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Detecting When "Quality of Life" Has Been "Enhanced": Estimating Change in Quality of Life Ratings.

ABSTRACT: OBJECTIVE:To demonstrate challenges in the estimation of change in quality of life (QOL). METHODS:Data were taken from a completed clinical trial with negative results. Responses to 13 QOL items were obtained 12 months apart from 258 persons with Alzheimer's disease (AD) participating in a randomized, placebo-controlled clinical trial with two treatment arms. Two analyses to estimate whether "change" in QOL occurred over 12 months are described. A simple difference (later - earlier) was calculated from total scores (standard approach). A Qualified Change algorithm (novel approach) was applied to each item: differences in ratings were classified as either: improved, worsened, stayed poor, or stayed "positive" (fair, good, excellent). The strengths of evidence supporting a claim that "QOL changed", derived from the two analyses, were compared by considering plausible alternative explanations for, and interpretations of, results obtained under each approach. RESULTS:Total score approach: QOL total scores decreased, on average, in the two treatment (both -1.0, p < 0.05), but not the placebo (=-0.59, p > 0.3) groups. Qualified change approach: Roughly 60% of all change in QOL items was worsening in every arm; 17% - 42% of all subjects experienced change in each item. CONCLUSIONS:Totalling the subjective QOL item ratings collapses over items, and suggests a potentially misleading "overall" level of change (or no change, as in the placebo arm). Leaving the items as individual components of "quality" of life they were intended to capture, and qualifying the direction and amount of change in each, suggests that at least 17% of any group experienced change on every item, with 60% of all observed change being worsening. DISCUSSION:Summarizing QOL item ratings as a total "score" collapses over the face-valid, multi-dimensional components of the construct "quality of life". Qualified Change provides robust evidence of changes to QOL or "enhancements of" life quality.

SUBMITTER: Tractenberg RE

PROVIDER: S-EPMC4514524 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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Detecting When "Quality of Life" Has Been "Enhanced": Estimating Change in Quality of Life Ratings.

Tractenberg Rochelle E RE Yumoto Futoshi F Aisen Paul S PS

Open journal of philosophy 20131101 4A

<h4>Objective</h4>To demonstrate challenges in the estimation of change in quality of life (QOL).<h4>Methods</h4>Data were taken from a completed clinical trial with negative results. Responses to 13 QOL items were obtained 12 months apart from 258 persons with Alzheimer's disease (AD) participating in a randomized, placebo-controlled clinical trial with two treatment arms. Two analyses to estimate whether "change" in QOL occurred over 12 months are described. A simple difference (later - earlie ...[more]

PMID: 26213645

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Project description:When a cardiac arrest occurs, it is necessary to perform cardiopulmonary resuscitation (CPR) as soon as possible. This requires maintaining the pressure depth at 5 cm at a rate of 100 cpm. For CPR machines, which are frequently used in ambulances, the return of spontaneous circulation (ROSC) is not superior to that of manual CPR, although CPR machines can maintain the compression rate and reciprocal distance of the compression plate more accurately. When the thoracic cavity is deformed due to repeated chest compressions, CPR machines must be adjusted. It is necessary to develop a method for measuring whether adequate CPR is achieved using CPR machines. CPR was performed on two pigs with a CPR machine, commencing 1 minute after the heart was stopped. Four CPR modes were used, with compression rates of 60 or 100 cpm and compression depths of 3 or 5 cm. The CPR machine was equipped with a load cell for measuring compression force, and a potentiometer for measuring compression depth. The measurement results obtained from the sensor were used to calculate the frequency components. The compression force and depth data were used to calculate the mechanical power of the CPR machine and mechanical impedance of the thoracic cavity. Changes in end-tidal carbon dioxide (ETCO2), coronary perfusion pressure (CPP), carotid blood flow (CBF), and right atrial pressure (RAP) were measured during performance of CPR; change in RAP refers to variation therein with chest compressions. Continuous CPR in both animals resulted in deformation of the chest cavity and a steady decline in impedance. The correlation between CPR power and change in RAP was 0.78, and that between compression force and CBF was 0.64. Impedance was not correlated with blood pressure or CBF. When the condition of the animal deteriorated due to cardiac arrest, the CPP decreased and ETCO2 increased. The CPR power and RAP varied according to the CPR mode rather than the condition of the animal. Measuring the CPR machine power does not require a separate procedure, such as catheter intubation, so should be suitable as an index of the quality of CPR in emergency situations.

Dataset Information

Detecting When "Quality of Life" Has Been "Enhanced": Estimating Change in Quality of Life Ratings.

Publications

Detecting When "Quality of Life" Has Been "Enhanced": Estimating Change in Quality of Life Ratings.

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