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Sample records for ucsf symptom management

  1. UCSF Center for HIV Information

    Science.gov (United States)

    ... from the UCSF Positive Health Program HIV/AIDS Clinic (Ward 86) at San Francisco General Hospital This series offers clinical practice recommendations for management of HIV-related conditions from the expert clinicians ...

  2. Management of somatic symptoms

    DEFF Research Database (Denmark)

    Schröder, Andreas; Dimsdale, Joel

    2014-01-01

    on the recognition and effective management of patients with excessive and disabling somatic symptoms. The clinical presentation of somatic symptoms is categorized into three groups of patients: those with multiple somatic symptoms, those with health anxiety, and those with conversion disorder. The chapter provides...

  3. Current status of the UCSF second-generation PACS

    Science.gov (United States)

    Huang, H. K.; Arenson, Ronald L.; Wong, Albert W. K.; Bazzill, Todd M.; Lou, Shyhliang A.; Andriole, Katherine P.; Wang, Jun; Zhang, Jianguo; Wong, Stephen T. C.

    1996-05-01

    This paper describes the current status of the second generation PACS at UCSF commenced in October 1992. The UCSF PACS is designed in-house as a hospital-integrated PACS based on an open architecture concept using industrial standards including UNIX operating system, C programming language, X-Window user interface, TCP/IP communication protocol, DICOM 3.0 image standard and HL7 health data format. Other manufacturer's PACS components which conform with these standards can be easily integrated into the system. Relevant data from HIS and RIS is automatically incorporated into the PACS using HL7 data format and TCP/IP communication protocol. The UCSF system also takes advantage of state-of-the-art communication, storage, and software technologies in ATM, multiple storage media, automatic programming, multilevel processes for a better cost-performance system. The primary PACS network is the 155 Mbits/sec OC3 ATM with the Ethernet as the back-up. The UCSF PACS also connects Mt. Zion Hospital and San Francisco VA Medical Center in the San Francisco Bay area via an ATM wide area network with a T1 line as the back-up. Currently, five MR and five CT scanners from multiple sites, two computed radiography systems, two film digitizers, one US PACS module, the hospital HIS and the department RIS have been connected to the PACS network. The image data is managed by a mirrored database (Sybase). The PACS controller, with its 1.3 terabyte optical disk library, acquires 2.5 gigabytes digital data daily. Four 2K, five, 1,600-line multiple monitor display workstations are on line in neuroradiology, pediatric radiology and intensive care units for clinical use. In addition, the PACS supports over 100 Macintosh users in the department and selected hospital sites for both images and textual retrieval through a client/server mechanism. We are also developing a computation and visualization node in the PACS network for advancing radiology research.

  4. Symptom Management of Bulimia.

    Science.gov (United States)

    Johnson, Craig; And Others

    1987-01-01

    Describes a treatment approach for the symptom management of bulimia that is a synthesis of various techniques, including cognitive-behavioral therapy, response prevention, relapse training, and psychodynamic therapy. The model has been a useful teaching tool for staff and patients in both group and individual formats. Addresses the challenges of…

  5. Enhancing UCSF Chimera through web services.

    Science.gov (United States)

    Huang, Conrad C; Meng, Elaine C; Morris, John H; Pettersen, Eric F; Ferrin, Thomas E

    2014-07-01

    Integrating access to web services with desktop applications allows for an expanded set of application features, including performing computationally intensive tasks and convenient searches of databases. We describe how we have enhanced UCSF Chimera (http://www.rbvi.ucsf.edu/chimera/), a program for the interactive visualization and analysis of molecular structures and related data, through the addition of several web services (http://www.rbvi.ucsf.edu/chimera/docs/webservices.html). By streamlining access to web services, including the entire job submission, monitoring and retrieval process, Chimera makes it simpler for users to focus on their science projects rather than data manipulation. Chimera uses Opal, a toolkit for wrapping scientific applications as web services, to provide scalable and transparent access to several popular software packages. We illustrate Chimera's use of web services with an example workflow that interleaves use of these services with interactive manipulation of molecular sequences and structures, and we provide an example Python program to demonstrate how easily Opal-based web services can be accessed from within an application. Web server availability: http://webservices.rbvi.ucsf.edu/opal2/dashboard?command=serviceList. © The Author(s) 2014. Published by Oxford University Press on behalf of Nucleic Acids Research.

  6. Symptom management in Behcets disease.

    Science.gov (United States)

    Ozel, Filiz; Tureyen, Aynur Esen; Aykar, Fisun Senuzun

    2018-01-01

    To determine the symptoms experienced by patients diagnosed with Behcet's Disease and how they cope with them. The qualitative study was conducted from September 2013 to March 2014 at Ege University Medical Faculty Hospital, Turkey, comprising patients having all symptoms of Behcet's Disease. Data was collected through semi-structured focus-group interview form. The findings were assessed using Theory of Unpleasant Symptoms and Symptom Management Theory. SPSS 20 and Nvivo 10 were used for data analysis. Of the 35 patients, 16(45.8%) were female and 19(54.2%) were male. The symptoms affected patients' lives, and the patients used either positive or negative symptom management strategies, leading to either positive or negative results during symptom management. Behcet's Disease patients needed effective symptom management.

  7. Aromatherapy for managing menopausal symptoms

    Science.gov (United States)

    Choi, Jiae; Lee, Hye Won; Lee, Ju Ah; Lim, Hyun-Ja; Lee, Myeong Soo

    2018-01-01

    Abstract Background: Aromatherapy is often used as a complementary therapy for women's health. This systematic review aims to evaluate the therapeutic effects of aromatherapy as a management for menopausal symptoms. Methods: Eleven electronic databases will be searched from inception to February 2018. Randomized controlled trials that evaluated any type of aromatherapy against any type of control in individuals with menopausal symptoms will be eligible. The methodological quality will be assessed using the Cochrane risk of bias tool. Two authors will independently assess each study for eligibility and risk of bias and to extract data. Results: This study will provide a high quality synthesis of current evidence of aromatherapy for menopausal symptoms measured with Menopause Rating Scale, the Kupperman Index, the Greene Climacteric Scale, or other validated questionnaires. Conclusions: The conclusion of our systematic review will provide evidence to judge whether aromatherapy is an effective intervention for patient with menopausal women. Ethics and dissemination: Ethical approval will not be required, given that this protocol is for a systematic review. The systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically and in print. Systematic review registration: PROSPERO CRD42017079191. PMID:29419673

  8. Tools for integrated sequence-structure analysis with UCSF Chimera

    Directory of Open Access Journals (Sweden)

    Huang Conrad C

    2006-07-01

    Full Text Available Abstract Background Comparing related structures and viewing the structures in the context of sequence alignments are important tasks in protein structure-function research. While many programs exist for individual aspects of such work, there is a need for interactive visualization tools that: (a provide a deep integration of sequence and structure, far beyond mapping where a sequence region falls in the structure and vice versa; (b facilitate changing data of one type based on the other (for example, using only sequence-conserved residues to match structures, or adjusting a sequence alignment based on spatial fit; (c can be used with a researcher's own data, including arbitrary sequence alignments and annotations, closely or distantly related sets of proteins, etc.; and (d interoperate with each other and with a full complement of molecular graphics features. We describe enhancements to UCSF Chimera to achieve these goals. Results The molecular graphics program UCSF Chimera includes a suite of tools for interactive analyses of sequences and structures. Structures automatically associate with sequences in imported alignments, allowing many kinds of crosstalk. A novel method is provided to superimpose structures in the absence of a pre-existing sequence alignment. The method uses both sequence and secondary structure, and can match even structures with very low sequence identity. Another tool constructs structure-based sequence alignments from superpositions of two or more proteins. Chimera is designed to be extensible, and mechanisms for incorporating user-specific data without Chimera code development are also provided. Conclusion The tools described here apply to many problems involving comparison and analysis of protein structures and their sequences. Chimera includes complete documentation and is intended for use by a wide range of scientists, not just those in the computational disciplines. UCSF Chimera is free for non-commercial use and is

  9. Home Care Nursing Improves Cancer Symptom Management

    Science.gov (United States)

    Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.

  10. Management of JJ stent-related symptoms.

    Science.gov (United States)

    Papatsoris, Athanasios; Dellis, Athanasios; Daglas, George; Sanguedolce, Francesco

    2014-01-01

    Ureteric JJ stents are inserted in numerous pa- tients as a routine procedure. Nevertheless, the ideal JJ stent that does not cause any lower urinary tract symptoms has not been developed yet. Even special validated ques- tionnaires have been used for the assessment of JJ stent-related symtoms. For the management of such symtoms usually alpha-blockers are admin- istered. Also, studies have examined the efficacy and safety of anticholinergics and calcium channel blo- ckers. In this article we review the literature upon the management of JJ stent-related symptoms.

  11. Menstruation: Symptoms, Management and Attitude of Female ...

    African Journals Online (AJOL)

    This study surveyed 120 student nurses from two schools of nursing in Ibadan, Nigeria to assess the symptoms experienced during menstruation, attitude towards and management of menstruation. The student nurses overall mean age at menarche was 14 years, average duration of menstrual period was five days and ...

  12. Heritability of MMPI-2 scales in the UCSF Family Alcoholism Study

    Science.gov (United States)

    Gizer, Ian R.; Seaton-Smith, Kimberley L.; Ehlers, Cindy L.; Vietan, Cassandra; Wilhelmsen, Kirk C.

    2009-01-01

    The present study evaluated the heritability of personality traits and psychopathology symptoms assessed by the Minnesota Multiphasic Personality Interview 2nd edition (MMPI-2) in a family-based sample selected for alcohol dependence. Participants included 950 probands and 1204 first-degree relatives recruited for the UCSF Family Alcoholism Study. Heritability estimates (h2) for MMPI-2 scales ranged from .25–.49. When alcohol dependence was used as a covariate, heritability estimates remained significant but generally declined. However, when the MMPI-2 scales were used as covariates to estimate the heritability of alcohol dependence, scales measuring antisocial behavior (ASP), depressive symptoms (DEP), and addictive behavior (MAC-R) led to moderate increases in the heritability of alcohol dependence. This suggests that the ASP, DEP, and MAC-R scales may explain some of the non-genetic variance in the alcohol dependence diagnosis in this population when utilized as covariates, and thus may serve to produce a more homogeneous and heritable alcohol dependence phenotype. PMID:20390702

  13. No sweat: managing menopausal symptoms at work.

    Science.gov (United States)

    Hickey, Martha; Riach, Kathleen; Kachouie, Reza; Jack, Gavin

    2017-09-01

    Menopause usually occurs between the ages of 45 and 55, a time when women are likely to be in the paid workforce. Most women have menopausal symptoms and these may impact on daytime function and work performance. This study examines the relationship between reproductive stage, menopausal symptoms and work, and advises how employers can best support menopausal women. An online and paper-based survey was completed in 2015-16 by 1092 women (22% response rate) aged 40 years plus employed in three hospitals in metropolitan Australia. Survey questions examined demographics, health and lifestyle variables, menopausal symptom reporting, and work-related variables. Reproductive stage was determined using modified STRAW +10 principal and descriptive criteria. Reproductive stage was not significantly associated with work engagement, organizational commitment, job satisfaction, work limitations and perceived supervisor support. Postmenopausal women had lower intention to leave their organizations than pre- and peri-menopausal women. While sleep problems were the most commonly reported menopausal symptom by peri-menopausal women, for postmenopausal women it was joint and muscular discomfort. Only hot flushes and vaginal dryness were significantly more frequent in peri- and post, compared to pre-menopausal women. In general, women rated their work performance as high and did not feel that menopausal symptoms impaired their work ability. Most women would appreciate greater organizational support, specifically temperature control, flexible work hours and information about menopause for employees and managers. Most women did not believe that menopausal symptoms negatively impacted on their work. Organizational changes may reduce the burden of menopausal symptoms in the workplace.

  14. PyChimera: use UCSF Chimera modules in any Python 2.7 project.

    Science.gov (United States)

    Rodríguez-Guerra Pedregal, Jaime; Maréchal, Jean-Didier

    2018-05-15

    UCSF Chimera is a powerful visualization tool remarkably present in the computational chemistry and structural biology communities. Built on a C++ core wrapped under a Python 2.7 environment, one could expect to easily import UCSF Chimera's arsenal of resources in custom scripts or software projects. Nonetheless, this is not readily possible if the script is not executed within UCSF Chimera due to the isolation of the platform. UCSF ChimeraX, successor to the original Chimera, partially solves the problem but yet major upgrades need to be undergone so that this updated version can offer all UCSF Chimera features. PyChimera has been developed to overcome these limitations and provide access to the UCSF Chimera codebase from any Python 2.7 interpreter, including interactive programming with tools like IPython and Jupyter Notebooks, making it easier to use with additional third-party software. PyChimera is LGPL-licensed and available at https://github.com/insilichem/pychimera. jaime.rodriguezguerra@uab.cat or jeandidier.marechal@uab.cat. Supplementary data are available at Bioinformatics online.

  15. Managing lower urinary tract symptoms in men.

    Science.gov (United States)

    MacKenzie, Kenneth R; Aning, Jonathan J

    2016-04-01

    Male lower urinary tract symptoms (LUTS) are common and increase in prevalence with age. Up to 90% of men aged 50 to 80 may suffer from troublesome LUTS. Men may attend expressing direct concern about micturition, describing one or more LUTS and the related impact on their quality of life. Frequently men may present for other medical or urological reasons such as concern regarding their risk of having prostate cancer or erectile dysfunction but on taking a history bothersome LUTS are identified. Men may present late in the community with urinary retention: the inability to pass urine. A thorough urological history is essential to inform management. It is important to determine whether men have storage or voiding LUTS or both. All patients must have a systematic comprehensive examination including genitalia and a digital rectal examination. Investigations performed in primary care should be guided by the history and examination findings, taking into account the impact of the LUTS on the individual's quality of life. Current NICE guidelines recommend the following to be performed at initial assessment: frequency volume chart (FVC); urine dipstick to detect blood, glucose, protein, leucocytes and nitrites; and prostate specific antigen. Men should be referred for urological review if they have: bothersome LUTS which have not responded to conservative management or medical therapy; LUTS in association with recurrent or persistent UTIs; urinary retention; renal impairment suspected to be secondary to lower urinary tract dysfunction; or suspected urological malignancy. All patients not meeting criteria for immediate referral to urology can be managed initially in primary care. Based on history, examination and investigation findings an individualised management plan should be formulated. Basic lifestyle advice should be given regarding reduction or avoidance of caffeinated products and alcohol. The FVC should guide advice regarding fluid intake management and all

  16. SymptomCare@Home: Developing an Integrated Symptom Monitoring and Management System for Outpatients Receiving Chemotherapy.

    Science.gov (United States)

    Beck, Susan L; Eaton, Linda H; Echeverria, Christina; Mooney, Kathi H

    2017-10-01

    SymptomCare@Home, an integrated symptom monitoring and management system, was designed as part of randomized clinical trials to help patients with cancer who receive chemotherapy in ambulatory clinics and often experience significant symptoms at home. An iterative design process was informed by chronic disease management theory and features of assessment and clinical decision support systems used in other diseases. Key stakeholders participated in the design process: nurse scientists, clinical experts, bioinformatics experts, and computer programmers. Especially important was input from end users, patients, and nurse practitioners participating in a series of studies testing the system. The system includes both a patient and clinician interface and fully integrates two electronic subsystems: a telephone computer-linked interactive voice response system and a Web-based Decision Support-Symptom Management System. Key features include (1) daily symptom monitoring, (2) self-management coaching, (3) alerting, and (4) nurse practitioner follow-up. The nurse practitioner is distinctively positioned to provide assessment, education, support, and pharmacologic and nonpharmacologic interventions to intensify management of poorly controlled symptoms at home. SymptomCare@Home is a model for providing telehealth. The system facilitates using evidence-based guidelines as part of a comprehensive symptom management approach. The design process and system features can be applied to other diseases and conditions.

  17. A randomized controlled trial of an HIV/AIDS Symptom Management Manual for depressive symptoms.

    Science.gov (United States)

    Eller, Lucille S; Kirksey, Kenn M; Nicholas, Patrice K; Corless, Inge B; Holzemer, William L; Wantland, Dean J; Willard, Suzanne S; Robinson, Linda; Hamilton, Mary Jane; Sefcik, Elizabeth F; Moezzi, Shahnaz; Mendez, Marta Rivero; Rosa, Maria; Human, Sarie

    2013-01-01

    Abstract Depressive symptoms are highly prevalent, underdiagnosed, and undertreated in people living with HIV/AIDS (PLWH), and are associated with poorer health outcomes. This randomized controlled trial examined the effects of the HIV/AIDS Symptom Management Manual self-care symptom management strategies compared with a nutrition manual on depressive symptoms in an international sample of PLWH. The sample consisted of a sub-group (N=222) of participants in a larger study symptom management study who reported depressive symptoms. Depressive symptoms of the intervention (n=124) and control (n=98) groups were compared over three months: baseline, one-month, and two-months. Use and effectiveness of specific strategies were examined. Depressive symptom frequency at baseline varied significantly by country (χ (2) 12.9; p=0.04). Within the intervention group there were significant differences across time in depressive symptom frequency [F(2, 207) = 3.27, p=0.05], intensity [F(2, 91) = 4.6, p=0.01], and impact [F(2, 252) = 2.92, p= 0.05), and these were significantly lower at one month but not at two months, suggesting that self-care strategies are effective in reducing depressive symptoms, however effects may be short term. Most used and most effective self-care strategies were distraction techniques and prayer. This study suggests that people living with HIV can be taught and will employ self-care strategies for management of depressive symptoms and that these strategies are effective in reducing these symptoms. Self-care strategies are noninvasive, have no side-effects, and can be readily taught as an adjunct to other forms of treatment. Studies are needed to identify the most effective self-care strategies and quantify optimum dose and frequency of use as a basis for evidence-based practice.

  18. Managing myelodysplastic symptoms in elderly patients

    Directory of Open Access Journals (Sweden)

    R Ria

    2009-10-01

    Full Text Available R Ria, M Moschetta, A Reale, G Mangialardi, A Castrovilli, A Vacca, F DammaccoDepartment of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, ItalyAbstract: Most patients with myelodysplastic syndromes (MDS are elderly (median age range 65 to 70 years; as a consequence, the incidence and prevalence of these diseases are rising as the population ages. Physicians are often uncertain about how to identify patients who may benefit from specific treatment strategies. The International Prognostic Scoring System is a widely used tool to assess the risk of transformation to leukemia and to guide treatment decisions, but it fails to take into account many aspects of treating elderly patients, including comorbid illnesses, secondary causes of MDS, prior therapy for MDS, and other age-related health, functional, cognitive, and social problems that affect the outcome and managing of myelodysplastic symptoms. Patients with low-risk disease traditionally have been given only best supportive care, but evidence is increasing that treatment with novel non-conventional drugs such as lenalidomide or methyltransferase inhibitors may influence the natural history of the disease and should be used in conjunction with supportive-care measures. Supportive care of these patients could also be improved in order to enhance their quality of life and functional performance. Elderly patients commonly have multiple medical problems and use medications to deal with these. In addition, they are more likely to have more than one health care provider. These factors all increase the risk of drug interactions and the consequent treatment of toxicities. Manifestations of common toxicities or illnesses may be more subtle in the elderly, owing to age-associated functional deficits in multiple organ systems. Particularly important to the elderly MDS patient is the age-related decline in normal bone

  19. Non-invasive neuromodulation as a new therapeutic strategy in the management of functional somatic symptoms

    NARCIS (Netherlands)

    Koops, Elouise; van Belkum, Sjoerd; Hanekamp, Sandra; Noort, P.D.; Broersma, Marja; van Beilen, Marije

    2017-01-01

    Objective A large proportion of medical symptoms remain unexplained and inadequate medical management is the result of this. These unexplained symptoms include functional neurological symptoms, fibromyalgia, complex regional pain syndrome and other symptoms such as chronic pain, tinnitus and

  20. Symptom resolution after operative management of complications from transvaginal mesh.

    Science.gov (United States)

    Crosby, Erin C; Abernethy, Melinda; Berger, Mitchell B; DeLancey, John O; Fenner, Dee E; Morgan, Daniel M

    2014-01-01

    Complications from transvaginal mesh placed for prolapse often require operative management. The aim of this study is to describe the outcomes of vaginal mesh removal. A retrospective review of all patients having surgery by the urogynecology group in the department of obstetrics and gynecology at our institution for a complication of transvaginal mesh placed for prolapse was performed. Demographics, presenting symptoms, surgical procedures, and postoperative symptoms were abstracted. Comparative statistics were performed using the χ or Fisher's exact test with significance at Pmesh and 84 had follow-up data. The most common presenting signs and symptoms were: mesh exposure, 62% (n=56); pain, 64% (n=58); and dyspareunia, 48% (n=43). During operative management, mesh erosion was encountered unexpectedly in a second area of the vagina in 5% (n=4), in the bladder in 1% (n=1), and in the bowel in 2% (n=2). After vaginal mesh removal, 51% (n=43) had resolution of all presenting symptoms. Mesh exposure was treated successfully in 95% of patients, whereas pain was only successfully treated in 51% of patients. Removal of vaginal mesh is helpful in relieving symptoms of presentation. Patients can be reassured that exposed mesh can almost always be successfully managed surgically, but pain and dyspareunia are only resolved completely in half of patients. III.

  1. COPD management: role of symptom assessment in routine clinical practice

    Science.gov (United States)

    van der Molen, Thys; Miravitlles, Marc; Kocks, Janwillem WH

    2013-01-01

    Patients with chronic obstructive pulmonary disease (COPD) present with a variety of symptoms that significantly impair health-related quality of life. Despite this, COPD treatment and its management are mainly based on lung function assessments. There is increasing evidence that conventional lung function measures alone do not correlate well with COPD symptoms and their associated impact on patients’ everyday lives. Instead, symptoms should be assessed routinely, preferably by using patient-centered questionnaires that provide a more accurate guide to the actual burden of COPD. Numerous questionnaires have been developed in an attempt to find a simple and reliable tool to use in everyday clinical practice. In this paper, we review three such patient-reported questionnaires recommended by the latest Global Initiative for Chronic Obstructive Lung Disease guidelines, ie, the modified Medical Research Council questionnaire, the clinical COPD questionnaire, and the COPD Assessment Test, as well as other symptom-specific questionnaires that are currently being developed. PMID:24143085

  2. HIV-related symptoms and management in HIV and antiretroviral ...

    African Journals Online (AJOL)

    Karl Peltzer

    2014-01-03

    Jan 3, 2014 ... To cite this article: Karl Peltzer (2013) HIV-related symptoms and management in HIV and antiretroviral therapy patients ...... Fear/worry. 14.2. 22. 2.5. 20 ..... Internalized Stigma, Discrimination, and Depression among Men and.

  3. UCSF partnership to enrich science teaching for sixth graders in San Francisco's schools.

    Science.gov (United States)

    Doyle, H J

    1999-04-01

    Increasing the diversity of students entering the health professions is a challenging goal for medical schools. One approach to this goal is to share the enthusiasm and energy of medical students with younger students, who may pursue medical education in the future. The MedTeach program, established in 1989 and coordinated by the Science & Health Education Partnership of the University of California, San Francisco (UCSF), does so by partnering volunteer medical students from UCSF with sixth-grade classes studying the human body. In 1997-98, around 350 sixth-graders in the San Francisco Schools benefitted from the program. Each team of medical student's visits its class ten to 12 times a year to present engaging, hands-on lessons on body systems and health. The medical students are also role models for the middle-school students. In addition, the diverse student population of San Francisco public schools provides a rich environment for the medical students to improve their communication and teaching skills.

  4. Complementary therapies for symptom management in cancer patients

    Directory of Open Access Journals (Sweden)

    Aanchal Satija

    2017-01-01

    Full Text Available Cancer patients are often poly-symptomatic which distressingly affects their quality of lives (QOLs. Alhough, conventional management provides adequate symptom control, yet is coupled with some limitations. Complementary therapies (CTs have shown beneficial effects in cancer patients for symptomatic relief. The aim of this article is to provide evidence-based review of commonly used CTs for symptom management in cancer care. Hypnosis has promising evidence to be used for managing symptoms such as pain, chemotherapy-induced nausea/vomiting, distress, fatigue, and hot flashes. Guided imagery increases comfort and can be used as a psycho-supportive therapy. Meditation substantially improves psychological function, mental health, and QOL. Cognitive behavioral therapies effectively reduce pain, distress, fatigue, anxiety, and depression; and improve subjective sleep outcomes along with mood and QOL. Yoga has short term beneficial effects for anxiety, depression, fatigue, perceived stress, QOL, and well-being. T'ai Chi and qigong are beneficial adjunctive therapies for supportive cancer care, but their role in reducing cancer pain is not well proven. Acupuncture is effective for reducing treatment related side-effects, pain and fatigue. Other therapies such as massage techniques, energy therapies, and spiritual interventions have also demonstrated positive role in managing cancer-related symptoms and improve overall well-being. However, the clinical effectiveness of these therapies for symptom management in cancer patients cannot be concluded due to poor strength of evidence. Nonetheless, these are relatively free from risks and hence can be given along with conventional treatments. Only by tailoring these therapies as per patient's beliefs and preferences, optimal patient-centered holistic care can be provided.

  5. Statin-associated muscle symptoms-Managing the highly intolerant.

    Science.gov (United States)

    Backes, James M; Ruisinger, Janelle F; Gibson, Cheryl A; Moriarty, Patrick M

    Musculoskeletal symptoms are the most commonly reported adverse effects associated with statin therapy. Yet, certain data indicate that these symptoms often present in populations with underlying musculoskeletal complaints and are not likely statin related. Switching statins or using lower doses resolves muscle complaints in most patients. However, there is a growing population of individuals who experience intolerable musculoskeletal symptoms with multiple statins, regardless of the individual agent or prescribed dose. Recent randomized, placebo-controlled trials enrolling highly intolerant subjects provide significant insight regarding statin-associated muscle symptoms (SAMS). Notable findings include the inconsistency with reproducing muscle complaints, as approximately 40% of subjects report SAMS when taking a statin but not while receiving placebo, but a substantial cohort reports intolerable muscle symptoms with placebo but none when on a statin. These data validate SAMS for those likely experiencing true intolerance, but for others, suggest a psychosomatic component or misattribution of the source of pain and highlights the importance of differentiating from the musculoskeletal symptoms caused by concomitant factors. Managing the highly intolerant requires candid patient counseling, shared decision-making, eliminating contributing factors, careful clinical assessment and the use of a myalgia index score, and isolating potential muscle-related adverse events by gradually reintroducing drug therapy with the utilization of intermittent dosing of lipid-altering agents. We provide a review of recent data and therapeutic guidance involving a focused step-by-step approach for managing SAMS among the highly intolerant. Such strategies usually allow for clinically meaningful reductions in low-density lipoprotein cholesterol and an overall lowering of cardiovascular risk. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  6. COPD management: role of symptom assessment in routine clinical practice

    Directory of Open Access Journals (Sweden)

    van der Molen T

    2013-10-01

    Full Text Available Thys van der Molen,1,2 Marc Miravitlles,3 Janwillem WH Kocks1,21Department of General Practice, 2GRIAC (Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 3Pneumology Department, Hospital Universitari Vall d'Hebron, Biomedical Research Networking Centre in Respiratory Diseases (CIBERES, Barcelona, SpainAbstract: Patients with chronic obstructive pulmonary disease (COPD present with a variety of symptoms that significantly impair health-related quality of life. Despite this, COPD treatment and its management are mainly based on lung function assessments. There is increasing evidence that conventional lung function measures alone do not correlate well with COPD symptoms and their associated impact on patients' everyday lives. Instead, symptoms should be assessed routinely, preferably by using patient-centered questionnaires that provide a more accurate guide to the actual burden of COPD. Numerous questionnaires have been developed in an attempt to find a simple and reliable tool to use in everyday clinical practice. In this paper, we review three such patient-reported questionnaires recommended by the latest Global Initiative for Chronic Obstructive Lung Disease guidelines, ie, the modified Medical Research Council questionnaire, the clinical COPD questionnaire, and the COPD Assessment Test, as well as other symptom-specific questionnaires that are currently being developed.Keywords: chronic obstructive pulmonary disease, symptoms, questionnaires

  7. Management of the behavioral and psychological symptoms of dementia

    Directory of Open Access Journals (Sweden)

    Elizabeth C Hersch

    2008-01-01

    Full Text Available Elizabeth C Hersch, Sharon FalzgrafVA Puget Sound Health Care System, Tacoma, Washington, USAAbstract: More than 50% of people with dementia experience behavioral and psychological symptoms of dementia (BPSD. BPSD are distressing for patients and their caregivers, and are often the reason for placement into residential care. The development of BPSD is associated with a more rapid rate of cognitive decline, greater impairment in activities of daily living, and diminished quality of life (QOL. Evaluation of BPSD includes a thorough diagnostic investigation, consideration of the etiology of the dementia, and the exclusion of other causes, such as drug-induced delirium, pain, or infection. Care of patients with BPSD involves psychosocial treatments for both the patient and family. BPSD may respond to those environmental and psychosocial interventions, however, drug therapy is often required for more severe presentations. There are multiple classes of drugs used for BPSD, including antipsychotics, anticonvulsants, antidepressants, anxiolytics, cholinesterase inhibitors and NMDA modulators, but the evidence base for pharmacological management is poor, there is no clear standard of care, and treatment is often based on local pharmacotherapy customs. Clinicians should discuss the potential risks and benefits of treatment with patients and their surrogate decision makers, and must ensure a balance between side effects and tolerability compared with clinical benefit and QOL.Keywords: dementia, management, behavioral symptoms, psychological symptoms

  8. A 'symptom-triggered' approach to alcohol withdrawal management.

    Science.gov (United States)

    Murdoch, Jay; Marsden, Janet

    In acute hospital settings, alcohol withdrawal often causes significant management problems and complicates a wide variety of concurrent conditions, placing a huge burden on the NHS. A significant number of critical incidents around patients who were undergoing detoxification in a general hospital setting led to the need for a project to implement and evaluate an evidence-based approach to the management of alcohol detoxification-a project that included a pre-intervention case note audit, the implementation of an evidence-based symptom-triggered detoxification protocol, and a post-intervention case note audit. This change in practice resulted in an average reduction of almost 60% in length of hospital stay and a 66% reduction in the amount of chlordiazepoxide used in detoxification, as well as highlighting that 10% of the sample group did not display any signs of withdrawal and did not require any medication. Even with these reductions, no patient post-intervention developed any severe signs of withdrawal phenomena, such as seizures or delirium tremens. The savings to the trust (The Pennine Acute Hospital Trust) are obvious,but the development of a consistent, quality service will lead to fewer long-term negative effects for patients that can be caused by detoxification. This work is a project evaluation of a locally implemented strategy, which, it was hypothesised,would improve care by providing an individualised treatment plan for the management of alcohol withdrawal symptoms.

