Measuring quality of life for patients with terminal illness: the Missoula-VITAS quality of life index

OBJECTIVE: To investigate whether fibronectin fragments (Fn-fs), shown to damage cultured cartilage, can be found in cartilage from patients with osteoarthritis (OA) or rheumatoid arthritis, or can be generated from fibronectin (Fn) within synovial fluids or from Fn in the matrix of cultured cartilage. To also determine whether cartilage or synovial fluid Fn-fs are active and, thus, could contribute to cartilage damage in vivo. METHODS: Fn-fs were immunochemically identified in cartilage extracts from patients with OA or rheumatoid arthritis or in bovine cartilage cultured with IL-1 alpha or in bovine synovial fluids treated with stromelysin-1 (MMP-3). The effect of removal of Fn-fs from OA synovial fluids was tested by passing fluids over an anti-Fn column and adding the resultant fluids to bovine cartilage cultures to measure proteoglycan (PG) degradation. Gelatin-Sepharose purified Fns from bovine plasma, synovial fluid or cartilage were digested with MMP-3 and the Fn-fs tested for degradation of PG in cultured cartilage. RESULTS: Extracts of cartilage from patients with rheumatoid arthritis or with OA contained a range of Fn-fs. Removal of Fn-fs from OA synovial fluids significantly reduced the resultant damage when the fluids were added to cultured cartilage. Addition of IL-1 alpha to cultured cartilage or of MMP-3 to synovial fluids enhanced generation of Fn-fs. Fn-fs, whether derived from bovine plasma or synovial fluid or cartilage Fns, damaged cartilage. CONCLUSIONS: These data demonstrate that although Fn-fs could be generated in vivo within synovial fluids and Fn-fs found in OA synovial fluid may contribute to cartilage damage in vivo, Fn-fs could also be generated within cartilage and amplify cartilage damage. Thus, Fn-fs may be both autocrine and paracrine regulators of cartilage metabolism.     

Self-control in children: Development of a rating scale.

Conducted 2 studies to develop a Self-Control Rating Scale (SCRS) for children. The 33-item SCRS showed high internal consistency (0.98) and test–retest reliability (0.84). In a validational study of 110 normal 3rd–6th graders, the SCRS correlated significantly with latency and error scores from the Matching Familiar Figures Test, the Q score from the Porteus mazes, and behavioral observations. These correlations remained significant when both MA and CA were partialed out. Discriminant validity was demonstrated by a very low and nonsignificant correlation with IQ and MA. An orthogonal factor analysis resulted in 1 major factor, which was labeled Cognitive-Behavioral Self-Control. The relationship of SCRS scores to age, the differences across grade levels, and the differences between boys and girls were also examined. The 2nd study compared 32 children referred for self-control training with 32 nonreferred children matched on age (127.13 and 126.73 mo, respectively), sex, and IQ. Significant differences were found on the SCRS, Matching Familiar Figures Test latencies, and behavioral observations. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring response empathy: The development of a multicomponent rating scale.

Describes psychometric data on a new approach to the measurement of the empathic quality of counselor behavior. The Response Empathy Rating Scale (1) divides the empathy construct into a set of components tapping different aspects of empathic behavior; (2) provides greater specification of the construct; and (3) focuses on the empathic qualities of individual counselor responses. Results from 28 counselor/client (undergraduates) pairs indicate good interrater reliability. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The first 100 cases: a personal audit of orthodontic treatment assessed by the PAR (peer assessment rating) index

The first 100 consecutively started cases treated by a specialist registrar in orthodontics were examined and pre- and post-study models were scored using the peer assessment rating (PAR) index. The PAR index proved both simple and reproducible to use: 92 cases had post-treatment records available, 91 patients registered a drop in PAR score, and one patient registered an increase. Of these 92 patients, 38 (41%) were greatly improved, 43 (47%) were improved, and 11 (12%) were made worse or no different (ie they failed to achieve a 30% drop in PAR score). Of the factors examined, only the appliance type used was significantly related to PAR score change. Of the 11 cases apparently made worse, individual examination revealed that four of these represented beneficial occlusal changes but due to limited treatment goals they did not register as improved using the PAR index according to previously agreed criteria. The PAR index measures 'good tooth position' which, although very important, is not the only factor in orthodontic treatment. The use of the PAR index to detect 'good' and 'bad' orthodontic treatment is not without problems. Its use in mixed dentition and adjunctive orthodontic treatments may not always be appropriate.     

The development of a rating scale for the prediction of success in weight reduction

A valid and reliable rating instrument was developed that has predictive value with regard to the ability to lose weight. The major constructs that the test was intended to measure were knowledge of the pragmatics of weight reduction and obesity and the role of fantasy in weight loss. Test items were drawn from research findings in the obesity literature and from subject matter experts in the fields of nutrition, internal medicine and clinical psychology. Test-retest reliability coefficients for the new instrument range from .64 to .95. Construct validity was ascertained through administration of the scale to groups of high school students (N=20), college nutrition students (N=30) and successful and unsuccessful dieters (Ns=28 and 20, respectively). It appears that the scale, The Dash-Brown Survey of Fact and Fiction in Weight Reduction (DBS), may be employed usefully to assess the remediability of obesity for potential dieters. The data further suggest that cognitive awareness of diet-related issues is significant in weight reduction.     

