Quality of life of people with schizophrenia in the supported group homes: assessing the individual

The study assessed the individual quality of life of people with schizophrenia who live in the supported group homes. Forty residents in seven group homes were interviewed using The Schedule for the Evaluation of Individual Quality of Life: A Direct Weighting Procedure Instrument (SEIQoL-DW). The SEIQoL-DW assesses the individualised QoL using semi-structured interview technique. The definition underpinning the SEIQoL-DW is that a person's QoL is what he or she determines it to be. The respondents defined the areas that are important to them, rated their current situation on each LQ-area as well as the relative importance of each area by using visual analogue scale (VAS 0-100). The mean QoL score was 64.71 (SD 19.05, range 6.81-93.49). A total of 18 QoL areas were formed of 200 individually nominated cues. The areas most frequently nominated by respondents were "human relations", "social life", "work", "leisure time", "finances and other material desires", "quality of living space", "autonomy" and "health". It showed clearly that nominated QoL-areas had for each respondent individual meaning as well as individual importance in his or her life. A positive correlation was found between length of stay in supported home and global quality of life. In addition, the respondents who had lived in supported home for a longer period rated their current situation higher with respect to autonomy, work and finding the meaning of life than respondents with shorter duration of stay. The individual nature of QoL was reflected in differences in QoL-areas defined, differences in levels of satisfaction, and differences in the relative importance of each LQ-area to individuals. The measures were generally acceptable, with all respondents showing great interest and being able of completing the SEIQoL-DW. This study showed also that instruments such as the SEIQoL-DW might have a therapeutic application for people with psychiatric disorders.     

Individual quality of life following radical prostatectomy in men with prostate cancer

PURPOSE: The aim of this study was to examine the individual quality of life (QoL) of men following radical prostatectomy for prostate cancer. The following research questions were addressed: (a) What are the most important areas of quality of life for men following radical prostatectomy? (b) How do these men rate their satisfaction in each area and what is the relative importance of each area to their overall quality of life? METHODS: The purposive sample consisted of 11 men with prostate cancer who had undergone a radical prostatectomy 3 to 4 months earlier. QoL was examined using the SEIQoL-DW (Schedule for the Evaluation of Individual QoL: A Direct Weighting Procedure). The data were analyzed by means of qualitative content analysis (five most important QoL areas). FINDINGS: The 11 respondents named a total of 55 QoL areas which they described and labelled. They then rated their current satisfaction in each area, and how important each one was to them. A second analysis of the content was made to identify the main QoL areas. The 55 quality of life areas mentioned by respondents were reduced to the following categories: health, activity, family, relationship with a partner, autonomy, independence, hobby, financial security, and sexuality. Health, family, and relationship with a partner are the thee areas which had the most impact on QoL. Overall, the respondents had a high quality of life value. Impotence and incontinence did not appear to have a very negative impact on quality of life. CONCLUSIONS: SEIQoL-DW was used for the first time in patients with prostate cancer. In a urology department where nurses and patients are confronted daily with the topics of intimacy, sexuality, and sense of embarrassment, more importance should be placed on the topic of sexuality when taking a patient history. Nurses should be trained in communication techniques that enable them to engage patients in a safe and therapeutic dialogue about their sexual concerns related to the diagnosis of prostate cancer. SEIQoL-DW can support the communication with patients.     

Quality of life assessed with Short Form 36 – a comparison between two populations with long-term musculoskeletal pain disorders

Purpose.?To assess quality of life (QoL) in two groups of patients with long-term musculoskeletal pain with and without psychiatric co-morbidity and to compare them with a reference group of normative controls. The patients in both study groups were sick-listed full or part time for 3 months or more.

Method.?The patients were recruited from a company health service and consulting psychiatry. A generic QoL questionnaire, the SF-36, was used to assess QoL. Each group was compared with age- and gender-matched normative controls.