  9. Nonmotor symptoms in Parkinson's disease: classification and management

    Directory of Open Access Journals (Sweden)

    Erro R

    2015-01-01

    Full Text Available Roberto Erro,1,2 Gabriella Santangelo,3,4 Paolo Barone,5 Carmine Vitale4,6 1Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom; 2Dipartimento di Scienze Neurologiche e del Movimento, Università di Verona, Verona, Italy; 3Neuropsychology Laboratory, Department of Psychology, Second University of Naples, Caserta, Italy; 4IDC Hermitage – Capodimonte, Naples, Italy; 5University of Salerno, Center for Neurodegenerative diseases – CEMAND, Salerno, Italy; 6University of Naples "Parthenope," Department of Motor Sciences, Naples, Italy Abstract: Despite the emphasis on the motor phenotype of Parkinson's disease (PD, it has been increasingly recognized that PD patients experience several nonmotor symptoms (NMS, which have even greater significance when assessed by quality-of-life measures and institutionalization rates. The burden of NMS tends to increase with age and disease severity and, in the very advanced stage of disease, NMS such as urinary problems, drooling, somnolence, psychosis, and dementia dominate the clinical phenotype. Moreover, the dopaminergic treatment used for the motor symptoms of PD can arise or worsen a number of NMS, including orthostatic hypotension, nausea, sleep disturbances, hallucinations, or impulsive compulsive behaviors. Here we review the most common NMS of PD with a focus on their pharmacological management. Keywords: disease management, PD, NMS

  10. University of California San Francisco (UCSF-2): Expression Analysis of Superior Cervical Ganglion from Backcrossed TH-MYCN Transgenic Mice | Office of Cancer Genomics

    Science.gov (United States)

    The CTD2 Center at University of California San Francisco (UCSF-2) used genetic analysis of the peripheral sympathetic nervous system to identify potential therapeutic targets in neuroblastoma. Read the abstract Experimental Approaches Read the detailed Experimental Approaches

  11. Pain and symptom management in palliative care and at end of life.

    Science.gov (United States)

    Wilkie, Diana J; Ezenwa, Miriam O

    2012-01-01

    The purpose of this review is to provide a literature update of the research published since 2004 on pain and symptom management in palliative care and at end of life. Findings suggest that pain and symptoms are inadequately assessed and managed, even at the end of life. Although not pervasive, there is evidence of racial/ethnic disparities in symptom management in palliative care and at end of life. There is a need for a broader conceptualization and measurement of pain and symptom management as multidimensional experiences. There is insufficient evidence about mechanisms underlying pain at end of life. Although there are advances in the knowledge of pain as a multidimensional experience and the many symptoms that occur sometimes with pain, gaps remain. One approach to addressing the gaps will involve assessment and management of pain and symptoms as multidimensional experiences in people receiving palliative care and at end of life. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Integrative medicine for managing the symptoms of lupus nephritis

    Science.gov (United States)

    Choi, Tae-Young; Jun, Ji Hee; Lee, Myeong Soo

    2018-01-01

    Abstract Background: Integrative medicine is claimed to improve symptoms of lupus nephritis. No systematic reviews have been performed for the application of integrative medicine for lupus nephritis on patients with systemic lupus erythematosus (SLE). Thus, this review will aim to evaluate the current evidence on the efficacy of integrative medicine for the management of lupus nephritis in patients with SLE. Methods and analyses: The following electronic databases will be searched for studies published from their dates of inception February 2018: Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as 6 Korean medical databases (Korea Med, the Oriental Medicine Advanced Search Integrated System [OASIS], DBpia, the Korean Medical Database [KM base], the Research Information Service System [RISS], and the Korean Studies Information Services System [KISS]), and 1 Chinese medical database (the China National Knowledge Infrastructure [CNKI]). Study selection, data extraction, and assessment will be performed independently by 2 researchers. The risk of bias (ROB) will be assessed using the Cochrane ROB tool. Dissemination: This systematic review will be published in a peer-reviewed journal and disseminated both electronically and in print. The review will be updated to inform and guide healthcare practice and policy. Trial registration number: PROSPERO 2018 CRD42018085205 PMID:29595669

  13. Depressive symptoms, self-esteem, HIV symptom management self-efficacy and self-compassion in people living with HIV.

    Science.gov (United States)

    Eller, L S; Rivero-Mendez, M; Voss, J; Chen, W-T; Chaiphibalsarisdi, P; Iipinge, S; Johnson, M O; Portillo, C J; Corless, I B; Sullivan, K; Tyer-Viola, L; Kemppainen, J; Rose, C Dawson; Sefcik, E; Nokes, K; Phillips, J C; Kirksey, K; Nicholas, P K; Wantland, D; Holzemer, W L; Webel, A R; Brion, J M

    2014-01-01

    The aims of this study were to examine differences in self-schemas between persons living with HIV/AIDS with and without depressive symptoms, and the degree to which these self-schemas predict depressive symptoms in this population. Self-schemas are beliefs about oneself and include self-esteem, HIV symptom management self-efficacy, and self-compassion. Beck's cognitive theory of depression guided the analysis of data from a sample of 1766 PLHIV from the USA and Puerto Rico. Sixty-five percent of the sample reported depressive symptoms. These symptoms were significantly (p ≤ 0.05), negatively correlated with age (r = -0.154), education (r = -0.106), work status (r = -0.132), income adequacy (r = -0.204, self-esteem (r = -0.617), HIV symptom self-efficacy (r = - 0.408), and self-kindness (r = - 0.284); they were significantly, positively correlated with gender (female/transgender) (r = 0.061), white or Hispanic race/ethnicity (r = 0.047) and self-judgment (r = 0.600). Fifty-one percent of the variance (F = 177.530 (df = 1524); p education, work status, income adequacy, self-esteem, HIV symptom self-efficacy, and self-judgment. The strongest predictor of depressive symptoms was self-judgment. Results lend support to Beck's theory that those with negative self-schemas are more vulnerable to depression and suggest that clinicians should evaluate PLHIV for negative self-schemas. Tailored interventions for the treatment of depressive symptoms in PLHIV should be tested and future studies should evaluate whether alterations in negative self-schemas are the mechanism of action of these interventions and establish causality in the treatment of depressive symptoms in PLHIV.

  14. Perioperative thirst: an analysis from the perspective of the Symptom Management Theory

    Directory of Open Access Journals (Sweden)

    Marilia Ferrari Conchon

    2015-02-01

    Full Text Available A theoretical study aimed to analyze the existing knowledge in the literature on the perioperative thirst symptom from the perspective of Symptom Management Theory, and supplemented with the experience of the study group and thirst research. Thirst is described as a very intense symptom occurring in the perioperative period, and for this reason it cannot be ignored. The Symptom Management Theory is adequate for understanding the thirst symptom and is a deductive theory, focused on the domains of the Person, Environment and Health / Illness Status, as well as on the dimensions of Experience, Management Strategies and Symptom Outcomes. Using the theory leads us to consider perioperative thirst in its multifactorial aspects, analyzing the interrelation of its domains and dimensions in order to draw attention to this symptom that has been insufficiently valued, recorded and treated in clinical practice.

  15. Perceived symptom manageability - synthesis of a new use of a known concept based on a sample of HIV outpatients

    OpenAIRE

    Fierz, Katharina

    2012-01-01

    Symptom management issues are regularly discussed in medical follow-up appointments, however, despite the integration of patients' perspectives in symptom management negotiations, traditional-ly used measures (i.e., symptom severity and frequency) to identify symptoms that need management do not seem to capture the patient's needs and, consequently, patients' expectations are frequently unmet 141. Although symptom frequency, symptom severity, and associated distress or bother are considered c...

  16. Symptom Management & Quality of Life Concept Design | Division of Cancer Prevention

    Science.gov (United States)

    This video covers a variety of practical considerations for developing a symptom management concept for clinical research. Co-sponsored by the National Cancer Institute Symptom Management and Health Related Quality of Life Steering Committee & the International Society for Quality of Life Research. |

  17. Home-Based Diabetes Symptom Self-Management Education for Mexican Americans with Type 2 Diabetes

    Science.gov (United States)

    García, Alexandra A.; Brown, Sharon A.; Horner, Sharon D.; Zuñiga, Julie; Arheart, Kristopher L.

    2015-01-01

    This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans, a fast growing minority population experiencing a diabetes epidemic. Patients with diabetes need assistance interpreting and managing symptoms, which are often annoying and potentially life-threatening. A repeated…

  18. Impact of UCSF criteria according to pre- and post-OLT tumor features: analysis of 479 patients listed for HCC with a short waiting time.

    Science.gov (United States)

    Decaens, Thomas; Roudot-Thoraval, Françoise; Hadni-Bresson, Solange; Meyer, Carole; Gugenheim, Jean; Durand, Francois; Bernard, Pierre-Henri; Boillot, Olivier; Sulpice, Laurent; Calmus, Yvon; Hardwigsen, Jean; Ducerf, Christian; Pageaux, Georges-Philippe; Dharancy, Sebastien; Chazouilleres, Olivier; Cherqui, Daniel; Duvoux, Christophe

    2006-12-01

    Orthotopic liver transplantation (OLT) indication for hepatocellular carcinoma (HCC) is currently based on the Milan criteria. The University of California, San Francisco (UCSF) recently proposed an expansion of the selection criteria according to tumors characteristics on the explanted liver. This study: 1) assessed the validity of these criteria in an independent large series and 2) tested for the usefulness of these criteria when applied to pre-OLT tumor evaluation. Between 1985 and 1998, 479 patients were listed for liver transplantation (LT) for HCC and 467 were transplanted. According to pre-OLT (imaging at date of listing) or post-OLT (explanted liver) tumor characteristics, patients were retrospectively classified according to both the Milan and UCSF criteria. The 5-yr survival statistics were assessed by the Kaplan-Meier method and compared by the log-rank test. Pre-OLT UCSF criteria were analyzed according to an intention-to-treat principle. Based on the pre-OLT evaluation, 279 patients were Milan+, 44 patients were UCSF+ but Milan- (subgroup of patients that might benefit from the expansion), and 145 patients were UCSF- and Milan-. With a short median waiting time of 4 months, 5-yr survival was 60.1 +/- 3.0%, 45.6 +/- 7.8%, and 34.7 +/- 4.0%, respectively (P OLT evaluation, the UCSF criteria are associated with a 5-yr survival below 50%. Their applicability is therefore limited, despite similar survival rates compared to the Milan criteria, when the explanted liver is taken into account.

  19. Expanding perspective on music therapy for symptom management in cancer care.

    Science.gov (United States)

    Potvin, Noah; Bradt, Joke; Kesslick, Amy

    2015-01-01

    Symptom management is a frequently researched treatment topic in music therapy and cancer care. Representations in the literature of music interventions for symptom management, however, have often overlooked the human experiences shaping those symptoms. This may result in music therapy being perceived as a linear intervention process that does not take into account underlying experiences that contribute to symptom experiences. This study explored patient experiences underlying symptoms and symptom management in cancer care, and examined the role of music therapy in that clinical process. This study analyzed semi-structured, open-ended exit interviews obtained from 30 participants during a randomized controlled trial investigating the differential impact of music therapy versus music medicine interventions on symptom management in participants with cancer. Interviews were conducted by a research assistant not involved with the clinical interventions. Exit interview transcripts for 30 participants were analyzed using an inductive, latent, constructivist method of thematic analysis. Three themes-Relaxation, Therapeutic relationship, and Intrapersonal relating-capture elements of the music therapy process that (a) modified participants' experiences of adjustments in their symptoms and (b) highlighted the depth of human experience shaping their symptoms. These underlying human experiences naturally emerged in the therapeutic setting, requiring the music therapist's clinical expertise for appropriate support. Symptom management extends beyond fluctuation in levels and intensity of a surface-level symptom to incorporate deeper lived experiences. The authors provide recommendations for clinical work, entry-level training as related to symptom management, implications for evidence-based practice in music therapy, and methodology for future mixed methods research. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Managing One's Symptoms: A Qualitative Study of Low-Income African Americans With Advanced Cancer.

    Science.gov (United States)

    Yeager, Katherine A; Sterk, Claire E; Quest, Tammie E; DiIorio, Colleen; Vena, Catherine; Bauer-Wu, Susan

    2016-01-01

    African Americans endure disproportionately high advanced cancer rates and also are disproportionately represented in the lower socioeconomic strata. These individuals work to manage symptoms in order to function and have a satisfactory quality of life. The purpose of this study was to discover what low-income African American adults with advanced cancer do on a day-to-day basis to relieve and manage symptoms. This study viewed the individuals as experts and asked them not what they are told to do, but rather what they actually do. A purposive sample of 27 individuals participated in semistructured interviews conducted by 2 research interviewers. This qualitative descriptive approach used content analysis to develop themes to describe symptom self-management. Participants described 2 approaches: making continual adjustments and finding stability through spirituality. In seeking comfort from the distress of their symptoms, they were constantly altering their activities and fine-tuning strategies. They adjusted medical regimens and changed the speed and selection of daily activities, including comfort measures and diet modifications. In contrast, their spirituality was a consistent presence in their lives that provided balance to their unstable symptom experience. This study illustrates that people with advanced cancer actively engage in multiple complex self-management strategies in response to symptoms. As providers assess how individuals manage their symptoms, they must find ways to support those efforts. Providers then will recognize the challenges faced by advanced cancer patients in obtaining the best quality of life while managing multiple symptoms, activities, and family responsibilities.

  1. Biomarkers as Common Data Elements for Symptom and Self-Management Science.

    Science.gov (United States)

    Page, Gayle G; Corwin, Elizabeth J; Dorsey, Susan G; Redeker, Nancy S; McCloskey, Donna Jo; Austin, Joan K; Guthrie, Barbara J; Moore, Shirley M; Barton, Debra; Kim, Miyong T; Docherty, Sharron L; Waldrop-Valverde, Drenna; Bailey, Donald E; Schiffman, Rachel F; Starkweather, Angela; Ward, Teresa M; Bakken, Suzanne; Hickey, Kathleen T; Renn, Cynthia L; Grady, Patricia

    2018-05-01

    Biomarkers as common data elements (CDEs) are important for the characterization of biobehavioral symptoms given that once a biologic moderator or mediator is identified, biologically based strategies can be investigated for treatment efforts. Just as a symptom inventory reflects a symptom experience, a biomarker is an indicator of the symptom, though not the symptom per se. The purposes of this position paper are to (a) identify a "minimum set" of biomarkers for consideration as CDEs in symptom and self-management science, specifically biochemical biomarkers; (b) evaluate the benefits and limitations of such a limited array of biomarkers with implications for symptom science; (c) propose a strategy for the collection of the endorsed minimum set of biologic samples to be employed as CDEs for symptom science; and (d) conceptualize this minimum set of biomarkers consistent with National Institute of Nursing Research (NINR) symptoms of fatigue, depression, cognition, pain, and sleep disturbance. From May 2016 through January 2017, a working group consisting of a subset of the Directors of the NINR Centers of Excellence funded by P20 or P30 mechanisms and NINR staff met bimonthly via telephone to develop this position paper suggesting the addition of biomarkers as CDEs. The full group of Directors reviewed drafts, provided critiques and suggestions, recommended the minimum set of biomarkers, and approved the completed document. Best practices for selecting, identifying, and using biological CDEs as well as challenges to the use of biological CDEs for symptom and self-management science are described. Current platforms for sample outcome sharing are presented. Finally, biological CDEs for symptom and self-management science are proposed along with implications for future research and use of CDEs in these areas. The recommended minimum set of biomarker CDEs include pro- and anti-inflammatory cytokines, a hypothalamic-pituitary-adrenal axis marker, cortisol, the

  2. Symptom management in the older adult: 2015 update.

    Science.gov (United States)

    Smith, Thomas J

    2015-05-01

    This article updates the 2002 Jamie von Roenn article about "the palliation of commonly observed symptoms in older patients, including pain, neuropsychiatric, gastrointestinal, and respiratory symptoms." When palliative care was last covered in Clinics in Geriatric Medicine, President George W. Bush had just signed the No Child Left Behind Act, Homeland Security was being established, Michael Jackson won the Artist of the Century Award at the American Music Awards, and gas cost $1.61 a gallon. What has changed in the last decade and a half? Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Experiences and own management regarding residual symptoms among people with coeliac disease.

    Science.gov (United States)

    Jacobsson, Lisa Ring; Milberg, Anna; Hjelm, Katarina; Friedrichsen, Maria

    2017-06-01

    Between 7% and 30% of people with treated coeliac disease suffer from residual symptoms, and there is a knowledge gap about their own management of these symptoms. To explore experiences and management concerning residual symptoms despite a gluten-free diet in people with coeliac disease. A qualitative explorative design with semi-structured interviews with 22 adults with coeliac disease in Sweden. Data were analysed using qualitative content analysis. The informants had, at diagnosis, thought that their symptoms would disappear if they followed a gluten-free diet, but the disease was continuing to have a substantial impact on their lives, despite several years of treatment. They experienced cognitive, somatic as well as mental symptoms, including impact on personality (e.g. having a "shorter fuse", being more miserable or tired). However, only a few informants had sought medical care for persistent symptoms. Instead they tried to manage these by themselves, e.g. abstaining from food during periods of more intense symptom, or using distraction. The management of persistent symptoms resembled thorough detective work. To prevent problems related to residual symptoms the informants used withdrawal of social contact as well as acceptance of their situation. People with treated coeliac disease may experience residual symptoms of both a physical and psychological nature, causing major negative impacts on their lives in different ways. In the light of this, healthcare staff should change their practices regarding the follow-up of these people, and in addition to medical care should provide guidance on management strategies to facilitate the daily life. Furthermore, information to newly diagnosed persons should make them aware of the possibility to experience continued symptoms, despite treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Symptoms associated in the diagnosis and management of malaria ...

    African Journals Online (AJOL)

    Symptomatic diagnosis of the 352 pregnant women and children, showed that 260 (79%) did not manifest any of the malarial symptoms within the past three months as at the time of the study, 20 (5.7%) patients had fever alone, chill and blisters (0.9%), headache, diarrhoea and joint pain (0.3%), and weakness and anorexia ...

  5. Pharmacotherapy for managing extraglandular symptoms of primary Sjogren's syndrome

    NARCIS (Netherlands)

    Verstappen, Gwenny M.; Kroese, Frans G. M.; Vissink, Arjan; Bootsma, Hendrika

    Introduction: Primary Sjogren's syndrome (pSS) is a systemic autoimmune disease, characterized by impaired function of the exocrine glands. Many pSS patients also experience extraglandular symptoms. Effective therapeutic interventions for pSS patients are not yet approved. However, advances in

  6. Diagnosis and management of functional neurological symptoms: The Dutch experience

    NARCIS (Netherlands)

    de Schipper, Laura J.; Vermeulen, Marinus; Eeckhout, Augustinus M.; Foncke, Elisabeth M. J.

    2014-01-01

    Functional neurological symptoms (FNS) were considered as a psychiatric disorder at the beginning of the 20th century (conversion disorder). Psychiatrists performed diagnosis and treatment throughout most of the past century in the Netherlands, but in the latest decades patients were usually firstly

  7. Diagnosis and management of functional neurological symptoms: The Dutch experience

    NARCIS (Netherlands)

    de Schipper, L.J.; Vermeulen, M; Eeckhout, A.M.; Foncke, E.M.J.

    2014-01-01

    Objectives Functional neurological symptoms (FNS) were considered as a psychiatric disorder at the beginning of the 20th century (conversion disorder). Psychiatrists performed diagnosis and treatment throughout most of the past century in the Netherlands, but in the latest decades patients were

  8. Adolescents' and Best Friend's Depressive Symptoms and Conflict Management: Intraindividual and Interpersonal Processes Over Time.

    Science.gov (United States)

    Boersma-van Dam, Elise; Hale, Bill; Koot, Hans; Meeus, Wim; Branje, Susan

    2016-12-12

    This 6-year longitudinal study examined the relation between 3 conflict management styles (i.e., problem solving, conflict engagement, and compliance) and depressive symptoms in adolescent-best friend relationships. Participants were 479 Dutch adolescents and their best friend who reported annually on depressive symptoms and conflict management styles toward each other. Bidirectional effects between conflict management styles and depressive symptoms were studied both within adolescents (intraindividual) and between adolescent best friends (interpersonal). A positive interpersonal effect of depressive symptoms of one dyad member on depressive symptoms of the other member was found. Similarly, higher positive problem solving and conflict engagement of one dyad member predicted respectively higher problem solving and conflict engagement of the other dyad member. Adolescents who reported more depressive symptoms reported more conflict engagement and compliance over time. In addition, for boys, higher levels of depressive symptoms of one dyad member were related to more problem solving by the other member over time. The current study contributed to the literature by showing that depressive symptoms and conflict management are related constructs in adolescents and that both intrapersonal and interpersonal processes contribute to this relation.

  9. Symptoms and medication management in the end of life phase of high-grade glioma patients

    NARCIS (Netherlands)

    Koekkoek, J.A.F.; Dirven, L.; Sizoo, E.M.; Pasman, H.R.W.; Heimans, J.J.; Postma, T.J.; Deliens, L.; Grant, R.; McNamara, S.; Stockhammer, G.; Medicus, E.; Taphoorn, M.J.B.; Reijneveld, J.C.

    2014-01-01

    During the end of life (EOL) phase of high-grade glioma (HGG) patients, care is primarily aimed at reducing symptom burden while maintaining quality of life as long as possible. In this study, we evaluated the prevalence of symptoms and medication management in HGG patients during the EOL phase. We

  10. Clinicians' Perspectives on Managing Symptom Clusters in Advanced Cancer: A Semistructured Interview Study.

    Science.gov (United States)

    Dong, Skye T; Butow, Phyllis N; Agar, Meera; Lovell, Melanie R; Boyle, Frances; Stockler, Martin; Forster, Benjamin C; Tong, Allison

    2016-04-01

    Managing symptom clusters or multiple concurrent symptoms in patients with advanced cancer remains a clinical challenge. The optimal processes constituting effective management of symptom clusters remain uncertain. To describe the attitudes and strategies of clinicians in managing multiple co-occurring symptoms in patients with advanced cancer. Semistructured interviews were conducted with 48 clinicians (palliative care physicians [n = 10], oncologists [n = 6], general practitioners [n = 6], nurses [n = 12], and allied health providers [n = 14]), purposively recruited from two acute hospitals, two palliative care centers, and four community general practices in Sydney, Australia. Transcripts were analyzed using thematic analysis and adapted grounded theory. Six themes were identified: uncertainty in decision making (inadequacy of scientific evidence, relying on experiential knowledge, and pressure to optimize care); attunement to patient and family (sensitivity to multiple cues, prioritizing individual preferences, addressing psychosocial and physical interactions, and opening Pandora's box); deciphering cause to guide intervention (disaggregating symptoms and interactions, flexibility in assessment, and curtailing investigative intrusiveness); balancing complexities in medical management (trading off side effects, minimizing mismatched goals, and urgency in resolving severe symptoms); fostering hope and empowerment (allaying fear of the unknown, encouraging meaning making, championing patient empowerment, and truth telling); and depending on multidisciplinary expertise (maximizing knowledge exchange, sharing management responsibility, contending with hierarchical tensions, and isolation and discontinuity of care). Management of symptom clusters, as both an art and a science, is currently fraught with uncertainty in decision making. Strengthening multidisciplinary collaboration, continuity of care, more pragmatic planning of clinical trials to address more than one

  11. Best practice in the management of storage symptoms in male lower urinary tract symptoms: a review of the evidence base

    Science.gov (United States)

    Gacci, Mauro; Sebastianelli, Arcangelo; Spatafora, Pietro; Corona, Giovanni; Serni, Sergio; De Ridder, Dirk; Gravas, Stavros; Abrams, Paul

    2017-01-01

    Storage lower urinary tract symptoms (LUTS) are characterized by an altered bladder sensation, increased daytime frequency, nocturia, urgency and urgency incontinence. Some evidence underlines the role of metabolic factors, pelvic ischemia, prostatic chronic inflammation and associated comorbidities in the pathophysiology of storage LUTS. A detailed evaluation of the severity of storage LUTS, and the concomitance of these symptoms with voiding and postmicturition symptoms, is mandatory for improving the diagnosis and personalizing treatment. A detailed medical history with comorbidities and associated risk factors, a physical examination, a comprehensive analysis of all the features of LUTS, including their impact on quality of life, and a frequency–volume chart (FVC) or bladder diary, are recommended for men with storage LUTS. Several drugs are available for the treatment of LUTS secondary to benign prostatic obstruction (BPO). Alpha-blockers (α-blockers), 5-α-reductase inhibitors and phosphodiesterase type 5 inhibitors are commonly used to manage storage LUTS occurring with voiding symptoms associated with BPO. Muscarinic receptor antagonists and Beta 3-agonists (β3-agonists) alone, or in combination with α-blockers, represent the gold standard of treatment in men with predominant storage LUTS. There is no specific recommendation regarding the best treatment options for storage LUTS after prostatic surgery. PMID:29434675

  12. Recrudescence of Focal Stroke Symptoms During Pain Management with Hydromorphone

    Directory of Open Access Journals (Sweden)

    Joshua D. Bernstock

    2016-03-01

    Full Text Available Abstract: Patients who have recovered from a prior stroke may experience a reemergence of their original stroke syndrome secondary to metabolic derangements, sedation, infection, and/or fatigue. Critically, the molecular/cellular mechanisms mediating symptom recurrence after exposure to analgesic agents remain unknown. Accordingly, herein we report a unique case of a patient with hydromorphone-induced recrudescence 30 years after her initial stroke event(s, and in so doing propose a putative mechanism related to post-infarction functional neuroplasticity.

  13. Sources and types of information on self-care symptom management strategies for HIV and AIDS

    Directory of Open Access Journals (Sweden)

    Regis R. Marie Modeste

    2014-04-01

    Full Text Available Background: It has been reported that South Africa has the highest number of people living with HIV worldwide, with more women being infected than men. Women living with HIV have been documented as experiencing various symptoms related to HIV and use various strategies to manage these symptoms. Objective: The objective of this study was to explore the sources and types of information regarding self-care symptom management strategies received by women living with HIV. Method: The study was conducted at an HIV clinic in an urban area of KwaZulu-Natal. Individual in-depth interviews were completed with 11 women who were living with HIV,exploring the sources of information received on how they manage the HIV- (and/or AIDS- related symptoms they experienced as well as the types of information received. The collecteddata were analysed using qualitative content analysis. Results: The participants identified various sources, which mainly included groups of people who provided them with information on how to manage their HIV-related symptoms, namely healthcare providers, their personal networks and the community. The different sources offered different types of information, including the use of medication, complementary treatments and self-comforting activities. Conclusion: The study highlights that participants used multiple sources to get information about how to manage the experienced symptoms related to HIV, namely, healthcare providers, family and friends as well as themselves. It is to be noted that each source provided a preferred type of information.

  14. Peripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management.

    Science.gov (United States)

    Watson, James C; Dyck, P James B

    2015-07-01

    Peripheral neuropathy is one of the most prevalent neurologic conditions encountered by physicians of all specialties. Physicians are faced with 3 distinct challenges in caring for patients with peripheral neuropathy: (1) how to efficiently and effectively screen (in less than 2 minutes) an asymptomatic patient for peripheral neuropathy when they have a disorder in which peripheral neuropathy is highly prevalent (eg, diabetes mellitus), (2) how to clinically stratify patients presenting with symptoms of neuropathy to determine who would benefit from specialty consultation and what testing is appropriate for those who do not need consultation, and (3) how to treat the symptoms of painful peripheral neuropathy. In this concise review, we address these 3 common clinical scenarios. Easily defined clinical patterns of involvement are used to identify patients in need of neurologic consultation, the yield of laboratory and other diagnostic testing is reviewed for the evaluation of length-dependent, sensorimotor peripheral neuropathies (the most common form of neuropathy), and an algorithmic approach with dosing recommendations is provided for the treatment of neuropathic pain associated with peripheral neuropathy. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  15. Exploring preferences for symptom management in primary care: a discrete choice experiment using a questionnaire survey.

