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PubMed2003

A life not worth living?

The work of Dan Brock and Helga Kuhse is typical of the current stream of thought rejecting the validity of sanctity of life appeals to instill objective inviolable worth in human life regardless of the quality of life of the patient. The context of a person's life is supremely important. In their systems life can have high value, yet the value of life can be outweighed by the force of other disvalues. The notion of quality of life has increasingly come to signify the measurement of the worth of a person's life itself. Having a life equals a personal life. Any objectivity to life resides in 'personal', 'biographical', or 'creative' life, not mere biological life. Personal life represents the minimal threshold for any objective worth. In responding to this challenge, John Finnis has argued extensively that life is an intrinsic good--a basic human good. Following from our grasp of human life as a basic incommensurable good, it cannot be practically reasonable both to affirm that (a) 'human life is a basic human good', and (b) that 'human life qua human life can be intentionally acted against to its destruction'. Yet, if the good of human life can be considered self-evident, the self-evidence of the basic human good qua good does not mean that dialectical reasoning cannot be engaged in to indirectly support the practical reasonableness of respecting the good of human life in the deliberative choices that persons make concerning their actions. It is to the use of such dialectical reasoning, supportive of the status of human life as such a basic human good, that the article is primarily concerned to draw out and articulate.

Attitude to Death↗
PubMed2006

Quality of life of patients with advanced cancer and acquired immune deficiency syndrome and their family caregivers.

BACKGROUND: Although definitions of palliative care include quality of life as a central concern, little research has been published about both the quality of life of patients with advanced illness and their family members, and particularly the changes in their quality of life over time. OBJECTIVES: The aims of this prospective longitudinal pilot study were to: (1) establish the reliability of multidimensional quality of life instruments based on patients with acquired immune deficiency syndrome (AIDS) and patients with cancer and caregivers; (2) identify differences in quality of life between patients with advanced AIDS and cancer, and their family caregivers with consideration of mortality, attrition, and compliance rates; and (3) examine differences in demographic variables and their potential confounding effect when measuring quality of life. METHODS: The sample included 101 patients with advanced illness (63 patients with advanced AIDS and 38 with advanced cancer) and 81 family caregivers (43 caregivers for patients with AIDS and 38 caregivers for patients with cancer). Data collection involved the monthly completion of the McGill Quality of Life Questionnaire (MQOL) for patients, and the Quality of Life Scale (QLS) for family caregivers. RESULTS: Reliability of the MQOL and QLS were established for patients with AIDS and patients with cancer and caregivers. Based on the MQOL, patients with advanced AIDS reported a lower total quality of life, and lower psychological quality of life, and a higher physical quality of life compared to patients with advanced cancer. There were no significant differences between patient groups on the one-item physical well-being subscale, or the existential well-being, and support subscales. Based on the QLS, AIDS caregivers reported greater overall quality of life, greater psychological well-being, and greater spiritual well-be- ing than cancer caregivers. There were no significant differences between AIDS and cancer caregivers with respect to physical or social well-being. From baseline entry into the study to third month of participation, there were no significant changes in total quality of life scores for patient or caregiver groups, although trends indicated a moderately high total quality of life over time for all patient and caregiver groups. Fourteen of 63 (22%) patients with AIDS patients died, while 19 of 38 (50%) patients with advanced cancer died after enrollment. Forty-six of 63 (73%) patients with advanced AIDS withdrew for various reasons other than death at some point during the 12 month time frame of the study, while 15 of 38 (39%) patients with advanced cancer withdrew. There were significant differences on all demographic variables for patients with advanced cancer and AIDS. Only religious affiliation was significantly related to quality of life for patients with AIDS, while gender was the only variable associated with quality of life for patients with cancer. There were significant differences on all demographic variables between caregivers with the exception of gender and living arrangements. Only the relationship between patients and caregivers and marital status were significantly associated with quality of life for cancer caregivers. CONCLUSIONS: In palliative care research, the challenge is to design studies that will capture changes in the domains of quality of life over time, yet will minimize participant burden and subsequent attrition rates. By measuring quality of life as an outcome variable in palliative care, health professionals can identify changes in the domains of quality of life over time for various patient populations and their family caregivers, and respond with appropriate interventions, which promote or maintain their quality of life even as death approaches.

Acquired Immunodeficiency Syndrome↗
PubMed1983

The nature of life and the nature of death.