Results.?Both groups reported a pronounced impairment of QoL (p?<?0.001) compared with their age- and gender-matched populations. The greatest impairment was seen among the patients referred for psychiatric assessment (n?=?30). The patients in the company health service (n?=?42) reported significantly higher QoL with regard to the dimensions mental health (p?<?0.028), social functioning (p?<?0.034) and role emotional (p?<?0.040) compared with the patients referred for psychiatric assessment.

Conclusion.?Patients with long-term pain in the company health care and patients with psychiatric co-morbidity, sick-listed full or part-time reported severely impaired QoL with regard both to physical, social and mental dimensions. Psychiatric co-morbidity reported even more pronounced impairment of emotional, social and mental dimensions of QoL which might indicate dysfunctional coping strategies.     

Factors associated with lower quality of life among patients receiving palliative care

Title.  Factors associated with lower quality of life among patients receiving palliative care.
Aim.  This paper is a report of a study conducted to (1) assess the quality of life (QoL) and physical functioning status of patients diagnosed with advanced cancer and receiving palliative care; (2) determine if there was a statistically significant relationship between their physical functioning and QoL and (3) identify the demographic and disease-related variables related to their QoL.
Background.  Achieving the best possible QoL is a major goal in palliative care. However, research findings about the relationship between QoL and demographic variables have been inconsistent.
Method.  Three hundred patients with advanced cancer were recruited from four district hospitals in Hong Kong between February 2005 and July 2006. Their QoL and physical functioning status were assessed by face-to-face interview, using the McGill Quality of Life Questionnaire (Hong Kong version) and the Palliative Performance Scale respectively.
Results.  Participants reported reduced ambulation, inability to perform hobbies or housework, and the need for occasional assistance in self-care (mean: 64·6 out of 100, sd : 19·3, range: 20–100). QoL was fair (mean: 6·2 out of 10, sd : 1·5, range: 0·9–10). There was a weak positive association between physical functioning and QoL scores. Multiple regression analysis showed that patients who were older, female, had ever been married, or had higher physical functioning tended to have better QoL.
Conclusion.  More could be done in symptom and psychosocial management to improve patients' QoL, in particular for those who are younger, male or single, or who have lower physical functioning.     

Quality of life and Kaposi sarcoma: using preference techniques to value the health gains from treatment

The goal of this work was to investigate preference techniques to value potential health gains from treatments of Kaposi sarcoma (KS). The study was designed to take the form of face-to-face interviews with a sample of men with a history of HIV/AIDS ( n=15) or HIV/AIDS and KS ( n=17). The main outcome measure was quality of life (QoL) associated with various KS disease states expressed on a scale from 0 (death) to 1 (perfect health), obtained though time trade-off (TTO) and rating scale techniques. For cutaneous lesions only, the mean TTO preference score value was 0.27. In other words, the men were willing to trade a life expectancy of 5 years for a shorter period (1.4 years) in perfect health. More severe KS health states were rated lower (0.07-0.09). The mean rating scale value for cutaneous lesions only was 0.11 and ranged from -0.10 to -0.04 for the more severe conditions; these values were systematically lower than the TTO ( P=0.014). A large overall potential gain in QoL from treatment (partial response minus stable disease) was found for each condition to be reflected in both the TTO (from 0.31 to 0.55) and the rating scale (from 0.38 to 0.44). Respondents associate KS health states with extremely poor QoL and indicate that large gains are possible through modest treatment effects. While TTO returns higher values than the rating scale, potential gains from treatments were similar. The techniques appear to be suitable for application to QoL and economic evaluation of treatments of KS.     

Quality of life in Jordanian children with asthma

The purpose of this study was to describe how Jordanian children with asthma experience their quality of life (QoL). Two hundred children with asthma (34% girls and 66% boys) participated in the study. The Paediatric Asthma Quality of Life Questionnaire was used to measure how children with asthma disease impaired their daily life during the previous week on three domains: ‘activity limitations’, ‘symptoms’ and ‘emotional function’. The main finding of this study was that children with asthma scored their QoL towards the negative end of the scale, but they scored more limitations in the domain of activities than in emotions and symptoms. Children reported that the most restricted activity was their ability to run. Younger children, being a girl and living in the rural areas, were associated with lower QoL. The children in the present study might not comply with their health regimen, and this might gave a darker view of the daily life of children with asthma. Further studies of Jordanian children and their QoL were suggested to identify and support the factors which influence QoL of children with asthma and other chronic diseases in Jordan.     

