Added value of co-morbidity in predicting health-related quality of life in COPD patients

AbstractThe extent to which a chronic obstructive pulmonary disease (COPD) patient is impaired in health-related quality of life (HRQoL) is only to a small extent reflected in clinical and demographical measures. As the influence of co-morbidity on HRQoL is less clear, we investigated the added value of 23 common diseases in predicting HRQoL in COPD patients with mild to severe airways obstruction.COPD patients from general practice who appeared to have an forced expiratory volume in 1 sec/inspiratory vital capacity (FEV1/IVC) < predicted −1·64 SD, FEV1<80% predicted, FEV1reversibility <12% and a smoking history, were included (n=163). HRQoL was assessed with the short-form-36 (SF-36) and the presence of co-morbidity was determined by a questionnaire, which asked for 23 common diseases.All domains of the SF-36 were best predicted by the presence of three or more co-morbid diseases. FEV1% predicted, dyspnoea and the presence of one or two diseases were second-best predictors. Co-morbidity explained an additional part of the variance in HRQoL, particularly for emotional functioning (ΔR2=0·11). When individual diseases were investigated, only insomnia appeared to be related to HRQoL.As HRQoL is still only partly explained, co-morbidity and other patient characteristics do not clearly distinguish between COPD patients with severe impairments in HRQoL and COPD patients with minor or no impairments in HRQoL. Therefore, it remains important to ask for problems in daily functioning and well-being, rather than to rely on patient characteristics alone

Unbearability of suffering at the end of life: the development of a new measuring device, the SOS-V

AbstractBackgroundUnbearable suffering is an important issue in end-of-life decisions. However, there has been no systematic, prospective, patient-oriented research which has focused on unbearable suffering, nor is there a suitable measurement instrument. This article describes the methodological development of a quantitative instrument to measure the nature and intensity of unbearable suffering, practical aspects of its use in end-stage cancer patients in general practice, and studies content validity and psychometric properties.MethodsRecognizing the conceptual difference between unbearability of suffering and extent or intensity of suffering, we developed an instrument. The compilation of aspects considered to be of importance was based on a literature search. Psychometric properties were determined on results of the first interviews with 64 end-stage cancer patients that participated in a longitudinal study in the Netherlands.ResultsThe instrument measures five domains: medical signs and symptoms, loss of function, personal aspects, aspects of environment, and nature and prognosis of the disease. Sixty nine aspects were investigated, and an overall score was asked. In 64 end-stage cancer patients the instrument was used in total 153 times with an average interview time varying from 20-40 minutes. Cronbachs alpha's of the subscales were in majority above 0.7. The sum scores of (sub)scales were correlated strongly to overall measures on suffering.ConclusionThe SOS-V is an instrument for measuring the unbearability of suffering in end-stage cancer patients with good content validity and psychometric properties, which is feasible to be used in practice. This structured instrument makes it possible to identify and study unbearable suffering in a quantitative and patient-oriented way

Adequate Help for Patients with Cervical Cancer ADEQUATE HELP FOR PATIENTS WITH CERVICAL CANCER? THE REFERRAL SYSTEM IN INDONESIA. A DESCRIPTIVE COMPARISON STUDY IN FOUR PROVINCES

ABSTRACT Backgroun

Psychiatrische problemen bij een motorische ziekte: Psychose bij de ziekte van Huntington

Huntington's disease is characterised by a triad of motor symptoms (choreic movements), psychiatric symptoms and cognitive decline. Much less is known about the psychiatric symptoms such as psychosis and anxiety than about the motor symptoms. We discuss the case of a patient with Huntington's disease and psychosis and comment on the possible types of medication that should be used

Kennis van huisartsen over chronische aandoeningen

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The Netherlands

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Towards a new clinical tool for needs assessment in the palliative care of cancer patients: the PNPC instrument.

Contains fulltext : 59243.pdf (publisher's version ) (Closed access)This study describes a new clinical tool for needs assessment in palliative care: the Problems and Needs in Palliative Care questionnaire (PNPC). It was developed to support the provision of care tailored to the specific demands of patients, which only can be provided when their needs are clearly identified. To test validity and reliability, 64 patients with metastatic cancer living at home completed the PNPC. Of 140 initial items, 2 were deleted because of low response. No important topics were missing. Dimensions were proposed to organize the problems and needs in a logical and practical array for use in individual patients, and to enable statistical analysis of patient-groups. Reliability analysis supported the proposed dimensions, with Cronbach's alpha coefficient >0.70 for dimensions with > or = 5 items, and alpha >0.65 for the 3- and 4-item dimensions. However, the dimensions 'physical symptoms' and 'social issues' lacked coherency with some low item-total correlations. The PNPC demonstrated convergent validity with the European Organization for Research and Treatment of Cancer (EORTC) and COOP-WONCA quality-of-life measures. These data are a first step in validating the PNPC, although the 'social issues' dimension needs reconsideration. Further studies are needed to evaluate clinical use

Assessment of the need for palliative care as perceived by individual cancer patients and their families.

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