Quality of life: a review.

BACKGROUND: Quality of life has become an important issue in evaluating clinical research outcomes, and in relationship to cost containment and managed care issues. METHODS: The literature on quality of life was reviewed to give the practicing optometrist an overview of the issue. RESULTS: Quality of life embraces a wide range of physical and psychological characteristics that describe a person's functional ability. There is no agreed upon definition of quality of life. This lack of agreement has led most researchers to adopt a multidimensional approach toward assessing quality of life since no single parameter has ever proven to be adequate. CONCLUSION: Quality of life measurement is an important issue in health care research and policy. In the future, awareness of quality of life issues will be of increasing importance for the optometrist.

On the mechanism of radiation-induced emesis: the role of serotonin.

PURPOSE: The aim of this study was to determine the mechanism of action of radiation-induced emesis by determining the incidence of radiation-induced emesis following hemibody irradiation; the effects of specific antiemetics especially ondansetron, a 5-hydroxytryptamine receptor antagonist, and to determine the relationship between radiation-induced emesis and serotonin (5-hydroxytryptamine) through its active metabolite, 5-hydroxyindoleacetic acid (5-HIAA). METHODS AND MATERIALS: Forty-one patients received 53 hemibody treatments of 5-8 Gy following intravenous hydration. The patients were divided into three groups according to prehemibody irradiation treatment: Group A: no pretreatment antiemetics, 30 patients; Group B: nonondansetron antiemetics (metoclopramide, dexamethasone, prochlorperazine), ten patients; and Group C: ondansetron, 13 patients. The incidence of radiation-induced emesis was determined prehemibody irradiation or baseline and at 1 h posthemibody irradiation in 38 patients and the results expressed as the percent change in 5-HIAA (ng/ug creatinine). RESULTS: The incidence of radiation-induced emesis was 82% (14/17) following upper/mid hemibody irradiation and 15% (2/11) following lower hemibody irradiation in Group A; 50% (3/6) and 25% (1/4) following upper/mid and lower hemibody irradiation respectively, in Group B; and 0% (0/13) after upper/mid hemibody irradiation in Group C. The incidence of emesis was significantly different (p < 0.001) between the patients of Group A and C who received upper/mid hemibody irradiation. The percent change in 5-HIAA excretion following upper/mid hemibody irradiation were greatest in Group A and smallest in Group C (p < 0.002). The degree of change following lower hemibody irradiation (15% incidence of emesis) in Group A was lower than upper/mid hemibody irradiation of the same group. CONCLUSION: The higher incidence of radiation-induced emesis following upper and mid hemibody irradiation in antiemetic naive patients compared to the incidence following lower hemibody irradiation suggests that the critical organ responsible for radiation sickness is in the abdomen. The control of emesis by ondansetron, a 5-HT3 receptor antagonist, attests to the efficacy of ondansetron in radiation-induced emesis and suggests a role for serotonin in mediating radiation-induced emesis. Finally, the parallel changes in 5-HIAA and the incidence of emesis provides additional evidence for a more direct role for serotonin in radiation-induced emesis.

Radiation-induced emesis: effects of ondansetron.

The incidence, severity, and onset of radiation-induced emesis (RIE) are related to field size, site, and dose per fraction. Radiation-induced emesis can occur (1) within 2 to 3 weeks in approximately 50% of patients after conventional fractionated radiotherapy (200 cGy/fraction) to the upper abdomen, (2) acutely in more than 90% of patients receiving fractionated total body irradiation (TBI) for bone marrow transplantation, and (3) within 30 to 60 minutes in more than 80% of patients following single high-dose (> 500 cGy)/large field hemibody irradiation (HBI). The increased frequency of emesis associated with TBI and HBI has renewed the interest in the mechanism and treatment of RIE. A number of studies have reported a significant difference in the incidence of emesis following doses of > or = 500 cGy to the upper-mid (> 80%) and lower (20% to 40%) hemibody. The data suggested that the organ responsible for emetic response was in the upper abdomen. However, the mechanism of RIE is not well understood, although degradation products from normal tissues and tumor have been suggested. The introduction and effectiveness of the 5-hydroxytryptamine3 receptor antagonists in chemotherapy-induced emesis and the location of these receptors in the upper abdomen (possible site of the radiation-associated emetic response) suggested that this group of compounds may have a role in RIE. Lucraft and Palmer (Clin Radiol 33:621-622, 1982) reported no differences between levonantradol and chlorpromazine in preventing RIE in patients treated with single doses of more than 10 Gy to a small upper abdominal field. Priestman (Eur J Cancer Clin Oncol 25:529-533, 1989 [Suppl]) reported on a pilot and randomized study with ondansetron after single doses of 8 to 10 Gy to the upper abdomen. In the pilot study, ondansetron achieved major or complete control of vomiting in 77% to 90% of patients; subsequently, he reported a significant difference between ondansetron (97%) and metoclopramide (45%) in controlling RIE on the day of radiotherapy. Hewitt et al (Bone Marrow Transpl 7:431-433, 1991) reported a complete or major response on 93% of the days of ondansetron therapy during pretreatment therapy with cyclophosphamide and TBI for bone marrow transplantation. A preliminary analysis of 41 patients treated with HBI at the Rex Cancer Center confirms the role of ondansetron in RIE. Twenty-eight patients (upper-mid 16 patients/lower HBI 12 patients) did not receive pretreatment antiemetics (group A); seven received non-ondansetron pre-HBI (group B); and six received ondansetron (group C).(ABSTRACT TRUNCATED AT 400 WORDS)