    Science.gov (United States)

    McAteer, Anne; Yi, Deokhee; Watson, Verity; Norwood, Patricia; Ryan, Mandy; Hannaford, Philip C; Elliott, Alison M

    2015-07-01

    Symptoms are important drivers for the use of primary care services. Strategies aimed at shifting the focus away from the GP have broadened the range of primary healthcare available. To explore preferences for managing symptoms and investigate trade-offs that the public are willing to make when deciding between different primary care services. UK-wide postal questionnaire survey of 1370 adults. A discrete choice experiment examined management preferences for three symptoms of differing seriousness (diarrhoea, dizziness, and chest pain). Willingness-to-pay estimates compared preferences between symptoms, and by sex, age, and income. Preferences differed significantly between symptoms. 'Self-care' was the preferred action for diarrhoea and 'consulting a GP' for dizziness and chest pain. 'Waiting time' and 'chance of a satisfactory outcome' were important factors for all three symptoms, although their relative importance differed. Broadly, people were more prepared to wait longer and less prepared to trade a good chance of a satisfactory outcome for symptoms rated as more serious. Generally, preferences within subgroups followed similar patterns as for the whole sample, although there were differences in the relative strength of preferences. Despite increased choices in primary care, 'traditional' actions of 'self-care' for minor symptoms and 'GP consultation' for more serious symptoms were preferred. The present findings suggest, however, that people may be willing to trade between different health services, particularly for less serious symptoms. Understanding the relative importance of different factors may help inform interventions aimed at changing management behaviour or improving services. © British Journal of General Practice 2015.

  16. Opinion paper: the role of work in the management of medically unexplained physical symptoms.

    Science.gov (United States)

    Tobback, Els; Mariman, An; Clauwaert, Lies; Godderis, Lode; Heytens, Stefan; Ruppol, Patrick; Spooren, Daniel; Tytgat, Rita; De Muynck, Martine; Vogelaers, Dirk

    2018-05-04

    Patients with medically unexplained physical symptoms suffer from chronic fatigue and/or pain in combination with a variety of other symptoms. A flexible, biopsychosocial approach is needed for diagnostic screening and global management. It is crucial to involve the direct patient environment, including family, friends, colleagues as well as health providers, evaluation, and reintegration sector. The aim of this paper is to review the importance of work in the management of medically unexplained physical symptoms. In this paper, different actors involved explain their views and handling concerning work in the management of MUPS. Symptom severity and lack of understanding from the environment can negatively impact on earning an independent income from labor for years. Work, whether or not paid, is however, an important life domain with positive effects on physical, psychological, and social well-being. Therefore, health actors are pivotal in starting the professional reintegration process as soon as possible and should discuss this item from the early stage onward. Support services can be consulted in mutual interaction as required. A case manager, acting as a central intermediator within this multidisciplinary approach, may promote effective communication and coordination between the patients and their surrounding actors. The professional reintegration process should start as soon as possible within the management of medically unexplained physical symptoms. As such, the care sector, the evaluation sector, and the professional integration sector should collaborate and effectively communicate with each other.

  17. Menstruation: symptoms, management and attitude of female nursing students in Ibadan, Nigeria.

    Science.gov (United States)

    Moronkola, O A; Uzuegbu, V U

    2006-12-01

    This study surveyed 120 student nurses from two schools of nursing in Ibadan, Nigeria to assess the symptoms experienced during menstruation, attitude towards and management of menstruation. The student nurses overall mean age at menarche was 14 years, average duration of menstrual period was five days and mean of menstrual cycle was 28 days. Out of the 120 study participants, 93% were having menstruation regularly. More participants experienced symptoms during premenstrual periods than menstrual periods. Majority (70%) used sanitary pad to manage their menstruation, 93% had positive attitude towards menstruation while only 20% consulted medical doctors whenever they experienced menstrual symptoms. Paracetamol was the drug of choice for many of the participants whenever they experienced menstrual symptoms It was recommended that authorities in schools of nursing should not overlook reproductive health needs of students. Also teaching of reproductive health education early in primary and secondary schools should be encouraged.

  18. Managing therapeutic competition in patients with heart failure, lower urinary tract symptoms and incontinence.

    Science.gov (United States)

    Tannenbaum, Cara; Johnell, Kristina

    2014-02-01

    Up to 50% of heart failure patients suffer from lower urinary tract symptoms. Urinary incontinence has been associated with worse functional status in patients with heart failure, occurring three times more frequently in patients with New York Heart Association Class III and IV symptoms compared with those with milder disease. The association between heart failure and urinary symptoms may be directly attributable to worsening heart failure pathophysiology; however, medications used to treat heart failure may also indirectly provoke or exacerbate urinary symptoms. This type of drug-disease interaction, in which the treatment for heart failure precipitates incontinence, and removal of medications to relieve incontinence worsens heart failure, can be termed therapeutic competition. The mechanisms by which heart failure medication such as diuretics, angiotensin-converting enzyme (ACE) inhibitors and β-blockers aggravate lower urinary tract symptoms are discussed. Initiation of a prescribing cascade, whereby antimuscarinic agents or β3-agonists are added to treat symptoms of urinary urgency and incontinence, is best avoided. Recommendations and practical tips are provided that outline more judicious management of heart failure patients with lower urinary tract symptoms. Compelling strategies to improve urinary outcomes include titrating diuretics, switching ACE inhibitors, treating lower urinary tract infections, appropriate fluid management, daily weighing, and uptake of pelvic floor muscle exercises.

  19. The utility of screening in the design of trials for symptom management in cancer.

    Science.gov (United States)

    Jeon, Sangchoon; Given, Charles W; Sikorskii, Alla; Given, Barbara

    2009-10-01

    Clinical trials that test interventions for symptom management must target patients whose symptoms are severe and can benefit from participation. Screening symptoms for their severity prior to trial entry may be an important element of trial design. This research describes the utility of screening for severity of symptoms prior to entry into clinical trials for symptom management in cancer. To accomplish this, 601 cancer patients undergoing chemotherapy were assessed at screening and at the initial intervention contact, using the 0-10 rating scale for severity of nine symptoms. Post-test probabilities and likelihood ratios (LRs) were estimated across cut-offs in screening severity scores. Areas under receiver operating characteristic curves for reaching threshold of four at the initial intervention contact were estimated by a nonparametric method. It was found that screening severity scores were good predictors for identifying patients who would not reach threshold but did not always accurately predict patients who would. The cut-offs between 2 and 4 on a 0-10 scale could be used to identify patients that might benefit from receipt of interventions. For all symptoms, the LRs were greater than one across possible screening cut-offs. The findings indicate that decision rules based on screening prior to entry into cancer symptom management trials can provide reasonable discriminative accuracy by differentiating among patients who are likely to reach higher levels of severity later in the trial from those who are not. Optimal severity cut-offs can be established based on LRs and desired sensitivity and specificity.

  20. Promoting self-care through symptom management: a theory-based approach for nurse practitioners.

    Science.gov (United States)

    Fowler, Christopher; Kirschner, Michelle; Van Kuiken, Debra; Baas, Linda

    2007-05-01

    To present a theory of illness representation useful in clinical practice along with two case studies as examples of theory implementation. Literature review of relevant theory and associated literature, case studies from clinical practice. An individual asks several questions when experiencing a physical sensation: "Am I sick, stressed, or is this a sign of aging? If I'm sick, is the symptom connected with a disease label?" After asking these questions, the individual develops a cognitive and emotional illness representation that includes the dimensions of identity, cause, consequences, control, and timeline. This representation is guided by personal, cultural, and environmental contexts and determines coping strategies. By assessing the individual's cognitive and emotional representations of the illness, the nurse practitioner (NP) can use the common sense model of illness representation (CSM) to establish interventions and action plans helpful in decreasing distress in the management of symptoms. NPs frequently care for patients who present with very severe symptoms related to their health problem. This becomes a major challenge in effective disease management. Leventhal's CSM can be used as a framework to identify the cognitive and emotional illness representations individuals develop when acute and chronic symptoms are presented. By assessing the individual's cognitive and emotional representations of the illness, the NP will be able to use the CSM to establish interventions and action plans that will be helpful in decreasing the patient's distress in the management of symptoms.

  1. HYPNOSIS FOR SYMPTOM MANAGEMENT IN WOMEN WITH BREAST CANCER: A Pilot Study

    Science.gov (United States)

    Jensen, Mark P.; Gralow, Julie R.; Braden, Alan; Gertz, Kevin J.; Fann, Jesse R.; Syrjala, Karen L.

    2018-01-01

    Eight women who were in treatment for breast cancer (n = 4) or breast cancer survivors (n = 4), presenting with 1 or more of 4 symptoms (chronic pain, fatigue, hot flashes, and sleep difficulties), were given 4 to 5 sessions of self-hypnosis training for symptom management. Analyses revealed (a) significant pre- to posttreatment decreases in pain intensity, fatigue, and sleep problems and (b) that pain intensity continued to decrease from posttreatment to 6-month follow-up. Although there was a slight increase in fatigue severity and sleep problems from posttreatment to 6-month follow-up, the follow-up scores did not return to pretreatment levels. The findings provide initial support for using hypnosis to manage symptoms in women who are breast cancer survivors. Clinical trials evaluating hypnosis efficacy over and above other treatments are warranted. PMID:22443523

  2. A program of symptom management for improving self-care for patients with HIV/AIDS.

    Science.gov (United States)

    Chiou, Piao-Yi; Kuo, Benjamin Ing-Tiau; Chen, Yi-Ming; Wu, Shiow-Ing; Lin, Li-Chan

    2004-09-01

    The purpose of this study was to investigate the effect of a symptom management program on self-care of medication side effects among AIDS/HIV-positive patients. Sixty-seven patients from a sexually transmitted disease control center, a medical center, and a Catholic AIDS support group in Taipei were randomly assigned to three groups: one-on-one teaching, group teaching, and a control group. All subjects in each teaching group attended a 60- or 90-minute program on highly active antiretroviral therapy (HAART) side effect self-care education and skill training once per week for 3 weeks; subjects also underwent counseling by telephone. A medication side effect self-care knowledge questionnaire, Rosenberg's Self-Esteem Scale (RSES), and unscheduled hospital visits were used to evaluate the effectiveness of the symptom management program. The results revealed there were significant differences in mean difference of knowledge and unscheduled hospital visits between baseline and post-testing at 3 months for symptom management in the two groups. The mean difference of the self-esteem scale was not significant between the two groups. In summary, the symptom management program effectively increased the ability of AIDS/HIV-positive patients to self-care for medication side effects. We recommend that this program be applied in the clinical nursing practice.

  3. Cultural Adaptation and the Psychometric Properties of the Korean Version of the Symptom Management Beliefs Questionnaire

    Directory of Open Access Journals (Sweden)

    Hyun-E Yeom, PhD, RN

    2013-09-01

    Conclusion: This study verified the psychometric properties of the K-SMBQ and provided evidence on the cultural relevance for the concept of ageist beliefs regarding symptom management in older Korean people. The development of nursing interventions to promote self-care of older people should be based on the consideration of negatively stereotyped and erroneous beliefs about health in old age.

  4. Occupational Stress in Secondary Education in Cyprus: Causes, Symptoms, Consequences and Stress Management

    Science.gov (United States)

    Hadjisymeou, Georgia

    2010-01-01

    The survey attempted to look into the causes, symptoms and consequences that occupational stress has on teachers in Secondary Education in Cyprus and find ways to manage it. Thirty eight schools with 553 teachers participated in the survey. The sample chosen is a result of a simple random sampling and it is representative of the country's…

  5. Bazedoxifene/conjugated estrogens for managing the burden of estrogen deficiency symptoms.

    Science.gov (United States)

    Mirkin, Sebastian; Ryan, Kelly A; Chandran, Arthi B; Komm, Barry S

    2014-01-01

    The bothersome vasomotor and vaginal symptoms and bone loss that accompany the menopausal transition are associated with significant direct costs due to physician visits and medication, as well as indirect costs from reduced health-related quality of life (HRQoL) and work productivity. With life expectancies increasing, the number of postmenopausal women is also increasing, and more women are remaining in the workforce. These factors have led to an increased burden of menopausal symptoms on healthcare systems. Hormone therapy (HT) has been shown to effectively reduce menopausal symptoms and significantly increase quality-adjusted life years in postmenopausal women, particularly in women experiencing severe symptoms. However, many women discontinue use of HT before their symptoms have dissipated due to safety and tolerability concerns. The tissue selective estrogen complex (TSEC) that pairs bazedoxifene (BZA) with conjugated estrogens (CE) has been developed to provide relief of menopausal symptoms and prevent bone loss without stimulating the breast or endometrium, and to have improved tolerability compared with HT. In this context, BZA 20mg/CE 0.45 and 0.625 mg were shown to prevent bone loss and effectively treat menopausal symptoms in postmenopausal women with an intact uterus, while also demonstrating a favorable safety/tolerability profile. BZA 20mg/CE 0.45 and 0.625 mg were further associated with clinically significant improvements in HRQoL, sleep, and treatment satisfaction. Taken together, the reduction in menopausal symptoms, improvement in HRQoL, and favorable safety/tolerability profile associated with BZA/CE suggest that it is a cost-effective alternative to HT for managing the burden of menopausal symptoms. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Effect of management of patients with Anorexia and Bulimia nervosa on symptoms and impulsive behavior.

    Science.gov (United States)

    Sernec, Karin; Tomori, Martina; Zalar, Bojan

    2010-12-01

    The aim of the study was to provide further and up to date information on the evaluation of the management of Anorexia and Bulimia nervosa at the Eating Disorders Unit (EDU) of the Ljubljana Psychiatric Clinic, based upon detailed assessment of the eating disorders specific and non specific symptoms of impulsive behaviors, highly correlated with these entities. 34 female patients with anorexia (restrictive or purgative type) and 38 female patients with Bulimia nervosa (purgative or non-purgative type) undergoing hospital treatment at the EDU were evaluated upon admission, as well as upon discharge and three and six months after discharge, using the Eating Disorder Questionnaire. Upon discharge a marked decrease in the overall symptoms was noted. The differences in symptoms incidences between the two groups were significantly specific for the individual form of eating disorder, especially upon admission, and were more pronounced in anorexia group. In later measurements, performed during the period of three and six months after discharge, a mild trend of increase in the disorder specific symptoms was detected in both groups, but was not statistically significant. In addition to binging on food, striking, quarreling and spending sprees are characteristics of patients with eating disorders, which in particular apply to the Bulimia nervosa group. Apart from the disorder specific symptoms, impulsive behavior was also reduced during study period, while the difference in its occurrence between the two groups gradually became non-significant. The management of patients with eating disorders at the EDU was successful in both groups, confirmed by an intense reduction of the disorder specific symptoms, impulsive behavior and increased stability recorded three and six months after discharge. The study strongly suggests that the effect of treatment regime for eating disorders can be predicted by careful assessment of the relevant symptoms and impulsive behavioral patterns.

  7. Family medicine physicians' advice about use of nonconventional modalities for menopausal symptom management.

    Science.gov (United States)

    Grant, Kathryn; Burg, Mary Ann; Fraser, Kathryn; Gui, Serena; Kosch, Shae Graham; Nierenberg, Barry; Oyama, Oliver; Pomm, Heidi; Sibille, Kimberly; Spruill, Timothy; Swartz, Virginia

    2007-05-01

    This study explores the beliefs and practices of family medicine physicians regarding the use of nonconventional modalities for menopausal symptom management. Anonymous self-administered questionnaires were distributed to faculty and residents from eight participating family medicine residency programs around Florida, with an overall response rate of 66% (212 respondents). The survey explored what physicians report about patterns of patient inquiries and their responses to patients' inquiries about nonconventional modalities for specific menopausal symptoms and what physicians' report on their advice to patients about using specific herbs and supplements for menopausal symptom relief. Behavioral approaches were encouraged more than herbal therapies, acupuncture, and body therapies for the treatment of most of the menopausal symptoms. However, the most frequent response category was No advice. Resident physicians were significantly more likely than faculty to encourage acupuncture. Faculty physicians were more likely than residents to recommend particular herbal remedies. The majority of the respondents believed there was not sufficient evidence for recommending any of the herbs and supplements listed. These data reveal some important trends about how family medicine physicians respond to nontraditional approaches for menopausal symptom management. Because family medicine physicians typically receive some training in behavioral and psychotherapeutic approaches and there is some evidence for the effectiveness of behavioral strategies in menopausal symptom management, it is not surprising that they are more likely to endorse these approaches. Most family medicine physicians, however, have little or no training in the other nonconventional modalities, and our data show that these modalities received lower levels of endorsement, suggesting that physicians are not clear on their advantages or disadvantages.

  8. Vulvar and vaginal atrophy as viewed by the Spanish REVIVE participants: symptoms, management and treatment perceptions.

    Science.gov (United States)

    Palacios, S; Cancelo, M J; Castelo Branco, C; Llaneza, P; Molero, F; Borrego, R Sanchez

    2017-02-01

    , an effective discussion of symptoms and therapies with doctors would improve its management.

  9. Stress management at the worksite: reversal of symptoms profile and cardiovascular dysregulation.

    Science.gov (United States)

    Lucini, Daniela; Riva, Silvano; Pizzinelli, Paolo; Pagani, Massimo

    2007-02-01

    Work stress may increase cardiovascular risk either indirectly, by inducing unhealthy life styles, or directly, by affecting the autonomic nervous system and arterial pressure. We hypothesized that, before any apparent sign of disease, work-related stress is already accompanied by alterations of RR variability profile and that a simple onsite stress management program based on cognitive restructuring and relaxation training could reduce the level of stress symptoms, revert stress-related autonomic nervous system dysregulation, and lower arterial pressure. We compared 91 white-collar workers, enrolled at a time of work downsizing (hence, in a stress condition), with 79 healthy control subjects. Psychological profiles were assessed by questionnaires and autonomic nervous system regulation by spectral analysis of RR variability. We also tested a simple onsite stress management program (cognitive restructuring and relaxation training) in a subgroup of workers compared with a sham subgroup (sham program). Workers presented an elevated level of stress-related symptoms and an altered variability profile as compared with control subjects (low-frequency component of RR variability was, respectively, 65.2+/-2 versus 55.3+/-2 normalized units; Pstress management program, which also slightly lowered systolic arterial pressure. No changes were observed in the sham program group. This noninvasive study indicates that work stress is associated with unpleasant symptoms and with an altered autonomic profile and suggests that a stress management program could be implemented at the worksite, with possible preventive advantages for hypertension.

  10. NIH State-of-the-Science Conference Statement on management of menopause-related symptoms.

    Science.gov (United States)

    To provide health care providers, patients, and the general public with a responsible assessment of currently available data on the management of menopause-related symptoms. A non-DHHS, nonadvocate 12-member panel representing the fields of obstetrics and gynecology, general internal medicine, endocrinology, rheumatology, family and health psychology, geriatric medicine, health services research, demography, biochemistry, epidemiology, clinical research, and biostatistics. In addition, 26 experts in fields related to the conference topic presented data to the panel and to the conference audience. Presentations by experts and a systematic review of the medical literature prepared by the Oregon Evidence-based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience. Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. A final copy of this statement is available, along with other recent conference statements, at the same web address of http://consensus.nih.gov. Menopause is the permanent cessation of menstrual periods that occurs naturally in women, usually in their early 50s. Many women have few or no symptoms; these women are not in need of medical treatment. Premenopausal or perimenopausal women who have menopause induced by surgery, chemotherapy, or radiation are more likely to experience bothersome and even disabling symptoms. These

  11. Managing symptoms during cancer treatments: evaluating the implementation of evidence-informed remote support protocols

    Directory of Open Access Journals (Sweden)

    Stacey Dawn

    2012-11-01

    Full Text Available Abstract Background Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©. Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments. Methods A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a establishing an advisory knowledge user team in each of three targeted settings; (b assessing factors influencing nurses’ use of protocols using interviews/focus groups and a standardized survey instrument; (c adapting protocols for local use, ensuring fidelity of the content; (d selecting intervention strategies to overcome known barriers and implementing the protocols; (e conducting think-aloud usability testing; (f evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g assessing satisfaction with remote support using symptom protocols and change in nurses’ barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing

  12. Effect of self-acupressure for symptom management: a systematic review.

    Science.gov (United States)

    Song, Hyun Jin; Seo, Hyun-Ju; Lee, Heeyoung; Son, Heejeong; Choi, Sun Mi; Lee, Sanghun

    2015-02-01

    To assess the efficacy and safety of self-administered acupressure to alleviate symptoms of various health problems, including allergic disease, cancer, respiratory disease, dysmenorrhea, perceived stress, insomnia, and sleep disturbances. We searched core, Korean, Chinese, and Japanese databases, including Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), six representative electronic Korean medical databases, China National Knowledge Infrastructure (CNKI), and Japan Science and Technology Information Aggregator (J-STAGE). We included randomized controlled trials (RCTs) and quasi-RCTs that examined disease-specific effects or symptom relief, adverse reactions, and quality-of-life (QOL) for self-administered acupressure. Data collection and assessment of the methodological quality of the included studies were conducted by two independent reviewers. Eight RCTs and two quasi-RCTs showed positive effects and safety of self-acupressure therapy in clinically diverse populations. Quality assessment revealed moderate quality for the RCTs, with 50% or more of the trials assessed as presenting a low risk of bias in seven domains. All of the selected 10 studies reported positive effects for primary outcomes of self-acupressure therapy for symptom management, including significant improvements in symptom scores in allergic disease, nausea and vomiting in cancer, symptom scores in respiratory disease, pain symptoms in dysmenorrhea, and stress/fatigue scores and sleep disturbances in healthy people. Our findings suggest that self-administered acupressure shows promise to alleviate the symptoms of various health problems. Therefore, further research with larger samples and methodologically well-designed RCTs is required to establish the efficacy of self-administered acupressure. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Radiation-Induced Organizing Pneumonia: A Characteristic Disease that Requires Symptom-Oriented Management.

    Science.gov (United States)

    Otani, Keisuke; Seo, Yuji; Ogawa, Kazuhiko

    2017-01-27

    Radiation-induced organizing pneumonia (RIOP) is an inflammatory lung disease that is occasionally observed after irradiation to the breast. It is a type of secondary organizing pneumonia that is characterized by infiltrates outside the irradiated volume that are sometimes migratory. Corticosteroids work acutely, but relapse of pneumonia is often experienced. Management of RIOP should simply be symptom-oriented, and the use of corticosteroids should be limited to severe symptoms from the perspective not only of cost-effectiveness but also of cancer treatment. Once steroid therapy is started, it takes a long time to stop it due to frequent relapses. We review RIOP from the perspective of its diagnosis, epidemiology, molecular pathogenesis, and patient management.

  14. Evaluation and management of children with lower urinary tract symptoms (LUTS

    Directory of Open Access Journals (Sweden)

    Guerrero Tinoco, Gustavo Adolfo

    2018-01-01

    Full Text Available Voiding dysfunction is a disorder of the bladder filling or emptying in children without neurological or anatomical disorders. Lower urinary tract symptoms (LUTS are a frequent reason for consulting the pediatrician, nephrologist or pediatric urologist, and even the neurologist and child psychologist. It is considered a relatively benign disease that sometimes generates disinterest among doctors and families, leading to late consultation and inadequate interpretation of symptoms. Urgency, incontinence, enuresis, post-void dribbling, urinary tract infections, recurrent vulvovaginitis and constipation in children without neurological disease should lead to consider the possibility of voiding dysfunction, in order to recognize it timely, restore the quality of life, prevent urinary tract infection and the irreversible kidney damage secondary to delayed diagnosis. Current recommendations emphasize on a less invasive approach, conservative treatment, management of constipation and bladder retraining. This article discusses the correct assessment, diagnosis and management of children with LUTS.

  15. Extending our knowledge of fermentable, short-chain carbohydrates for managing gastrointestinal symptoms.

    Science.gov (United States)

    Barrett, Jacqueline S

    2013-06-01

    The Monash University low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet is now accepted as an effective strategy for managing symptoms of irritable bowel syndrome (IBS) in Australia, with interest expanding across the world. These poorly absorbed, short-chain carbohydrates have been shown to induce IBS symptoms of diarrhea, bloating, abdominal pain, and flatus due to their poor absorption, osmotic activity, and rapid fermentation. Four clinical trials have been published to date, all with significant symptomatic response to the low FODMAP diet. Up to 86% of patients with IBS have achieved relief of overall gastrointestinal symptoms and, more specifically, bloating, flatus, abdominal pain, and altered bowel habit from the approach. This review provides an overview of the low FODMAP diet and summarizes the research to date, emerging concepts, and limitations. FODMAPs are known to be beneficial to bowel health; the importance of this and how this should be considered in the clinical management of IBS is also discussed. A clinical management flowchart is provided to assist nutrition professionals in the use of this approach.

  16. Guide to managing persistent upper gastrointestinal symptoms during and after treatment for cancer.

    Science.gov (United States)

    Andreyev, H Jervoise N; Muls, Ann C; Shaw, Clare; Jackson, Richard R; Gee, Caroline; Vyoral, Susan; Davies, Andrew R

    2017-10-01

    Guidance : the practical management of the gastrointestinal symptoms of pelvic radiation disease was published in 2014 for a multidisciplinary audience. Following this, a companion guide to managing upper gastrointestinal (GI) consequences was developed. The development and peer review of an algorithm which could be accessible to all types of clinicians working with patients experiencing upper GI symptoms following cancer treatment. Experts who manage patients with upper GI symptoms were asked to review the guide, rating each section for agreement with the recommended measures and suggesting amendments if necessary. Specific comments were discussed and incorporated as appropriate, and this process was repeated for a second round of review. 21 gastroenterologists, 11 upper GI surgeons, 9 specialist dietitians, 8 clinical nurse specialists, 5 clinical oncologists, 3 medical oncologists and 4 others participated in the review. Consensus (defined prospectively as 60% or more panellists selecting 'strongly agree' or 'agree') was reached for all of the original 31 sections in the guide, with a median of 90%. 85% of panellists agreed that the guide was acceptable for publication or acceptable with minor revisions. 56 of the original 61 panellists participated in round 2. 93% agreed it was acceptable for publication after the first revision. Further minor amendments were made in response to round 2. Feedback from the panel of experts developed the guide with improvement of occasional algorithmic steps, a more user-friendly layout, clearer time frames for referral to other teams and addition of procedures to the appendix.

  17. Engaging Stakeholders in the Development of an eHealth Intervention for Cancer Symptom Management for Rural Residents.

    Science.gov (United States)

    Gilbertson-White, Stephanie; Yeung, Chi W; Saeidzadeh, Seyedehtanaz; Tykol, Hannah; Vikas, Praveen; Cannon, Ashley

    2018-04-25

    Late-stage cancer diagnoses disproportionately occur in rural residents, frequently resulting in increased need for symptom management support with minimal access to these services. Oncology Associated Symptoms and Individualized Strategies (OASIS) is an eHealth symptom self-management intervention that was developed to provide cancer symptom self-management support and address this disparity. To engage stakeholders about the symptom management needs and concerns of patients with advanced cancer living in rural areas. A 3-phased, mixed-methods design was used to (1) assess stakeholder needs and opinions; (2) develop a symptom self-management website; and (3) obtain usability feedback from potential users. Interviews with stakeholders (patients and clinic staff) from rural areas using a descriptive qualitative approach were analyzed; cross-cutting themes were identified; a symptom management web application was developed; and stakeholders completed a 12-item usability survey about the web application. Patients (n = 16) and clinical staff (n = 10) participated in phase 1. Three major themes were identified: "symptom experience," "symptom management," and "technology." Through an iterative process using these results and evidence from the literature, the OASIS web application was developed. Usability testing with N = 126 stakeholders demonstrated that the web application is easy to use, contains relevant content, and has pleasing graphics. No differences were found among patients, family/friends, and staff. Both frequent and infrequent internet users positively evaluated the web application.  CONCLUSIONS: Rural stakeholders report significant symptom management needs, are interested in eHealth technologies, and perceived OASIS positively. Future research is needed to evaluate the feasibility, acceptability, and efficacy of OASIS. © 2018 National Rural Health Association.