Effect of the disclosure of MS diagnosis on anxiety, mood and quality of life of patients: a prospective study

Background: In the light of the new diagnostic criteria for multiple sclerosis (MS) and currently available early treatment, this study aimed to explore whether, and to what extent, disclosure of the diagnosis of MS or clinically isolated syndrome (CIS) affects patients’ anxiety, mood and quality of life (QoL). Methods: Eligible participants were all patients referred for the first time to the Neurological Unit who had manifested symptoms suggestive of MS for no more than 6 months. All patients were evaluated for (i) QoL (SEIQoL and MS‐QoL54), (ii) Anxiety (STAI) and Depression (CMDI) on study inclusion (T0), 30 days after diagnosis disclosure (T30), and after 1 (T1y) and 2 (T2y) years’ follow‐up. Results: Two hundred and twenty‐nine patients were enrolled; 93 of these were unaware of their diagnosis. Patients who already knew their diagnosis (100 with CIS and 22 with MS) were excluded from the main analyses and used to perform control analyses. At the end of the screening, an MS diagnosis was disclosed to 18 of the 93 patients, whereas a CIS diagnosis was disclosed to 62 patients (12 patients received a diagnosis other than MS or CIS). Thirty days after diagnosis disclosure, irrespective of the diagnosis disclosed, both QoL and Anxiety and Depression were significantly rated as better compared to the start of screening, (p_s < 0.03), and this improvement remained stable over the two annual follow‐ups. However, as suggested by a significant ‘Time’ × ‘Diagnosis’ interaction with regard to both QoL and Anxiety and Depression (p_s < 0.02), the effect of the disclosure in the short term differed depending on CIS or MS diagnosis. Specifically, on MSQoL, which is a health‐related QoL scale, we found a statically significant improvement, immediately after the diagnosis disclosure, in both the MS and CIS groups (p_s < 0.01). Differently, on SEIQoL, which is a non health‐related QoL measure, and on the anxiety scale, we observed a statistically significant improvement only in the group which received a MS diagnosis (p_s < 0.03). Conclusions: This first prospective study provides objective data showing that early disclosure of MS diagnosis improves both the patient’s QoL and psychological well‐being. In addition, the results seem to suggest that CIS disclosure does not lead to the same favourable effects.     

Validity and reliability study of the Turkish psychiatric nurses of job motivation scale

This methodological study was planned to explore the validity and reliability of the evaluation scale for measuring the job motivation of nurses who work in psychiatric clinics. The sample was composed of 378 nurses who work in all psychiatric units or psychiatric hospitals located in Turkey's four large cities – Ankara, Istanbul, Izmir and Manisa. For testing reliability of 'job motivation scale', the internal consistency tests were executed with split scale analysis, Cronbach's α coefficient and item–total score correlation. For construct validity, factor analysis was used. For the first part of scale, Cronbach's α was determined to be 0.79. For the second part, Cronbach's α was 0.72. Factor analysis was performed in an attempt to establish validity and underlying associations between items in the scale. The first analysis produced nine eigenvalues (>1) and nine factors were extracted. The scree test indicated that a two-factor model would be suitable. The factor structure of the tool for measuring the job motivation of nurses who work in psychiatric clinics was parallel with motivation concepts. Validity and reliability levels of the scale for measuring the job motivation of nurses who work in psychiatric clinics were found to be sufficient in the Turkish population.     

