The 32-item Asthma Quality of Life Questionnaire (AQLQ) has shown good responsiveness, reliability and construct validity; properties that are essential for use in clinical trials, clinical practice and surveys. However, to meet the needs of large clinical trials and long-term monitoring, where efficiency may take precedent over precision of measurement, the 15-item self-administered MiniAQLQ has been developed.The MiniAQLQ was tested in a 9-week observational study of 40 adults with symptomatic asthma. Patients completed the MiniAQLQ, the AQLQ, the Short Form (SF)-36, the Asthma Control Questionnaire and spirometry at baseline, 1, 5 and 9 weeks.In patients whose asthma was stable between clinic visits, reliability was very acceptable for the MiniAQLQ (intraclass correlation coefficient (ICC)=0.83), but not quite as good as for the AQLQ (ICC=0.95). Similarly, responsiveness in the MiniAQLQ (p=0.0007) was good but not quite so good as for the AQLQ (p<0.0001). Construct validity (correlation with other indices of health status) was strong for both the MiniAQLQ and the AQLQ. Criterion validity showed that there was no bias between the instruments (p=0.61) and the correlation between them was high (r=0.90).The Mini Asthma Quality of Life Questionnaire has good measurement properties but they are not quite as strong as those of the original Asthma Quality of Life Questionnaire. The choice of questionnaire should depend on the task at hand. Eur Respir J 1999; 14: 32±38.

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Summary This international multidisciplinary consensus statement was developed to provide balanced guidance on the safe peri‐operative use of opioids in adults. An international panel of healthcare professionals evaluated the literature relating to postoperative opioid‐related harm, including persistent postoperative opioid use; opioid‐induced ventilatory impairment; non‐medical opioid use; opioid diversion and dependence; and driving under the influence of prescription opioids. Recommended strategies to reduce harm include pre‐operative assessment of the risk of persistent postoperative opioid use; use of an assessment of patient function rather than unidimensional pain scores alone to guide adequacy of analgesia; avoidance of long‐acting (modified‐release and transdermal patches) opioid formulations and combination analgesics; limiting the number of tablets prescribed at discharge; providing deprescribing advice; avoidance of automatic prescription refills; safe disposal of unused medicines; reducing the risk of opioid diversion; and better education of healthcare professionals, patients and carers. This consensus statement provides a framework for better prescribing practices that could help reduce the risk of postoperative opioid‐related harm in adults.

Many studies have shown that correlation between clinical asthma status and asthma-specific quality of life is only weak to moderate. However, this relationship has never been explored to determine whether the weakness is due to noise of measurement or whether quality of life is a distinct component of asthma health status.With a database from three clinical trials (n=763), factor analysis was used to explore the relationships between quality of life, measured by the Asthma Quality of Life Questionnaire (AQLQ), and conventional measures of asthma clinical status (symptoms, airway calibre and rescue b 2 -agonist use).The analysis revealed that although patients with severe, poorly controlled asthma tend to have worse quality of life than milder, well-controlled patients, overall asthma health status has four components (factors): asthma-specific quality of life; airway calibre; daytime symptoms and daytime b 2 -agonist use, and night-time symptoms and night-time b 2 -agonist use.The clean loading of all 21 outcomes onto four distinct and clinically identifiable factors suggests that, although some weakness of correlation between clinical indices and quality of life may be due to noise of measurement, it is mainly attributable to asthma health status being composed of distinct components. Identifying and treating impaired health-related quality of life is now recognised as an important component of asthma management. International guidelines identify that treatments should not only improve asthma clinical status, and thus reduce the risk of exacerbations and possibly airway remodelling, but should also enable patients to feel and function better in their day-to-day lives [1]. Asthma-specific quality of life questionnaires have been developed and validated so that this aspect of patient management can be accurately measured and treatment effectiveness assessed [2][3][4]. These questionnaires are now used in both clinical trials [5] and clinical practice [6] alongside the more traditional clinical measures of airway status such as airway calibre, symptoms and markers of inflammation.The rationale for including both clinical and quality of life measures has been based on the observation that correlations between these two measures are only weak to moderate and therefore patient experiences cannot be imputed from the clinical variables [2][3][4][7][8][9]. Correlations between symptoms and asthma-specific quality of life rarely exceed a Pearson correlation coefficient of 0.6 [2][3][4][7][8][9], and correlations between quality of life and airway calibre are usuallyv0.2 and rarely statistically significant [2,3,[7][8][9]. Despite the consistency of these observations [2][3][4][7][8][9], it has been argued that these poor correlations arise through imprecision of measurement (both of clinical status and of quality of life).To determine whether the weakness of association is solely attributable to noise of measurement or whether quality of life is a distinct component of asthma health status, a factor analysis w...

Fall-related medical conditions affect a substantial number of the community-dwelling elderly and result in direct medical costs of dollar 6 to dollar 8 billion per year in the United States. The total economic burden of falls is significantly higher because this estimate does not include direct nonmedical, intangible, and indirect costs. The results of this study highlight the importance of research aimed at decreasing the incidence and severity of falls in the elderly.