Impact of cognitive-behavioral treatment on quality of life in panic disorder patients.

Panic disorder (PD) is associated with significant social and health consequences. The present study examined the impact of treatment on PD patients' quality of life. Patients (N?=?156) meeting DSM-III—R (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]; American Psychiatric Association, 1987) criteria for PD with agoraphobia were randomly assigned to group cognitive behavioral treatment (CBT) or a delayed-treatment control. An assessment battery measuring the major clinical features of PD as well as quality of life was administered at baseline (Week 0), post treatment (Week 9) and 6-month follow-up (Week 35). Consistent with previous studies, PD patients displayed significant impairment in quality of life at intake. Compared with delayed-treatment control participants, CBT-treated participants showed significant reductions in impairment that were maintained at follow-up. Consistent with prediction, anxiety and phobic avoidance were significantly associated with quality of life, whereas frequency of panic attacks was not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Organ preservation and quality of life: the quality of life of patients undergoing radiation therapy

In the definition of quality of life (QL) conventional medical indicators (rate of cure, disease-free survival, side-effects, costs) should be combined with those of the patient's personality the impact of the disease, the level of satisfaction, the general health conditions. This assessment being complex, obviously needs an integration of competences for correct decision making in diagnosis and treatment. In oncology, numerous attempts have been made towards the systematization of toxicity in radiotherapy based on physical and functional rather than multidimensional criteria. However the categorization of possible side-effects according to scoring systems already marks an improvement towards the quality assurance of care and thus the patient's quality of life.     

A new assessment of quality of life (QOL) for cancer patients

A new assessment of quality of life (QOL) was made for cancer patients. The QOL assessment consists of 12 items: pain; nausea; constipation; general fatigue; sleep; eating; activity; a daily life pattern; conversation; treatment acceptability; satisfaction at the present status and family exhaustion. Ranges of scores are one (best) to five (worst). For visual expression of QOL, the author made an original method called "QOL diagram", drawn with a circle which has 12 diverging lines marked five points indicating the score for each item. QOL changes after cancer pain control with either oral or intravenous morphine were examined in 22 adult cancer patients by the QOL assessment. Laxatives and anti-nausea drugs were mostly prescribed at the same time in order to avoid side effects of morphine. QOL was evaluated and recorded by the author through an individual interview with each patient. It was observed that the psychological factors were improved along with pain relief. Although items such as general fatigue, nausea, constipation, sleep and eating did not change considerably at first, they improved well with time in the oral morphine group. On the other hand, there was no marked time-dependent change in the intravenous morphine group. Items such as activity, a daily life pattern and conversation were rather negative than positive. These items seem to be more important to improve QOL of the cancer patients, in particular, whose general status is relatively good. In conclusion, the QOL diagram helped us to follow subtle changes of status and needs of cancer patients. And it enables us to easily assess risks and benefits of the treatment plans including palliative care and home supportive programs. It is designed for both patients and medical staffs to use easily and repeatedly. However, the further evaluation and refinement will be needed to verify validity and reliability of the QOL diagram before a routine clinical application.     

The life attitudes schedule: a scale to assess adolescent life-enhancing and life-threatening behaviors

The purpose of this study was to develop a questionnaire to measure suicidal and other risk-taking behaviors, the Life Attitudes Schedule (LAS), and to test a theoretical model that postulates a single domain of behaviors to which all life-threatening and life-enhancing behaviors belong. The LAS was developed and piloted on 1539 high school students and young adults. The schedule measures four different content categories: death related, health related, injury related, and self-related. Each content category includes an equal number of items designed to assess actions, thoughts, and feelings. Consistent with the theoretical model, the LAS includes positive (life-enhancing) and negative (life-threatening) behaviors. In this paper we present psychometric information for the LAS. The results are interpreted as providing support for a broad, bipolar conceptualization of suicidal and other risk-taking behavior that encompasses life-threatening and life-enhancing behaviors.     

The implant quality scale: a clinical assessment of the health--disease continuum

Implant success is as difficult to describe as the success criteria required for a tooth. A range from health to disease exists in both conditions. The primary criteria for assessing implant quality are pain and mobility. The presence of either one greatly compromises the implant, and removal is usually indicated. Probing depths may be related to the presence of local disease or pre-existing tissue thickness before the implant was inserted. An increasing probing depth is more diagnostic and signifies bone loss, gingival hyperplasia or hypertrophy. Bone loss is usually evaluated best with probing rather than with radiographs. The most common cause of bone loss during the first few years of function are exaggerated factors of stress. The bleeding index is easily observed and indicates inflammation of the gingiva. However, implant health status is not as related to sulcular inflammation as would be the case for a natural tooth. Implant failure is easier to describe and may consist of a variety of factors. Any pain, vertical mobility, uncontrolled progressive bone loss, and/or generalized periradiolucency warrant implant removal. Implant quality factors were established by James and modified by Misch into an implant quality scale which not only assesses the implant health-disease continuum, but relates treatment and prognosis to the existing conditions.     