Life is defined as a "condition" that distinguishes animals and plants from inorganic materials and dead organisms. Life is comprised of processes and is a maintained state. The most sophisticated form of life is man and our though focuses upon the nature of the life and death of man. Man demonstrates three lives or aspects of life: Life of the body--the physical, life of the mind and life of the spirit. Physical life is basic existence; the mind contributes effectiveness and scope; the spiritual entity contributes maximum living. Physiology: The existence of life physical is demonstrated by the presence of functions. Living tissues and organisms exhibit: Irritability: the ability to be excited or detect stimuli and to respond thereto; Growth and reproduction: this consists of the power of multiplication and duplication, regeneration and differentiation; Adaptability: permitting both change and maintenance of balances (homeostasis); and finally and most characteristic of all is Metabolism: the transformation of energy and the use of materials. These properties, however, can be retained for a while by tissues after death of the organism so there is another mystery of life which we understand only in part. Life consists of structure and processes operating under integrative control. This integrative power is the secret we do not understand--we know it confers all the life properties, the continuous flow of processes related to the organism's need for survival. Death is failure not so much of process but of integrative drive and coordination--but, of course, structure and process can fail too, destroying integrated activity. The total organism is under integrative control by brain and mind, the autonomic nervous system and by the neuroendocrine-endocrine complex, all acting in unison. These physical processes contribute to the existence of the life of the mind and spirit and are in turn powerfully affected by intellect and morale. However, we do not understand the driving force which converts inorganic matter, organizes it and then propels it into life. Life seems to be only a continuation of a heritage--life creating life. Philosophy: The life of the mind requires acquisition of knowledge, curiosity, cultivation of the power to reason, use of thought and contemplation, all under discipline. True life of the mind may not exist and may cease to be even though physical existence may be present. Somewhat the same can be said of the life of the spirit; it also is not automatically genetically granted in completed form.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2003

[The medicine of nurturing life energy--health creation and self-organization].

It is reality that human's body and mind are being created by life energy through every moment of life. As modern medicine does not consider this life energy itself, the most modern people hardly does not think it's intuitive meaning and use it to actualize their health and happiness in life. They can consider the outcome of life phenomena in the fields of physical, psychological, sociological and ethical sides, but they can not ask what life energy is, and subsequently can not use it in their life. Therefore, they live to make effort to actualize how to change life style considering of medical scientific facts (Evidence-Based-Medical Health Care). The intuitive life's action which can contact with the outer worlds, has the dynamic relationship with them and it creates new body and mind continuously. Modern medicine has not researched this dynamic life energy itself. What has life energy, single gene, single cell, single organ such as the brain and heart and single human beings, have been maintained their life by using their common and universal two life energies which are called self-organization, self-creativity and communicative ability. These two life energies of them were communicating with themselves or each others and their environments, and recreating their form and function continuously every moment of lives. It was conceptualized "Body-Mind-Spirit (Life-energy)-Life Dynamics". All of life phenomena which are not only diseases but also health, come from the results of "Body-Mind-Spirit-Life Dynamics". When we communicate with the outer worlds in "Real Self", human beings will keep the highest state of "Body-Mind-Spirit-Life Dynamics". We clarified that human beings can actualize the healthy and happy lives by themselves from understanding this idea, it also means for them to be able to create healthy personality through their lives and we clarified new assessment way of life energy simultaneously.

Evidence-Based Medicine↗
PubMed1998

[Evaluation of the impact of peripheral obliterative arteriopathy on quality of life].

Peripheral arterial occlusive disease is a common condition with possible serious consequences. It is usually diagnosed at the intermittent claudication stage. There are 2 objectives of treatment: to prevent ischaemic attacks and to improve quality of life. Treatment efficacy is, however, usually evaluated only in terms of walking distance. When making medical decisions, it is now generally accepted that patients are as much concerned by quality of life as by life expectancy, particularly with regard to chronic diseases for which the aim of therapy is not only to treat the disease but also to relieve pain or restore function. Quality-of-life evaluation is therefore necessary to assess treatment efficacy, guiding clinicians in their choice of therapy and manufacturers in their choice of new molecules for development. Three types of instruments can be used to evaluate quality of life. Currently, those most often used are health status and health-related quality-of-life scales. These scales can be nonspecific, giving information on both health status and quality of life independently of any particular condition [the Medical Outcomes Study (MOS) Short Form-36 items (SF-36), for example], or they may be relevant to one disease. Specific scales are usually more sensitive than nonspecific ones. When the ARTEMIS scale, which is specific to peripheral arterial occlusive disease, was developed in 1993, there were 400 scales in existence. However, none were specific to peripheral arterial occlusive disease. The ARTEMIS scale is a self-administered questionnaire, composed of a general (SF-36) and a specific instrument. It comprises 64 items covering the 8 dimensions of the SF-36, 5 specific dimensions and 2 differential dimensions (perception of health status evolution and perception of the future). The ARTEMIS questionnaire was validated in 177 patients with intermittent claudication (phases IIa and IIb of the Leriche and Fontaine classification). Results obtained with the ARTEMIS questionnaire are presented and compared with those obtained by other authors using nonspecific or specific scales for quality-of-life evaluation. All results showed that intermittent claudication has a significant effect on the various dimensions of quality of life (except in one study). Nevertheless, the relationship between walking distance (or other functional measures) and quality of life did not prove to be as close as had been expected, indicating that functional measures do not reflect the patient's overall perception of the disease. The ARTEMIS questionnaire showed that quality-of-life scores were significantly higher (better quality of life) in patients with walking distances greater than 500 metres than in those with shorter walking distances (less than 500 metres). Moreover, quality-of-life scores were both high and similar in patients with walking distances greater than 500 metres, while in patients with shorter walking distances quality-of-life scores ranged from high (good quality of life) to low (bad quality of life). In the absence of curative treatment, the patient's perception of quality of life must therefore be evaluated prior to any treatment. Treatment will help to prevent ischaemic attacks in patients with walking distances greater than 500 metres, and will have a preventive effect and improve functional measures in patients with low quality-of-life scores, regardless of walking distance. The ARTEMIS questionnaire can therefore assist clinicians in their choice of therapeutic strategy and in the evaluation of treatment efficacy.