Pictorial cues and enhancement of patient recall of instructions or information.

Optometrists utilize handouts and pamphlets to facilitate information and instruction recall by their patients. A study was conducted to determine the effect of using pictorial cues. Thirty-six college students learned fifteen nouns in numerical order. In one condition subjects perceived the nouns alone, in another they perceived the nouns with illustrations. Half of the subjects in each condition were tested immediately after stimuli presentation; the remaining subjects were tested after a one-hour delay. It was determined that a picture-word association occurred, and decreased memory decay (longer memory) occurred for compound stimuli. This indicated that visual stimuli can facilitate word memory and pictorial cues would, therefore, be beneficial.

The relationship of contrast sensitivity functions to sports vision.

Contrast sensitivity, a more recent test of visual function, has never been studied in its relationship to sports vision. The hypothesis that contrast sensitivity functions among college varsity level baseball players significantly differs from that of a random sample of optometry students was tested using Arden grating plates. A statistically significant difference was found at the 98 percent confidence level, demonstrating that in this study, a sample of college varsity level baseball players have higher level contrast sensitivity functions than those of a randomly selected sample of Southern California College of Optometry students.

A three step method of the determination of fixation status and retinal correspondence.

In examination and treatment of patients with strabismus one often encounters abnormal sensory adaptations such as eccentric fixation and anomalous retinal correspondence. Prognosis and treatment of strabismus are dependent on the presence or absence of these conditions. When eccentric fixation is present it becomes difficult to interpret the results of many tests used to determine retinal correspondence. This determination is further complicated when the patient is unable to give accurate responses. A technique utilizing visuoscopy and an afterimage has been performed on somewhat less cooperative patients. The results compare favorably to amblyoscopic measurements of the angle of anomaly.

The effect of time on the developmental test of visual motor integration.

Studies have shown that many children with learning problems have difficulties of an integrative nature. In addition, these same children often require more time for visual information processing. In this study, the Developmental Test of Visual-Motor Integration (VMI) was given to children between the ages of 5 and 12 years, the children being categorized into normal and learning problem groups. The forms were administered with and without a time restriction. It was hypothesized that the time restriction would result in lower scores for children with visual motor perceptual deficiencies and learning problems than for those without. Results of the study showed a significant difference with time restrictions for children between ages 5 and 7 years and 9 year-1 month to 12 years. This suggests that within these age groups, timing the test items of the VMI could supply additional information relative to visual motor perceptual development. In the middle age group, the test time appears to be too complex for children with visual motor perceptual deficiencies to complete.

The effect of accommodative deficiencies on the developmental level of perceptual skills.

The relation of accommodative to visual-motor perceptual abilities was investigated. patients between 5 and 13 years of age manifesting both accommodative and visual-motor perceptual deficits were given accommodative therapy. The effect of this therapy was analyzed, and the results indicated that improvement in the visual and motor perceptual abilities occurred in the 5 to 7 years, 11 month age group.

Incidence of vision difficulties in children with learning disabilities.

The article discusses the incidence of three categories of visual difficulties found in a learning disabled population seen at the Southern California College of Optometry. Four of the areas showing the largest incidence were also examined in a nonlearning disabled clinic population. The relationship between the two populations shows a much larger incidence of these problems in the learning disabled group, although the problems were noted in both groups.

Referral recommendations for binocular function and/or developmental perceptual deficiencies.

The complexity of the area of binocular function and perceptual development has resulted in the necessity of intraprofessional referrals. We have divided this specialty into systems. These include the accommodative, vergence, ocular motor, sensory and perceptual systems. In each system we have provided symptoms and clinical findings, which can be utilized for tentative diagnostic purposes. It is incumbent on those practitioners whose interests do not lie in this area to be sufficiently knowledgeable relative to both the patient's difficulty, and to the referral source who might best serve the patient's needs.