Psychiatric patients' perception of music therapy and other psychoeducational programming

The purpose of this study was to quantitatively evaluate psychiatric patients' perception of their psychoeducational programming. Participants (N = 73) completed a survey rating on each class/therapy in which they were enrolled and its helpfulness. Participants answered questions concerning which class/therapy addressed specific psychiatric deficit areas most effectively. Results indicated that participants rated music therapy as significantly more helpful than all other programming (p < .05). Further analyses indicated that participants admitted to a psychiatric institution only once rated their classes as more helpful when compared to participants who had been admitted multiple times. Additionally, participants who were minorities rated programming as more helpful than participants who were Caucasian. Participants consistently rated music therapy as more effective than other programming in addressing specific psychiatric deficit areas. Additionally, 57% of participants noted that music therapy was their favorite class/therapy. Reasons for these discrepancies are discussed and suggestions for future research are made.     

An Assessment of Clinical Wound Evaluation Scales

Abstract. Objective : To compare 2 clinical wound scales and to determine a minimal clinically important difference (MCID) on the visual analog cosmesis scale. Methods : Using data from 2 previously published clinical trials, 91 lacerations and 43 surgical incisions were assessed on the 2 scales; a 100-mm visual analog scale (VAS) (0 = worst possible scar, 100 = best possible scar) and a wound evaluation scale (WES) assessing 6 clinical variables (a score of 6 is considered optimal, while a score of ≤5 suboptimal). All wound assessments on the VAS were done by 2 cosmetic surgeons who rated photographs on 2 occasions. A cohort of wounds on the WES were assessed by a second observer. The difference of the mean optimal and suboptimal VAS scores for each study was used to determine a MCID on the VAS scale. Results : The VAS scale yielded intraobserver agreements of 0.93 and 0.87 (95% CI: 0.89–0.96 and 0.78–0.93) and interobserver agreements of 0.50 and 0.71 (95% CI: 0.32–0.65 and 0.52–0.84) for lacerations and incisions, respectively. Kappa coefficient measuring agreement on the WES was 0.79 (95% CI: 0.57–1.0). The mean (±SD) VAS scores of optimal wounds were 72 ± 12 mm and 65 ± 20 mm, while the mean scores of suboptimal wounds were 57 ± 17 mm and 50 ± 23 mm for lacerations and incisions, respectively. Conclusions : An MCID on the VAS cosmesis scale is 15 mm. Studies should be designed to have a sample size and power to detect this difference.     

Quality of life change and response shift in patients admitted to palliative care units: a pilot study

This pilot study was carried out to determine to what extent patients admitted to palliative care units (PCUs) in The Netherlands maintained good levels of individual quality of life (QoL), and to what extent response shift - a measure of adaptation - influenced QoL at the end of life. Two components of response shift were measured: reconceptualization (exchanging important areas of life) and value change (changing the perceived importance of important areas of life). Twenty patients admitted to PCUs were interviewed at one week, three weeks, and five weeks after admission. Results show that individual QoL was high and remained stable over the three measurement points. The individual QoL of patients who did not reconceptualize or did not change values was higher than the individual QoL of patients who did. The current pilot data need to be corroborated with data from additional respondents.     

Life after the mental hospital: the way of life of deinstitutionalized psychiatric patients

This article describes and analyses the way of life of deinstitutionalized long-term psychiatric patients in Northern Finland. The major focus of the paper is the central areas of life of the outpatients as one dimension of subjectivity. The data were collected by interviewing 25 discharged long-term psychiatric patients. The findings suggest that home was the central area of life for the outpatients but they differed in their relation to it. Some of the patients were actively building their home. For some others home was an asylum in which to hide from social life. Many patients had hobbies that only took place inside their homes. One of the problems that the outpatients had to face was lack of work. The elderly patients who generally regarded work as a virtue experienced difficulties in finding something to do in their modern suburban homes. Social participation was mostly labelled by the old and familiar hospital models. The patients had no new acquaintances. They kept contact with their former fellow patients.     