Arterial Occlusive Diseases↗
PubMed1996

Quality of life: perception of lung cancer patients.

An investigation was carried out to examine what quality of life means to lung cancer patients. 200 patients with either lung cancer (108) or chronic respiratory disease (92) were interviewed using a short open-ended questionnaire. They were asked to define quality of life in general, identify what they considered to be a good quality of life for themselves and to rank the relative importance attached to each nominated item. A content analysis was carried out and patients' responses were categorised into eight items. These were: ability to do what one wants to do/work, enjoyment of life, family life, financial security, happiness, health, living longer and social life/leisure activities. Of these, health (42%), enjoyment of life (25%) and family life (24%) were the three most nominated items as definition of quality of life in general. Patients perceived a good quality of life for themselves differently. Family life (58%), health (51%) and social life (43%) were found to be the most nominated components of a good quality of life for the patients. Overall, patients ranked family life and health as the first or second most important factors. There were no significant differences between cases and controls. The study results are challenging and serve to remind us that the term quality of life is misused in many studies. Most existing measures do not encompass the wider aspects of quality of life identified here, but rather concentrate on the "health-related" aspects of quality of life. To achieve this, the research into the best ways of measuring and assessing quality of life must continue to seek individual values and preferences and how these can be applied in a simple way in clinical studies.

Adult↗
PubMed2004

Standard expected years of life lost as a measure of mortality: norms and reference to New Zealand data.

OBJECTIVES: Standard expected years of life lost (SEYLL) is a component of the disability adjusted life year (DALY) measure of disease burden. SEYLL is calculated from the expected remaining years, as specified by a normative survivorship that is derived from a model life table. Because every death has non-zero remaining years, years of life lost are never zero, even in a population that achieves the ideal life expectancy of the model life table itself. As zero is unattainable, what is an acceptable years of life lost? The study calculates norms and examines NZ data against them. METHOD: Using model life tables with expectancy 80 years for men and 82.5 years for women, the years of life lost in cohorts that achieve the model life table expectancy are evaluated. Years of life lost per death and per head of population are considered and the effects of age-standardising, discounting and age-weighting are evaluated. Mortality and Census data are used to compute actual years of life lost in New Zealand, which are compared with the norms. RESULTS: Crude years of life lost per death is about 9-10 years in a population that achieves the model life table distribution. New Zealand European years of life lost are about five years in excess of the 9-10 year norm; Maori about 21 years. The effects of age standardising, using the Segi standard population, give a norm of about 21 years; both Maori and European values are about two years in excess of this figure. CONCLUSIONS: Crude and age-standardised YLLs in New Zealand exceed the ideal set by the model life tables norms, especially so in Maori. Age-standardising has a strong influence on the statistics. IMPLICATIONS: Years of life lost measures need to be considered against the established norms. Unless done so, the measures can appear more adverse than they actually are.

Age Factors↗
PubMedDate not supplied

Psychopathology and quality of life for adolescents with asthma and their parents.