  18. Contemporary management of median arcuate ligament syndrome provides early symptom improvement

    Science.gov (United States)

    Columbo, Jesse A.; Trus, Thadeus; Nolan, Brian; Goodney, Philip; Rzucidlo, Eva; Powell, Richard; Walsh, Daniel; Stone, David

    2017-01-01

    Objective Optimal diagnosis and management of median arcuate ligament (MAL) syndrome (MALS) remains unclear in contemporary practice. The advent and evolution of laparoscopic and endovascular techniques has redirected management toward a less invasive therapeutic algorithm. This study examined our contemporary outcomes of patients treated for MALS. Methods All patients treated for MALS at Dartmouth-Hitchcock Medical Center from 2000 to 2013 were retrospectively reviewed. Demographics and comorbidities were recorded. Freedom from symptoms and freedom from reintervention were the primary end points. Return to work or school was assessed. Follow-up by clinic visits and telephone allowed quantitative comparisons among the patients. Results During the study interval, 21 patients (24% male), with a median age of 42 years, were treated for MALS. All patients complained of abdominal pain in the presence of a celiac stenosis, 16 (76%) also reported weight loss at the time of presentation, and 57% had a concomitant psychiatric history. Diagnostic imaging most commonly used included duplex ultrasound (81%), computed tomography angiography (66%), angiography (57%), and magnetic resonance angiography (5%). Fourteen patients (67%) underwent multiple diagnostic studies. All patients underwent initial laparoscopic MAL release. Seven patients (33%) underwent subsequent celiac stent placement in the setting of recurrent or unresolved symptoms with persistent celiac stenosis at a mean interval of 49 days. Two patients required surgical bypass after an endovascular intervention failed. The 6-month freedom from symptoms was 75% and freedom from reintervention was 64%. Eighteen patients (81%) reported early symptom improvement and weight gain, and 66% were able to return to work. Conclusions A multidisciplinary treatment approach using initial laparoscopic release and subsequent stent placement and bypass surgery provides symptom improvement in most patients treated for MALS. The

  19. Chemotherapy-related neuropathic symptom management: a randomized trial of an automated symptom-monitoring system paired with nurse practitioner follow-up.

    Science.gov (United States)

    Kolb, Noah Allan; Smith, Albert Gordon; Singleton, John Robinson; Beck, Susan L; Howard, Diantha; Dittus, Kim; Karafiath, Summer; Mooney, Kathi

    2018-05-01

    The purpose of this study was to evaluate a new care model to reduce chemotherapy-induced neuropathic symptoms. Neuropathic symptom usual care was prospectively compared to an automated symptom-monitoring and coaching system, SymptomCare@Home (SCH), which included nurse practitioner follow-up triggered by moderate to severe symptoms. Patients beginning chemotherapy were randomized to usual care (UC) or to the SCH intervention. This sub-analysis included only taxane/platin therapies. Participants called the automated telephone symptom-monitoring system daily to report numbness and tingling. The monitoring system recorded patient-reported neuropathic symptom severity, distress, and activity interference on a 0-10 scale. UC participants were instructed to call their oncologist for symptom management. SCH participants with symptom severity of ≥ 4 received automated self-care strategies, and a nurse practitioner (NP) provided guideline-based care. There were 252 participants, 78.6% of which were female. Mean age was 55.1 years. Mean follow-up was 90.2 ± 39.9 days (81.1 ± 40.3 calls). SCH participants had fewer days of moderate (1.8 ± 4.0 vs. 8.6 ± 17.3, p < 0.001) and severe chemotherapy-induced peripheral neuropathy symptoms (0.3 ± 1.0 vs. 1.1 ± 5.2, p = 0.006). SCH participants had fewer days with moderate and severe symptom-related distress (1.4 ± 3.7 vs. 6.9 ± 15.0, p < 0.001; 0.2 ± 0.9 vs. 1.5 ± 6.1, p = 0.001) and trended towards less activity interference (3.3 ± 1.9 vs. 3.8 ± 2.1, p = 0.08). Other neuropathic symptoms were addressed in 5.8-15.4% of SCH follow-up calls. The SCH system effectively identified neuropathic symptoms and their severity and, paired with NP follow-up, reduced symptom prevalence, severity, and distress compared to usual care.

  20. [Management of symptoms associated with spasticity in patients with multiple sclerosis].

    Science.gov (United States)

    Fernández-Pablos, María Asunción; Costa-Frossard, Lucienne; García-Hernández, Carlos; García-Montes, Inmaculada; Escutia-Roig, Matilde

    To describe the role of nurses in the management of symptoms related to spasticity in patients with multiple sclerosis (MS). A descriptive study was developed based on a questionnaire on spasticity in MS patients. The questionnarie was completed through an anonymous tele-voting system at a national meeting with nurses involved in the management of these patients. Apart from fatigue, according to the opinion of the participants, the spasticity symptom associated with MS most notified by patients was difficulty in walking, followed by spasms and pain. Participants thought that it is important that nursing takes: 1) a role in identifying these symptoms, 2) should focus on the detection of the triggering or aggravating factors, and 3) on providing support in the assessment of the level of spasticity. It is important to inform about the correct use of anti-spasticity drugs, how to adjust the dosage and side effects of treatments, including cannabinoids via an oromucosal spray, titrating its doses according to each patient, and monitoring its tolerability, efficacy and adherence. Although there are usually resources to follow up these patients, there are still important gaps, including the lack of a specific follow-up protocol. Although all the participants are experts in the management of patients with MS, there is still diversity in the functions they perform, and the available resources they have in their hospitals. Nurses act as a key element in the process of identification of symptoms, training and monitoring of these patients with spasticity in EM. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  1. Exploratory study of impact of cancer-related posttraumatic stress symptoms on diabetes self-management among cancer survivors.

    Science.gov (United States)

    James, Janey; Harris, Yael T; Kronish, Ian M; Wisnivesky, Juan P; Lin, Jenny J

    2018-02-01

    Posttraumatic stress symptoms (PTSS) can be triggered by a diagnosis of a potentially life-threatening illness such as cancer. Little is known about the impact of cancer-related PTSS symptoms on self-management behaviors for comorbid chronic medical conditions such as diabetes mellitus (DM). We recruited patients with DM and a recent diagnosis of early-stage cancer from 2 medical centers in New York City. Cancer-related PTSS were assessed using the Impact of Events Scale (score ≥ 26). DM self-management behaviors (medication adherence, exercise, healthy diet, and glucose testing) were measured 3 months later. Logistic regression was used to assess the association between cancer-related PTSS symptoms and DM self-management behaviors, adjusting for gender, marital status, and anxiety symptoms. Of 56 participants recruited, 33% reported cancer-related PTSS symptoms. Elevated cancer-related PTSS symptoms were associated with lack of healthy diet (odds ratio: 0.08, 95% confidence interval: 0.01-0.62). Early-stage cancer survivors with cancer-related PTSS symptoms were less likely to adhere to some DM self-management behaviors. Providers should recognize the impact of cancer-related PTSS symptoms to better support comorbid disease management in cancer survivors. Copyright © 2017 John Wiley & Sons, Ltd.

  2. The Promise and Potential Perils of Big Data for Advancing Symptom Management Research in Populations at Risk for Health Disparities.

    Science.gov (United States)

    Bakken, Suzanne; Reame, Nancy

    2016-01-01

    Symptom management research is a core area of nursing science and one of the priorities for the National Institute of Nursing Research, which specifically focuses on understanding the biological and behavioral aspects of symptoms such as pain and fatigue, with the goal of developing new knowledge and new strategies for improving patient health and quality of life. The types and volume of data related to the symptom experience, symptom management strategies, and outcomes are increasingly accessible for research. Traditional data streams are now complemented by consumer-generated (i.e., quantified self) and "omic" data streams. Thus, the data available for symptom science can be considered big data. The purposes of this chapter are to (a) briefly summarize the current drivers for the use of big data in research; (b) describe the promise of big data and associated data science methods for advancing symptom management research; (c) explicate the potential perils of big data and data science from the perspective of the ethical principles of autonomy, beneficence, and justice; and (d) illustrate strategies for balancing the promise and the perils of big data through a case study of a community at high risk for health disparities. Big data and associated data science methods offer the promise of multidimensional data sources and new methods to address significant research gaps in symptom management. If nurse scientists wish to apply big data and data science methods to advance symptom management research and promote health equity, they must carefully consider both the promise and perils.

  3. [PHARMACOLOGICAL TREATMENT IN PALLIATIVE CARE. DRUG ADMINISTRATION ROUTE, CONTINUOUS SUBCUTANEOUS INFUSION, ADVERSE SIDE EFFECTS, SYMPTOM MANAGEMENT].

    Science.gov (United States)

    Dominguez Álvarez, Rocío; Calderón Carrasco, Justo; García Colchero, Francisco; Postigo Mota, Salvador; Alburquerque Medina, Eulalia

    2015-01-01

    To achieve well-being in patients in Palliative Care is required to know which are the most common symptoms, which are the drugs used for relief, which are the routes of administration of drugs that are suitable, how effective the drugs are and what incompatibilities, interactions and adverse effects occur. The aim of this article is to review the relevant issues in the management of the drugs commonly used by nursing in Palliative Care and presenting recommendations to clinical practice. Management interventions drugs for nurses in Palliative Care recommended by the scientific literature after a search of Scopus, CINAHL, Medline, PubMed, UpToDate and Google Scholar are selected. The oral route is the choice for patients in palliative situation and subcutaneous route when the first is not available. The symptoms, complex, intense and moody, should be systematically reevaluated by the nurse, to predict when a possible decompensation of it needing extra dose of medication. Nurses must be able to recognize the imbalance of well-being and act quickly and effectively, to get relief to some unpleasant situations for the patient as the pain symptoms, dyspnea or delirium. For the proper administration of rescue medication, the nurse should know the methods of symptomatic evaluation, pharmacokinetics and pharmacodynamics of drugs, the time intervals to elapse between different rescues and nccocc rocnnnco t thocm

  4. Heart failure patients' perceptions and use of technology to manage disease symptoms.

    Science.gov (United States)

    Hall, Amanda K; Dodd, Virginia; Harris, Amy; McArthur, Kara; Dacso, Clifford; Colton, Lara M

    2014-04-01

    Technology use for symptom management is beneficial for both patients and physicians. Widespread acceptance of technology use in healthcare fuels continued development of technology with ever-increasing sophistication. Although acceptance of technology use in healthcare by medical professionals is evident, less is known about the perceptions, preferences, and use of technology by heart failure (HF) patients. This study explores patients' perceptions and current use of technology for managing HF symptoms (MHFS). A qualitative analysis of in-depth individual interviews using a constant comparative approach for emerging themes was conducted. Fifteen participants (mean age, 64.43 years) with HF were recruited from hospitals, cardiology clinics, and community groups. All study participants reported use of a home monitoring device, such as an ambulatory blood pressure device or bathroom scale. The majority of participants reported not accessing online resources for additional MHFS information. However, several participants stated their belief that technology would be useful for MHFS. Participants reported increased access to care, earlier indication of a worsening condition, increased knowledge, and greater convenience as potential benefits of technology use while managing HF symptoms. For most participants financial cost, access issues, satisfaction with current self-care routine, mistrust of technology, and reliance on routine management by their current healthcare provider precluded their use of technology for MHFS. Knowledge about HF patients' perceptions of technology use for self-care and better understanding of issues associated with technology access can aid in the development of effective health behavior interventions for individuals who are MHFS and may result in increased compliance, better outcomes, and lower healthcare costs.

  5. Multimodal, integrative therapies for the self-management of chronic pain symptoms.

    Science.gov (United States)

    Lee, Courtney; Crawford, Cindy; Swann, Steven

    2014-04-01

    Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM therapies (ACT-CIM) allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. A systematic review was conducted, using Samueli Institute's rapid evidence assessment of the literature methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A working group of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities. Following key database searches, 146 randomized controlled trials were included in the review, 26 of which investigated multimodal, integrative therapies, as defined by the authors. This article summarizes the current evidence, quality, and effectiveness of these modalities. Recommendations and next steps to move this field of research forward are also discussed. The entire scope of the review is detailed throughout the current Pain Medicine supplement. Wiley Periodicals, Inc.

  6. Sensory art therapies for the self-management of chronic pain symptoms.

    Science.gov (United States)

    Crawford, Cindy; Lee, Courtney; Bingham, John

    2014-04-01

    Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM therapies (ACT-CIM) allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. A systematic review was conducted, using Samueli Institute's rapid evidence assessment of the literature methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A working group of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities. Following key database searches, 146 randomized controlled trials were included in the review, eight of which investigated sensory art therapies, as defined by the authors. This article summarizes the current evidence, quality, efficacy, and safety of these modalities. Recommendations and next steps to move this field of research forward are also discussed. The entire scope of the review is detailed throughout the current Pain Medicine supplement. Wiley Periodicals, Inc.

  7. Physically oriented therapies for the self-management of chronic pain symptoms.

    Science.gov (United States)

    Crawford, Cindy; Lee, Courtney; May, Todd

    2014-04-01

    Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures that are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. A systematic review was conducted, using Samueli Institute's Rapid Evidence Assessment of the Literature methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A working group of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities. Following key database searches, 146 randomized controlled trials were included in the review, 10 of which investigated physically oriented therapies, as defined by the authors. This article summarizes the current evidence, quality, efficacy, and safety of these modalities. Recommendations and next steps to move this field of research forward are also discussed. The entire scope of the review is detailed throughout the current Pain Medicine supplement. Wiley Periodicals, Inc.

  8. Movement therapies for the self-management of chronic pain symptoms.

    Science.gov (United States)

    Lee, Courtney; Crawford, Cindy; Schoomaker, Eric

    2014-04-01

    Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM therapies (ACT-CIM) allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. A systematic review was conducted, using Samueli Institute's rapid evidence assessment of the literature methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A working group of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities. Following key database searches, 146 randomized controlled trials were included in the review, 30 of which investigated movement therapies, as defined by the authors. This article summarizes the current evidence, quality, efficacy, and safety of these modalities. Recommendations and next steps to move this field of research forward are also discussed. The entire scope of the review is detailed throughout the current Pain Medicine supplement. Wiley Periodicals, Inc.

  9. Mind-body therapies for the self-management of chronic pain symptoms.

    Science.gov (United States)

    Lee, Courtney; Crawford, Cindy; Hickey, Anita

    2014-04-01

    Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care complementary and integrative medicine (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. A systematic review was conducted, using Samueli Institute's rapid evidence assessment of the literature (REAL©) methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A panel of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities. Following key database searches, 146 randomized controlled trials were included in the review, 54 of which investigated mind-body therapies, as defined by the authors. This article summarizes the current evidence, quality, efficacy, and safety of these modalities. Recommendations and next steps to move this field of research forward are also discussed. The entire scope of the review is detailed throughout the current Pain Medicine supplement. Wiley Periodicals, Inc.

  10. Bowel obstruction and delirium: managing difficult symptoms at the end of life.

    Science.gov (United States)

    Lynch, Maureen; Dahlin, Constance; Bakitas, Marie

    2012-08-01

    Palliative care has become an essential component of oncology care, with a focus on maximizing quality of life and optimizing function, as well as promoting pain and symptom management. This article focuses on the care of a patient experiencing bowel obstruction and delirium, two common issues in patients with advanced cancer, and demonstrates the integration of palliative care and oncology care to achieve an individualized care plan. Management focuses on identifying and treating reversible causes and improving quality of life while respecting the patient's values and goals. Sometimes the causes are not easily identified or treatment of the cause may impair quality of life, at least temporarily. At other times, the causes may be irreversible and the focus is exclusively on quality of life. Determination of best care for individual patients requires synthesis of data from holistic assessment, including the patient's goals of care and values, as well as knowledge of the patient's disease state with evidence-based approaches to management.

  11. Advances in the management of multiple sclerosis symptoms: pathophysiology and assessment of spasticity in multiple sclerosis.

    Science.gov (United States)

    Tintoré, Mar

    2015-01-01

    Spasticity is a prevalent and troublesome symptom for people with multiple sclerosis (MS). Common instruments to measure MS spasticity include the clinician-rated (modified) Ashworth scale and the patient-rated 0-10 spasticity Numerical Rating Scale (NRS). Current opinion is that measurement of MS spasticity should incorporate the patient's perspective. Other instruments to assess spasticity-associated symptoms such as the Penn spasms frequency scale, sleep quality NRS and pain NRS can assist in tracking MS spasticity evolution and inform management choices. Worsening spasticity reduces patient autonomy, impacts negatively on quality of life and increases health resource utilization and costs. Despite the wide range of issues associated with MS spasticity, undertreatment is common and standard treatment options (physiotherapy and classical oral therapies) often fail to provide adequate symptomatic control.

  12. An international comparison of occupational health guidelines for the management of mental disorders and stress-related psychological symptoms

    NARCIS (Netherlands)

    Joosen, Margot C. W.; Brouwers, Evelien P. M.; van Beurden, Karlijn M.; Terluin, Berend; Ruotsalainen, Jani H.; Woo, Jong-Min; Choi, Kyeong-Sook; Eguchi, Hisashi; Moriguchi, Jiro; van der Klink, Jac J. L.; van Weeghel, Jaap

    Background We compared available guidelines on the management of mental disorders and stress-related psychological symptoms in an occupational healthcare setting and determined their development and reporting quality. Methods To identify eligible guidelines, we systematically searched National

  13. Usability and feasibility of health IT interventions to enhance Self-Care for Lymphedema Symptom Management in breast cancer survivors

    Directory of Open Access Journals (Sweden)

    Mei R. Fu, PhD, RN, FAAN

    2016-09-01

    Conclusions: This usability study provided evidence on breast cancer survivor's acceptance and highly positive evaluation of TOLF's usability as well as feasibility of using technologically-driven delivery model to enhance self-care strategies for lymphedema symptom management.

  14. Conservative management of vestibular schwannoma--a prospective cohort study: treatment, symptoms, and quality of life.

    Science.gov (United States)

    Breivik, Cathrine Nansdal; Varughese, Jobin K; Wentzel-Larsen, Tore; Vassbotn, Flemming; Lund-Johansen, Morten

    2012-05-01

    One hundred ninety-three patients with sporadic unilateral vestibular schwannoma given conservative management were enrolled in a prospective study. To evaluate the efficacy of conservative management and to determine the effect of an initial conservative management on the quality of life (QOL) and severity of audio vestibular symptoms. The patients underwent magnetic resonance imaging scans, clinical examination, and QOL assessment by 2 validated questionnaires, the Short Form-36 (SF-36) and Glasgow Benefit Inventory (GBI). Using regression analysis of clustered data, we analyzed possible associations between tumor growth and symptoms and tested whether our earlier finding that vertigo is associated with reduced QOL could be verified. The median follow-up time was 43 months (range, 9-115 months; SD, 21.48 months). Results are based on 703 clinical controls and 642 (SF-36) and 638 (GBI) questionnaires. Seven patients were lost to follow-up. Approximately 40% of patients were in need of treatment during follow-up. We found a statistically significant association between tinnitus and vertigo and tumor growth. Vertigo was found to significantly reduce QOL. There was a significant drop in the Social Function subscales of both SF-36 and GBI, possibly attributable to progressive hearing loss. Otherwise, there was no overall trend toward any change in QOL during the observation period. In addition, QOL seemed to be little affected by treatment. There was a small but statistically significant improvement in vestibular complaints and no change in the occurrence of tinnitus. Except for hearing loss caused by surgery, treatment did not affect symptoms or QOL significantly. Growth was associated with the occurrence of tinnitus and balance problems.

  15. Saw Palmetto for Symptom Management During Radiation Therapy for Prostate Cancer.

    Science.gov (United States)

    Wyatt, Gwen K; Sikorskii, Alla; Safikhani, Abolfazl; McVary, Kevin T; Herman, James

    2016-06-01

    Lower urinary tract symptoms (LUTSs) affect 75%-80% of men undergoing radiation therapy (RT) for prostate cancer. To determine the safety, maximum tolerated dose (MTD), and preliminary efficacy of Serenoa repens commonly known as saw palmetto (SP) for management of LUTS during RT for prostate cancer. The dose finding phase used the time-to-event continual reassessment method to evaluate safety of three doses (320, 640, and 960 mg) of SP. Dose-limiting toxicities were assessed for 22 weeks using the Common Terminology Criteria for Adverse Events for nausea, gastritis, and anorexia. The exploratory randomized controlled trial phase assessed preliminary efficacy of the MTD against placebo. The primary outcome of LUTS was measured over 22 weeks using the International Prostate Symptom Score. Additional longitudinal assessments included quality of life measured with the Functional Assessment of Cancer Therapy-Prostate. The dose finding phase was completed by 27 men who reported no dose-limiting toxicities and with 20 participants at the MTD of 960 mg daily. The exploratory randomized controlled trial phase included 21 men, and no statistically significant differences in the International Prostate Symptom Score were observed. The prostate-specific concerns score of the Functional Assessment of Cancer Therapy-Prostate improved in the SP group (P = 0.03). Of 11 men in the placebo group, two received physician-prescribed medications to manage LUTS compared with none of the 10 men in the SP group. SP at 960 mg may be a safe herbal supplement, but its efficacy in managing LUTS during RT needs further investigation. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  16. Burden of upper gastrointestinal symptoms in patients receiving low-dose acetylsalicylic acid for cardiovascular risk management

    DEFF Research Database (Denmark)

    Bytzer, Peter; Pratt, Stephen; Elkin, Eric

    2013-01-01

    Continuous low-dose acetylsalicylic acid (aspirin; ASA) is a mainstay of cardiovascular (CV) risk management. It is well established, however, that troublesome upper gastrointestinal (GI) symptoms are commonly experienced among low-dose ASA users.......Continuous low-dose acetylsalicylic acid (aspirin; ASA) is a mainstay of cardiovascular (CV) risk management. It is well established, however, that troublesome upper gastrointestinal (GI) symptoms are commonly experienced among low-dose ASA users....

  17. Junior doctors' experiences of managing patients with medically unexplained symptoms: a qualitative study.

    Science.gov (United States)

    Yon, Katherine; Nettleton, Sarah; Walters, Kate; Lamahewa, Kethakie; Buszewicz, Marta

    2015-12-01

    To explore junior doctors' knowledge about and experiences of managing patients with medically unexplained symptoms (MUS) and to seek their recommendations for improved future training on this important topic about which they currently receive little education. Qualitative study using in-depth interviews analysed using the framework method. Participants were recruited from three North Thames London hospitals within the UK. Twenty-two junior doctors undertaking the UK foundation two-year training programme (FY1/FY2). The junior doctors interviewed identified a significant gap in their training on the topic of MUS, particularly in relation to their awareness of the topic, the appropriate level of investigations, possible psychological comorbidities, the formulation of suitable explanations for patients' symptoms and longer term management strategies. Many junior doctors expressed feelings of anxiety, frustration and a self-perceived lack of competency in this area, and spoke of over-investigating patients or avoiding patient contact altogether due to the challenging nature of MUS and a difficulty in managing the accompanying uncertainty. They also identified the negative attitudes of some senior clinicians and potential role models towards patients with MUS as a factor contributing to their own attitudes and management choices. Most reported a need for more training during the foundation years, and recommended interactive case-based group discussions with a focus on providing meaningful explanations to patients for their symptoms. There is an urgent need to improve postgraduate training about the topics of MUS and avoiding over-investigation, as current training does not equip junior doctors with the necessary knowledge and skills to effectively and confidently manage patients in these areas. Training needs to focus on practical skill development to increase clinical knowledge in areas such as delivering suitable explanations, and to incorporate individual management

  18. Psychosocial and organizational work environment of nurse managers and self-reported depressive symptoms: Cross-sectional analysis from a cohort of nurse managers

    Directory of Open Access Journals (Sweden)

    Nathalie Nourry

    2014-04-01

    Full Text Available Objectives: The association between depressive symptoms and psycho‑organisational work environment has been established in the literature. Some studies have evaluated depressive symptoms in healthcare workers, but little research has been carried out among nurse managers. The aim of the study is to evaluate the depressive symptoms prevalence among nurse managers' population and work environment factors. Material and Methods: A descriptive correlational research design was used. Data were collected from 296 nurse managers in five hospitals in the eastern area of France between 2007 and 2008. Health outcomes were evaluated by measuring depressive symptoms (CES-D scale, the exposure data by assessing psycho‑organisational work environment with effort-reward imbalance-model of Siegrist. Multiple logistic regressions were used to describe the strength of the association between depressive symptoms and effort-reward imbalance adjusted for personal and occupational characteristics of the nurse managers. Results: Among the nurse managers, a third had depressive symptoms, and 18% presented an effort-reward imbalance (ratio: ≥ 1. A significant association was found between depressive symptoms and effort-reward imbalance (OR = 10.81, 95% CI: 5.1-23, p < 10-3, and with esteem as a reward (OR = 3.21, 95% CI: 1.6-6.3, p < 10-2. Conclusion: In view of the hierarchical situation of nurse managers and their primary roles in hospitals, it is necessaryto take prevention measures to improve their work environment and health.

  19. Symptom management strategies for men with early-stage prostate cancer: results from the Prostate Cancer Patient Education Program (PC PEP).

    Science.gov (United States)

    Vij, Alok; Kowalkowski, Marc A; Hart, Tae; Goltz, Heather Honoré; Hoffman, David J; Knight, Sara J; Caroll, Peter R; Latini, David M

    2013-12-01

    While the literature on prostate cancer health-related quality of life has grown extensively, little is known about symptom management strategies used by men to manage treatment-related side effects and the effectiveness of those strategies. We collected 628 symptom management reports from 98 men treated for localized prostate cancer. Participants were recruited from email lists and a prostate cancer clinic in Northern California. Data were collected using the Critical Incident Technique. Symptom management reports were assigned to categories of urinary, sexual, bowel, mental health, systemic, or "other." We calculated descriptive statistics by symptom type and management strategy effectiveness. The most common symptoms were urinary (26 %) and sexual (23 %). Participants' symptom management strategies varied widely, from medical and surgical interventions (20 %) to behavioral strategies (11 %) to diet and lifestyle interventions (12 %). The effectiveness of symptom management strategies varied, with sexual symptoms being managed effectively only 47 % of the time to mental health symptom management strategies considered effective 89 % of the time. Doing nothing was a commonly reported (15 %) response to symptoms and was effective only 14 % of the time. Men report the least effectiveness in symptom management for sexual dysfunction after prostate cancer treatment. Including men's experience with managing treatment side effects may be an important way to improve survivorship programs and make them more acceptable to men. More work is needed to find out why men frequently do nothing in response to symptoms when effective solutions exist and how providers can successfully engage such men.

  20. Aromatherapy for managing menopausal symptoms: A protocol for systematic review and meta-analysis.

    Science.gov (United States)

    Choi, Jiae; Lee, Hye Won; Lee, Ju Ah; Lim, Hyun-Ja; Lee, Myeong Soo

    2018-02-01

    Aromatherapy is often used as a complementary therapy for women's health. This systematic review aims to evaluate the therapeutic effects of aromatherapy as a management for menopausal symptoms. Eleven electronic databases will be searched from inception to February 2018. Randomized controlled trials that evaluated any type of aromatherapy against any type of control in individuals with menopausal symptoms will be eligible. The methodological quality will be assessed using the Cochrane risk of bias tool. Two authors will independently assess each study for eligibility and risk of bias and to extract data. This study will provide a high quality synthesis of current evidence of aromatherapy for menopausal symptoms measured with Menopause Rating Scale, the Kupperman Index, the Greene Climacteric Scale, or other validated questionnaires. The conclusion of our systematic review will provide evidence to judge whether aromatherapy is an effective intervention for patient with menopausal women. Ethical approval will not be required, given that this protocol is for a systematic review. The systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically and in print. PROSPERO CRD42017079191.

  1. Holistic Management of Schizophrenia Symptoms Using Pharmacological and Non-pharmacological Treatment.

    Science.gov (United States)

    Ganguly, Pronab; Soliman, Abdrabo; Moustafa, Ahmed A

    2018-01-01

    Individuals with schizophrenia lead a poor quality of life, due to poor medical attention, homelessness, unemployment, financial constraints, lack of education, and poor social skills. Thus, a review of factors associated with the holistic management of schizophrenia is of paramount importance. The objective of this review is to improve the quality of life of individuals with schizophrenia, by addressing the factors related to the needs of the patients and present them in a unified manner. Although medications play a role, other factors that lead to a successful holistic management of schizophrenia include addressing the following: financial management, independent community living, independent living skill, relationship, friendship, entertainment, regular exercise for weight gained due to medication administration, co-morbid health issues, and day-care programmes for independent living. This review discusses the relationship between different symptoms and problems individuals with schizophrenia face (e.g., homelessness and unemployment), and how these can be managed using pharmacological and non-pharmacological methods. Thus, the target of this review is the carers of individuals with schizophrenia, public health managers, counselors, case workers, psychiatrists, and clinical psychologists aiming to enhance the quality of life of individuals with schizophrenia.

  2. Reiki Therapy for Symptom Management in Children Receiving Palliative Care: A Pilot Study.

    Science.gov (United States)

    Thrane, Susan E; Maurer, Scott H; Ren, Dianxu; Danford, Cynthia A; Cohen, Susan M

    2017-05-01

    Pain may be reported in one-half to three-fourths of children with cancer and other terminal conditions and anxiety in about one-third of them. Pharmacologic methods do not always give satisfactory symptom relief. Complementary therapies such as Reiki may help children manage symptoms. This pre-post mixed-methods single group pilot study examined feasibility, acceptability, and the outcomes of pain, anxiety, and relaxation using Reiki therapy with children receiving palliative care. A convenience sample of children ages 7 to 16 and their parents were recruited from a palliative care service. Two 24-minute Reiki sessions were completed at the children's home. Paired t tests or Wilcoxon signed-rank tests were calculated to compare change from pre to post for outcome variables. Significance was set at P Reiki therapy did decrease pain, anxiety, heart, and respiratory rates, but small sample size deterred statistical significance. This preliminary work suggests that complementary methods of treatment such as Reiki may be beneficial to support traditional methods to manage pain and anxiety in children receiving palliative care.

  3. Locoregional symptoms in patients with de novo metastatic prostate cancer: Morbidity, management, and disease outcome.

