Purpose: The Schedule for Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) recognizes the individuals’ values with no pre-judgement. The objective of this study was to determine if clinician awareness and understanding of individual patients’ subjective quality of life (SQoL), bothersome symptoms and symptom interference on SQoL, would lead to improvement over time in the SQoL of patients with advanced cancer. Methods: SEIQoL-DW and symptom bother/interference with SQoL was measured up to 4 time points on Sixty-five (n=65) patients receiving chemotherapy for advanced cancer. Measurements from the intervention group (n=33) was reported to the clinical team at each time point via an info-graph placed in the clinical notes. Measurements from the control group (n=32) was not reported to the clinical team. Results: SEIQoL-DW of all patients improved from baseline to time point 4 (p >0.05).A significant improvement in patient’s perception of health functioning was seen in the intervention group compared to the control group (51% v 19%, p=0.014). Symptom interference in SQoL reduced by 9% in the intervention group versus 37% increase in the control group. In totality, a 46% difference was observed between groups (p < 0.05). Interpretation: Translating SEIQoL-DW and symptom bother/interference into a format for use as a ‘Clinical Tool’ in routine practice improves patient reported health functioning and symptom interference on their SQoL. This patient centered approach could lead to a paradigm shift in our understanding of patient’s needs and in harmony with other clinical interventions, should be considered a valuable step towards personalized medicine.

Staphylococcus aureus is an important cause of bacteremia, and S. aureus bacteremia constitutes a serious condition with high morbidity and mortality, secondary to multiple complications including infective endocarditis and embolization. The incidence of bacteremia with S. aureus is increasing with more frequent use of medications that lower immune system response, and with the utilization of more invasive medical procedures. In addition, the emergence of resistant S. aureus isolates is becoming more common and can negatively affect the outcome of an individual if not diagnosed and managed properly. Health care workers encounter S. aureus bloodstream infections on a routine basis, and in certain situations, it becomes a very challenging infection to control. Because of the impact this entity has on health care costs and the increased use of resources, it is necessary to highlight the causes, clinical presentation, associated complications, and treatment measures. In this chapter, we will cover each of these points, with somewhat more emphasis on methicillin-resistant S. aureus that is prevalent in both community and hospital settings and is more commonly associated with worsening prognosis and higher mortality.

Traditionally changes in quality of life (QoL) are assessed using self report questionnaires. They rely on the assumption that the patient’s point of reference does not change over time. However in reality patients with chronic and life threatening illness appear to undergo an adaptation to their disease or “Response Shift” (RS). In this study of a population of patients with advanced lung cancer receiving palliative chemotherapy we examine for a RS in subjective QoL. Methods: 33 patients completed the Schedule for the Evaluation of Individual Quality of Life (SEIQoL), SEIQOL–DW and the EORTC-QLQ C-30 at diagnosis. At 1, 3 and 6 months patients completed SEIQoL/ SEIQOL–DW and retrospectively re-assessed their baseline QoL (the “then” test) using SEIQoL-DW. Results: The initial mean SEIQoL-DW score was 67.48 changing to 66.71 at one month. Retrospectively, patients reassessed their initial mean SEIQoL-DW score as 59.61, suggesting a RS of 7.87 (p ≤0.0001) and an actual improvement in QoL of 7.1 points. At three months the mean SEIQoL-DW score was 65.13; retrospectively patients rated their QoL at one month much lower, mean SEIQoL-DW then – test’ score was 59.92, suggesting a RS of 6.79 (p = 0.0013). At six months patients’ mean SEIQoL-DW score was 61.86. Again, when retrospectively rating their QoL at three months they rated it lower, mean SEIQoL-DW score of 58.84, indicating a ‘positive’ RS of 6.28 (p = 0.0007). Conclusion: Traditional pre/post SEIQOL–DW scores show little change in subjective QOL however by incorporating the ‘then-test’ we can see that patients have undergone a RS and a significant positive change in subjective QOL. By explicitly measuring RS it may be possible to assess changes in QoL with greater validity and sensitivity.

Context: The aim of this study was to profile a cardiac rehabilitation population in the West of Ireland and establish Subjective Quality of Life (SQoL), using The Schedule for Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), a validated subjective QoL measure. Bothersome symptoms (SB) and Symptom Interference in SQoL (SBIQoL) were also assessed using a using a modified SEIQoL-DW. Objectives: QoL is a difficult concept to define, therefore the medical profession often premise QoL on health and illness. The focus of this study was to explore the QoL needs of a cardiac population, with a view to informing the development of a newly formed cardiac rehabilitation support group. The SEIQoL-DW was developed to overcome the limitations of quantitative questionnaires, as it is based on the individual’s personal view of life and its quality. Methods: SQoL, symptoms and SBIQoL, of 22 individuals, who had suffered a cardiac event were explored. SEIQoL-DW is a semi-structured interview, enabling the individual to convert their perspectives into scientific values. QoL areas of importance to patients are called ‘cues’. A modified SEIQoL-DW was used to assess SB and SBIQoL. Data were analysed using both quantitative analysis and qualitative descriptive analysis. Findings: Participants highlighted a range of QoL cues; findings from this study showed that 45% of participants did not rate ‘health’ in the first five QoL cues. A significant number of participants experienced symptoms; a medium negative correlation was found between symptom interference and QoL, rho = -0.353, with high levels of symptom interference associated with low levels of QoL. Conclusions: The range of QoL cues and bothersome symptoms identified in this study had implications for the development of the group, with participants eager to participate and talk candidly about their needs. SEIQoL-DW proved to be an acceptable, reliable and valid technique for measuring both individual QoL, SB and SBIQoL, taking greater consideration of individual perspectives compared with traditional measurement approaches. The significance of nominated symptoms and SBIQoL warrants further attention, especially if these symptoms are reversible.