I ntroduction Increasingly, researchers are faced with situations where patients may not gain benefits in terms of traditional end points, such as survival or disease-free survival. However, it is possible to see significant changes in health-related quality of life (HRQOL) []. HRQOL, a multidimensional construct and an important concept, has, for many years, proven difficult to define. A number of definitions proposed by various authors as to the exact nature of HRQOL and the formulation of a defining consensus are shown in Table 1. The Cancer Awareness Measures (CAM). (British Journal of Cancer 2009) Validation of a measurement tool to assess awareness of breast cancer. New blood test developed to diagnose ovarian cancer Non-invasive diagnostic tool being developed to measure circulating microRNAs to predict ovarian cancer with. RadiologyGenerally, HRQOL covers the subjective perceptions of the positive and negative aspects of cancer patients' symptoms, including physical, emotional, social, and cognitive functions and, importantly, disease symptoms and side effects of treatment []. Only 20 years ago, scant literature reported quality-of-life benefits. However, in recent years, there has been a large increase in studies reporting the assessment of HRQOL. At present, some 10% of all randomized cancer clinical trials include HRQOL as the main end point []. However, while the U.S. Food and Drug Administration now recognizes the benefits of HRQOL as a basis for approval of new anticancer drugs, and many international research groups include HRQOL in their studies, introducing HRQOL into oncology has been difficult. There are several reasons for this [–]. One problem involves understanding the subjective nature of the results that HRQOL studies generate and the barriers to acceptance by clinicians []. Furthermore, as Moinpour [] points out, bringing these metrics into a busy practice is difficult. The purpose of this review is to help clinicians understand the value of HRQOL. F easibility and I nterest in HRQOL Fortunately, more clinicians are considering the importance of HRQOL as critical to cancer patients' care [, ]. Recently, Tanaka and Gotay [] demonstrated this in a HRQOL awareness survey of U. Clinicians and medical students. HRQOL was perceived to be as important as survival in making treatment decisions. However, medical students were more likely to emphasize HRQOL over survival than practicing clinicians. This emphasis was confirmed by Morris et al. [], who undertook a survey of 260 senior oncologists to study how HRQOL is viewed in clinical practice. An impressive number (80%) of the questionnaire responders believe that HRQOL should be collected from patients; although, in practice, only some 50% managed to do this, claiming problems of limited time and resources. Importantly, confusion about the measure to use is the biggest barrier. The latter is a major problem in the use of measures and definitions, as Taylor et al. [] noted when interviewing 60 oncologists in Canada and the U.S. The results are broadly in line with Tanaka and Gotay [] and Morris et al. ![]() []: some 88% of clinicians thought that it was important to examine HRQOL, while over 33% of clinicians felt that the current measurement tools were inadequate. Bezjak et al. [] found, in a survey of 357 Eastern Cooperative Oncology Group clinicians, that 84% felt that their individual knowledge of HRQOL was limited. However, over 82% believed that HRQOL data are appropriate for patient care. With more specific knowledge, oncologists are likely to increase their use of HRQOL. Detmar and Aaronson [], in order to assess the value of individual HRQOL assessments, undertook a small-scale study with six clinicians and 18 cancer patients. Just prior to the consultation, clinicians were given the results of the patients' HRQOL. The results suggested that patients were more satisfied with the consultation, stating that the clinician showed greater understanding. The clinician also rated the consultation as more satisfying, without greatly increasing the time taken. The main inference from this small study is that HRQOL can be used in an individual setting, and clinicians may benefit from completing and using HRQOL data for treatment and clinical care-making decisions. M easuring HRQOL While there is increasing evidence for the value of HRQOL assessment, one of the most difficult tasks is actually measuring it. HRQOL is subjective and can prove a challenge to measure. Many of the components, such as social functioning and spirituality, cannot be directly observed. Therefore, these are measured using classical measurement paradigms. We regularly see great signal quality, with harmonic content reduced to about –40 dB. The signal generated by the DDS chip itself is quite small so we use an AD8008 low power amplifier to provide about 18 dB of gain to boost the signal to almost 4V p-p, which is 40 mW or about +16 dBm into a 50-ohm load. Quite usable in a variety of applications. Once your controller-of-choice serially loads the 40-bit control word into the DDS, the raw waveform is presented to an elliptic filter that removes unwanted high-end frequency components, resulting in a signal of sufficient quality to serve as a local oscillator for a transceiver. Dds vfo soft rock. See the section for a number of custom solutions for you to easily control your DDS-60 daughtercard.
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