    Science.gov (United States)

    Patrikidou, Anna; Brureau, Laurent; Casenave, Julien; Albiges, Laurence; Di Palma, Mario; Patard, Jean-Jacques; Baumert, Hervé; Blanchard, Pierre; Bossi, Alberto; Kitikidou, Kyriaki; Massard, Christophe; Fizazi, Karim; Blanchet, Pascal; Loriot, Yohann

    2015-05-01

    The paradigm change observed over the last few years in several solid tumors emphasizes the value of locoregional treatment in the presence of metastatic disease, currently ignored in de novo prostate cancer (CaP). We investigated the effect of the primary tumor that is left untreated on prostate cancer-specific morbidity and mortality, time to castration resistance, and overall survival (OS). We performed a bicentric cohort study. The overall population included de novo metastatic CaP managed at the Genito-Urinary Oncology Unit of the Gustave Roussy Institute and the Urology Clinic of the University Hospital of Pointe-à-Pitre, France. Descriptive statistical and outcome analyses were performed in the overall cohort and also separately in the N+M0 and M+subgroups. The overall cohort included 263 patients. Approximately two-thirds of patients (64%) presented with locoregional symptoms at diagnosis, and 78% throughout the disease. Of the symptomatic patients, 59% required a locoregional procedure. Median OS of patients with locoregional symptoms at diagnosis was shorter than in those who were asymptomatic (47 vs. 86 mo, P = 0.0007); this difference was maintained in the N+M0 and M+subgroups. Median OS and time to castration resistance showed a nonsignificant trend in favor of patients undergoing a locoregional treatment at diagnosis. The presence of symptoms due to locoregional disease in de novo metastatic CaP entails significant morbidity and even mortality and requires active management. Randomized prospective trials are needed to evaluate the role of initial definite locoregional treatment in these patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. [Perioperative management of a patient with myotonic dystrophy developing the cardiac symptoms initially prior to the neuromuscular symptoms].

    Science.gov (United States)

    Wake, M; Matsushita, M; Aono, H; Matsumoto, M; Kohri, Y

    1994-08-01

    The authors anesthetized a 48-year-old woman with endometrial cancer and a large ovarian cyst. She developed cardiac failure initially followed by the sick sinus syndrome and A-V block from hypertrophic cardiomyopathy, prior to neuromuscular symptoms. Epidural anesthesia assisted by general anesthesia was carried out safely without intravenous administration of any muscle relaxants. From this experience, it is considered that epidural anesthesia assisted with some other proper methods is suitable for surgery of lower abdomen.

  5. Diabetes self-management, depressive symptoms, quality of life and metabolic control in youth with type 1 diabetes in China.

    Science.gov (United States)

    Guo, Jia; Whittemore, Robin; Grey, Margaret; Wang, Jing; Zhou, Zhi-Guang; He, Guo-Ping

    2013-01-01

    To assess diabetes self-management, depressive symptoms, quality of life and metabolic control in a cohort of youth with type 1 diabetes in mainland China. Predictors of self-management and depressive symptoms were also explored. Studies have shown that adaptation to childhood chronic illness is important in determining outcomes. Few studies have been reported on the behavioural, psychosocial and physiological adaptation processes and outcomes in Chinese youth with type 1 diabetes. This is a cross-sectional study as part of a multi-site longitudinal descriptive study. Data for this report were collected at baseline. A convenience sample of 136 eligible youth was recruited during follow-up visits in hospitals in 14 major cities of Hunan Province (located in central southern mainland China) from July 2009-October 2010. Data were collected on socio-demographic background, clinical characteristics, diabetes self-management, depressive symptoms, quality of life and metabolic control. Diabetes self-management was lower in Chinese youth compared with a US cohort and was associated with insulin treatment regimen, treatment location, depressive symptoms and gender. A total of 17·6% of youth reported high depressive symptoms, and depressive symptoms were correlated with family annual revenue, school attendance, peer relationship and parent-child relationship. The mean score of global satisfaction with quality of life was 17·14 ± 3·58. The mean HbA1c was 9·68%. Living with type 1 diabetes poses considerable challenges, and Chinese youth report lower self-management than US youth and high depressive symptoms. Metabolic control and quality of life were sub-optimal. More clinic visits, treatment for high depressive symptoms and an intensive insulin regimen may improve diabetes self-management for youth with type 1 diabetes in China. Culturally appropriate interventions aimed at helping them adapt to living with the disease and improving outcomes are urgently needed. © 2012

  6. Prospective memory in schizophrenia: relationship to medication management skills, neurocognition, and symptoms in individuals with schizophrenia.

    Science.gov (United States)

    Raskin, Sarah A; Maye, Jacqueline; Rogers, Alexandra; Correll, David; Zamroziewicz, Marta; Kurtz, Matthew

    2014-05-01

    Impaired adherence to medication regimens is a serious concern for individuals with schizophrenia linked to relapse and poorer outcomes. One possible reason for poor adherence to medication is poor ability to remember future intentions, labeled prospective memory skills. It has been demonstrated in several studies that individuals with schizophrenia have impairments in prospective memory that are linked to everyday life skills. However, there have been no studies, to our knowledge, examining the relationship of a clinical measure of prospective memory to medication management skills, a key element of successful adherence. In this Study 41 individuals with schizophrenia and 25 healthy adults were administered a standardized test battery that included measures of prospective memory, medication management skills, neurocognition, and symptoms. Individuals with schizophrenia demonstrated impairments in prospective memory (both time and event-based) relative to healthy controls. Performance on the test of prospective memory was correlated with the standardized measure of medication management in individuals with schizophrenia. Moreover, the test of prospective memory predicted skills in medication adherence even after measures of neurocognition were accounted for. This suggests that prospective memory may play a key role in medication management skills and thus should be a target of cognitive remediation programs.

  7. Avatar-based depression self-management technology: promising approach to improve depressive symptoms among young adults.

    Science.gov (United States)

    Pinto, Melissa D; Hickman, Ronald L; Clochesy, John; Buchner, Marc

    2013-02-01

    Major depressive disorder is prevalent among American young adults and predisposes young adults to serious impairments in psychosocial functioning. Without intervention, young adults with depressive symptoms are at high risk for worsening of depressive symptoms and developing major depressive disorder. Young adults are not routinely taught effective depression self management skills to reduce depressive symptoms and preempt future illness. This study reports initial results of a randomized controlled trial among young adults (18-25 years of age) with depressive symptoms who were exposed to an avatar-based depression self-management intervention, eSMART-MH. Participants completed self-report measures of depressive symptoms at baseline and at 4, 8, and 12 weeks follow-up. Participants who received eSMART-MH had a significant reduction in depressive symptoms over 3 months, while individuals in the attention-control condition had no change in symptoms. In this study, eSMART-MH demonstrated initial efficacy and is a promising developmentally appropriate depression self-management intervention for young adults. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. [Warning symptoms of asthma attack and asthma self-management: a national asthma control survey from China].

    Science.gov (United States)

    Lin, J T; Wang, W Q; Zhou, X; Wang, C Z; Huang, M; Cai, S X; Chen, P; Lin, Q C; Zhou, J Y; Gu, Y H; Yuan, Y D; Sun, D J; Yang, X H; Yang, L; Huo, J M; Chen, Z C; Jiang, P; Zhang, J; Ye, X W; Liu, H G; Tang, H P; Liu, R Y; Liu, C T; Zhang, W; Hu, C P; Chen, Y Q; Liu, X J; Dai, L M; Zhou, W; Huang, Y J; Xu, J Y

    2017-08-08

    Objective: To investigate warning symptoms of asthma attack and evaluate asthma self-management status of asthma patients in urban China. Methods: A multi-center, cross-sectional, questionnaire-based survey was carried out from 30 general hospitals dispersed in 30 provinces of mainland China (except for Tibet) during Oct 2015 to May 2016. Information of frequency and warning symptoms of asthma attack, the time from warning symptoms to asthma attack, the impact of asthma attack and asthma self-management were collected from asthma patients of outpatient department. Results: Altogether 3 875 asthmatic outpatients were recruited. 78.1% (3 026/3 875) of the patients reported restriction of exercise and daily activities during asthma exacerbation. 82.5% (3 160/3 829) of the patients had warning symptoms before asthma attack, the most common warning symptoms were cough, chest tightness and shortness of breath. The median time from warning symptoms to asthma attack was 2 h, the mean time was 90 h. Only 4.4% (167/3 829) of the patients had definite confidence to control asthma when symptoms deteriorated. 76.7% (2 937/3 828) of the patients used medications to control asthma when asthma symptoms deteriorated. Medication choice: inhaled corticosteroid (ICS) + formoterol 45.8% (1 776/3 875), short-acting beta-agonist (SABA) 23.9% (927/3 875). Conclusions: Most asthma patients have warning symptoms before asthma attack, the most common symptoms are cough, chest tightness and shortness of breath. The proportion of patients conducting effective asthma self-management remains low.

  9. Patient considerations in the management of menopausal symptoms: role of conjugated estrogens with bazedoxifene

    Directory of Open Access Journals (Sweden)

    Kagan R

    2016-04-01

    Full Text Available Risa Kagan,1,2 Steven R Goldstein,3 James H Pickar,4 Barry S Komm5 1Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 2East Bay Physicians Medical Group, Berkeley, CA, 3Department of Obstetrics and Gynecology, New York University School of Medicine, 4Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, 5Global Medical Affairs, Pfizer Inc., Collegeville, PA, USA Abstract: Menopausal symptoms (eg, hot flushes and vaginal symptoms are common, often bothersome, and can adversely impact women’s sexual functioning, relationships, and quality of life. Estrogen–progestin therapy was previously considered the standard care for hormone therapy (HT for managing these symptoms in nonhysterectomized women, but has a number of safety and tolerability concerns (eg, breast cancer, stroke, pulmonary embolism, breast pain/tenderness, and vaginal bleeding and its use has declined dramatically in the past decade since the release of the Women’s Health Initiative trial results. Conjugated estrogens paired with bazedoxifene (CE/BZA represent a newer progestin-free alternative to traditional HT for nonhysterectomized women. CE/BZA has demonstrated efficacy in reducing the frequency and severity of vasomotor symptoms and preventing loss of bone mineral density in postmenopausal women. CE/BZA provides an acceptable level of protection against endometrial hyperplasia and does not increase mammographic breast density. Compared with traditional estrogen–progestin therapy, it is associated with lower rates of breast pain/tenderness and vaginal bleeding. Patient-reported outcomes indicate that CE/BZA improves menopause-specific quality of life, sleep, some measures of sexual function (especially ease of lubrication, and treatment satisfaction. This review looks at the rationale for selection and combination of CE with BZA at the dose ratio in the approved product and provides

  10. Patients' perceptions and experiences of using a mobile phone-based advanced symptom management system (ASyMS) to monitor and manage chemotherapy related toxicity.

    Science.gov (United States)

    McCann, L; Maguire, R; Miller, M; Kearney, N

    2009-03-01

    Chemotherapy forms a core component of treatment for the majority patients with cancer. Recent changes in cancer services mean patients frequently receive such treatment as outpatients and are often required to manage side effects at home without direct support from oncology health professionals. Information technology continues to develop to support patients in the community; this study evaluated the impact of a mobile phone-based advanced symptom management system (ASyMS) on chemotherapy related toxicity in patients with lung, breast or colorectal cancer. One hundred and twelve patients were randomized from seven clinical sites across the UK; 56 patients used the mobile phone to record their symptoms, sending their reports directly to the nurses at their clinical site; 56 control group patients received standard care. Health professionals were alerted about any severe or life-threatening symptoms through the development of a chemotherapy symptom risk model. Patients' perceptions of ASyMS were evaluated pre and post participation. Patients reported many benefits of using ASyMS including improved communication with health professionals, improvements in the management of their symptoms, and feeling reassured their symptoms were being monitored while at home. ASyMS has the potential to positively impact on the management of symptoms in patients receiving chemotherapy treatment.

  11. Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life.

    Science.gov (United States)

    Breivik, Cathrine Nansdal; Nilsen, Roy Miodini; Myrseth, Erling; Pedersen, Paal Henning; Varughese, Jobin K; Chaudhry, Aqeel Asghar; Lund-Johansen, Morten

    2013-07-01

    There are few reports about the course of vestibular schwannoma (VS) patients following gamma knife radiosurgery (GKRS) compared with the course following conservative management (CM). In this study, we present prospectively collected data of 237 patients with unilateral VS extending outside the internal acoustic canal who received either GKRS (113) or CM (124). The aim was to measure the effect of GKRS compared with the natural course on tumor growth rate and hearing loss. Secondary end points were postinclusion additional treatment, quality of life (QoL), and symptom development. The patients underwent magnetic resonance imaging scans, clinical examination, and QoL assessment by SF-36 questionnaire. Statistics were performed by using Spearman correlation coefficient, Kaplan-Meier plot, Poisson regression model, mixed linear regression models, and mixed logistic regression models. Mean follow-up time was 55.0 months (26.1 standard deviation, range 10-132). Thirteen patients were lost to follow-up. Serviceable hearing was lost in 54 of 71 (76%) (CM) and 34 of 53 (64%) (GKRS) patients during the study period (not significant, log-rank test). There was a significant reduction in tumor volume over time in the GKRS group. The need for treatment following initial GKRS or CM differed at highly significant levels (log-rank test, P < .001). Symptom and QoL development did not differ significantly between the groups. In VS patients, GKRS reduces the tumor growth rate and thereby the incidence rate of new treatment about tenfold. Hearing is lost at similar rates in both groups. Symptoms and QoL seem not to be significantly affected by GKRS.

  12. An approach to and the rationale for the pharmacological management of behavioral and psychological symptoms of dementia

    Directory of Open Access Journals (Sweden)

    Tripathi Manjari

    2010-10-01

    Full Text Available The behavioral and psychological symptoms of dementia (BPSD have been a difficult management area for neurologists and psychiatrists alike. The correct identification of each symptom and the underlying precipitating cause is the key to proper management-nonpharmacological as well as pharmacological. BPSD has been well documented in all types of dementia in various stages of the disease and in all dementias at an advanced stage. The proper management is not only rewarding in terms of responsiveness in an otherwise "incurable" and progressive disease, but also improves the quality of life of the patients and the caregivers alike. The caregiver burden is greatly decreased by an efficient management of BPSD. This review discusses the implications and boundaries of the term BPSD and unravels each symptom and its identification. Manifestations of psychological symptoms such as delusion, hallucination, misidentification, psychosis, depression, apathy, and anxiety are briefly described. Correct identification of behavior symptoms such as wandering, agitation, catastrophic reaction, disinhibition, and delirium has been outlined. While the subtle differences in each entity make the precise identification difficult, the different therapeutics of each make the exercise necessary. Pharmacological recommendations and side effects of medications have been mentioned thereafter. The review will help in the identification and correct pharmacological management of BPSD.

  13. Chinese American Parents' Acculturation and Enculturation, Bicultural Management Difficulty, Depressive Symptoms, and Parenting.

    Science.gov (United States)

    Kim, Su Yeong; Shen, Yishan; Huang, Xuan; Wang, Yijie; Orozco-Lapray, Diana

    2014-12-01

    This study examined whether Chinese American parents' acculturation and enculturation were related to parenting practices (punitive parenting, democratic child participation, and inductive reasoning) indirectly through the mediation of parents' bicultural management difficulty and parental depressed mood. Data came from a two-wave study of Chinese American families in Northern California. Mothers and fathers were assessed when their children were in early adolescence and then again in middle adolescence (407 mothers and 381 fathers at Wave 1; 308 mothers and 281 fathers at Wave 2). For both waves, we examined cross-sectional models encompassing both direct and indirect links from parental cultural orientations to parenting practices. We also used individual fixed-effects techniques to account for selection bias in testing model relationships at Wave 2. At Wave 1, via bicultural management difficulty and depressive symptoms, American orientation was related to less punitive parenting and more inductive reasoning for both parents, and Chinese orientation was related to more punitive parenting and less inductive reasoning for fathers. The findings indicate that bicultural management difficulty and parental depressed mood are important mechanisms to be considered when studying the relation between Chinese American parents' acculturation/enculturation and parenting.

  14. Attention Deficit Disorder (ADHD: Primary school teachers' knowledge of symptoms, treatment and managing classroom behaviour

    Directory of Open Access Journals (Sweden)

    Beryl Topkin

    2015-05-01

    Full Text Available ADHD is one of the most common chronic conditions of childhood. Teachers are a valuable source of information with regard to referral and diagnosis of the disorder. They also play a major role in creating an environment that is conducive to academic, social and emotional success for children with ADHD. The aim of this study was to examine primary school teachers' knowledge of the symptoms and management of children in their classrooms who were diagnosed with ADHD. The participants were 200 South African primary school teachers (178 female, 22 male; mean age = 43 years of children enrolled in Grades One to Four. A self-administered questionnaire, the Knowledge of Attention-Deficit Disorder Scale (KADDS, which measures the misperceptions and understanding of the disorder, was used to collect the data. The results indicated that overall, 45% of the teachers correctly identified the responses to the items asked in the questionnaire. The "don't know responses" accounted for 31% of responses, while 22% of the responses were incorrectly identified. Furthermore, teachers were more knowledgeable of the general associated features of ADHD than of symptoms, diagnosis and treatment. A majority of teachers indicated that they had received training. These findings suggest a need to consider improving evidenced-based classroom interventions for ADHD among South African teachers.

  15. Management of sexuality, intimacy, and menopause symptoms in patients with ovarian cancer.

    Science.gov (United States)

    Whicker, Margaret; Black, Jonathan; Altwerger, Gary; Menderes, Gulden; Feinberg, Jacqueline; Ratner, Elena

    2017-10-01

    Issues of sexuality, intimacy, and early menopause significantly impact the quality of life of patients following the diagnosis and treatment of ovarian cancer. These are undertreated problems. Successful treatment requires the provider's awareness of the problem, ability to identify it, and willingness to treat it. Unfortunately many providers do not address these issues in the pretreatment or perioperative period. Furthermore, patients do not often alert their providers to their symptoms. While systemic hormone therapy may improve many of the issues, they are not appropriate for all patients given their action on estrogen receptors. However, other nonhormonal treatments exist including selective serotonin reuptake inhibitors, antiepileptics, natural remedies, and pelvic floor physical therapy. In addition psychological care and the involvement of the partner can be helpful in managing the sexual health concerns of these patients. At the time of diagnosis or at initial consultation, women should be informed of the potential physiologic, hormonal, and psychosocial effects of ovarian cancer on sexuality and that there is a multimodal approach to dealing with symptoms. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Management of menopause-associated vasomotor symptoms: Current treatment options, challenges and future directions

    Directory of Open Access Journals (Sweden)

    Deirdre R Pachman

    2010-05-01

    Full Text Available Deirdre R Pachman1, Jason M Jones1, Charles L Loprinzi21Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Medical Oncology, Mayo Clinic, Rochester, MN, USAAbstract: Hot flashes are one of the most common and distressing symptoms associated with menopause, occurring in more than 75% of postmenopausal women. They are especially problematic in breast cancer patients since some breast cancer therapies can induce hot flashes. For mild hot flashes, it is proposed that behavioral modifications are the first step in management. Hormonal therapies, including estrogens and progestogens, are the most well known effective agents in relieving hot flashes; however, the safety of these agents is controversial. There is an increasing amount of literature on nonhormonal agents for the treatment of hot flashes. The most promising data regard newer antidepressant agents such as venlafaxine, which reduces hot flashes by about 60%. Gabapentin is another nonhormonal agent that is effective in reducing hot flashes. While many complimentary therapies, including phytoestrogens, black cohosh, and dehydroepiandrosterone, have been explored for the treatment of hot flashes; none can be recommended at this time. Furthermore, there is a lack of strong evidence to support exercise, yoga, or relaxation for the treatment of hot flashes. Paced respirations and hypnosis appear to be promising enough to warrant further investigation. Another promising nonpharmacological therapy, currently under investigation, involves a stellate ganglion block.Keywords: vasomotor symptoms, hot flashes, menopause, therapy

  17. Anxiety and psychosomatic symptoms in palliative care: from neuro-psychobiological response to stress, to symptoms' management with clinical hypnosis and meditative states.

    Science.gov (United States)

    Satsangi, Anirudh Kumar; Brugnoli, Maria Paola

    2018-01-01

    Psychosomatic disorder is a condition in which psychological stresses adversely affect physiological (somatic) functioning to the point of distress. It is a condition of dysfunction or structural damage in physical organs through inappropriate activation of the involuntary nervous system and the biochemical response. In this framework, this review will consider anxiety disorders, from the perspective of the psychobiological mechanisms of vulnerability to extreme stress in severe chronic illnesses. Psychosomatic medicine is a field of behavioral medicine and a part of the practice of consultation-liaison psychiatry. Psychosomatic medicine in palliative care, integrates interdisciplinary evaluation and management involving diverse clinical specialties including psychiatry, psychology, neurology, internal medicine, allergy, dermatology, psychoneuroimmunology, psychosocial oncology and spiritual care. Clinical conditions where psychological processes act as a major factor affecting medical outcomes are areas where psychosomatic medicine has competence. Thus, the psychosomatic symptom develops as a physiological connected of an emotional state. In a state of rage or fear, for example, the stressed person's blood pressure is likely to be elevated and his pulse and respiratory rate to be increased. When the fear passes, the heightened physiologic processes usually subside. If the person has a persistent fear (chronic anxiety), however, which he is unable to express overtly, the emotional state remains unchanged, though unexpressed in the overt behavior, and the physiological symptoms associated with the anxiety state persist. This paper wants highlight how clinical hypnosis and meditative states can be important psychosocial and spiritual care, for the symptom management on neuro-psychobiological response to stress.

  18. Relationships between three beliefs as barriers to symptom management and quality of life in older breast cancer survivors.

    Science.gov (United States)

    Yeom, Hyun-E; Heidrich, Susan M

    2013-05-01

    To describe relationships among perceived barriers to symptom management and quality of life and to test the mediating role of perceived communication difficulties on the relationships between other perceived barriers to symptom management and quality of life in older adult breast cancer survivors. Cross-sectional descriptive-correlational design using baseline data from a randomized, controlled trial that tested the efficacy and durability of the individualized representational intervention in reducing symptom distress and improving quality of life in older adult breast cancer survivors. The community, an oncology clinic, and a state tumor registry. 190 older adult breast cancer survivors (X age = 70.4 years) who were an average of 3.3 years after breast cancer diagnosis. Path analysis using Mplus, version 5.1. Negative beliefs about symptom management (Symptom Management Beliefs Questionnaire [SMBQ]), perceived negative attitudes from healthcare providers (Communication Attitudes [CommA]), perceived communication difficulties (CommD), and quality of life. Significant direct effects of SMBQ and CommA on CommD were found after controlling for age, number of health problems, and number of symptoms. CommD was a significant mediator of the effects of CommA on quality of life after controlling for the covariates. SMBQ had significant total effects on quality of life after adjusting for the covariates but was not mediated by CommD. Patient-provider communication is an important factor in the quality of life of older adult breast cancer survivors. Developing and testing nursing interventions focusing on enhancing both positive beliefs about symptom management and effective communication in old age is suggested. Older adults and healthcare providers must overcome stereotyped beliefs about aging that may affect self-care and health outcomes for this population. Older adults must be allowed to express their views and emotions about aging.

  19. Managing severe behavioral symptoms of a patient with anti-NMDAR encephalitis: case report and findings in current literature

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    Vanina Lima Monteiro

    2015-03-01

    Full Text Available Objective: Psychiatric symptoms emerge in the early stages of anti-N-methyl-D-aspartate receptor (anti-NMDAR encephalitis, and patients often seek treatment in psychiatric departments before visiting any other general medical services. Numerous articles about anti-NMDAR encephalitis have been published in the scientific community worldwide, but few emphasize the role of psychiatry in symptom management.Case description: We describe the case of a patient with anti- -NMDAR encephalitis seen in our service and discuss the management of behavioral symptoms based on current scientific literature. High doses of atypical antipsychotics and benzodiazepines were used to control agitation, and trazodone was administered to treat insomnia.Comments: Consultation-liaison psychiatry may help the healthcare team adjust the management of neuropsychiatric complications that might affect inpatients with anti-NMDAR encephalitis.

  20. Feasibility testing of a web-based symptom self-management system for persons living with HIV.

    Science.gov (United States)

    Schnall, Rebecca; Wantland, Dean; Velez, Olivia; Cato, Kenrick; Jia, Haomiao

    2014-01-01

    The purpose of this study was to explore the feasibility of using a Web-based tool to provide tailored symptom management strategies for persons living with HIV (PLWH) and to estimate the effect size of the tool for future studies. Testing the components of the Web-based system was done by incorporating a repeated-measures design measuring the outcomes of symptom frequency and intensity, use of symptom management strategies, and engagement with health care providers. We recruited 42 PLWH; participants were enrolled in the study for 12 weeks and were asked to use the system and complete the questionnaires every 2 weeks. Our results showed that participants who used the strategies were more likely to have a decrease in symptom frequency and intensity. Findings from this feasibility study provide preliminary evidence for the use of a Web-based HIV symptom management tool with self-management strategies for individuals living with HIV infection. Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  1. Scope of symptoms and self-management strategies for chemotherapy-induced peripheral neuropathy in breast cancer patients.

    Science.gov (United States)

    Speck, Rebecca M; DeMichele, Angela; Farrar, John T; Hennessy, Sean; Mao, Jun J; Stineman, Margaret G; Barg, Frances K

    2012-10-01

    This study explored the self-management strategies utilized by female breast cancer patients to cope with the impact of chemotherapy-induced peripheral neuropathy (CIPN) symptoms. We also examined the variety of taxane-related side effects in women with and without CIPN in order to discriminate the CIPN symptom experience. A purposive sample of 25 patients treated with docetaxel or paclitaxel were recruited, half with and half without CIPN. Semistructured interviews and patient level data were utilized for this exploratory, descriptive study. Interview data were analyzed with the constant comparative method; patient level data were abstracted from the electronic medical record. Participants were aged 24-60 years, were currently receiving chemotherapy or within 6 months of having completed treatment, and 14 had CIPN. CIPN impacted routine activities, functions, and behaviors in the areas of domestic, work, and social/leisure life. Multiple self-management and coping strategies to minimize the impact of CIPN symptoms were reported; the focus was on movement to reduce symptoms, attitude awareness, logistics to simplify demands, and environmental change. Women with and without CIPN were similar in the quantity and type of other reported side effects. CIPN affects breast cancer patients' routine activities, functions, and behaviors, but they develop management strategies to reduce the impact. The management strategies reported in this study suggest breast cancer patients may adopt interventions that focus on exercise, mindfulness, occupational therapy, and environmental planning toward the goal of reducing the impact of CIPN symptoms on their lives.

  2. Utilization of Patient-Reported Outcomes to Guide Symptom Management during Stereotactic Body Radiation Therapy for Clinically Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Malika Danner

    2017-10-01

    Full Text Available IntroductionUtilization of patient-reported outcomes (PROs to guide symptom management during radiation therapy is increasing. This study focuses on the use of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP as a tool to assess urinary and bowel bother during stereotactic body radiation therapy (SBRT and its utility in guiding medical management.MethodsBetween September 2015 and January 2017, 107 patients with clinically localized prostate cancer were treated with 35–36.25 Gy via SBRT in five fractions. PROs were assessed using EPIC-CP 1 h prior to the first fraction and after each subsequent fraction. Symptom management medications were prescribed based on the physician clinical judgment or if patients reported a moderate to big problem. Clinical significance was assessed using a minimally important difference of 1/2 SD from baseline score.ResultsA median baseline EPIC-CP urinary symptom score of 1.5 significantly increased to 3.7 on the day of the final treatment (p < 0.0001. Prior to treatment, 9.3% of men felt that their overall urinary function was a moderate to big problem that increased to 28% by the end of the fifth treatment. A median baseline EPIC-CP bowel symptom score of 0.3 significantly increased to 1.4 on the day of the final treatment (p < 0.0001. Prior to treatment, 1.9% of men felt that their overall bowel function was a moderate to big problem that increased to 3.7% by the end of the fifth treatment. The percentage of patients requiring an increased dose of alpha-antagonist increased to 47% by the end of treatment, and an additional 28% of patients required a short steroid taper to manage moderate to big urinary problems. Similarly, the percentage of patients requiring antidiarrheals reached 12% by the fifth treatment.ConclusionDuring the course of SBRT, an increasing percentage of patients experienced clinically significant symptoms many of which required medical management

  3. Disability intervention model for older adults with arthritis: an integration of theory of symptom management and disablement process model.

    Science.gov (United States)

    Shin, So Young

    2014-12-01

    To evolve a management plan for rheumatoid arthritis, it is necessary to understand the patient's symptom experience and disablement process. This paper aims to introduce and critique two models as a conceptual foundation from which to construct a new model for arthritis care. A Disability Intervention Model for Older Adults with Arthritis includes three interrelated concepts of symptom experience, symptom management strategies, and symptom outcomes that correspond to the Theory of Symptom Management. These main concepts influence or are influenced by contextual factors that are situated within the domains of person, environment, and health/illness. It accepts the bidirectional, complex, dynamic interactions among all components within the model representing the comprehensive aspects of the disablement process and its interventions in older adults with rheumatoid arthritis. In spite of some limitations such as confusion or complexity within the model, the Disability Intervention Model for Older Adults with Arthritis has strengths in that it encompasses the majority of the concepts of the two models, attempts to compensate for the limitations of the two models, and aims to understand the impact of rheumatoid arthritis on a patient's physical, cognitive, and emotional health status, socioeconomic status, and well-being. Therefore, it can be utilized as a guiding theoretical framework for arthritis care and research to improve the functional status of older adults with rheumatoid arthritis. Copyright © 2014. Published by Elsevier B.V.

