ФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация Изучение показателя качества жизни прижизненных органных доноров в трансплантологии с помощью опросников все чаще становится предметом клинических исследований. Однако не существует единых критериев и стандартных норм качества жизни. Каждый опросник имеет свои критерии и шкалу оценки. В настоящем обзоре представлены основные общие опросники, которые были применены в мировой практике для оценки качества жизни прижизненных доноров почки и фрагмента печени. Рассмотрены специальные опросники, применяемые для уточнения интересующих параметров качества жизни и их согласование с общими опросниками. Выявлен оптимальный опросник для проведения современных исследований качества жизни прижизненных органных доноров.Ключевые слова: прижизненный донор; качество жизни; опросник SF-36. aSSeSSMenT MeThODS Of QualiTY Of life Of liVinG OrGan DOnOrS S.V. Gautier, V.K. Konstantinov V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian FederationThe study of quality of life of living organ donors in transplantation by questionnaires has increasingly become the subject of clinical studies. However, there are no unified criteria and standard norms of quality of life. Each questionnaire has its own criteria and evaluation scale. This review presents the main general questionnaires that have been applied worldwide for the quality of life assessment of living kidney and liver donors. Special questionnaires used to refine the parameters of quality of life and their coordination with common questionnaires are considered. Optimal questionnaire to detect quality of life in modern research for living organ donors is identified.
In a study concerning a group of cancer patients undergoing radiotherapy three research questions were addressed. (1) Is fatigue a valid criterion for depression in these somatically ill patients? (2) What is the 'cause-andeffect' relation between fatigue and depression? (3) To what extent are fatigue and depression related to patients' quality of life. A heterogeneous sample of cancer patients (n p 250) were interviewed before treatment, 2 weeks after treatment and 9 months later. Fatigue was measured using the MFI, a self-report instrument covering five dimensions of fatigue. Depression was assessed with the non-somatic items of the CES-D. Quality of life had to be indicated on a Cantrill ladder. Fatigue and depression do not follow the same course over time. Just after radiotherapy, fatigue had either increased or remained stable, depending on the dimension under consideration. Depression, in contrast, decreased. Nine months later fatigue had decreased, whereas levels of depression remained stable. Concurrent relations between fatigue and depression were mostly moderate. There was no strong evidence for a cause-and-effect relationship between depression and fatigue. Depression showed highest concurrent relationships with quality of life, especially before treatment. Prospectively, depression and the dimension of physical fatigue were the main predictors for quality of life. Fatigue is not a valid criterion for depression in these patients. Nor is there a strong cause-and-effect relationship. Both depression and physical fatigue are relevant to patients' quality of life.
Summary In this paper the psychometric properties of the multidimensional fatigue inventory are established further in cancer patients. The MFI is a 20-item self-report instrument designed to measure fatigue. It covers the following dimensions: general fatigue, physical fatigue, reduced activity, reduced motivation and mental fatigue. The instrument was used in a Dutch and Scottish sample of cancer patients receiving radiotherapy. The dimensional structure was assessed using confirmatory factor analyses (Lisrel's unweighted least-squares method). The hypothesised five-factor model appeared to fit the data in both samples (adjusted goodness of fit; AGFI: 0.97 and 0.98). Internal consistency of the separate scales was good in both the Dutch and Scottish samples with Cronbach's alpha coefficients ranging from 0.79 to 0.93. Construct validity was assessed by correlating the MFI-20 to activities of daily living, anxiety and depression. Significant relations were assumed. Convergent validity was investigated by correlating the MFI scales with a visual analogue scale measuring fatigue and with a fatigue-scale derived from the Rotterdam Symptom Checklist. Results support the validity of the MFI-20. The highly similar results in the Dutch and Scottish sample suggest that the portrayal of fatigure using the MFI-20 is quite robust.
Summary Cognitive function items are increasingly included in quality of life measures, and complaints of concentration and memory difficulties are often reported by cancer patients. The aim of this study was to examine the factors influencing patients' level of complaint by comparing subjective reports with objective test performance of a sample of adult lymphoma patients, disease-free and > 6 months after treatment. There was no significant difference between complainers and non-complainers in sociodemographic or clinical characteristics or in their performance on standard neuropsychometric tests of concentration and memory. Those reporting concentration and memory difficulties had significantly higher scores on measures of anxiety, depression and fatigue. This calls into question the validity of including cognitive function items in self-report quality of life measures. Patients who report concentration and memory difficulties should be screened for clinically significant and potentially remediable mood disorder. Objective testing remains the method of choice for assessing higher mental function.
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