Asthma is known to have a direct impact on the quality of life of children with asthma and their families as a consequence of the attacks on day-to-day life. Psychopathological factors may be associated with poor quality of life by modulating the handicap and the patient's experience of it. The authors' objective was to evaluate the relationship between emotional and behavioral problems and quality of life, as assessed by the Pediatric Asthma Quality of Life Questionnaire and the Pediatric Asthma Caregiver's Quality of Life Questionnaire. The study group consisted of 100 adolescent outpatients with asthma who were undergoing regular checkups: 70 boys and 30 girls, ages 12 to 19. They were evaluated by means of self-administered questionnaires completed by their parents. Path analysis was used to propose a model of relationships between psychopathology and quality of life. The quality of life of the children with asthma and their parents was clearly associated with the presence or absence of psychological problems in the patients. Emotional problems were associated with the quality of life of both the patients and their parents; behavioral problems had a smaller effect on the quality of life of the parents only. The authors proposed a structural model of the quality of life of adolescents with asthma and their parents in which quality of life is dependent on psychological variables and is responsible for emotional problems. Multivariate analyses indicated that the quality of life of the children with asthma and their parents and the correlation between quality of life and psychopathology depended little on medical variables such as the duration of illness, its pretreatment severity, or hospitalizations in the past year. In contrast, the quality of life of the parents depended on that of the children and vice versa. This study showed that scores on the Pediatric Asthma Quality of Life Questionnaire and the Pediatric Asthma Caregiver's Quality of Life Questionnaire reflected not only the medical status of the patients but also psychological variables, which appeared to be a consequence of the functional handicap associated with asthma. Patients who assess the quality of their lives as poor would benefit from psychological evaluation and support.

Adolescent↗
PubMed2003

Life goals: the concept and its relevance to rehabilitation.

OBJECTIVE: Life goals are desired states that people seek to obtain maintain or avoid. These goals may influence motivation to participate in the rehabilitation process. The aim of this paper is to review the literature on life goals and the influence of life goals on the rehabilitation process. METHODS: The MEDLINE, EMBASE, Psychlit and CINAHL databases were searched with the keywords goals, life goals, aim of life, meaning of life, motivation, assessment (identification) of life goals, goal planning, disability, coping and rehabilitation. RESULTS: The initial search produced 917 abstracts. After going through these abstracts, 39 articles were selected for inclusion in the review. Age, gender, personality, experiences and society and environment influence life goals. Pursuit and attainment of life goals affect sense of well-being. Life goals are accessible to conscious awareness and can be identified. Several questionnaires are available for assessment of life goals. Different questionnaires assess different aspects of life goals. All except one of these questionnaires need to be tested for validity and reliability in a rehabilitation setting. Disabilities interfere with goal striving and result in emotional distress. Motivation to participate in a rehabilitation programme depends on concurrence between a patient's life goals and treatment goals. Incorporation of a subject's life goals into a management programme resulted in better outcomes in various physical and psychiatric disorders. There are no data on the efficacy of life goal-orientated rehabilitation programmes. CONCLUSIONS: Life goals influence patients' motivation to participate in and compliance with treatment programmes. We still do not know whether rehabilitation programmes focusing on life goals make any difference in outcome. There is need for further studies in this area.

Adaptation, Psychological↗
PubMed2000

Coping behavior and social support contribute independently to quality of life after surgery for inflammatory bowel disease.

PURPOSE: The purpose of this study was to examine the association between coping behavior at the time of surgery and inflammatory bowel disease-related quality of life after surgery. We also investigated the relationship between perceived social support and both coping style and postsurgical quality of life. Finally, the value of the Medical Outcomes Study Social Support Scale for preoperative screening was assessed. METHODS: Eighty-six subjects who had surgery during a 12-month period completed the Inflammatory Bowel Disease Questionnaire, the Ways of Coping, a measure of inflammatory bowel disease symptom severity, and the Medical Outcomes Study Social Support Scale. Analysis of variance was used to test an association between Ways of Coping score and membership in a high quality of life (Inflammatory Bowel Disease Questionnaire > mean) or low quality of life (Inflammatory Bowel Disease Questionnaire < mean) cohort. Comparison of group means between the high quality of life and low quality of life cohorts identified Ways of Coping behavior scales that differed between the high quality of life and low quality of life cohorts. Stepwise linear regression analysis was then used to determine the independent contribution of 1) current inflammatory bowel disease symptoms, 2) current perceived social support, and 3) identified coping behaviors (self-control, self-blame, and escape, summed as a single index named "maladaptive coping") to postsurgical quality of life. The sensitivity, specificity, and negative predictive value of the Medical Outcomes Study Social Support Scale were assessed. RESULTS: The lower quality of life group distinguished itself by more frequent use of maladaptive coping. Regression analysis revealed that current inflammatory bowel disease-related symptoms, current perceived social support, and maladaptive coping behaviors at the time of surgery each made a highly significant independent contribution to postsurgical quality of life. The sensitivity of the Medical Outcomes Study Social Support Scale in identifying patients with poor postsurgical quality of life was 81 percent, and the specificity was 77 percent. The negative predictive value was 93 percent. CONCLUSIONS: Three coping behaviors which seem to be maladaptive (self-control, self-blame, and escape) are associated with lower quality of life after surgery for inflammatory bowel disease. These coping behaviors make a contribution to postsurgical quality of life independent of the negative effect on quality of life of inflammatory bowel disease symptoms. Perceived social support is a third factor that makes an independent contribution to postsurgical quality of life. The Medical Outcomes Study Social Support Scale has properties associated with an effective screening tool and merits further investigation as an instrument to screen presurgically for individuals at higher risk of poor subjective outcome of inflammatory bowel disease surgery.

