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[Progress in surgery and quality of life, quality of life after organ transplantation].
Kidney and liver transplantations are well established surgical procedures. During the past years survival rates have improved 3% of kidney transplantations have 1-year mortality. Subjective quality of life and professional rehabilitation are associated with the graft function parameters of successful therapy. Seventy-six percent of liver-transplanted patients consider their quality of life improved after the operation. 52% are able to return to work. Future efforts must focus on improving immunosuppression for specific tolerance and sensitizing the public to the problems of obtaining organs for transplantation.
[Life quality of patients with muscular failure, using permanent respiratory support, seen from their point of view. 1. Information, choice and quality of life].
Sixteen patients with neuromuscular disease receiving long-term assisted ventilation participated in a combined questionnaire/interview investigation with the purpose of illustrating: 1. What information the patient had received prior to institution of the respirator treatment, 2. The difficult choice which had to be made, 3. Whether life as a severely disabled person with assisted ventilation is worth living, and 4. The factors on which successful respirator treatment depends. It is concluded that the general information on use of assisted ventilation should be implemented at an early stage, preferably before problems of respiratory insufficiency occur, and that information should be carried out by people other than merely professionals and be as broad and truthful as possible in order to provide the disabled person with sufficient foundation and sufficient time to consider his personal choice of potential respirator treatment. Further, it is concluded that life for these sixteen ventilator-dependent persons definitely is worth living. The fact that the respirator implies the prospect of longer life, partly freed from symptoms of hypoventilation, means that they have got strength and time for education, work, family and dreams. No correlation was found between the success of the respirator treatment and the patients' sense of achieved quality of life and factors such as age, family-/working situation, extent of disability etc., and professionals should not attach importance to such factors in the selection of "suitable" patients for assisted ventilation.
[Quality of life--quality of work].
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The dimensions of life quality in a community.
In this study the dimensions of the quality of life construct were investigated; 454 residents of a large suburban community were asked questions on life changes, psychiatric distress, happiness, and effective participation in life concerns. Selected variables from this survey were factor-analyzed in order to define the dimensions of life quality and six demographic variables; age, sex, marital status, education, income, and religious participation were studied to see how they influenced those dimensions. The results of the analysis revealed that life quality is measurable in terms of a person's happiness, his community participation, and his preferences, answering three major questions that person may pose for himself: (1) How well do I like the life I lead? (2) In what meaningful ways do I spend my time? (3) Why? Each of the six demographic variables influenced these dimensions. Marital status and age, two life-cycle statistics, had the most powerful effects on quality-of-life ratings.
Compliance and quality in residential life. Quality, organization design, and standards.
Regulations and voluntary standards within the context of organizational design and mission as well as leadership in management for quality were discussed. Rules and regulations are closely associated with the structure and mission of the organization. Altering them may require fundamental redesign of organizational structure and purpose. Likewise, alterations in organizational design can change the need for rules and regulations. In addition, standards do not automatically yield quality. Rather, they define expected levels of performance from individuals, programs, and the organization. The senior management of organizations is responsible for exercising the leadership in managing for quality.
Pancreas transplantation: assessing secondary complications and life quality.
Two sequential studies of life quality among pancreas transplant recipients are reported. The first study (n = 32) investigated symptoms of neuropathy, enteropathy and retinopathy, along with well-being post successful transplantation. Patients noted improvement in secondary complications, were satisfied with the procedure and expressed hope for the future. The second study compared physical and social function, burden of symptoms, emotional/mental state and sense of well-being in successful (n = 31) and successful (n = 13) pancreas transplant recipients. Patient satisfaction with pancreas transplantation was high. Successful transplant patients perceived their health to be good, believed it would continue to be good, with life quality becoming better over time. The failed group expected life quality to become worse.
Life quality in non-pharmacological therapy of hypertension.
Measurements of life quality have recently been included in drug trials on hypertension. In literature, not one single reference was found on life quality in non-pharmacological therapy of hypertension. More or less a tacit understanding is, however, that the life quality is unchanged, or at least not impaired, during non-pharmacological therapy. Experiences from a study of 400 patients with the aim to reduce or withdraw antihypertensive drugs, at the same time as non-pharmacological methods were introduced, show the difficulties to evaluate changes of life quality in a non-pharmacological study.
[Comparison of life expectancy and life quality in chronic dialysis and renal transplant patients (author's transl)].
Quality of life of patients on RDT and after renal transplantation is compared. The somatic and psychic situation and the grade of rehabilitation are discussed.