  4. Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for veterans with traumatic brain injury: pilot randomized controlled trial.

    Science.gov (United States)

    Twamley, Elizabeth W; Jak, Amy J; Delis, Dean C; Bondi, Mark W; Lohr, James B

    2014-01-01

    Traumatic brain injury (TBI) can result in cognitive impairments and persistent postconcussive symptoms that limit functional recovery, including return to work. We evaluated a 12 wk compensatory cognitive training intervention (Cognitive Symptom Management and Rehabilitation Therapy [CogSMART]) in the context of supported employment for Veterans with mild to moderate TBI. Participants were randomly assigned to receive 12 wk of supported employment plus CogSMART or enhanced supported employment that controlled for therapist attention (control). CogSMART sessions were delivered by the employment specialist and included psychoeducation regarding TBI; strategies to improve sleep, fatigue, headaches, and tension; and compensatory cognitive strategies in the domains of prospective memory, attention, learning and memory, and executive functioning. Compared with controls, those assigned to supported employment plus CogSMART demonstrated significant reductions in postconcussive symptoms (Cohen d = 0.97) and improvements in prospective memory functioning (Cohen d = 0.72). Effect sizes favoring CogSMART for posttraumatic stress disorder symptom severity, depressive symptom severity, and attainment of competitive work within 14 wk were in the small to medium range (Cohen d = 0.35-0.49). Those who received CogSMART rated the intervention highly. Results suggest that adding CogSMART to supported employment may improve postconcussive symptoms and prospective memory. These effects, as well as smaller effects on psychiatric symptoms and ability to return to work, warrant replication in a larger trial.

  5. Effects of stress management and relaxation training on the relationship between diabetes symptoms and affect among Latinos.

    Science.gov (United States)

    Wagner, Julie; Armeli, Stephen; Tennen, Howard; Bermudez-Millan, Angela; Pérez-Escamilla, Rafael

    2018-06-01

    Stress management and relaxation (SMR) interventions can reduce symptoms of chronic disease and associated distress. However, there is little evidence that such interventions disrupt associations between symptoms and affect. This study examined whether SMR dampened the link between symptoms of hyperglycemia and proximal levels of affect. We predicted that during periods of increased hyperglycemia, individuals receiving SMR training, relative to controls, would demonstrate smaller increases in negative affect. Fifty-five adult Latinos with type 2 diabetes were randomised to either one group session of diabetes education (DE-only; N = 23) or diabetes education plus eight group sessions of SMR (DE + SMR; N = 32). After treatment, participants reported five diabetes symptoms and four affective states twice daily for seven days using a bilingual telephonic system. Mean age = 57.8 years, mean A1c = 8.4%, and ¾ was female with less than a high school education. Individuals receiving DE + SMR, compared to DE-only, showed a weaker positive within-person association between daily diabetes symptoms and nervous affect. Groups also differed on the association between symptoms and enthusiasm. Age moderated these associations in most models with older individuals showing less affect reactivity to symptoms. Findings provide partial support for theorised mechanisms of SMR.

  6. Management Strategies for Statin-Associated Muscle Symptoms: How Useful Is Same-Statin Rechallenge?

    Science.gov (United States)

    Brennan, Emily T; Joy, Tisha R

    2017-05-01

    Statin-associated muscle symptoms (SAMS) are common. Rechallenge with the same statin (same-statin rechallenge) has recently been included as part of a proposed scoring index for diagnosing SAMS, but data regarding tolerability and efficacy of same-statin rechallenge, compared with other strategies, is minimal. In this study we evaluated the tolerability, percent change in low-density lipoprotein cholesterol (LDL-C), and proportion of patients achieving their LDL-C targets among 3 common management strategies-same-statin rechallenge, switching to a different statin (statin switch), and use of nonstatin medications only. We performed a retrospective analysis of 118 patients referred to our tertiary care centre for management of SAMS, defined as development of muscle-related symptoms with 2 or more statins. Baseline and last follow-up lipid parameters were documented. Patients were classified as tolerant of a strategy if, at their last follow-up, they remained on that strategy. After a median follow-up of 17 months, most (n = 79; 67%) patients were able to tolerate a statin. Tolerability was similar among the 3 treatment strategies (71% same-statin rechallenge vs 53% statin switch vs 57% for nonstatin therapy only; P = 0.11). Those in the same-statin rechallenge and statin switch groups achieved greater LDL-C reductions compared with those who only tolerated nonstatins (-38.8 ± 3.4% vs -36.4 ± 2.9% vs -17.3 ± 4.5%; P = 0.0007). A greater proportion of patients in the same-statin rechallenge group achieved their target LDL-C compared with those in the nonstatin therapy only group (50% vs 15%; odds ratio, 6.8; 95% confidence interval, 1.5-40.7; P = 0.04). Among individuals with a history of SAMS, most will tolerate statin therapy. Same-statin rechallenge was highly tolerable and efficacious. Thus, same-statin rechallenge might warrant increased utilization. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  7. A randomised controlled trial of four management strategies for dyspepsia : relationships between symptom subgroups and strategy outcome

    NARCIS (Netherlands)

    Lewin-van den Broek, NT; Numans, ME; Buskens, E; Verheij, TJM; Smout, AJPM

    Background: The first step in the management of uncomplicated dyspepsia in primary care often consists of prescribing empirical therapy, bite in certain cases prompt endoscopy might be preferred. Any decision is usually based on the patient's symptoms and the presumed underlying pathology that

  8. A randomised controlled trial of four management strategies for dyspepsia: relationships between symptom subgroups and strategy outcome

    NARCIS (Netherlands)

    Lewin van den Broek, N. T.; Numans, M. E.; Buskens, E.; Verheij, T. J.; de Wit, N. J.; Smout, A. J.

    2001-01-01

    BACKGROUND: The first step in the management of uncomplicated dyspepsia in primary care often consists of prescribing empirical therapy, but in certain cases prompt endoscopy might be preferred. Any decision is usually based on the patient's symptoms and the presumed underlying pathology that causes

  9. Perceived Stress in Patients with Common Gastrointestinal Disorders: Associations with Quality of Life, Symptoms and Disease Management.

    Science.gov (United States)

    Edman, Joel S; Greeson, Jeffrey M; Roberts, Rhonda S; Kaufman, Adam B; Abrams, Donald I; Dolor, Rowena J; Wolever, Ruth Q

    Research supports relationships between stress and gastrointestinal (GI) symptoms and disorders. This pilot study assesses relationships between perceived stress, quality of life (QOL), and self-reported pain ratings as an indicator of symptom management in patients who self-reported gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). In the full sample (n = 402) perceived stress positively correlated with depression (r = 0.76, P stress also correlated with lower mental health-related QOL. Similar correlations were found for the participants with GERD (n = 188), IBS (n = 132), and IBD (n = 82). Finally, there were significant correlations in the GERD cohort between perceived stress, and average pain (r = 0.34, P stress, and average pain (r = 0.32, P stress broadly correlated with QOL characteristics in patients with GERD, IBS, and IBD, and their overall QOL was significantly lower than the general population. Perceived stress also appeared to be an indicator of symptom management (self-reported pain ratings) in GERD and IBD, but not IBS. While future research using objective measures of stress and symptom/disease management is needed to confirm these associations, as well as to evaluate the ability of stress reduction interventions to improve perceived stress, QOL and disease management in these GI disorders, integrative medicine treatment programs would be most beneficial to study. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management

    International Nuclear Information System (INIS)

    Millet, Ingrid; Pages-Bouic, Emma; Curros-Doyon, Fernanda; Taourel, Patrice; Sebbane, Mustapha; Molinari, Nicolas; Riou, Bruno

    2017-01-01

    To assess the added-value of systematic unenhanced abdominal computed tomography (CT) on emergency department (ED) diagnosis and management accuracy compared to current practice, in elderly patients with non-traumatic acute abdominal symptoms. Institutional review board approval and informed consent were obtained. This prospective study included 401 consecutive patients 75 years of age or older, admitted to the ED with acute abdominal symptoms, and investigated by early systematic unenhanced abdominal CT scan. ED diagnosis and intended management before CT, after unenhanced CT, and after contrast CT if requested, were recorded. Diagnosis and management accuracies were evaluated and compared before CT (clinical strategy) and for two conditional strategies (current practice and systematic unenhanced CT). An expert clinical panel assigned a final diagnosis and management after a 3-month follow-up. Systematic unenhanced CT significantly improved the accurate diagnosis (76.8% to 85%, p=1.1 x 10 -6 ) and management (88.5% to 95.8%, p=2.6 x 10 -6 ) rates compared to current practice. It allowed diagnosing 30.3% of acute unsuspected pathologies, 3.4% of which were unexpected surgical procedure requirement. Systematic unenhanced abdominal CT improves ED diagnosis accuracy and appropriate management in elderly patients presenting with acute abdominal symptoms compared to current practice. (orig.)

  11. Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management

    Energy Technology Data Exchange (ETDEWEB)

    Millet, Ingrid; Pages-Bouic, Emma; Curros-Doyon, Fernanda; Taourel, Patrice [CHU Lapeyronie, Department of Medical Imaging, Montpellier Cedex 5 (France); Sebbane, Mustapha [Department of Emergency Medicine, CHU Lapeyronie, Montpellier (France); Molinari, Nicolas [Department of Medical Information and Statistics, CHU Montpellier (France); Riou, Bruno [GH Pitie-Salpetriere, APHP, Department of Emergency Medicine and Surgery, Paris (France)

    2017-02-15

    To assess the added-value of systematic unenhanced abdominal computed tomography (CT) on emergency department (ED) diagnosis and management accuracy compared to current practice, in elderly patients with non-traumatic acute abdominal symptoms. Institutional review board approval and informed consent were obtained. This prospective study included 401 consecutive patients 75 years of age or older, admitted to the ED with acute abdominal symptoms, and investigated by early systematic unenhanced abdominal CT scan. ED diagnosis and intended management before CT, after unenhanced CT, and after contrast CT if requested, were recorded. Diagnosis and management accuracies were evaluated and compared before CT (clinical strategy) and for two conditional strategies (current practice and systematic unenhanced CT). An expert clinical panel assigned a final diagnosis and management after a 3-month follow-up. Systematic unenhanced CT significantly improved the accurate diagnosis (76.8% to 85%, p=1.1 x 10{sup -6}) and management (88.5% to 95.8%, p=2.6 x 10{sup -6}) rates compared to current practice. It allowed diagnosing 30.3% of acute unsuspected pathologies, 3.4% of which were unexpected surgical procedure requirement. Systematic unenhanced abdominal CT improves ED diagnosis accuracy and appropriate management in elderly patients presenting with acute abdominal symptoms compared to current practice. (orig.)

  12. Probiotic capsules and xylitol chewing gum to manage symptoms of pharyngitis: a randomized controlled factorial trial.

    Science.gov (United States)

    Little, Paul; Stuart, Beth; Wingrove, Zoe; Mullee, Mark; Thomas, Tammy; Johnson, Sophie; Leydon, Gerry; Richards-Hall, Samantha; Williamson, Ian; Yao, Lily; Zhu, Shihua; Moore, Michael

    2017-12-18

    Reducing the use of antibiotics for upper respiratory tract infections is needed to limit the global threat of antibiotic resistance. We estimated the effectiveness of probiotics and xylitol for the management of pharyngitis. In this parallel-group factorial randomized controlled trial, participants in primary care (aged 3 years or older) with pharyngitis underwent randomization by nurses who provided sequential intervention packs. Pack contents for 3 kinds of material and advice were previously determined by computer-generated random numbers: no chewing gum, xylitol-based chewing gum (15% xylitol; 5 pieces daily) and sorbitol gum (5 pieces daily). Half of each group were also randomly assigned to receive either probiotic capsules (containing 24 × 10 9 colony-forming units of lactobacilli and bifidobacteria) or placebo. The primary outcome was mean self-reported severity of sore throat and difficulty swallowing (scale 0-6) in the first 3 days. We used multiple imputation to avoid the assumption that data were missing completely at random. A total of 1009 individuals consented, 934 completed the baseline assessment, and 689 provided complete data for the primary outcome. Probiotics were not effective in reducing the severity of symptoms: mean severity scores 2.75 with no probiotic and 2.78 with probiotic (adjusted difference -0.001, 95% confidence interval [CI] -0.24 to 0.24). Chewing gum was also ineffective: mean severity scores 2.73 without gum, 2.72 with sorbitol gum (adjusted difference 0.07, 95% CI -0.23 to 0.37) and 2.73 with xylitol gum (adjusted difference 0.01, 95% CI -0.29 to 0.30). None of the secondary outcomes differed significantly between groups, and no harms were reported. Neither probiotics nor advice to chew xylitol-based chewing gum was effective for managing pharyngitis. Trial registration: ISRCTN, no. ISRCTN51472596. © 2017 Joule Inc. or its licensors.

  13. Metabolic Correction in the Management of Diabetic Peripheral Neuropathy: Improving Clinical Results Beyond Symptom Control

    Science.gov (United States)

    Miranda-Massari, Jorge R.; Gonzalez, Michael J.; Jimenez, Francisco J.; Allende-Vigo, Myriam Z.; Duconge, Jorge

    2013-01-01

    Current Clinical Management Guidelines of Diabetic Peripheral Neuropathy (DPN) are based on adequate glucose control and symptomatic pain relief. However, meticulous glycemic control could delay the onset or slow the progression of diabetic neuropathy in patients with DM type 2, but it does not completely prevent the progression of the disease. Complications of DPN as it continues its natural course, produce increasing pain and discomfort, loss of sensation, ulcers, infections, amputations and even death. In addition to the increased suffering, disability and loss of productivity, there is a very significant economic impact related to the treatment of DPN and its complications. In USA alone, it has been estimated that there are more than 5,000,000 patients suffering from DPN and the total annual cost of treating the disease and its complications is over $10,000 million dollars. In order to be able to reduce complications of DPN, it is crucial to improve or correct the metabolic conditions that lead to the pathology present in this condition. Pathophysiologic mechanisms implicated in diabetic neuropathy include: increased polyol pathway with accumulation of sorbitol and reduced Na+/K+-ATPase activity, microvascular damage and hypoxia due to nitric oxide deficit and increased oxygen free radical activity. Moreover, there is a decrease in glutathione and increase in homocysteine. Clinical trials in the last two decades have demonstrated that the use of specific nutrients can correct some of these metabolic derangements, improving symptom control and providing further benefits such as improved sensorium, blood flow and nerve regeneration. We will discuss the evidence on lipoic acid, acetyi-L-carnitine, benfotiamine and the combination of active B vitamins L-methylfolate, methylcobalamin and piridoxal-6-phosphate. In addition, we discuss the role of metforrnin, an important drug in the management of diabetes, and the presence of specific polymorphic genes, in the risk

  14. Evaluation of a mobile phone-based, advanced symptom management system (ASyMS) in the management of chemotherapy-related toxicity.

    Science.gov (United States)

    Kearney, N; McCann, L; Norrie, J; Taylor, L; Gray, P; McGee-Lennon, M; Sage, M; Miller, M; Maguire, R

    2009-04-01

    To evaluate the impact of a mobile phone-based, remote monitoring, advanced symptom management system (ASyMS) on the incidence, severity and distress of six chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand-foot syndrome and diarrhoea) in patients with lung, breast or colorectal cancer. A two group (intervention and control) by five time points (baseline, pre-cycle 2, pre-cycle 3, pre-cycle 4 and pre-cycle 5) randomised controlled trial. Seven clinical sites in the UK; five specialist cancer centres and two local district hospitals. One hundred and twelve people with breast, lung or colorectal cancer receiving outpatient chemotherapy. A mobile phone-based, remote monitoring, advanced symptom management system (ASyMS). Chemotherapy-related morbidity of six common chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand-foot syndrome and diarrhoea). There were significantly higher reports of fatigue in the control group compared to the intervention group (odds ratio = 2.29, 95%CI = 1.04 to 5.05, P = 0.040) and reports of hand-foot syndrome were on average lower in the control group (odds ratio control/intervention = 0.39, 95%CI = 0.17 to 0.92, P = 0.031). The study demonstrates that ASyMS can support the management of symptoms in patients with lung, breast and colorectal cancer receiving chemotherapy.

  15. Coping Skills Practice and Symptom Change: A Secondary Analysis of a Pilot Telephone Symptom Management Intervention for Lung Cancer Patients and Their Family Caregivers.

    Science.gov (United States)

    Winger, Joseph G; Rand, Kevin L; Hanna, Nasser; Jalal, Shadia I; Einhorn, Lawrence H; Birdas, Thomas J; Ceppa, DuyKhanh P; Kesler, Kenneth A; Champion, Victoria L; Mosher, Catherine E

    2018-05-01

    Little research has explored coping skills practice in relation to symptom outcomes in psychosocial interventions for cancer patients and their family caregivers. To examine associations of coping skills practice to symptom change in a telephone symptom management (TSM) intervention delivered concurrently to lung cancer patients and their caregivers. This study was a secondary analysis of a randomized pilot trial. Data were examined from patient-caregiver dyads (n = 51 dyads) that were randomized to the TSM intervention. Guided by social cognitive theory, TSM involved four weekly sessions where dyads were taught coping skills including a mindfulness exercise, guided imagery, pursed lips breathing, cognitive restructuring, problem solving, emotion-focused coping, and assertive communication. Symptoms were assessed, including patients' and caregivers' psychological distress and patients' pain interference, fatigue interference, and distress related to breathlessness. Multiple regression analyses examined associations of coping skills practice during the intervention to symptoms at six weeks after the intervention. For patients, greater practice of assertive communication was associated with less pain interference (β = -0.45, P = 0.02) and psychological distress (β = -0.36, P = 0.047); for caregivers, greater practice of guided imagery was associated with less psychological distress (β = -0.30, P = 0.01). Unexpectedly, for patients, greater practice of a mindfulness exercise was associated with higher pain (β = 0.47, P = 0.07) and fatigue interference (β = 0.49, P = 0.04); greater practice of problem solving was associated with higher distress related to breathlessness (β = 0.56, P = 0.01) and psychological distress (β = 0.36, P = 0.08). Findings suggest that the effectiveness of TSM may have been reduced by competing effects of certain coping skills. Future interventions should consider focusing on assertive communication

  16. Stress spillover of health symptoms from healthy spouses to patient spouses in older married couples managing both diabetes and osteoarthritis.

    Science.gov (United States)

    Yorgason, Jeremy B; Roper, Susanne O; Sandberg, Jonathan G; Berg, Cynthia A

    2012-12-01

    Many studies examining illness within marriage have investigated how illness in one spouse influences the other spouse. In later-life marriages, where both spouses are more likely to have health challenges, there is an increased likelihood that health symptoms from both spouses affect each other. In the current study we examined how health symptoms in a "healthy" spouse may exacerbate health problems in a partner (the patient) who is managing multiple chronic illnesses. Surveys were collected across 14 days from 27 later-life couples where patients had both diabetes and osteoarthritis. Results indicated that higher healthy spouse symptoms were generally associated with higher patient symptoms, suggesting a spillover effect. Spouse reports of positive and negative mood were inversely linked with patient health outcomes. Spouse reports of higher positive marital interactions were surprisingly linked with higher patients' arthritis activity and activity limitations, possibly indicating a compensatory effect where marital interactions increase with symptoms. Daily spouse reports of positive marital interactions and mood were linked with patient health outcomes even after the spillover of health symptoms was taken into account.

  17. Music Therapy for Symptom Management After Autologous Stem Cell Transplantation: Results From a Randomized Study.

    Science.gov (United States)

    Bates, Debbie; Bolwell, Brian; Majhail, Navneet S; Rybicki, Lisa; Yurch, Melissa; Abounader, Donna; Kohuth, Joseph; Jarancik, Shannon; Koniarczyk, Heather; McLellan, Linda; Dabney, Jane; Lawrence, Christine; Gallagher, Lisa; Kalaycio, Matt; Sobecks, Ronald; Dean, Robert; Hill, Brian; Pohlman, Brad; Hamilton, Betty K; Gerds, Aaron T; Jagadeesh, Deepa; Liu, Hien D

    2017-09-01

    High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is frequently performed in patients with hematologic malignancies. ASCT can result in significant nausea, pain, and discomfort. Supportive care has improved, and pharmacologic therapies are frequently used, but with limitations. Music has been demonstrated to improve nausea and pain in patients undergoing chemotherapy, but little data are available regarding the effects of music therapy in the transplantation setting. In a prospective study, patients with lymphoma or multiple myeloma undergoing ASCT were randomized to receive either interactive music therapy with a board-certified music therapist or no music therapy. The music therapy arm received 2 music therapy sessions on days +1 and +5. Primary outcomes were perception of pain and nausea measured on a visual analog scale. Secondary outcomes were narcotic pain medication use from day -1 to day +5 and impact of ASCT on patient mood as assessed by Profile of Mood States (POMS) on day +5. Eighty-two patients were enrolled, with 37 in the music therapy arm and 45 in the no music therapy arm. Patients who received MT had slightly increased nausea by day +7 compared with the no music therapy patients. The music therapy and no music therapy patients had similar pain scores; however, the patients who received music therapy used significantly less narcotic pain medication (median, 24 mg versus 73 mg; P = .038). Music therapy may be a viable nonpharmacologic method of pain management for patients undergoing ASCT; the music therapy patients required significantly fewer morphine equivalent doses compared with the no music therapy patients. Additional research is needed to better understand the effects of music therapy on patient-perceived symptoms, such as pain and nausea. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  18. Exposure to a patient-centered, Web-based intervention for managing cancer symptom and quality of life issues: impact on symptom distress.

    Science.gov (United States)

    Berry, Donna L; Blonquist, Traci M; Patel, Rupa A; Halpenny, Barbara; McReynolds, Justin

    2015-06-03

    Effective eHealth interventions can benefit a large number of patients with content intended to support self-care and management of both chronic and acute conditions. Even though usage statistics are easily logged in most eHealth interventions, usage or exposure has rarely been reported in trials, let alone studied in relationship to effectiveness. The intent of the study was to evaluate use of a fully automated, Web-based program, the Electronic Self Report Assessment-Cancer (ESRA-C), and how delivery and total use of the intervention may have affected cancer symptom distress. Patients at two cancer centers used ESRA-C to self-report symptom and quality of life (SxQOL) issues during therapy. Participants were randomized to ESRA-C assessment only (control) or the ESRA-C intervention delivered via the Internet to patients' homes or to a tablet at the clinic. The intervention enabled participants to self-monitor SxQOL and receive self-care education and customized coaching on how to report concerns to clinicians. Overall and voluntary intervention use were defined as having ≥2 exposures, and one non-prompted exposure to the intervention, respectively. Factors associated with intervention use were explored with Fisher's exact test. Propensity score matching was used to select a sample of control participants similar to intervention participants who used the intervention. Analysis of covariance (ANCOVA) was used to compare change in Symptom Distress Scale (SDS-15) scores from pre-treatment to end-of-study by groups in the matched sample. Radiation oncology participants used the intervention, overall and voluntarily, more than medical oncology and transplant participants. Participants who were working and had more than a high school education voluntarily used the intervention more. The SDS-15 score was reduced by an estimated 1.53 points (P=.01) in the intervention group users compared to the matched control group. The intended effects of a Web-based, patient

  19. Herbal medicine for management of the behavioural and psychological symptoms of dementia (BPSD): A systematic review and meta-analysis.

    Science.gov (United States)

    Hyde, Anna J; May, Brian H; Dong, Lin; Feng, Mei; Liu, Shaonan; Guo, Xinfeng; Zhang, Anthony Lin; Lu, Chuanjian; Xue, Charlie Changli

    2017-02-01

    Management of the behavioural and psychological symptoms of dementia remains a challenge worldwide. Herbal medicines may play a role in the development of new interventions. To determine effects of herbal medicines for management of the behavioural and psychological symptoms of dementia, meta-analysis was conducted of 31 controlled trials (3613 participants). Frequently tested herbal medicines were the Ginkgo biloba leaf extract EGb 761 (seven studies) and the multi-ingredient formula Yokukansan (eight studies). Sixteen studies tested other herbal medicines. Improvements were detected in Neuropsychiatric Inventory scores in EGb 761 groups compared to placebo (MD -3.46 [-5.94, -0.98]; I 2 = 93%; n = 1757) and Yokukansan groups compared to no treatment (SMD -0.53 [-0.86, -0.21]; I 2 = 0%; n = 150). Cognitive scores were improved in EGb 761 groups while Yokukansan did not appear to affect cognitive function. Of the other herbal medicines, there were improvements in the behavioural and psychological symptoms of dementia and cognitive outcomes in two of four placebo-controlled studies. EGb 761 and Yokukansan appeared safe and well tolerated. Adverse effects and dropouts were not reported consistently for the other herbal medicines. Weaknesses of these included short durations, small sample sizes, lack of blinding and other risks of bias. Well-designed studies are needed to further investigate the reported effects of these interventions on the behavioural and psychological symptoms of dementia.

  20. Management of Depression and Related Neuropsychiatric Symptoms Associated with HIV/AIDS and Antiretroviral Therapy

    OpenAIRE

    Mark Halman

    2001-01-01

    Persons with HIV/AIDS may experience a wide range of neuropsychiatric symptoms, including depressed mood, anxiety, irritability, suicidal ideation, agitation and insomnia. These symptoms may be related to psychosocial stressors, biological diathesis to psychiatric syndromes, HIV-related medical illness and/or the medications used in the treatment of HIV/AIDS. Depressed mood is the most common neuropsychiatric complaint in persons with HIV/AIDS seeking psychiatric evaluation. Prevalence rates ...

  1. Occlusal management for a patient with aural symptoms of unknown etiology: a case report

    Directory of Open Access Journals (Sweden)

    Torii Kengo

    2007-09-01

    Full Text Available Abstract Background Although the discrepancy between the habitual occlusal position (HOP and the flat bite plate-induced occlusal position (BPOP (regarded as the muscular physiological reference position has been recently reported to be related to symptoms of temporomandibular disorders (TMDs, it still remains unclear whether the occlusal equilibration in the reference position is effective to resolve TMD-related discrepancy and symptoms. Aural symptoms (otalgia, tinnitus, vertigo et cetera have been included under TMD symptoms. Methods To examine the effect of occlusal equilibration for the treatment of TMDs, occlusal equilibration was performed for a patient with aural symptoms (otalgia, tinnitus and vertigo of unknown etiology in the right ear. An occlusal analysis was performed on this patient with dental models mounted on an articulator after relieving painful symptoms by an appliance therapy and a discrepancy was identified (p Results At completion of treatment, the discrepancy was not significant (p > 0.25, and the patient's right condyle had shifted 2.8 mm posteromedially in the horizontal plane, and the left condyle had shifted 1.0 mm laterally in the voluntarily closed position from the previous HOP. The aural symptoms of the patient were resolved, and there has been no recurrence to date after a two-year follow-up period. Conclusion An occlusal analysis should be performed in patients exhibiting TMD symptoms to identify the presence or absence of any discrepancy between the HOP and the BPOP. If a discrepancy exists, occlusal equilibration should be attempted in the reference position.

  2. Mobile Health Technology for Improving Symptom Management in Low Income Persons Living with HIV.

    Science.gov (United States)

    Schnall, Rebecca; Cho, Hwayoung; Mangone, Alexander; Pichon, Adrienne; Jia, Haomiao

    2018-01-03

    Persons living with HIV (PLWH) are living longer but experiencing more adverse symptoms associated with the disease and its treatment. This study aimed to examine the impact of a mHealth application (app) comprised of evidence-based self-care strategies on the symptom experience of PLWH. We conducted a 12-week feasibility study with 80 PLWH who were randomized (1:1) to a mHealth app, mobile Video Information Provider (mVIP), with self-care strategies for improving 13 commonly experienced symptoms in PLWH or to a control app. Intervention group participants showed a significantly greater improvement than the control group in 5 symptoms: anxiety (p = 0.001), depression (p = 0.001), neuropathy (p = 0.002), fever/chills/sweat (p = 0.037), and weight loss/wasting (p = 0.020). Participants in the intervention group showed greater improvement in adherence to their antiretroviral medications (p = 0.017) as compared to those in the control group. In this 12-week trial, mVIP was associated with improved symptom burden and increased medication adherence in PLWH.

  3. Daily physical activity enhances resilient resources for symptom management in middle-aged women.

    Science.gov (United States)

    Kishida, Moé; Elavsky, Steriani

    2015-07-01

    The aim of the present study was to evaluate the direct and indirect associations between physical activity and menopausal symptoms. Community-dwelling middle-aged women (N = 103; age range 40-60 years) completed daily Internet surveys at the end of the day and wore an accelerometer for the objective assessment of physical activity for 21-days. 1-1-1 multilevel mediation models were estimated to test whether resilient resources (i.e., positive affect and coping efficacy) mediated the association between physical activity and symptom burden at the between- and within-person level. Analyses demonstrated physical activity had an indirect effect (-0.16) on symptom burden through the enhancement of positive affect at the within-person level (p physical activity on symptom burden at the within-person level was -0.08 (p physical activity may help a woman to cope with her symptoms is through the enhancement of positive affect and coping efficacy on a day-to-day basis. (c) 2015 APA, all rights reserved.