When the safe place does not protect: reports of victimisation and adverse experiences in psychiatric institutions

Psychiatric patients report higher levels of victimisation and are at risk for further victimisation in different contexts, such as psychiatric institutions. Studies in this field tend to focus on hospital staff as victims, experiencing classic forms of victimisation (e.g. physical assault, threats, verbal abuse), through qualitative studies. This is a quantitative retrospective study that aims to know the occurrence of psychiatric victimisation and other adverse experiences in Portuguese psychiatric patients. Ninety‐five psychiatric patients, between 20 and 79 years old (M – 45.18, SD – 13.06), with a history of psychiatric hospitalisation answered the Experiences in Psychiatric Institution Inventory. Participants were recruited in four psychiatric hospitals. Inpatients were approached during their hospitalisation; outpatients were approached in scheduled appointment days. Only 23 (24.2%) participants reported no victimisation. Total Experiences of Self varied from 0 to 7 (M – 1.75, SD – 1.72), Total Witnessed Experiences varied from 0 to 7 (M – 1.17, SD – 1.64), and Total Global Experiences varied from 0 to 14 (M – 2.92, SD – 3.01). These results show that victimisation and adverse experiences in psychiatric contexts are frequent and go beyond classic forms of victimisation. A deeper knowledge of these experiences and their impact in the mental health of psychiatric patients may promote quality of care provided and lead to more effective treatments, thus reducing the number and length of hospitalisations, and the financial burden for public health services.     

Asthma--quality of life for Swedish children

Aims and objectives. The purpose of this study was to describe how Swedish children with asthma experience their QoL and to search for possible associations between their experience of QoL and some determinants. Background. Asthma is a chronic disorder that can restrict a child's life, physically, emotionally, socially and spiritually, and this has an impact on a child's quality of life (QoL). Methods. Two hundred and twenty‐six children with asthma (37% girls and 63% boys) and 371 parents of these children participated in the study. The Paediatric Asthma Quality Of Life Questionnaire (PAQLQ) was used to measure the children's QoL. This questionnaire reveals how the children's asthma interferes with their normal activities, their symptoms and how this interference has made them feel. Results. The findings show that most children with asthma estimated their QoL towards the positive end of the scale. The children reported more impairment in the domain of activities than in emotions and symptoms. The most commonly restricted activity was the children's ability to run. Significant associations were found between a higher QoL outcome and being a boy, as well as living in the south of Sweden. A higher QoL was also found in children with mothers older than 40 years of age and in children with cohabiting parents. It was also associated with their fathers’ QoL in a positive direction. Conclusions. It is important that children with asthma will maintain a high QoL. In this study the children were being treated with asthma medication when they evaluated their QoL. Perhaps this fact might have influenced the results in a positive direction. Relevance to clinical practice. The findings of our study underline the importance of accurate nursing assessment including background variables of the children. Nurses also have to be aware that some of the children in the study have a low QoL and these children must not be forgotten. In addition, as caring tends to focus on the patients’ limitations, another important issue for nurses is to try to discover those aspects in a child's daily life that contribute to a high QoL in order to improve and maintain the child's wellbeing.     

Neuropsychiatric side-effects of lidocaine: examples from the treatment of headache and a review

Lidocaine has been used in treatment of patients with refractory headache. Personal observations of neuropsychiatric toxicity in these patients led us to review our cases and the literature systematically for lidocaine side-effects, especially neuropsychiatric symptoms. In our series of 20 patients, side-effects were observed in all, the most frequent being neuropsychiatric (75%) and cardiological (50%). When reviewing published series on intravenous lidocaine use, reports of side-effects range from 0 to 100%, with neuropsychiatric symptoms being reported in 1.8–100%. Thirty-six case reports of lidocaine-induced psychiatric symptoms were also analysed. Psychiatric symptoms of toxicity were similar in most patients, despite their differing ages, pathologies, co-therapies and lidocaine dosages. In conclusion, lidocaine neuropsychiatric toxicity has a well-recognized stereotypical clinical presentation that is probably unrecognized in headache series. As lidocaine represents an emerging alternative therapy in headache, particularly in short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, clinicians and patients should be aware of the extent of this problem.     