Adaptation, Psychological↗
PubMed2002

Good deaths, bad deaths, and preferences for the end of life: a qualitative study of geriatric outpatients.

OBJECTIVES: Patient involvement in decision-making has been advocated to improve the quality of life at the end of life. Although the size of the oldest segment of the population is growing, with greater numbers of older adults facing the end of life, little is known about their preferences for the end of life. This study aimed to explore the attitudes of older adults with medical illness about the end of life, and to investigate whether current values could be extended to end-of-life preferences. DESIGN: Descriptive study with interviews using open- and closed-ended questions. SETTING: Patients attending two university-affiliated geriatric clinics were interviewed in a private conference room near the clinic they attended or in their homes. PARTICIPANTS: Sixteen older men and women identified by their physicians as having nonterminal heart disease or cancer. MEASUREMENTS: The interview contained open-ended questions such as: "What are the most important things in your life right now?" and "What would you consider a good/bad death?" The interview also contained closed-ended questions about symptoms, quality of life, and health status. Additional questions elicited preferences for the end of life, such as location of death and the presence of others. The open-ended questions were tape-recorded, transcribed, and analyzed using qualitative methods. The closed-ended questions were analyzed using descriptive statistics. RESULTS: Patients with heart disease and cancer provided similar responses. Participants' views about good deaths, bad deaths, and end-of-life scenarios were heterogeneous. Each participant voiced a unique combination of themes in describing good and bad deaths. Because each participant described a multifaceted view of a good death, for instance, no theme was mentioned by even half of the participants. Participants provided differing explanations for why given themes contributed to good deaths. Currently valued aspects of life were not easily translated into end-of-life preferences. For example, although the majority of participants identified their family as being important, many gave reasons why they did not want their family members present when they died. CONCLUSIONS: Because of the heterogeneity of views and the difficulty in inferring end-of-life preferences from current values, older adults should be asked not only questions about general values, but also specific questions about their end-of-life choices and the reasons for these choices. A thorough understanding of an individual's end-of-life preferences may help health professionals working with older adults develop patient-centered care plans for the end of life.

Aged↗
PubMed1995

Quality of life in phase II trials: a study of methodology and predictive value in patients with advanced breast cancer treated with paclitaxel plus granulocyte colony-stimulating factor.

BACKGROUND: Despite the clinical benefit that may be associated with reduction of tumor volume, chemotherapy may produce physical or psychological distress that could compromise a patient's quality of life. Although palliation may be as relevant as tumor response in patients with metastatic breast cancer, quality of life is not commonly evaluated in phase II clinical trials of new therapeutic agents. PURPOSE: We evaluated the utility of quality-of-life assessment in two phase II clinical trials of patients receiving paclitaxel (Taxol) and recombinant human granulocyte colony-stimulating factor (rhG-CSF) as salvage therapy for metastatic breast cancer. METHODS: A battery of instruments (i.e., Memorial Symptom Assessment Scale [MSAS], Functional Living Index-Cancer [FLIC], Rand Mental Health Inventory [MHI], Brief Pain Inventory [BPI], and Memorial Pain Assessment Card [MPAC]) designed to capture information about social, psychological, and functional aspects of quality of life, as well as symptom prevalence and distress, was completed prior to treatment; serial assessments were obtained at regular intervals during the treatment period. Univariate and multivariate analyses were performed evaluating base-line quality-of-life parameters and standard prognostic factors in relation to outcome measures of survival, tumor response, and toxicity. For 30 consecutive patients with extensive prior chemotherapy for metastatic disease, longitudinal data were analyzed associating tumor response to changes in quality-of-life scores throughout the course of treatment with paclitaxel. RESULTS: Base-line scores of two validated quality-of-life instruments, the MSAS and the FLIC, independently predicted the overall survival (P < .01 for each). In this model, however, neither standard prognostic factors nor quality of life instruments predicted the likelihood of tumor response or the probability of encountering grade 3 or grade 4 nonhematologic toxicity. With serial assessments of quality of life, the majority of patients who achieved partial tumor response or stable disease reported improved or unchanged quality-of-life scores, while those patients with progressive disease experienced rapid deterioration in quality of life. CONCLUSIONS: Base-line quality-of-life assessment may provide prognostic information distinct from that obtained through standard prognostic indicators alone. The combination of two factors--extent of disease and a base-line quality-of-life assessment--predicted survival more accurately than either used separately. Evaluation of quality-of-life outcomes in relation to tumor response may illuminate previously unmeasured palliative effects of chemotherapy, such as pain relief, as well as the burdens it imposes. IMPLICATIONS: Information obtained from quality-of-life assessment in conjunction with phase II testing of new chemotherapeutic agents for metastatic breast cancer can guide quality-of-life evaluation planned in large, randomized future studies.