Return to work after a myocardial infarction: evaluation of planned rehabilitation and of a predictive rating scale

This paper reports the first recorded controlled trial of cardiac rehabilitation after myocardial infarction in men of working age, viewed as a team intervention effort to facilitate the patient's return to normal work. Our results show that this intervention is helpful in returning to jobs which they can handle successfully men who would otherwise be at risk of remaining unemployed. A previously developed rating scale for predicting return to work after myocardial infarction was used and reevaluated. Employment and occupational level at admission to hospital, work history, availability of the previous job, educational level, family and social stability, age at which regular cigarette smoking commenced, and level of anxiety and depression on a personality scale proved highly predictive.     

Early and long-term results of 233 heart transplant patients in University Bordeaux in France: quality of life following heart transplantations

Between March 1986 and December 1993 we had 233 heart transplant patients who were 218 males and 15 females and had a mean age of 50.9 years (range, 2 to 65 years). We analyzed the actuarial survival for these patients and investigated the status of rehabilitation and return-to-work from the view point of quality of life after heart transplant. Actuarial survival (Kaplan-Meier) was 81.7% at 1 year, 76.3% at 3 years, and 72.2% at 5 years. In 57 dead patients 24 patients (42%) died in 1 month after heart transplant. In 176 living patients 165 patients (53%) returned to life. In 129 patients except 76 retired patients only 69 patients (53%) returned to work. In 60 patients, who didn't return to work, 38 patients (63%) were physically able to work.     

Prediction of improvement in treated and untreated patients using the Rorschach prognostic rating scale.

An attempt was made to evaluate the predictive validity for improvement of the Rorschach Prognostic Rating Scale (RPRS) and the MMPI. A group of untreated psychiatric outpatients (N = 40) and a group of outpatients treated with psychotherapy (N = 21) were given the Rorschach and MMPI before their assignment to the treatment or waiting list groups. After a waiting or treatment period of approximately 6 mo., each patient was clinically rated as improved or unimproved. The RPRS was significantly (p     

The chronic illness quality of life (CIQOL) model: Explaining life satisfaction in people living with HIV disease.

The chronic illness quality of life (CIQOL) model theorizes that life satisfaction in persons living with a chronic illness such as HIV disease is a function of illness-related discrimination, barriers to health care and social services, physical well-being, social support, and coping. The CIQOL model was evaluated using data from 275 persons living with HIV disease. Women reported less life satisfaction and confronted more barriers to health care and social services than men, and White participants reported higher perceptions of AIDS-related discrimination than non-White participants. The CIQOL model provided an excellent fit to study data (root-mean-square error of approximation = .03) and accounted for almost a third of the variance in life satisfaction scores. Barriers to health care and social services played a particularly prominent role in the model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward a developmental psychology of Sehnsucht (life longings): The optimal (utopian) life.

The topic of an optimal or utopian life has received much attention across the humanities and the arts but not in psychology. The German concept of Sehnsucht captures individual and collective thoughts and feelings about one's optimal or utopian life. Sehnsucht (life longings; LLs) is defined as an intense desire for alternative states and realizations of life. Presenting a first effort at capturing this phenomenon, the authors conceptualize LLs as composed of 6 interrelated core characteristics: (a) utopian conceptions of ideal development; (b) sense of incompleteness and imperfection of life; (c) conjoint time focus on the past, present, and future; (d) ambivalent (bittersweet) emotions; (e) reflection and evaluation of one's life; and (f) symbolic richness. Self-report data from 299 adults (19-81 years) support the postulated structure and support predictions regarding the functional role of Sehnsucht. Having LLs was evaluated as providing direction to development and helping to manage life's incompleteness. At the same time, the frequent and intense experience of LLs was associated with lower well-being. When LLs were perceived as controllable, however, this negative association disappeared. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological interventions for cancer patients to enhance the quality of life.

Although the thrust of the nation's cancer objectives for the year 2000 is prevention and screening, each year approximately 1 million Americans are diagnosed and must cope with the disease and treatments. They do so with the aid of family, friends, and the health care system, but accumulating data suggest that psychological interventions may be important for reducing emotional distress, enhancing coping, and improving "adjustment." Experimental and quasi-experimental studies of psychological interventions are reviewed, and a discussion of treatment components and mechanism is offered. A final section discusses future research directions and challenges to scientific advance. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Patient satisfaction as an index of the quality of medical care (according to data of a sociologic survey)

Sociological survey has been carried out in 2 hospitals of Irkutsk. 600 respondents were asked to express their opinion on the quality of medical care and offer proposals on improvement of hospital care.