Preliminary reliability of an observer rating scale for assessing medication adherence on psychiatric wards

Objectives  Medication non-adherence is a major contributor to poor outcomes following discharge from psychiatric hospitals. It is therefore imperative that staff are able to accurately assess the extent to which patients have engaged with treatment. This study presents data on a new observer rating instrument of patient medication adherence.
Methods  Staff participating in a medication adherence training programme ('Medication Alliance') were given a brief overview of the Observer Rating of Medication Taking (ORMT) scale. Participants then watched six video vignettes of patient adherence behaviour and provided a rating on their scale for each vignette. Participant ratings were then compared with 'expert' ratings.
Results  Percentage agreement between 'experts' and participants ranged from a low of 68% through to 98% agreement. Only one vignette was rated significantly differently [ Mdiff  = 0.33, t (49) = 2.08, P  = 0.007], with 32% of people falling outside the expert rating range (all of those ratings being higher). This difference was attributed to between group differences, [ F (2,47) = 3.49, P  < 0.05] and post hoc assessment suggested that the differences between expert and trainee ratings for the vignette may be explained by trainee characteristics, as distinct from inherent characteristics of the rating scale.
Conclusion  The ORMT can help mental health professionals identify particular non-adherent behaviours thus facilitating identification and treatment of likely non-adherence before discharge. The scale appears to be accessible to a variety of professions with a range of experience and requires minimum training in order to be used reliably.     

Reduced quality of life in ICU survivors - the story behind the numbers: A mixed methods study

PurposeTo gain insight into the daily functioning of ICU survivors who reported a reduced quality of life (QoL) one year after ICU admission.Materials and methodsA two-phase mixed method study design. QoL was assessed using the SF-36 questionnaire before admission and after one year (Phase 1). Participants reporting a reduced QoL were invited for an in-depth interview (Phase 2). Interview data were coded thematically using the PROMIS framework.ResultsOf the 797 participants, 173 (22%) reported a reduced QoL, of which 19 purposively selected patients were interviewed. In line with their questionnaire scores, most participants described their QoL as reduced. They suffered from physical, mental and/or cognitive problems, impacting their daily life, restricting hobbies, work, and social activities. A new balance in life, including relationships, had to be found. Some interviewees experienced no changes in their QoL; they were grateful for being alive, set new life priorities, and were able to accept their life with its limitations.ConclusionsReduction in QoL is due to physical, mental, and cognitive health problems, restricting participants what they want to do. However, QoL was not only affected by the critical illness, but also by factors including independency, comorbidity, and life events.Registration: NCT03246334 (clinical trials.gov).     

Quality of Life with Atrial Fibrillation: Do the Spouses Suffer as Much as the Patients?

Background: Atrial fibrillation (AF) can have a significant effect on quality of life (QoL). Other chronic diseases are known to not only affect the patient but to also impact the QoL of persons living with them. Scant data exist on the QoL effect of AF in spouses/significant others (SOs). Methods: An anonymous survey regarding the perceived effect of AF on QoL was designed and distributed to both patients and spouses/SOs during an educational symposium about living with AF. Both were asked to fill out the survey independently according to how their life was affected by either their AF or their partner's AF. Questions included demographics, perceived impairment of overall QoL on a 5‐point scale, as well as effect on subcategories of QoL, namely daily activity, work life, sex life, physical activity, psychological well‐being, and social activity. Results: Five hundred and sixty‐eight subjects completed the survey of which 411 were AF patients and 129 were spouses/SOs. The perceived effect of AF on overall QoL (N = 527) was similar in patients and spouses (AF patients: mild 42.0%, moderate 26.0%, severe 32.0% vs. spouses: 44.1%, 25.2%, 31.7%; P = 0.917). This result did not change when adjusted for age and gender. There was also no significant difference between patients and spouses in the subcategories of QoL with the exception of the perceived effect on work life, which was greater in patients than spouses (P = 0.041). Conclusions: AF has a similar perceived impact on the QoL of spouses and patients. QoL improvement strategies for patients with AF should take spouses into account. (PACE 2011; 34:804–809)