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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.
The relationship between quality of care, quality of life, quality of work life and research.
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[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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Dermatology in-patient management greatly improves life quality.
The aim of this study was to measure the effect of in-patient management on the quality of life of adult dermatology patients, and to identify the diagnostic categories which show the greatest improvement. Over a 6-month period, all 230 patients admitted to the dermatology ward of the University Hospital of Wales were invited to complete a Dermatology Life Quality Index (DLQI) questionnaire on admission, and again 4 weeks after discharge. Two hundred and seventeen (93%) of these patients entered the study, and 181 (83.4%) returned both questionnaires. The mean DLQI on admission was 13.2 (standard deviation [SD] 7.6; n = 181), and 4 weeks after discharge it was 7.7 (SD 6.8; P < 0.001). Seventy-three per cent of the 181 patients showed improvement, 5.5% remained unchanged, and 21.5% worsened. Patients with psoriasis improved from 13.7 (SD 6.5) to 6.7 (SD 5.6; n = 63; P < 0.001), and those with eczema improved from 16.2 (SD 6.3) to 9.6 (SD 7.6; n = 56; P < 0.001). Patients with pruritus showed little improvement, as did those admitted for liver biopsy. Patients with psoriasis and severe eczema showed, overall, a significant decrease in impairment of life quality following in-patient treatment. Severe eczema has a greater adverse impact on the quality of life than severe psoriasis. The parameters for which most improvement was seen were those which were of most concern to the patients, i.e. their symptoms (score after discharge = 1.2; DS 0.9; P < 0.001) and their embarrassment (0.9; SD 1.0; P < 0.001).
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.
The Children's Dermatology Life Quality Index (CDLQI): initial validation and practical use.
Skin disease can cause severe disability and handicap in children. Measurement of the impact of skin disease on the quality of life is required to aid clinical decision-making, for clinical research, for audit of paediatric dermatology services, and for political reasons, to aid arguments for more resources for the care of children with skin disease. Adult measures are inappropriate, as the lives of children differ markedly from those of adults. The purpose of this study was to create and initially validate a simple practical questionnaire for use in children. One hundred and sixty-nine children, aged 3-16 years, attending a paediatric dermatology clinic, wrote down, with the help of their parents, all the ways in which their skin disease affected their lives. One hundred and eleven different aspects were identified; 10 questions were composed to cover these aspects, using a structure similar to the Adult Dermatology Life Quality Index. This draft questionnaire was piloted on two series, totalling 40 children, and minor alterations were made to improve clarity. The Children's Dermatology Life Quality Index (CDLQI) questionnaire (maximum score 30) was then given to a further 233 dermatology paediatric out-patients (CDLQI mean = 5.1, SD = 4.9), 47 normal controls (mean 0.4, 0.7) and 55 control patients attending a general paediatric clinic (mean 0.7, 2.5). The CDLQI scores for eczema (mean = 7.7, 5.6, n = 47), psoriasis (5.4, 5.0, n = 25) and acne (5.7, 4.4, n = 40), were all highly significantly greater than for moles and naevi (2.3, 2.9, n = 29). The highest mean score was that for scabies (mean = 9.5, 10.5, n = 6).(ABSTRACT TRUNCATED AT 250 WORDS)
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.
Provision and receipt of social support and disregard: what is their impact on the marital life quality of infertile and fertile couples?
A longitudinal study examined perceptions of received and provided social support and disregard among members of 248 infertile and fertile married couples. Correlational and structural equation modeling analyses were conducted. Women's and men's perceptions of the amount of social support they gave to and received from their partner were highly positively related. In contrast, agreement between spouses about the amount of provided support was moderate. Both social support and disregard mediated the relationships between stress and marital quality of life. Overall, highly similar patterns of results were found for members of infertile and fertile couples. These results demonstrate the perceptual element of received support and disregard as well as the importance of considering the provider's perspective.
[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.