Adult↗
PubMed2003

Quality of life philosophy VI. The concepts.

The about a hundred central concepts related to research in the global quality of life can, in a holistic medical frame of interpretation, be organized under ten abstract key concepts: existence, creation of the world, state of being, daily living, talents, relations, sex, health, personal development, and therapy with subthemes as discussed in this paper. The paper shows that the concepts in each group can be seen as related to each other in a quite intuitive and logical way, to give a coherent quality of life philosophy that allows the physician to encourage, inspire, and support his patient. In every consultation, one new concept and idea of existence can be taught to the patient, helping him or her to realize the meaning of life, the source of joy, and the reason for the actual suffering. In this way, we help the patient to mobilize hidden and known resources and to improve quality of life, subjective health, and the ability to function. The concepts were harvested in 2003 at a Nordic seminar on quality of life research, held in Sweden. Life does not only cohere on the inside, but also on the outside. The same power that ties together all the cells in our body, seems to tie us together in relationships and new wholeness. This power evolves into new kinds of relations that unite on more and more complex levels, with the global ecosystem as the highest known level. Our intentions come from this coherent matrix of life. In the beginning of our life, the web of life itself gave birth to our fundamental purpose of life. The abstract purpose determines the frame of interpretation of reality: How we will perceive ourselves throughout life, our inner life, and the world around us. The frame of interpretation is pitched in language and concepts, in fact it creates our perceptions. Based on these perceptions and our purposes of life, our behavior arises. Our consciousness evolves through the witnessing of our behavior and through the response caused by it. Through the slowly acquired mastering of our surrounding world, we obtain our power, which gives us success in life, when we use it responsibly and unite it in harmony with our deepest purpose of life. When many people experience not having success, it is because they are not conscious about their original purpose or the deepest meaning of their lives. They do not know themselves. They do not experience the world in that way and do not realize that they themselves are the cause. Therefore responsibility and self-knowledge, which add up to wisdom, are the ways to a good and successful life.

Animals↗
PubMed2003

Measurement of quality of life III. From the IQOL theory to the global, generic SEQOL questionnaire.

The Danish Quality of Life Survey is based on the philosophy of life known as the integrative quality-of-life (IQOL) theory. It consists of eight different quality-of-life concepts, ranging from the superficially subjective via the deeply existential to the superficially objective (well being, satisfaction with life, happiness, meaning in life, biological order, realizing life potential, fulfillment of needs, and objective factors [ability of functioning and fulfilling societal norms]). This paper presents the work underlying the formulation of the theories of a good life and how these theories came to be expressed in a comprehensive, multidimensional, generic questionnaire for the evaluation of the global quality of life--SEQOL (self-evaluation of quality of life)--presented in full length in this paper. The instruments and theories on which the Quality of Life Survey was based are constantly being updated. It is an on-going process due to aspects such as human development, language, and culture. We arrived at eight rating scales for the quality of life that, guided by the IQOL theory, were combined into a global and generic quality-of-life rating scale. This was simplified to the validated QOL5 with only five questions, made for use in clinical databases. Unfortunately, the depth of human existence is to some extent lost in QOL5. We continue to aim towards greater simplicity, precision, and depth in the questions in order to explore the depths of human existence. We have not yet found a final form that enables us to fully rate the quality of life in practice. We hope that the several hundred questions we found necessary to adequately implement the theories of the Quality of Life Survey can be replaced by far fewer; ideally, only eight questions representing the eight component theories. These eight ideal questions have not yet been evaluated, and therefore they should not form the basis of a survey. However, the perspective is clear. If eight simple questions can accurately rate the quality of life as well as its depth, we have found an instrument of immense practical scope.

Health Status↗
PubMed2006

Exploring community nurses' perceptions of life review in palliative care.