[Continent ileostomy - improvement of life quality].
Fifteen patients who had undergone proctocolectomy and conversion of conventional ileostomy into continent ileostomy as devised by KOCK were investigated an average of 4 1/2 years after continent ileostomy. The aspects investigated were skin problems, frequency of ileal pouch emptying, continence, and quality of life. It is concluded that successful conversion to continent ileostomy has eliminated most of the drawbacks of conventional ileostomy. The technically complex method of continent ileostomy should be employed only by surgeons experienced in this type of surgery and at centers where more experience with the method can be accumulated.
Some aspects of life quality after surgery for acoustic neuroma.
This investigation was performed to describe some aspects of the quality of life in subjects after translabyrinthine removal of an acoustic neuroma, resulting in unilateral total deafness. Two hundred ninety-three subjects who had been operated on during 1976 through 1990 and who were living outside the Copenhagen (Denmark) City and County received a postal questionnaire, to which 93% (n = 273) responded: 118 men and 155 women with a median age of 58 years (range, 18 to 81 years). The median observation period from surgery to the questionnaire was 6 years (range, 6 months to 14 years), and the median age at operation was 52 years (range, 15 to 76 years). Among the subjects, 22% had received postoperative hearing rehabilitation with various types of hearing aids in the ear not operated on. In 62%, tinnitus was experienced in the ear with tumor before surgery, and at the time of the questionnaire, 49% experienced tinnitus in the ear operated on. Half a year after surgery, 56% still experienced dizziness. Sixty-four percent reported damage to the facial nerve in relationship to the operation. At the time of the questionnaire, 12% indicated a total loss of facial nerve function. No vocational consequences were found in 74% after surgery. Information concerning different symptoms related to surgery was insufficient in 29%, while the quality of information in relation to surgery was more satisfying. In conclusion, the study demonstrates that deafness, dysequilibrium, and reduced facial nerve function caused the most severe problems. Improved information to patients before surgery may reduce the frequency of negative experiences.
Impact of dental conditions on patients' quality of life.
Quality of life measures have rarely been used in dentistry to assess oral health status. The purpose of this paper is to assess the utility of using standard indicators to measure the impacts of dental conditions on patients' quality of life. Quality of life was conceptualized as a multidimensional construct including three major aspects: social functioning, measured by the Sickness Impact Profile; well-being, measured by the Gill Well-Being Scale, Spielberger State/Trait Anxiety Scale, and the Corah Dental Anxiety Scale; and symptoms, measured by the Kiyak Oral Functioning Scale, the McGill Pain Questionnaire, and the West Haven Multidimensional Pain Inventory. 152 patients were recruited from private dental practices consisting of 48 TMJ, 33 periodontal, 23 denture, and 48 recall patients. Patients in the first three groups reported numerous impacts on quality of life and the impacts were particularly severe for the TMJ patients. The indicators used were sensitive to differences among the four groups and hold promise for further development of quality of life indicators for use in epidemiologic surveys and clinical dental trials.
[Cancer of the gallbladder: survival and life quality depending on the type of surgical treatment].
An analysis is made of the survival and life quality of 47 patients diagnosed by histopathology as gallbladder cancer, in relation to surgical treatment. The 47 patients, with a mean age of 70 years and a male female ratio of 1:3.7, were classified according to the Nevin stages: there were no stage I patients, 1 stage II, 8 III-IV and 38 V. The operations performed were 20 simple cholecystectomies with excision of a portion of adjacent hepatic tissue; 11 radical cholecystectomies; 10 surgical intubations; 3 percutaneous endoprosthesis; 2 gastroenteroanastomoses and 1 exploratory laparotomy. The results showed: 1) Radical cholecystectomy was the best therapeutic method, providing the longest survival (433 days) with the smallest proportion of days of poor life quality (10%). 2) In patients in stages II, III, IV, simple cholecystectomy with excision of the adjacent liver tissue yielded a survival of more than a year, even in patients of advanced age (greater than 80 years). 3) Although percutaneous and surgical intubation achieved a similar survival, the first technique produced a better quality of life. 4) In view of the diversity of the surgical techniques practiced in patients in stage V, a revaluation of this stage is necessary to individualize treatment.
Life quality of patients with chronic obstructive pulmonary disease.
