Achieving consensus on assessing health-related quality of life (HRQoL) in people with cognitive impairments (CI)a Delphi study.

BACKGROUND: The prevalence of impairments of cognitive functions is expected to increase. Enhancing the QoL of those affected is important. HRQoL in people with CI can be assessed by self-report, proxy-report or observation but there is uncertainty how to best assess HRQoL in people with CI, and which assessment method is most appropriate. Therefore the aim of our study was to use Delphi methodology in order to achieve consensus on how HRQoL should be assessed in people with CI and which content domains should be assessed. METHODS: The Delphi process consisted of three online survey rounds and a concluding consensus conference. Participants were experts as well as individuals and relatives of people affected by CI. The Delphi survey was developed based on existing literature and included 55 statements at the first round. Consensus was considered to be achieved when a minimum of 75 % of responses fell into the categories 6 (agree) and 7 (strongly agree) (positive consensus) or in categories 1 (strongly disagree) and 2 (disagree) (negative consensus). RESULTS: Consensus was reached for a total of 41 of 56 statements/substatements. In the 1st survey round 102 experts and 11 relatives participated. In the 2nd survey round 68 experts and 11 relatives continued to participate. In the 3rd survey round 41 experts and 9 relatives participated. In the consensus conference 17 experts and 4 relatives of individuals with CI and in the second one-hour online conference session 14 experts and 2 relatives of individuals with CI participated. CONCLUSION: The combination of the three assessment methods self-report, proxy-report and observation across all stages of CI is the preferred method and should be used whenever possible. As domains Physical capacity, Psychological, Level of Independence, Social Relationships, Environment and Spirituality/Relogion/Personal Beliefs should be assessed.

Hormonal response to stress in brittle diabetes.

Acute psychological stress may play a role in the glycaemic instability of some patients with type I diabetes through an increased secretion of insulin-counteracting hormones. To examine the validity of this hypothesis, we subjected to a video-recorded public-speaking stress seven healthy persons, six type I diabetics with stable blood glucose levels and six type I diabetics with unstable or brittle diabetes (with more than 10 hypoglycaemia/month and frequent hyperglycaemia). During the test and on a control day, heart rate, blood pressure, plasma ACTH, cortisol, catecholamines and prolactin were measured. The comparison between the stable and unstable diabetics during the stress session by two-way analysis of variance (group/time) showed a significant difference for heart rate, blood pressure, ACTH and cortisol. Psychological interview showed that most unstable diabetics perceived a link between life stress and their blood glucose control. The unstable patients had much more difficulty in verbalizing their emotions. Our study shows that the two groups of diabetic patients display distinct cardiovascular and neuroendocrine responses to psychological stress, as well as distinct psychological profiles. In conclusion, hormonal response to an acute psychological stress is more pronounced in brittle diabetes and might be one of its pathogenic factors.