  4. Methotrimeprazine for the management of end-of-life symptoms in infants and children.

    Science.gov (United States)

    Hohl, Christopher M; Stenekes, Simone; Harlos, Michael S; Shepherd, Erin; McClement, Susan; Chochinov, Harvey Max

    2013-01-01

    This retrospective chart review assessed the efficacy, dose, and safety of methotrimeprazine in palliating end-of-life symptoms in children and infants. A retrospective chart review was conducted of 18 hospitalized pediatric patients who were treated with methotrimeprazine in their last two weeks of life. Data collected included age, diagnosis, symptoms, methotrimeprazine dose, route, efficacy, and any documented adverse effects. Patients' ages ranged from 16 days to 17 years. Underlying conditions included malignancies, trauma, and various neurodegenerative and congenital diseases. All patients (n = 18) were treated for symptoms of agitation, delirium, or restlessness. Most patients also experienced respiratory secretions/congestion (n = 15), pain (n = 13), and/ or dyspnea (n = 9). Less common symptoms included nausea/emesis (n = 5) and spasticity (n = 1). Methotrimeprazine dosages ranged from 0.02 mg/kg/dose to 0.5 mg/kg/dose. Routes of administration included intravenous (n = 13), oral/gastrostomy tube (n = 6), or subcutaneous (n = 4). Sedation (n = 6) was the only documented adverse effect, although when agitation was present, this was potentially an intended and perceived-to-be-beneficial effect. Methotrimeprazine, an old drug with diverse receptor activity and multiple routes of administration, appears to be an effective tool in treating complicated end-of-life symptoms in children and infants. This study provides a foundation for analysis with prospective and comparative trials, which may further quantify its benefit.

  5. Do Pre-Existing Diabetes Social Support or Depressive Symptoms Influence the Effectiveness of a Diabetes Management Intervention?

    Science.gov (United States)

    Rosland, Ann-Marie; Kieffer, Edith; Spencer, Michael; Sinco, Brandy; Palmisano, Gloria; Valerio, Melissa; Nicklett, Emily; Heisler, Michele

    2015-01-01

    Objective Examine influences of diabetes-specific social support (D-SS) and depressive symptoms on glycemic control over time, among adults randomized to a diabetes self-management education and support (DSME/S) intervention or usual care. Methods Data were from 108 African-American and Latino participants in a six-month intervention trial. Multivariable linear regression models assessed associations between baseline D-SS from family and friends and depressive symptoms with changes in HbA1c. We then examined whether baseline D-SS or depression moderated intervention-associated effects on HbA1c. Results Higher baseline D-SS was associated with larger improvements in HbA1c (adjusted ΔHbA1c -0.39% for each +1-point D-SS, p=0.02), independent of intervention-associated HbA1c decreases. Baseline depressive symptoms had no significant association with subsequent HbA1c change. Neither D-SS nor depression moderated intervention-associated effects on HbA1c. Conclusions and Practice Implications Diabetes self-management education and support programs have potential to improve glycemic control for participants starting with varying levels of social support and depressive symptoms. Participants starting with more support for diabetes management from family and friends improved HbA1c significantly more over six months than those with less support, independent of additional significant DSME/S intervention-associated HbA1c improvements. Social support from family and friends may improve glycemic control in ways additive to DSME/S. PMID:26234800

  6. Managing Menstruation: Moderating Role of Symptom Severity on Active Coping and Acceptance.

    Science.gov (United States)

    Kennett, Deborah J; O'Hagan, Fergal T; Meyerhoff, Tanya J

    2016-05-01

    Although research has examined women's thoughts toward menstruation, the role passive and active coping strategies play in the acceptance of menses and getting-on with daily activities remains relatively unexplored. In total, 217 undergraduate females having normal regular monthly menstrual periods completed inventories assessing severity of menstrual symptoms, cognitive and emotional representation of health state, general and specific coping strategies, and acceptance. It was found that women having a more emotionally focused representation of menstruation (passive coping style) had a heightened belief that menstruation is debilitating and bothersome and, regardless of symptom severity, scored lower in acceptance of menstruation. Conversely, women using more active strategies to cope with menstrual symptoms were observed to be more generally resourceful and to conjunctively use more palliative coping strategies. More importantly, for women experiencing high levels of menstrual discomfort, use of active coping was associated with better acceptance and getting-on with everyday activities. © The Author(s) 2015.

  7. Mobile Application to Promote Adherence to Oral Chemotherapy and Symptom Management: A Protocol for Design and Development.

    Science.gov (United States)

    Fishbein, Joel Nathan; Nisotel, Lauren Ellen; MacDonald, James John; Amoyal Pensak, Nicole; Jacobs, Jamie Michele; Flanagan, Clare; Jethwani, Kamal; Greer, Joseph Andrew

    2017-04-20

    Oral chemotherapy is increasingly used in place of traditional intravenous chemotherapy to treat patients with cancer. While oral chemotherapy includes benefits such as ease of administration, convenience, and minimization of invasive infusions, patients receive less oversight, support, and symptom monitoring from clinicians. Additionally, adherence is a well-documented challenge for patients with cancer prescribed oral chemotherapy regimens. With the ever-growing presence of smartphones and potential for efficacious behavioral intervention technology, we created a mobile health intervention for medication and symptom management. The objective of this study was to develop and evaluate the usability and acceptability of a smartphone app to support adherence to oral chemotherapy and symptom management in patients with cancer. We used a 5-step development model to create a comprehensive mobile app with theoretically informed content. The research and technical development team worked together to develop and iteratively test the app. In addition to the research team, key stakeholders including patients and family members, oncology clinicians, health care representatives, and practice administrators contributed to the content refinement of the intervention. Patient and family members also participated in alpha and beta testing of the final prototype to assess usability and acceptability before we began the randomized controlled trial. We incorporated app components based on the stakeholder feedback we received in focus groups and alpha and beta testing. App components included medication reminders, self-reporting of medication adherence and symptoms, an education library including nutritional information, Fitbit integration, social networking resources, and individually tailored symptom management feedback. We are conducting a randomized controlled trial to determine the effectiveness of the app in improving adherence to oral chemotherapy, quality of life, and burden of

  8. Efficacy of Parent Management Training on Reducing Symptoms of External Disturbances in Children with Attention Deficit/Hyperactivity

    Directory of Open Access Journals (Sweden)

    S. Arabi

    2013-08-01

    Full Text Available Background: The objective of this study was to determine the effectiveness of the group program "parent management training" to reduce the symptoms of external disorders of children affected by attention deficit/hyperactivity disorder (ADHD. Methods: The method was semi-experimental design with pretest, posttest, control group, and follow-up was two months. Statistical population were all parents of children with ADHD in the Alborz province, who had referred from 2010 to clinic of childhood and adolescence disorders’ Dr. Maryam Dalili, and had records there. Among them 30 children aged 3-10 and their parents were selected by sampling and matched with regard to research criteria and were randomly divided into two groups of 15 people. Research tool was Rutter`s behavioral assessment questionnaire 1964 that was performed in both groups in pretest, posttest and follow-up. The Management training program for parents of Barkely 1987, included 9 session one-hour, once a week was presented to parents of experimental group, and the control group received no intervention. Data were analyzed by using one-way intra group covariance analysis. Results: Results showed that parents management training significantly has reduced the behavioral disorders symptoms and external signs including aggression, impulsivity, hyperactivity and anxiety in children with ADHA compared with the control group and pretest stage. Conclusion: Parent management training can be an effective method to treat the external symptoms of children with ADHA, and this method can be used in combination with other treatments that are performed about these children, such as drug therapy, behavioral therapy and so on.

  9. Effectiveness of active self-care complementary and integrative medicine therapies: options for the management of chronic pain symptoms.

    Science.gov (United States)

    Crawford, Cindy; Lee, Courtney; Freilich, Daniel

    2014-04-01

    Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures that are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. A systematic review was conducted, using Samueli Institute's Rapid Evidence Assessment of the Literature methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A working group of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities. Following key database searches, 146 randomized controlled trials were included in the review, 18 of which directly compared ACT-CIM approaches with one another. This article summarizes the current evidence, quality, effectiveness, and safety of these modalities. Recommendations and next steps to move this field of research forward are also discussed. The entire scope of the review is detailed throughout the current Pain Medicine supplement. Wiley Periodicals, Inc.

  10. HIV-related symptoms and management in HIV and antiretroviral therapy patients in KwaZulu-Natal, South Africa: A longitudinal study

    Science.gov (United States)

    Peltzer, Karl

    2014-01-01

    Aim The study aimed to determine the prevalence, predictors, and self-reported management of HIV- or ARV-related symptoms among HIV patients prior to antiretroviral therapy (ART) and over three time points while receiving ART in KwaZulu-Natal, South Africa. Method A total of 735 consecutive patients (29.8% male and 70.2% female) who attended three HIV clinics completed assessments prior to ARV initiation, 519 after 6 months, 557 after 12 months, and 499 after 20 months on ART. Results The HIV patients reported an average of 7.5 symptoms (prior to ART), 1.2 symptoms after 6 months on ART, 0.3 symptoms after 12 months on ART, and 0.2 symptoms after 20 months on ART on the day of the interview, with a higher symptom frequency amongst patients who were not employed, had lower CD4 cell counts, experienced internalised stigma, and used alcohol. The most common symptoms or conditions identified by the self-report included tuberculosis, diarrhoea, headaches, rash, nausea and vomiting, pain, neuropathy, lack of appetite, cough, and chills. Overall, the participants reported medications as the most frequently occurring management strategy, with the second being spiritual, and the third being complementary or traditional treatments. The use of all other management strategies decreased over the four different assessment periods from prior to ART to 20 months on ART. Conclusion This study found a high symptom burden among HIV patients, which significantly decreased with progression on antiretroviral treatment. Several symptoms that persisted over time and several sociodemographic factors were identified that can guide symptom management. The utilisation of different symptom management strategies (medical, spiritual, complementary, and traditional) should be taken into consideration in HIV treatment. PMID:24405285

  11. Management of recurrent symptoms after per-oral endoscopic myotomy in achalasia

    NARCIS (Netherlands)

    van Hoeij, Froukje B.; Ponds, Fraukje A.; Werner, Yuki; Sternbach, Joel M.; Fockens, Paul; Bastiaansen, Barbara A.; Smout, André J. P. M.; Pandolfino, John E.; Rösch, Thomas; Bredenoord, Albert J.

    2018-01-01

    Background and Aims: Per-oral endoscopic myotomy (POEM) has been rapidly gaining ground as a treatment for achalasia. Although POEM is a safe and effective treatment, a subset of patients has persistent or recurrent symptoms after POEM. This study aimed to examine the efficacy of different

  12. Food choice as a key management strategy for functional gastrointestinal symptoms.

    Science.gov (United States)

    Gibson, Peter R; Shepherd, Susan J

    2012-05-01

    Recognition of food components that induce functional gut symptoms in patient's functional bowel disorders (FBD) has been challenging. Food directly or indirectly provides considerable afferent input into the enteric nervous system. There is an altered relationship between the afferent input and perception/efferent response in FBD. Defining the nature of food-related stimuli may provide a means of minimizing such an input and gut symptoms. Using this premise, reducing the intake of FODMAPs (fermentable oligo-, di-, and mono-saccharides and polyols)--poorly absorbed short-chain carbohydrates that, by virtue of their small molecular size and rapid fermentability, will distend the intestinal lumen with liquid and gas--improves symptoms in the majority of patients. Well-developed methodologies to deliver the diet via dietician-led education are available. Another abundant source of afferent input is natural and added food chemicals (such as salicylates, amines, and glutamates). Studies are needed to assess the efficacy of the low food chemical dietary approach. A recent placebo-controlled trial of FODMAP-poor gluten provided the first valid evidence that non-celiac gluten intolerance might actually exist, but its prevalence and underlying mechanisms require elucidation. Food choice via the low FODMAP and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for functional gut symptoms.

  13. Testosterone versus clomiphene citrate in managing symptoms of hypogonadism in men

    Directory of Open Access Journals (Sweden)

    Pranav Dadhich

    2017-01-01

    Conclusions: Both TST and CC are effective medications in treating hypogonadism; however, our study indicates that TST is more effective in raising serum testosterone levels and improving hypogonadal symptoms. CC remains a viable treatment modality for hypogonadal men but its adverse effect on libido warrant further study.

  14. An experiential mind-body approach to the management of medically unexplained symptoms.

    Science.gov (United States)

    Bakal, D; Steiert, M; Coll, P; Schaefer, J

    2006-01-01

    This article outlines an experiential mind-body framework for understanding and treating patients with medically unexplained symptoms. The model relies on somatic awareness, a normal part of consciousness, to resolve the mind-body dualism inherent in conventional multidisciplinary approaches. Somatic awareness represents a guiding healing heuristic which allows for a linear treatment application of the biopsychosocial model. The heuristic acknowledges the validity of the patient's physical symptoms and identifies psychological and social factors needed for the healing process. Somatic awareness is used to direct changes in coping styles, illness beliefs, medication dependence and personal dynamics that are necessary to achieve symptom control. The mind-body concept is consistent with and supported by neurobiological models which draw on central nervous system mechanisms to explain medically unexplained symptoms. The concept is also supported by a recent hypothesis concerning the role peripheral connective tissue may play in influencing illness and well-being. Finally, somatic awareness is described as having potential to enhance understanding and conscious use of inner healing mechanisms at the basis of the placebo effect.

  15. Fatigue in lung cancer patients: symptom burden and management of challenges

    Directory of Open Access Journals (Sweden)

    Carnio S

    2016-05-01

    Full Text Available Simona Carnio, Rosario Francesco Di Stefano, Silvia Novello Oncology Department, University of Turin, AOU San Luigi, Orbassano, Italy Abstract: Lung cancer (LC remains the most common cause of cancer death in several countries across the world. Fatigue is the most frequently reported symptom in LC patients throughout the entire course of disease, and all international guidelines recommend early screening for cancer-related fatigue (CRF and symptoms that can affect patients' quality of life. In patients with LC, fatigue belongs to the symptom cluster of pain, depression, and insomnia, which are commonly observed simultaneously, but are typically treated as separate although they may have common biological mechanisms. The treatment of CRF remains one of the difficult areas in the oncology field: scarce evidence supports pharmacological therapies, while some interesting data arising indicates alternative remedies and physical exercise seem to be one of the most effective approaches for CRF at any stage of LC. Keywords: fatigue, lung cancer, symptom cluster, quality of life

  16. The relationship between caregivers' subjective social status and asthma symptoms and management for urban children.

    Science.gov (United States)

    Diep, Judy; Fagnano, Maria; Tremblay, Paul; Halterman, Jill S

    2018-03-01

    Subjective social status (SSS) is a person's perception of his/her social standing among others. We explored the relationship between caregivers' SSS and asthma symptoms, visits, and medication use among children with persistent asthma. We analyzed baseline data of children (3-10 years) from the SB-TEAM trial in Rochester, NY. Using a modified MacArthur Scale of SSS, caregivers rated themselves "a lot worse off" to "a lot better off" compared to 4 groups (e.g., neighbors). "Low SSS" was defined by a response of "a lot worse off" or "somewhat worse off" for any of the referent groups. Caregivers reported their child's asthma symptoms, healthcare visits for asthma, and medication use. Bivariate and multivariate statistics were used. We found that, of the 230 children enrolled (participation rate:78%, 62% Black, 72% Medicaid), 29% of caregivers had low SSS. Caregivers with low SSS had more depressive symptoms (46% vs. 28%) and lower social support (69.1 vs. 77.7). In multivariable analyses, children of caregivers with low SSS had fewer symptom-free days/2 weeks (5.8 vs. 7.9, p = .01). While they were more likely to have a routine asthma visit in the past year (35% vs. 23%, adjusted p = .03), there was no difference in their use of preventive medication. Many caregivers of children with persistent asthma report low SSS. While children of these caregivers had fewer symptom-free days, they were not more likely to use preventive medications. Efforts are needed to support these caregivers to ensure optimal preventive care and reduce morbidity.

  17. Shift, Interrupted: Strategies for Managing Difficult Patients Including Those with Personality Disorders and Somatic Symptoms in the Emergency Department.

    Science.gov (United States)

    Moukaddam, Nidal; AufderHeide, Erin; Flores, Araceli; Tucci, Veronica

    2015-11-01

    Difficult patients are often those who present with a mix of physical and psychiatric symptoms, and seem refractory to usual treatments or reassurance. such patients can include those with personality disorders, those with somatization symptoms; they can come across as entitled, drug-seeking, manipulative, or simply draining to the provider. Such patients are often frequent visitors to Emergency Departments. Other reasons for difficult encounters could be rooted in provider bias or countertransference, rather than sole patient factors. Emergency providers need to have high awareness of these possibilities, and be prepared to manage such situations, otherwise workup can be sub-standard and dangerous medical mistakes can be made. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Symptom Severity: Stress Management Skills are Related to Lower Illness Burden.

    Science.gov (United States)

    Lattie, Emily G; Antoni, Michael H; Fletcher, Mary Ann; Czaja, Sara; Perdomo, Dolores; Sala, Andreina; Nair, Sankaran; Fu, Shih Hua; Penedo, Frank J; Klimas, Nancy

    2013-01-01

    The onset of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) typically involves reductions in activities of daily living and social interactions (jointly referred to as "illness burden"). Emotional distress has been linked to increased reported symptoms, and stress management skills have been related to lower fatigue severity in CFS patients. Symptom severity and illness burden are highly correlated. The ability to manage stress may attenuate this relationship, allowing individuals to feel less burdened by the illness independent of the severity of their symptoms. This study aimed to evaluate if perceived stress management skills affect illness burden via emotional distress, independent of ME/CFS symptom severity. A total of 117 adults with ME/CFS completed measures of perceived stress management skills, emotional distress, ME/CFS symptom severity and illness burden. Regression analyses revealed that greater perceived stress management skills related to less social and fatigue-related illness burden, via lower emotional distress. This relationship existed independent of the association of symptom severity on illness burden, and was stronger among those not currently employed. Ability to manage stress is associated with a lower illness burden for individuals with ME/CFS. Future studies should evaluate the efficacy of psychosocial interventions in lowering illness burden by targeting stress management skills.

  19. [Childhood sexual abuse: how important is the diagnosis to understand and manage sexual, anorectal and lower urinary tract symptoms].

    Science.gov (United States)

    Cour, F; Robain, G; Claudon, B; Chartier-Kästler, E

    2013-07-01

    To understand and manage the sequels of childhood sexual abuse on sexual, anorectal and lower urinary tract functions. Review of articles published in the Medline database, selected according to their scientific relevance and published guidelines on this subject together with our own experience. A history of sexual abuse is frequently found when assessing dysfunction or symptoms of the lower urinary tract. In this context, urinary stress incontinence is rarely involved but it can be linked by epidemiological factors. Dysuria with urgency is the most frequent expressed symptom. When associated with anorectal disorders and pelvic pain or a sexual disorder in particular dyspareunia, a sexual abuse should be evoked and specific questions asked to the patient. Although these symptoms are frequently encountered in 12 to 33% of women, and 8 to 16% of men, few practitioners, whatever their speciality ask about them as routine. It is important that the physician diagnose the existence of sexual abuse, in particular when the symptoms mentioned by the patient are not conclusive, in spite of thorough urological assessment. Patients finding the initial examination difficult and painful and the failure of the initial treatment should lead to questions concerning abuse, if neglected by the initial medical inquiry. Clinicians involved in perineal functional pathology are able to acquire standardized modalities of inquiry about child sexual abuse for a better time management and efficacy in the therapeutic approach. The interest of a multidisciplinary diagnostic and therapeutic approach is primordial, associating psychological therapy and if necessary perineal re-education. This can avoid unnecessary tests and out-patient visits. Directing patients towards a multidisciplinary approach is highly advisable. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  20. Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice – an evidence-based international guide

    Science.gov (United States)

    Hungin, A P S; Mulligan, C; Pot, B; Whorwell, P; Agréus, L; Fracasso, P; Lionis, C; Mendive, J; Philippart de Foy, J-M; Rubin, G; Winchester, C; Wit, N

    2013-01-01

    BackgroundEvidence suggests that the gut microbiota play an important role in gastrointestinal problems. AimTo give clinicians a practical reference guide on the role of specified probiotics in managing particular lower gastrointestinal symptoms/problems by means of a systematic review-based consensus. MethodsSystematic literature searching identified randomised, placebo-controlled trials in adults; evidence for each symptom/problem was graded and statements developed (consensus process; 10-member panel). As results cannot be generalised between different probiotics, individual probiotics were identified for each statement. ResultsThirty seven studies were included; mostly on irritable bowel syndrome [IBS; 19 studies; treatment responder rates: 18–80% (specific probiotics), 5–50% (placebo)] or antibiotic-associated diarrhoea (AAD; 10 studies). Statements with 100% agreement and ‘high’ evidence levels indicated that: (i) specific probiotics help reduce overall symptom burden and abdominal pain in some IBS patients; (ii) in patients receiving antibiotics/Helicobacter pylori eradication therapy, specified probiotics are helpful as adjuvants to prevent/reduce the duration/intensity of AAD; (iii) probiotics have favourable safety in patients in primary care. Items with 70–100% agreement and ‘moderate’ evidence were: (i) specific probiotics help relieve overall symptom burden in some patients with diarrhoea-predominant IBS, and reduce bloating/distension and improve bowel movement frequency/consistency in some IBS patients and (ii) with some probiotics, improved symptoms have led to improvement in quality of life. ConclusionsSpecified probiotics can provide benefit in IBS and antibiotic-associated diarrhoea; relatively few studies in other indications suggested benefits warranting further research. This study provides practical guidance on which probiotic to select for a specific problem. PMID:23981066

  1. Identification and Management of Statin-Associated Symptoms in Clinical Practice: Extension of a Clinician Survey to 12 Further Countries.

    Science.gov (United States)

    Rosenson, Robert S; Gandra, Shravanthi R; McKendrick, Jan; Dent, Ricardo; Wieffer, Heather; Cheng, Lung-I; Catapano, Alberico L; Oh, Paul; Kees Hovingh, G; Stroes, Erik S

    2017-04-01

    Statins are the first-choice pharmacological treatment for patients with hypercholesterolemia and at risk for cardiovascular disease; however, a minority of patients experience statin-associated symptoms (SAS) and are considered to have reduced statin tolerance. The objective of this study was to establish how patients with SAS are identified and managed in clinical practice in Austria, Belgium, Colombia, Croatia, the Czech Republic, Denmark, Portugal, Switzerland, Russia, Saudi Arabia, Turkey, and the United Arab Emirates. A cross-sectional survey was conducted (2015-2016) among clinicians (n = 60 per country; Croatia: n = 30) who are specialized/experienced in the treatment of hypercholesterolemia. Participants were asked about their experience of patients presenting with potential SAS and how such patients were identified and treated. Muscle-related symptoms were the most common presentation of potential SAS (average: 51%; range across countries [RAC] 17-74%); other signs/symptoms included persistent elevation in transaminases. To establish whether symptoms are due to statins, clinicians required rechallenge after discontinuation of statin treatment (average: 77%; RAC 40-90%); other requirements included trying at least one alternative statin. Clinicians reported that half of high-risk patients with confirmed SAS receive a lower-dose statin (average: 53%; RAC 43-72%), and that most receive another non-statin lipid-lowering therapy with or without a concomitant statin (average: 65%; RAC 52-83%). The specialists and GPs surveyed use stringent criteria to establish causality between statin use and signs or symptoms, and persevere with statin treatment where possible.

  2. Management of osteoporosis and menopausal symptoms: focus on bazedoxifene/conjugated estrogen combination

    Directory of Open Access Journals (Sweden)

    Mirkin S

    2013-08-01

    Full Text Available Sebastian Mirkin,1 James H Pickar21Pfizer Inc, Collegeville, PA, 2Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USAAbstract: Loss of estrogen production in women during menopause results in a state of estrogen deficiency which has been associated with multiple problems, including vasomotor symptoms, symptoms of vulvovaginal atrophy, bone loss, and difficulties with sleep, mood, memory, and sexual activity. The only treatment option currently available to address multiple postmenopausal symptoms in women with an intact uterus is estrogen/progestin-containing hormone therapy (HT. Concerns surrounding side effects and published data regarding the association of HT with the increased risk for breast cancer have induced a decrease in the number of women seeking, initiating, and continuing this type of therapy. A combination containing bazedoxifene and conjugated estrogens (BZA/CE maintains the established benefits of estrogen therapy for treatment of postmenopausal vasomotor symptoms, vulvovaginal atrophy, and osteoporosis, while certain estrogenic effects, such as stimulation of the uterus and breast, are antagonized without the side effects associated with HT. BZA/CE has been evaluated in a series of multicenter, randomized, double-blind, placebo-controlled, and active-controlled Phase III trials known as the Selective estrogens, Menopause, And Response to Therapy (SMART trials. BZA/CE demonstrated clinically meaningful improvements in vasomotor symptoms, vulvovaginal atrophy, and a protective effect on the skeleton. These clinical benefits were associated with an acceptable safety profile and an improved tolerability compared with HT. BZA/CE showed a favorable safety profile on the breast, endometrium, and ovaries. The incidence of venous thromboembolism was low and the risk does not appear to be any greater than for CE alone or BZA alone or greater than HT. The incidence of coronary heart disease and

  3. Celiac disease: management of persistent symptoms in patients on a gluten-free diet.

    Science.gov (United States)

    Dewar, David H; Donnelly, Suzanne C; McLaughlin, Simon D; Johnson, Matthew W; Ellis, H Julia; Ciclitira, Paul J

    2012-03-28

    To investigate all patients referred to our center with non-responsive celiac disease (NRCD), to establish a cause for their continued symptoms. We assessed all patients referred to our center with non-responsive celiac disease over an 18-mo period. These individuals were investigated to establish the eitiology of their continued symptoms. The patients were first seen in clinic where a thorough history and examination were performed with routine blood work including tissue transglutaminase antibody measurement. They were also referred to a specialist gastroenterology dietician to try to identift any lapses in the diet and sources of hidden gluten ingestion. A repeat small intestinal biopsy was also performed and compared to biopsies from the referring hospital where possible. Colonoscopy, lactulose hydrogen breath testing, pancreolauryl testing and computed tomography scan of the abdomen were undertaken if the symptoms persisted. Their clinical progress was followed over a minimum of 2 years. One hundred and twelve consecutive patients were referred with NRCD. Twelve were found not to have celiac disease (CD). Of the remaining 100 patients, 45% were not adequately adhering to a strict gluten-free diet, with 24 (53%) found to be inadvertently ingesting gluten, and 21 (47%) admitting non-compliance. Microscopic colitis was diagnosed in 12% and small bowel bacterial overgrowth in 9%. Refractory CD was diagnosed in 9%. Three of these were diagnosed with intestinal lymphoma. After 2 years, 78 patients remained well, eight had continuing symptoms, and four had died. In individuals with NRCD, a remediable cause can be found in 90%: with continued gluten ingestion as the leading cause. We propose an algorithm for investigation.

  4. Update on the management of symptoms in schizophrenia: focus on amisulpride

    Directory of Open Access Journals (Sweden)

    Ann M Mortimer

    2009-05-01

    Full Text Available Ann M MortimerDepartment of Psychiatry, Hertford Building, The University of Hull, Cottingham Road, Hull HU6 7RX, United KingdomAbstract: Amisulpride is an atypical antipsychotic drug with a unique receptor pharmacology which is dose dependent. It is a standard treatment in dysthymia as well as in psychosis. Amisulpride is efficacious, effective and well tolerated in positive symptoms of schizophrenia: there is extensive evidence that it treats negative symptoms when given in low doses, although relative lack of EPS and an antidepressant effect may contribute. In first-episode patients amisulpride is an option, although there is little comparative work available. Amisulpride has the best evidence as an effective adjunct to clozapine treatment. Regarding intellectual function, amisulpride appears cognitive sparing but the clinical relevance of this remains obscure. There is evidence that amisulpride can improve social function but again there is little comparative work to demonstrate any particular advantages. Regarding the current conventional versus atypical antipsychotic controversy, amisulpride did better in switching studies and meta-analyses than in the single large pragmatic randomized trial reported to date. It is a versatile drug, and may offer advantages over other atypical antipsychotic drugs in the treatment of negative and depressive symptoms, and tolerability advantages such as the avoidance of weight gain. Essentially it rests with the treating clinician to employ a rational psychopharmacological approach towards the individual patient: there will be few circumstances in which amisulpride will not be a likely contender as a treatment choice.Keywords: amisulpride, negative symptoms, clozapine, depression 

  5. Beyond symptom monitoring: Consumer needs for bipolar disorder self-management using smartphones.

    Science.gov (United States)

    Nicholas, J; Boydell, K; Christensen, H

    2017-07-01

    To investigate the potential use of smartphone apps to support self-management in young adults with bipolar disorder. We recruited 89 young adults (18-30 years) with bipolar disorder to complete a cross-sectional online survey. The survey contained quantitative and qualitative questions regarding technology use, current use of disorder-management apps, types of apps desired for disorder management, and app features that users would consider important when selecting apps. Results were analysed using descriptive statistics and thematic analysis. Almost all participants used a smartphone daily and 40% currently used apps for disorder management. Of those not currently using apps, 79% indicated they would like to try them. On average, participants rated 61% of the self-management strategies listed as desirable for app support, with sleep-management, understanding early warning signs and triggers, and stay-well plans the most frequently endorsed. App features considered important during app selection were ease-of-use, scientific quality, flexibility/customisation, and data privacy. The results indicate that young adults with bipolar disorder are interested in a wide range of apps for self-management. Participants were interested in apps to support self-management strategies considered clinically important for disorder management. Many of these app needs are currently unmet. Results suggest diversifying and prioritising app capabilities to ensure evidence-based resources for a broader range of app functions are available to consumers. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  6. Management of reticular oral lichen planus patients with burning mouth syndrome-like oral symptoms: a pilot study.