AIMS AND OBJECTIVES: This exploratory study aimed to identify community nurses' understanding of life review as a therapeutic intervention for younger people requiring palliative care. The objectives set out to: (i) Describe the participants' understanding of reminiscence and life review (ii) Detail their current ideas regarding a structured approach to using life review in the community setting. (iii) Outline their understanding of the possible advantages and limitations of life review in relation to palliative care. (iv) Identify future training requirements. BACKGROUND: The literature review illustrated how the eighth developmental stage of Erikson's theory, ego-integrity vs. despair, is a 'crisis' often faced by older people entering the final stage of life. Life review is considered a useful therapeutic intervention in the resolution of this crisis. Younger terminally ill people in the palliative stage of an illness may face the same final crises due to their reduced lifespan. Therefore, this study explored the benefits and limitations of life review as an intervention in palliative care. METHOD: The study used a purposive sample of community nurses responsible for delivering generic and specialist palliative care. A qualitative method of data collection in the form of three focus group interviews was used. Subsequent data were manually analysed, categorized and coded with associations between the themes identified. RESULTS: The findings suggested that community nurses have limited knowledge pertaining to the use of life review and tend to confuse the intervention with reminiscence. Furthermore, they believed that life review could potentially cause harm to practitioners engaged in listening to another person's life story. However, the participants concur that with appropriate training they would find life review a useful intervention to use in palliative care. CONCLUSIONS: The results led to the identification of a number of key recommendations: Community nurses require specific education in the technicalities of life review and additional interpersonal skills training. The need for formalized support through clinical supervision is also recognized and discussed. Finally, suggestions are offered regarding the need to generate wider evidence and how, possibly, to integrate life review into existing palliative care services. RELEVANCE TO CLINICAL PRACTICE: This study has demonstrated that community nurses are keen to extend the support offered to younger terminally ill people who are in the palliative stage of their illness. Despite having limited knowledge of life the main components and underpinning theory pertaining to life review participants could appreciate the potential of life review as a therapeutic intervention in palliative care and were keen to learn more about its use and gain the necessary knowledge and skills.

Adult↗
PubMed1998

Quality of life measurement in mental health. Introduction and overview of workshop findings.

The Quality of Life Measurement Workshop was designed to address a number of specific questions relating to measurement and use of quality of life indicators among persons with chronic and severe mental illnesses. The issues surrounding measurement of quality of life among severely and persistently mentally ill people proved to be considerably more complex than originally imagined. Workshop discussions concentrated on the clear elaboration of the scope and nature of these complexities rather than on their complete resolution. Important themes that emerged were: the importance of quality of life for consumers/survivors and their family members, and as a basis for evaluating program effectiveness and the progress of mental health reform; the fact that persons with mental illness experience lower life satisfaction than the population as a whole; the importance for consumers/survivors of having a sense of control, companionship, feelings of optimism, and a purposeful and meaningful life; the subjective and personal nature of quality of life perspective and the need for flexible measurement instruments that permit differential weighting of factors to take account of these different views; the lack of attention to social stigma and family or caregiver burden in current conceptualizations and measurement approaches and the importance of these factors to consumers/survivors and family members; the overt focus on psychiatric symptomatology and the relative neglect of key quality of life considerations that are important to consumers/survivors and their families; the need for more operational measures, such as those in the health-related quality of life field, to be used as a basis for evaluating the worth of new and alternate models of service delivery; the potential for competing interests with respect to program accountability to consumers/survivors and their families, on the one hand, and funders on the other, and the importance of striking a balance; the importance of including quality of life measurements within the context of controlled clinical trials; the need for multiple measurement approaches, ensuring that scales are appropriately matched to study goals and objectives, recognizing that scales differ in their sensitivity to treatment change; commonly used measures such as rates of hospital recidivism or psychiatric symptomatology are ultimately too narrow and, when used alone, are un-satisfactory measures of quality of program outcomes; the importance of minimizing data collection burden by ensuring that routine data collection systems have clinical utility within the context of the consumer/provider encounter; the need for extreme caution when directly linking quality of life outcomes to program funding within the context of outcomes-management systems; the need to gain a greater understanding of determinants of quality of life such as gender, age, diagnosis, comorbidities, stage of illness, or cognitive and emotional impairments; the importance of normative data and the need to develop statistical benchmarks; the importance of distinguishing quality of life outcomes on which specific interventions can have an impact (proximal outcomes) from the broader socioeconomic determinants of quality of life over which programs and interventions have little direct control (distal outcomes); the added cost of collecting quality of life outcome data on a routine basis and the general lack of technical resources available to most intervention programs; the potential for quality of life outcomes to be misused within the context of accountability frameworks given their embryonic stage of development, a lack of understanding of what constitutes appropriate clinical or statistical benchmarks, and the risk of data degradation when outcomes are tied to program funding; and the need for client-based research which incorporates consumers/survivors and their family members into all facets of the research process from study design to interpretati

Canada↗
PubMed2003

[Quality of life in patients with essential arterial hypertension. Part I: The effect o socio-demographic factors ].