Two hundred three patients with hypoxemic chronic obstructive pulmonary disease (COPD) and 73 healthy control subjects matched for age, sex, race, and neighborhood of residence were administered three self-report inventories concerned with the following four dimensions of life quality: emotional functioning, social-role functioning, activities of daily living, and recreational pastimes. An additional inventory was administered to a spouse or another close relative of each patient. The life quality of patients with COPD was found to be impaired relative to healthy subjects on all dimensions. Depression was the preponderant emotional disturbance reported; difficulties with home management and reduction in social interaction were the primary social-role deficits. Ambulation, mobility, sleep and rest, and a variety of recreational pastimes were also severely affected. Life quality exhibited moderate but significant relationships to neuropsychological, pulmonary, and cardiac functioning and to exercise capability. Age and socioeconomic status were found to be possible moderators of the relationship of COPD to life quality. A model to integrate these findings is proposed. Implications for the management of COPD and for the evaluation of medical treatments of chronic disabling conditions are described.
Economic evaluation of new drug therapies in terms of improved life quality.
Assessment of the benefits is one of the major and largely unresolved problems in the economic evaluation of new drugs, particularly so when major benefits concern patients' well-being, joy of life or life quality rather than increased longevity or improved earnings capacity. In this study, a method for assessing the benefits of new drug therapies in terms of improved life quality is proposed. The approach is illustrated for psoriasis, one of the most common and disabling skin diseases. A MIMIC-structural-equation-model for psoriasis-related medical care demand is developed and estimated, treating the psycho-social disability associated with the disease as a latent (unobservable) variable which is characterized fully by its causes and indicators. The model allows computation of a MIMIC-DISABILITY-index, a one-dimensional measure of the overall psoriasis-related impairment in life-quality, for each patient or by selected patient characteristics. Contrary to traditional methods, the MIMIC-index incorporates a large number of disease aspects (indicators) without using arbitrary weights. Application of this approach to the evaluation of new drugs is straightforward. However, it requires a prospective study design, i.e. patients have to be interviewed at least twice, along with a control group, once before and at least once after onset of the new therapy. The MIMIC-index can then be computed for successive stages of the new therapy, expressing the therapy's effectiveness in improving patients' well-being. The index can be used as a physical output measure in cost-effectiveness analysis. Finally, it can be transformed into monetary units allowing performance of formal cost-benefit analysis of new treatment alternatives.
Measures of symptoms and life quality to predict emergent use of institutional health care resources in chronic obstructive airways disease.
Thirty subjects with severe chronic obstructive airways disease participated in a study to identify differences in symptoms and life quality between those with high and low emergent use of institutional health care resources. Emergent use was defined as care obtained through unscheduled, nonroutine methods of access to health care providers. There were 15 subjects in each group; the groups had similar sex distribution and were not significantly different for percent predicted forced expiratory volume in 1 second (mean 29.8%), use of home oxygen (15 of 30 subjects), or prevalence of CO2 retention (nine of 30). Symptoms and life quality were measured by using three paper and pencil tests, the Bronchitis-Emphysema Symptom Checklist, the Sickness-Impact Profile, and the Katz Adjustment Scale for relatives. Findings demonstrated consistently more symptoms and impairment of life quality in the "high emergent" group. The differences reached statistical significance for irritability, anxiety, helplessness, nervousness, peripheral sensory complaints, alienation, social interaction, and emotional behavior. Discriminant analysis provided a prediction formula that yielded 80% correct prediction for the two groups.
Conceptual views on quality of life.
Quality of life can be discussed in many ways. One way is to analyse the empirical quantitative approach to determine whether the research categories are operational, empirically unambiguous, and thematically relevant; progress, in the sense of changing the number of research categories, does not take place through a systematic empirical test but through a modification of the theory of quality of life. The current debate on quality of life has included a conflict between natural science and a humanistic approach. Our view is that quality of life must be defined through the difficult concept of happiness. When cancer threatens happiness, not one but two fundamental crises influence quality of life, which we regard as a key concept of a therapeutic method.
Life quality in patients under hypotensive treatment.
The authors studied the life quality in a group of 74 patients--31 males and 43 females--affected with essential hypertension of World Health Organization I or II degree. All patients began treatment with frusemide at a dose of 25 mg once a day. The 35 non-responsive patients to frusemide were then treated, by random selection, with captopril at a dose of 25 mg twice a day, or nadolol at a dose of 80 mg once a day, for three months. The results show no significant differences on the hypotensive effect with either drug; in view of the incidence of side-effects of the two drugs, treatment with captopril is clearly better tolerated by the patients.