The adaptations of a quality of life questionnaire for routine use in clinical practice: the Chronic Respiratory Disease Questionnaire in Cystic Fibrosis.

The assessment of quality of life (QOL) is necessary to monitor the course of disease and to assess the effect of new and existing interventions in clinical practice. This will only be achieved if QOL can be measured accurately and routinely. The aim of this study was to demonstrate the methodology involved in the adaptation and shortening of the Chronic Respiratory Disease Questionnaire (CRDQ) in a population of adults with cystic fibrosis (CF). A single interviewer administered the CRDQ to a sample of 45 adult patients (32 males) with CF prior to assessment of spirometric measures of lung function. Those patients whose lung function was stable at the time of study, and who could attend for a retest within 14 days, were asked to complete the questionnaire at a subsequent visit (n=10). The average interval between visits was 7 days (range 5-14 days). Correlations between spirometry and CRDQ dimensions ranged from -0.003 to 0.426. The fatigue, emotion and mastery dimensions showed high internal consistency, and adequate construct validity. In the small number of patients suitable for retest, the results indicated that the dimensions exhibited adequate test retest reliability. In contrast low internal consistency was demonstrated for the dyspnoea dimension. The fatigue, emotion and mastery dimensions could be reduced, in terms of their number of items without a substantial loss in explanatory power. This study suggests that QOL measurement can be made convenient, and so more easily accessible for routine clinical assessment.

Generic, disease-specific and individualised approaches to measuring health-related quality of life among people with heart disease - a comparative analysis.

Increasing emphasis is being placed on the evaluation of health-related quality of life. However, there is no consensus on the definition of this concept and as a result there are a plethora of existing measurement instruments. Head-to-head comparisons of the psychometric properties of existing instruments are necessary to facilitate evidence-based decisions about which instrument should be chosen for routine use. Therefore, an individualised instrument (the modified Patient Generated Index), a generic instrument (the Short Form 36) and a disease-specific instrument (the Quality of Life after Myocardial Infarction questionnaire) were administered to patients with ischaemic heart disease (n=117) and the evidence for the validity, reliability and sensitivity of each instrument was examined and compared. The modified Patient Generated Index compared favourably with the other instruments but none of the instruments examined provided sound evidence for sensitivity to change. Therefore, any recommendation for the use of the individualised approach in the routine collection of health-related quality of life data in clinical practice must be conditional upon the submission of further evidence to support the sensitivity of such instruments.

Researching the history of social work: Exposition of a history of the present approach.

This paper provides an exposition of Michel Foucault's 'history of the present' in order to make the case for its relevance to the study of social work history. It sets out the general principles underpinning this practice and considers its application to a particular research question relating to history of child welfare and protection social work in the Republic of Ireland. The paper seeks to highlight the challenges involved in its use and illuminate its potential value as an approach for researching the history of social work. It is concluded that this exposition offers one appropriate approach that could be employed within the growing field of social work history research across Europe.

Social Work in the Republic of Ireland: A History of the Present

This article reports on research carried out into the nature and position of social work in the child protection and welfare system in Ireland. Employing a methodology of a history of the present, this research sought to crtically examine the nature and position of social work within the social as a 'psy expert'. Selected findings relating to the genealogical and archaeological construction of social work discourse in Ireland are provided to illuminate how its particular historical pathways both enabled and constrained its development. It was found that, to some extent, conceptualizations of social work in the context of its space within the social were applicable to the Irish context. however, it was also found that a number of other factors were also significant, implying the need for problematization of existing theories of the social. Although some of the findings relate directly to the particular spatial context of Ireland, others are transferable to the UK and international contexts. The research asserts that, while social work represents a diffuse and complex activity, enabled and constrained by its genealogical context, the potential exists in the profesion for greater attention to be apid to its archaeoloigcal construction. In light of contemporary neo-liberal conditions of governance, the need for such attention is emphasized.

Improving the quality of life for patients with angina pectoris: a team approach to disease management.

The evaluation of outcome of management of angina patients is now inextricably linked with an assessment of quality of life. Angina, as a manifestation of coronary heart disease, is a major cause of morbidity and mortality in many countries. Optimal management of patients with angina is of undeniable national and global significance.

This paper attempts to indicate the importance of a team approach and the implications for patients’ quality of life of involving professionals with a variety of different skills. It outlines current guidelines for the management of angina, including aspects of diagnosis, treatment and rehabilitation. Factors of relevance to the management of patients as individuals are discussed. The association of improved quality of life and reduced severity of symptoms with benefit for both the individual and society is considered.