Currently, one of the methods of comprehensive evaluation of patient health status is quality of life assessment. In the management of hypertension, evaluation of quality of life helps in individualization of therapy and improves its efficiency. The aim of the study was to compare the general quality of life between patients with essential hypertension and normal blood pressure values, and to analyse the effect of socio-demographic factors on the quality of life. An open questionnaire was distributed among 1539 patients (775 men and 764 women), aged from 18 to 88 years (x = 51.7 +/- 14.6 years) with essential hypertension detected at least 3 months earlier, referring to treatment for the first time or already treated by general practitioners and the Outpatient Department on Hypertension of the I Cardiac Department. Hypotensive treatment was given to 82.6% of the subjects, whereas 17.4% were untreated. A group of 995 subjects (459 men and 536 women) aged from 18 to 82 years (x = 48.6 +/- 11.2 years) with normal blood pressure values served as controls. All subjects provided data on education employment, body mass index, duration of arterial hypertension, family history, target organ damage, co-morbidity, blood pressure value, heart rate and pharmacological treatment. All subjects filled out a standardised questionnaire--Psychological General Well-Being (PGWB), which evaluated the general quality of life and its sin dimensions: Anxiety, Depressive mood, Subjective Well-being, Self-control, General health and Vitality. Statistical analysis included descriptive statistics, analysis of variance and multiple regression. The general quality of life in patients with essential hypertension was significantly lower than that in age-matched normotensives. The quality of life in women was lower than that in men irrespective of arterial hypertension presence. The quality of life was decreasing with age both in hypertensive and normotensives; however in hypertensive men there was a trend towards improved quality of life above 65 years of age in contrast to age-matched women in whom the quality of life deteriorated. The quality of life in untreated hypertensives was lower than that in age-matched healthy subjects, but until 40 years of age was higher than in treated age-matched hypertensives. The quality of life was related to the level of education, employment and familial history of hypertension. A lower quality of life was observed among hypertensives with coronary heart disease and diabetes. Multiple regression analysis revealed that gender, education, age and familial hypertension were the socio-demographic factors, which independently affected the quality of life among hypertensives. These factors accounted for 32.7% of the observed variance of quality of life. In normotensives subjects the independent factors were gender, age, education and employment--accounting for 65.8% of variance of quality of life.

Adaptation, Psychological↗
PubMed1993

Extracorporeal life support for pediatric respiratory failure: predictors of survival from 220 patients.

OBJECTIVE: The purpose of this report was to examine the Extracorporeal Life Support Organization registry database for predictors of outcome for severe pediatric respiratory failure managed with extracorporeal life support. DESIGN: Retrospective cohort study. SETTING: Extracorporeal Life Support Organization data registry. PATIENTS: All nonneonatal pediatric patients who were treated in the United States with extracorporeal life support for severe pediatric respiratory failure reported to the Extracorporeal Life Support Organization registry as of August 1991. Patients with congenital heart disease and congenital gastrointestinal malformations were excluded from study. INTERVENTIONS: Venoarterial or venovenous extracorporeal life support for severe life-threatening pulmonary failures. MEASUREMENTS AND MAIN RESULTS: As of August 1991, 220 pediatric patients meeting study entry criteria were reported to the Registry having received extracorporeal life support for severe pulmonary failure, since 1982. Forty-six percent (102 of 220 patients) were successfully managed with this technology and survived to hospital discharge. The mean patient age was 36.8 +/- 51.6 months. Fifty-one percent of the patients were male. The mean duration of mechanical ventilation before extracorporeal life support was 6.3 +/- 5.9 days. Mean blood gas and ventilatory measurements obtained before extracorporeal life support were as follows: PaCO2 52 +/- 23 torr (6.9 +/- 3.0 kPa); PaO2 59 +/- 32 torr (7.8 +/- 4.3 kPa); estimated alveolar-arterial oxygen gradient 561 +/- 63.4 torr (74.8 +/- 8.5 kPa); peak airway pressure 49.5 +/- 13.1 cm H2O; mean airway pressure 24.3 +/- 8.2 cm H2O; positive end-expiratory pressure 11.8 +/- 6.3 cm H2O; ventilator rate 58 +/- 64.4 breaths/min; and FIO2 0.98 +/- 0.07. The mean duration of extracorporeal life support for all patients was 247 +/- 164 hrs. For the 102 survivors, the mean time for decannulation from extracorporeal life support to extubation from mechanical ventilation was 6.5 +/- 7.6 days. Stepwise multivariate logistic regression modeling found the following variables to be associated with patient survival: a) patient age, b) days of mechanical ventilation before extracorporeal life support, c) peak inspiratory pressure, d) alveolar-arterial oxygen gradient, and e) extracorporeal life support administered since December 31, 1988 (all p < .05). CONCLUSIONS: Extracorporeal life support may represent an effective rescue therapy for some selected pediatric patients with severe respiratory failure for whom conventional mechanical ventilation support has failed to improve. Predictors of survival for this life-support therapy exist that may be helpful for individual patient prognostication and future prospective study.

Adolescent↗