer care.

Nursing models tend to be based on theory, and are not always rigorously tested for effectiveness. For people with cancer, often the prime nursing input is aimed at improving quality of life. A model has been developed to better facilitate this, which may also apply in other specialties.

Anxiety↗
PubMed1989

[Treatment of diabetes and quality of life. On possibilities of a more normalized life style using an insulin pen for multi-injection therapy].

Forty-eight insulindependent diabetics were interviewed by a psychologist about their experiences when changing from conventional diabetes regimen to multi-injection therapy using NovoPen (a pen-like insulin injection system). They had then used the new therapy for 1 1/2 years. Most of them had made only small changes in their eating habits, but they strongly appreciated the new possibility for flexibility in eating patterns. The most mentioned advantages were: The new therapy was practical and easy to use, gave more freedom, made social life easier and improved blood glucose control. Many, mainly women, experienced less feelings of guilt, and women also placed the social advantages highest on the list of advantages. The youngest persons thought the greatest benefit was increased freedom, and persons in middle age the possibilities for improved metabolic control. Multi-injection insulin therapy is an important advancement, and is probably not acceptable to most diabetics without a practical and reliable insulin pen.

Adolescent↗
PubMed1984

The practical effect of obesity on the insured life--relative risks associated with obesity and various disease states--"the imparied life".

The 1979 Build and Blood Pressure Study was based on 4,200,000 North American life assurance policies issued after medical examinations between 1950 and 1971 and studied over the period of 1954 to 1972. The experience included 106,000 deaths. The study investigated the mortality experience of overweight lives assured by cause of death. Actual mortality was significantly above that expected for the following causes: diabetes mellitus, cerebrovascular disease, coronary artery disease and hypertensive heart disease. The implications of these observations are discussed.

Actuarial Analysis↗
PubMedDate not supplied

Life-support and end-of-life questions: treatment or intervention?

Advances in medical care during the past hundred years have been phenomenal. Before modern times, little could be done to overcome life-threatening situations from injury, trauma, or disease. Most interventions were counterproductive; they did more harm than good. It has been during the last 30 years that medicine has been able to save more lives than cause death.

Decision Making↗
PubMed1996

Trial-related quality of life: using quality-of-life assessment to distinguish among cancer therapies.

Issues in selecting quality-of-life (QOL) measures that are best suited to assessing differences among treatments in cancer clinical trials, as well as challenges to interpreting QOL outcome data, are discussed. When used in the context of randomized trials of cancer therapies, QOL assessments must provide an answer to the question, "Did the treatments differentially affect patient well-being?" In order to detect differences in treatment efficacy against a background of great similarity, the broad concept of QOL needs to be refined to reflect "trial-related QOL." In many cases, this will entail emphasis on actual patient experience of symptoms and functional changes, as opposed to emphasis solely on evaluation and satisfaction. A model is proposed to identify cognitive, emotional, and sociocultural factors that influence a patient's QOL evaluation and that need to be considered in understanding the meaning of QOL data.

Aged↗
PubMedDate not supplied

Extension of surgical indication for advanced hepatocellular carcinoma: is it possible to prolong life span or improve quality of life?

BACKGROUND/AIMS: We have tried to break through the limitations of treatment for advanced hepatocellular carcinoma (HCC), which has been regarded as a contraindication for surgical treatment. MATERIALS AND METHODS: In 640 cases of hepatic resection for Liver cancer, we analyzed 55 cases of HCC with tumor thrombi in the trunk or first branch of the portal vein (PV) which required additional PV thrombectomy, 5 cases with direct invasion or compression to the inferior vena cava (IVC) which required replacement of IVC with a polytetrafluoroethylene (PTFE) tube, 9 cases with involvement of the extrahepatic bile duct (BD) which required additional extirpation of tumor fragments in the BD, 6 cases with tumor thrombi in the IVC which required IVC thrombectomy, and 4 cases of huge main tumor with intrahepatic metastasis in the entire liver which required intraoperative ethanol injection. RESULTS: Mean survival times in these groups were 796, 717, 650, 220, and 147 days, respectively. All patients with IVC thrombi and large tumor with intrahepatic metastasis in the entire liver died of early recurrence in spite of surgical treatment. By contrast, half of the patients with PV thrombi, BD involvement and IVC invasion or compression survived approximately 500 days because of a combination of hepatic resection, additional intraoperative treatment and postoperative treatment, and some patients could enjoy a longer life. CONCLUSIONS: Multimodality treatment including hepatic resection should be encouraged for advanced HCC patients with PV thrombi, BD involvement or compression or invasion of the IVC, as long as the remnant liver can overcome postoperative liver failure.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Quality of life assessment during six months of NSAID treatment [Gonarthrosis and Quality of Life (GOAL) Study].

OBJECTIVE: To identify the time point of the greatest degree of improvement in daily living activities, pain and depression in patients with osteoarthritis (OA) of the knee during 6 months of treatment with NSAIDs, in order to define compliance and drop-out rate. METHODS: 107 patients were recruited into a multicentre, prospective, randomized, controlled trial comparing two treatments, piroxicam-beta-cyclodextrin (PBCD) and slow release diclofenac (DCL). RESULTS: The greatest improvement in quality of life occurred in both groups after 3 months, with a slight further gain observed by the end of treatment. The Stanford Health Assessment Questionnaire score improved (p < 0.05 vs baseline) at 3 and 6 months with PBCD and at 6 months with DCL. The Arthritis Impact Measurement Scale score improved (p < 0.05 vs baseline) after 6 months in both groups. Significant (p < 0.05 vs baseline) improvement in other psychological and pain scores were recorded in both groups after 3 and 6 months. Compliance with treatment at 3 months was 73% for PBCD and 72% for DCL, and was 60% in both groups at 6 months. CONCLUSIONS: The results of this study indicate that the optimal length of time for an NSAID trial in OA patients is 3 months, when assessment of daily living activities is considered as the main outcome criterion.

Activities of Daily Living↗