    Science.gov (United States)

    Adamo, Daniela; Mignogna, Michele Davide; Pecoraro, Giuseppe; Aria, Massimo; Fortuna, Giulio

    2018-01-31

    We sought to determine the efficacy of psychotropic drug in the management of BMS-like oral symptoms in patients with reticular oral lichen planus (R-OLP) refractory to conventional therapies, and its impact on anxious and depressive symptoms. We enrolled 28 cases of symptomatic R-OLP. The Numeric Rating Scale (NRS), the Total Pain Rating Index (T-PRI), the Hamilton rating scales for Depression (HAM-D) and Anxiety (HAM-A) were performed at baseline (time 0), after 2 months of topical clonazepam (time 1) and after 6 months of benzodiazepine and antidepressant drugs (time 2). R-OLP patients showed a statistically significant improvement in the NRS and T-PRI scores from time 0 [median: 9.0 (IQR: 7.2-10.0) and 10.5 (IQR: 7.0-13.0), respectively] to time 2 [(median: 2.0 (IQR: 2.0-3.0) (p oral symptoms in R-OLP patients refractory to conventional immunosuppressive therapy, although in a long-term period.

  7. Impression management or real change? Reports of depressive symptoms before and after the preoperative psychological evaluation for bariatric surgery.

    Science.gov (United States)

    Fabricatore, Anthony N; Sarwer, David B; Wadden, Thomas A; Combs, Christopher J; Krasucki, Jennifer L

    2007-09-01

    Many bariatric surgery programs require that candidates undergo a preoperative mental health evaluation. Candidates may be motivated to suppress or exaggerate psychiatric symptoms (i.e., engage in impression management), if they believe doing so will enhance their chances of receiving a recommendation to proceed with surgery. 237 candidates for bariatric surgery completed the Beck Depression Inventory-II (BDI-ll) as part of their preoperative psychological evaluation (Time 1). They also completed the BDI-II approximately 2-4 weeks later, for research purposes, after they had received the mental health professional's unconditional recommendation to proceed with surgery (Time 2). There was a small but statistically significant increase in mean BDI-II scores from Time 1 to Time 2 (11.4 vs 12.7, Ppsychological "clearance" for surgery. Possible explanations for these findings include measurement error, impression management, and true changes in psychiatric status.

  8. Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomised controlled feasibility study.

    Science.gov (United States)

    Hsu, Ming Hung; Flowerdew, Rosamund; Parker, Michael; Fachner, Jörg; Odell-Miller, Helen

    2015-07-18

    Previous research highlights the importance of staff involvement in psychosocial interventions targeting neuropsychiatric symptoms of dementia. Music therapy has shown potential effects, but it is not clear how this intervention can be programmed to involve care staff within the delivery of patients' care. This study reports initial feasibility and outcomes from a five month music therapy programme including weekly individual active music therapy for people with dementia and weekly post-therapy video presentations for their carers in care homes. 17 care home residents and 10 care staff were randomised to the music therapy intervention group or standard care control group. The cluster randomised, controlled trial included baseline, 3-month, 5-month and post-intervention 7-month measures of residents' symptoms and well-being. Carer-resident interactions were also assessed. Feasibility was based on carers' feedback through semi-structured interviews, programme evaluations and track records of the study. The music therapy programme appeared to be a practicable and acceptable intervention for care home residents and staff in managing dementia symptoms. Recruitment and retention data indicated feasibility but also challenges. Preliminary outcomes indicated differences in symptoms (13.42, 95 % CI: [4.78 to 22.07; p = 0.006]) and in levels of wellbeing (-0.74, 95 % CI: [-1.15 to -0.33; p = 0.003]) between the two groups, indicating that residents receiving music therapy improved. Staff in the intervention group reported enhanced caregiving techniques as a result of the programme. The data supports the value of developing a music therapy programme involving weekly active individual music therapy sessions and music therapist-carer communication. The intervention is feasible with modifications in a more rigorous evaluation of a larger sample size. Clinicaltrials.gov, number NCT01744600.

  9. Management of New Symptoms of Dyspepsia in the Elderly in Quebec

    Directory of Open Access Journals (Sweden)

    Jacques LeLorier

    1997-01-01

    Full Text Available OBJECTIVE: To use the Régie de l'assurance-maladie du Québec (RAMQ database to study the clinical strategies used by Quebec physicians in the management of dyspepsia in the elderly.

  10. Mismatch between asthma symptoms and spirometry: implications for managing asthma in children.

    Science.gov (United States)

    Schifano, Elizabeth D; Hollenbach, Jessica P; Cloutier, Michelle M

    2014-11-01

    To examine the concordance between spirometry and asthma symptoms in assessing asthma severity and beginning therapy by the general pediatrician. Between 2008 and 2012, spirometry testing was satisfactorily performed in 894 children (ages 5-19 years) whose asthma severity had been determined by their pediatrician using asthma guideline-based clinical criteria. Spirometry-determined asthma severity using national asthma guidelines and clinician-determined asthma severity were compared for concordance using weighted Kappa coefficients. Thirty percent of participants had clinically determined intermittent asthma; 32%, 33%, and 5% had mild, moderate, and severe, persistent asthma, respectively. Increasing disease severity was associated with decreases in the forced expiratory volume in 1 second/forced vital capacity (FVC) ratio (P spirometry-determined severity. Concordance was 0.16 (95% CI 0.10, 0.23), and when adjusted for bias and prevalence, was 0.20 (95% CI 0.17, 0.23). When accounting for age, sex, exposure to smoke, and insurance type, only spirometry-determined asthma severity was a significant predictor of agreement (P spirometry-determined severity increased. Concordance between spirometry and asthma symptoms in determining asthma severity is low even when guideline-based clinical assessment tools are used. Because appropriate therapy reduces asthma morbidity and is guided by disease severity, results from spirometry testing could better guide pediatricians in determining appropriate therapy for their patients with asthma. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Using near infrared light to manage symptoms associated with restless legs syndrome.

    Science.gov (United States)

    Guffey, J Stephen; Motts, Susan; Barymon, Deanna; Wooten, Amber; Clough, Tim; Payne, Emily; Henderson, McCall; Tice, Neal

    2016-01-01

    The purpose of this study was to determine whether the application of near infrared (NIR) light could positively modulate symptoms associated with restless legs syndrome (RLS). Twenty-one subjects with RLS were treated with NIR three times weekly for four weeks. Baseline measures of: (1) international restless legs syndrome rating scale (IRLSRS) score; (2) Semmes Weinstein monofilament (SWM) test; (3) visual analog pain scale (VAS); (4) ankle-brachial index (ABI); and (5) sonographic imaging of the popliteal and posterior tibial arteries were compared to post-treatment values. NIR (850 nm) was delivered transcutaneously at 8 J/cm(2) to four locations on each leg and the plantar surface of each foot. A pre-test-post-test one group design was employed. Baseline and post-treatment measures were compared using either a dependent t-test when data were normal or the Wilcoxon signed rank test in the absence of normality. A significant improvement in IRLSRS scores was observed. Sensation improved from less than protective in 16.6% of sites tested at the baseline to 13.4% post-intervention. There was a significant improvement in ABI scores. VAS and sonographic imaging measures other than ABI remained unchanged. The use of NIR to modulate symptoms associated with RLS was supported by the data.

  12. [Towards new therapeutic paradigms beyond symptom control in the management of inflammatory bowel diseases.

    Science.gov (United States)

    Festa, Stefano; Zerboni, Giulia; Aratari, Annalisa; Ballanti, Riccardo; Papi, Claudio

    2018-01-01

    Inflammatory bowel diseases, Crohn's disease and ulcerative colitis are chronic relapsing conditions that may result in progressive bowel damage, high risk of complications, surgery and permanent disability. The conventional therapeutic approach for inflammatory bowel diseases is based mainly on symptom control. Unfortunately, a symptom-based therapeutic approach has little impact on major long-term disease outcomes. In other chronic disabling conditions such as diabetes, hypertension and rheumatoid arthritis, the development of new therapeutic approaches has led to better outcomes. In this context a "treat to target" strategy has been developed. This strategy is based on identification of high-risk patients, regular assessment of disease activity by means of objective measures, adjustment of treatment to reach the pre-defined target. A treat to target approach has recently been proposed for inflammatory bowel disease with the aim at modifying the natural history of the disease. In this review, the evidence and the limitations of the treat to target paradigm in inflammatory bowel disease are analyzed and discussed.

  13. Managing the consultation with patients with medically unexplained symptoms: a grounded theory study of supervisors and registrars in general practice.

    Science.gov (United States)

    Stone, Louise

    2014-12-05

    Patients with medically unexplained symptoms (MUS) commonly present in general practice. They often experience significant disability and have difficulty accessing appropriate care. Many feel frustrated and helpless. Doctors also describe feeling frustrated and helpless when managing these patients. These shared negative feelings can have a detrimental effect on the therapeutic relationship and on clinical outcomes. The aim of this study was to explore how novice and experienced GPs manage patients with MUS and how these skills are taught and learned in GP training. A constructivist grounded theory study with 24 general practice registrars and supervisors in GP training practices across Australia. Registrars lacked a framework for managing patients with MUS. Some described negative feelings towards patients that were uncomfortable and confronting. Registrars also were uncertain about their clinical role: where their professional responsibilities began and ended. Supervisors utilised a range of strategies to address the practical, interpersonal and therapeutic challenges associated with the care of these patients. Negative feelings and a lack of diagnostic language and frameworks may prevent registrars from managing these patients effectively. Some of these negative feelings, such as frustration, shame and helplessness, are shared between doctors and patients. Registrars need assistance to identify and manage these difficult feelings so that consultations are more effective. The care of these patients also raises issues of professional identity, roles and responsibilities. Supervisors can assist their registrars by proactively sharing models of the consultation, strategies for managing their own feelings and frustrations, and ways of understanding and managing the therapeutic relationship in this difficult area of practice.

  14. Feasibility of an interactive ICT-platform for early assessment and management of patient-reported symptoms during radiotherapy for prostate cancer.

    Science.gov (United States)

    Sundberg, Kay; Eklöf, Ann Langius; Blomberg, Karin; Isaksson, Ann-Kristin; Wengström, Yvonne

    2015-10-01

    The aim of this study was to test the feasibility and acceptability of an Information and Communication Technology platform for assessing and managing patient reported symptoms during radiotherapy for prostate cancer. In cooperation with a health management company, using a patient experience co-design, we developed the platform operated by an interactive application for reporting and managing symptoms in real time. Nine patients diagnosed with prostate cancer and receiving radiotherapy were recruited from two university hospitals in Sweden. Evidence-based symptoms and related self-care advice specific to prostate cancer were implemented in the application based on a literature review and interviews with patients and health care professionals. In the test of the platform the patients reported symptoms, via a mobile phone, daily for two weeks and were afterwards interviewed about their experiences. Overall, the patients found the symptom questionnaire and the self-care advice relevant and the application user friendly. The alert system was activated on several occasions when the symptoms were severe leading to a nurse contact and support so the patients felt safe and well cared for. The platform enabled increased patient involvement and facilitated symptom assessment and communication between the patient and the health care provider. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Diabetes insipidus as the first symptom caused by lung cancer metastasis to the pituitary glands: Clinical presentations, diagnosis, and management

    Directory of Open Access Journals (Sweden)

    J F Mao

    2011-01-01

    Full Text Available Background : Central diabetes insipidus (CDI, secondary to pituitary metastatic lesions, is uncommon; however, lung and breast cancer are the commonest malignancies to have metastases to the pituitary. Early management of systemic chemotherapy and pituitary irradiation might improve the prognosis of patients. Aims : To investigate the clinical features, diagnosis, and management of CDI caused by lung cancer metastasis to the pituitary glands. Materials and Methods : We retrospectively reviewed 10 patients who had CDI as their first symptom before their lung cancers were diagnosed. Their clinical presentations, anterior pituitary gland function, sellar magnetic resonance imaging (MRI, management, and prognosis were described. Settings and Design : This retrospective cross-sectional clinical study was conducted in a medical college hospital. Results : The patient′s mean age was 58.6±7.8 years. Diabetes insipidus was the main complaint when they were referred to our hospital. MRI revealed specific dumbbell-shaped masses in the sella turcica in five patients. In seven patients whose hormones were measured, the levels of hormones from adenohypophysis were abnormally low in six patients. The main treatments included surgery, systemic chemotherapy, and sellar irradiation. Although nine patients had poor prognoses, one patient has survived for more than 3 years, suggesting benefit from early diagnosis and treatment. Conclusions : New-onset CDI might be the only symptom presented by the patients with pituitary metastasis (PM from lung cancer. Dumbbell-shaped sellar masses in MRI are prone to the diagnosis of PM. A thorough examination for primary cancer should be carried out in these aged and elderly patients.

  16. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women

    Directory of Open Access Journals (Sweden)

    Zimmermann Anne

    2012-03-01

    Full Text Available Abstract Background In 2009 the Uterine Bleeding and Pain Women's Research Study (UBP-WRS was conducted interviewing 21,479 women across 8 countries in order to gain patient-based prevalence data on uterine pain and bleeding indications and investigate uterine symptoms and women's treatment experiences. This article shows relevant results of the study for the indication uterine fibroids providing data on self-reported prevalence, symptomatology and management of uterine fibroids. Methods 2,500 women (USA: 4,500 women in each country (Brazil, Canada, France, Germany, Italy, South Korea, the UK, the USA completed an online survey. Women included were in their reproductive age (age group 15-49 years; USA: 18-49 years and had ever experienced menstrual bleedings. Quotas were applied for age, region, level of education and household income of respondents. Variables have been analyzed descriptively and exploratory statistical tests have been performed. Results The self-reported prevalence of uterine fibroids ranged from 4.5% (UK to 9.8% (Italy, reaching 9.4% (UK to 17.8% (Italy in the age group of 40-49 years. Women with a diagnosis of uterine fibroids reported significantly more often about bleeding symptoms than women without a diagnosis: heavy bleedings (59.8% vs. 37.4%, prolonged bleedings (37.3% vs. 15.6%, bleeding between periods (33.3% vs. 13.5%, frequent periods (28.4% vs. 15.2%, irregular and predictable periods (36.3% vs. 23.9%. Furthermore women with diagnosed uterine fibroids reported significantly more often about the following pain symptoms: pressure on the bladder (32.6% vs. 15.0%, chronic pelvic pain (14.5% vs. 2.9%, painful sexual intercourse (23.5% vs. 9.1% and pain occurring mid-cycle, after and during menstrual bleeding (31.3%, 16.7%, 59.7%, vs. 17.1%, 6.4%, 52.0%. 53.7% of women reported that their symptoms had a negative impact on their life in the last 12 month, influencing their sexual life (42.9%, performance at work (27

  17. Mood Management Intervention for College Smokers with Elevated Depressive Symptoms: A Pilot Study

    Science.gov (United States)

    Schleicher, Holly E.; Harris, Kari Jo; Campbell, Duncan G.; Harrar, Solomon W.

    2012-01-01

    Objective: This pilot study examined smoking reduction and cessation among college smokers with elevated depressive symptomatology participating in a group-based behavioral counseling, mood management, and motivational enhancement combined intervention (CBT). Participants and Methods: Fifty-eight smokers (smoked 6 days in the past 30) were…

  18. Diabetes at work. Fatigue in relation to job characteristics, diabetes symptoms and self-management

    NARCIS (Netherlands)

    Weijman, Iris

    2005-01-01

    The focus of this thesis is on employees with diabetes. Fatigue, work characteristics and diabetes self-management are core aspects. Diabetes may have many consequences in the working situation and is expected to become an even bigger health problem, because the number of people with diabetes is

  19. An international comparison of occupational health guidelines for the management of mental disorders and stress-related psychological symptoms.

    Science.gov (United States)

    Joosen, Margot C W; Brouwers, Evelien P M; van Beurden, Karlijn M; Terluin, Berend; Ruotsalainen, Jani H; Woo, Jong-Min; Choi, Kyeong-Sook; Eguchi, Hisashi; Moriguchi, Jiro; van der Klink, Jac J L; van Weeghel, Jaap

    2015-05-01

    We compared available guidelines on the management of mental disorders and stress-related psychological symptoms in an occupational healthcare setting and determined their development and reporting quality. To identify eligible guidelines, we systematically searched National Guideline Clearinghouse, Guidelines International Network Library and PubMed. Members of the International Commission on Occupational Health (ICOH), were also consulted. Guidelines recommendations were compared and reporting quality was assessed using the AGREE II instrument. Of 2126 titles retrieved, 14 guidelines were included: 1 Japanese, 2 Finnish, 2 Korean, 2 British and 7 Dutch. Four guidelines were of high-reporting quality. Best described was the Scope and Purpose, and the poorest described were competing interests (Editorial independence) and barriers and facilitators for implementation (Applicability). Key recommendations were often difficult to identify. Most guidelines recommend employing an inventory of symptoms, diagnostic classification, performance problems and workplace factors. All guidelines recommend specific return-to-work interventions, and most agreed on psychological treatment and communication between involved stakeholders. Practice guidelines to address work disability due to mental disorders and stress-related symptoms are available in various countries around the world, however, these guidelines are difficult to find. To promote sharing, national guidelines should be accessible via established international databases. The quality of the guideline's developmental process varied considerably. To increase quality and applicability, guideline developers should adopt a common structure for the development and reporting of their guidelines, for example Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. Owing to differences in social systems, developers can learn from each other through reviews of this kind. Published by the BMJ Publishing Group Limited

  20. The effect of cognitive–behavioral stress management training on improving psychological symptoms and quality of life in nurses

    Directory of Open Access Journals (Sweden)

    Leila Bahmanzadeh

    2017-11-01

    Full Text Available As a stressful profession, nursing deals with different aspects of human health and illness, and stress can threaten nurses’ health and performance. As a result, using preventive stress management programs seems necessary. The present study aimed to evaluate the effectiveness of cognitive–behavioral stress management training in improving psychological symptoms (stress, anxiety, and depression and quality of life in nurses. The design of this study was quasi-experimental with pretest-posttest and a control group. The statistical population comprised all nurses working in Bandar Abbas Shari'ati Hospital. The study sample included all 30 nurses selected through convenience sampling method. They equally and randomly were divided into experiment and control groups. Depression, anxiety, and stress scale and the Farsi version of WHOQOL-BREF were used to collect data. The results showed there was a significant difference between pretest and posttest of experimental group in the mean scores of stress, anxiety, and quality of life; however, there was no significant difference in depression. Control group mean scores did not show a significant difference between pretest and posttest. There was no significant difference between the control and experimental groups before intervention in stress, anxiety, depression, and quality of life. The findings of this study suggest that, as a useful clinical intervention, stress management skill training is an effective way to improve mental distress and quality of life.

  1. Intramuscular Olanzapine in the Management of Behavioral and Psychological Symptoms in Hospitalized Older Adults: A Retrospective Descriptive Study

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    Silvia Duong

    2015-01-01

    Full Text Available Background. While behavioral and psychological symptoms are frequent in hospitalized older adults with dementia or delirium, data supporting the off-label use of intramuscular atypical antipsychotics remain scarce. We examined the use of short-acting intramuscular (IM olanzapine in hospitalized older adults to manage behavioral and psychological symptoms. Methods. A retrospective observational study of inpatients 65 years or older with at least one order for olanzapine IM during admission in urban Ontario Canada was conducted. Patient demographics, prescriptions for olanzapine IM, reason for administration, perceived effectiveness, adverse events, concurrently prescribed psychotropics, comorbidities, and patient discharge destination were recorded. Results. Among 82 patients aged 65–96 years (mean ± SD 79.3 ± 7.7 85 cases were identified. Cognitive impairment or dementia affected 63.5% and 50.6% had comorbidities. Olanzapine IM was ordered 102 times and 34 patients (41% received at least one dose. The intended efficacy was achieved in 79.4% of 78 cases of 124 doses given (62.9%. Fourteen (41% patients who received doses experienced adverse events, with sedation and hypotension being the most common. Conclusions. Olanzapine IM appears effective in hospitalized older adults but is associated with potential adverse events. Structured monitoring and documentation are needed to ensure safe use in this high-risk population.

  2. Symptom management in complex post-traumatic stress disorder (ICD-11), view and experience of patients and their relatives: a mixed methods approach (Research Proposal).

    Science.gov (United States)

    Stadtmann, Manuel P; Maercker, Andreas; Binder, Jochen; Schnepp, Wilfried

    2017-09-07

    Using the framework of IDC-11, complex post-traumatic stress disorder will be diagnosed using the core criteria of a post-traumatic stress disorder and the presence of at least one symptom from the following three domains: symptoms of emotional dysregulation, negative self-concept, and problems in interpersonal relationships. In the literature, these symptoms are discussed as a common reason for seeking treatment. The symptoms can influence and impair the quality of life. This article describes a mixed methods study with a sequential exploratory design. The aim is to describe specific patient characteristics, levels of symptom burden and perspectives of adult inpatients and to describe the experiences, views and needs of patients' relatives. The study will also investigate facilitators of and barriers to symptom management. The research will be conducted in four phases. The first phase will assess patients' symptom burdens. The second phase will use semi-structured interviews to explore attitudes to symptom management and perceptions of patients and their relatives. The third phase will statistically explore hypotheses generated after the qualitative interviews. The fourth phase will mix the quantitative and qualitative results and interpret critically. The present study will add new results to the growing literature on complex post-traumatic stress disorder. These results could serve as the basis for further research into the development of interventions to improve symptom management. Trial registration Ethical approval has been obtained from the Swiss cantonal ethic commission (Nr. 201500096). This research was also registered to the World Health Organization Clinical Trials Search Portal through the German Clinical Trial Register, Trial DRKS00012268 (21/04/2017).

  3. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society.

    Science.gov (United States)

    2015-11-01

    To update and expand The North American Menopause Society's evidence-based position on nonhormonal management of menopause-associated vasomotor symptoms (VMS), previously a portion of the position statement on the management of VMS. NAMS enlisted clinical and research experts in the field and a reference librarian to identify and review available evidence. Five different electronic search engines were used to cull relevant literature. Using the literature, experts created a document for final approval by the NAMS Board of Trustees. Nonhormonal management of VMS is an important consideration when hormone therapy is not an option, either because of medical contraindications or a woman's personal choice. Nonhormonal therapies include lifestyle changes, mind-body techniques, dietary management and supplements, prescription therapies, and others. The costs, time, and effort involved as well as adverse effects, lack of long-term studies, and potential interactions with medications all need to be carefully weighed against potential effectiveness during decision making. Clinicians need to be well informed about the level of evidence available for the wide array of nonhormonal management options currently available to midlife women to help prevent underuse of effective therapies or use of inappropriate or ineffective therapies. Recommended: Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS, although other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence of efficacy. Recommend with caution: Some therapies that may be beneficial for alleviating VMS are weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but additional studies of these therapies are

  4. Systematic Review of Occupational Therapy and Adult Cancer Rehabilitation: Part 1. Impact of Physical Activity and Symptom Management Interventions.

    Science.gov (United States)

    Hunter, Elizabeth G; Gibson, Robert W; Arbesman, Marian; D'Amico, Mariana

    This article is the first part of a systematic review of evidence for the effectiveness of cancer rehabilitation interventions within the scope of occupational therapy that address the activity and participation needs of adult cancer survivors. This article focuses on the importance of physical activity and symptom management. Strong evidence supports the use of exercise for cancer-related fatigue and indicates that lymphedema is not exacerbated by exercise. Moderate evidence supports the use of yoga to relieve anxiety and depression and indicates that exercise as a whole may contribute to a return to precancer levels of sexual activity. The results of this review support inclusion of occupational therapy in cancer rehabilitation and reveal a significant need for more research to explore ways occupational therapy can positively influence the outcomes of cancer survivors. Part 2 of the review also appears in this issue. Copyright © 2017 by the American Occupational Therapy Association, Inc.

  5. Reforming Management of Behavior Symptoms and Psychiatric Conditions in Long-Term Care Facilities: A Different Perspective.

    Science.gov (United States)

    Levenson, Steven A; Desai, Abhilash K

    2017-04-01

    Despite much attention including national initiatives, concerns remain about the approaches to managing behavior symptoms and psychiatric conditions across all settings, including in long-term care settings such as nursing homes and assisted living facilities. One key reason why problems persist is because most efforts to "reform" and "correct" the situation have failed to explore or address root causes and instead have promoted inadequate piecemeal "solutions." Further improvement requires jumping off the bandwagon and rethinking the entire issue, including recognizing and applying key concepts of clinical reasoning and the care delivery process to every situation. The huge negative impact of cognitive biases and rote approaches on related clinical problem solving and decision making and patient outcomes also must be addressed. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  6. Nurse's perceptions and experiences of using of a mobile-phone-based Advanced Symptom Management System (ASyMS) to monitor and manage chemotherapy-related toxicity.

    Science.gov (United States)

    Maguire, R; McCann, L; Miller, M; Kearney, N

    2008-09-01

    Many people diagnosed with cancer will receive chemotherapy as a core component of their care. Recent changes in the delivery of cancer services mean that patients frequently receive care on an out-patient basis and are therefore often required to manage related side effects at home without direct support from oncology health professionals. The use of information and communications technology may be seen as a means of supporting patients receiving chemotherapy in the home care setting. This mixed methods study, reports on the perceptions of nurses (n=35) who participated in a randomised controlled trial of a mobile phone based, Advanced Symptom Management System (ASyMS), in the management of chemotherapy-related toxicity in patients with breast, lung and colorectal cancer. Nurses' perceptions of ASyMS were evaluated at the start and the end of the study. Overall, they could see the benefits of ASyMS in the remote monitoring of chemotherapy toxicity and its role in facilitating early intervention and subsequent management, demonstrating the potential utility of the system within clinical practice.

  7. Companion Animals Symposium: dietary management of feline lower urinary tract symptoms.

    Science.gov (United States)

    Kerr, K R

    2013-06-01

    Experimental and clinical investigations have confirmed the importance of dietary modifications in medical protocols designed to treat and prevent feline lower urinary tract signs (LUTS). The objective of this review is to discuss common medical conditions contributing to feline LUTS and to present currently used and potential preventative dietary modifications. Feline LUTS are a set of clinical conditions with similar symptoms related to inappropriate urine elimination due to a combination of genetics, stress and frustration reactions, environment, and medical condition or conditions, for example, idiopathic cystitis, urolithiasis, urethral obstruction, and urinary tract infection. The main goals of dietary modifications to prevent LUTS are 1) promote large dilute volumes of urine, 2) decrease the relative supersaturation of urine for specific stone types, and 3) promote healthy bacterial populations in the gastrointestinal and urogenital tracts. The impact of dietary composition, including dietary moisture, protein concentration and digestibility, mineral concentrations (i.e., Na, Cl, Ca, P, and Mg), inclusion of acidifiers and alkalinizing agents, inclusion of vitamin B6, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and γ-linolenic acid, fiber concentration and characteristics, and oxalate degrading probiotics, on these outcomes is discussed, and dietary guidelines for cats are provided. Because of the complex interaction of diet composition, environment, and animal physiology, there is a need for clinical research linking current recommendations or dietary options for the treatment and prevention of LUTS with physiological outcomes (i.e., decreased relative supersaturation and LUTS recurrence). Additionally, for many recommendations (e.g., probiotic administration, EPA, DHA), extrapolation from other species was necessary. Research is needed in feline patients with LUTS on these dietary components.

  8. The Role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs in the Management of the Post-Embolization Symptoms after Uterine Artery Embolization

    Directory of Open Access Journals (Sweden)

    Tiago Bilhim

    2010-05-01

    Full Text Available Uterine artery embolization (UAE is usually a very painful procedure. Although pain after the procedure can occur as a single symptom, it usually is associated with other symptoms such as nausea, vomiting, pelvic pain, general malaise, fever and leukocytosis that characterize the post-embolization syndrome. Management of the post-embolization symptoms and of pain in particular, is paramount if UAE is to be performed as an outpatient procedure. Different protocols have used analgesic and/or anti-inflammatory agents to control these symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs are frequently used in association with analgesic drugs to control post-embolization symptoms. In our institution the patients start oral medication with NSAIDs the day before the procedure and continue it during and after UAE. We also mix NSAIDs with the embolizing particles. This enables a reduction in the inflammation present in the uterine fibroids and helps controlling the pain. The purpose of this paper is to review the importance of NSAIDs in the management of the post-embolization symptoms. We describe the protocol that we use in our institution that enables us to perform the procedure on an outpatient basis with same day discharge and good control of the post-embolization symptoms with oral NSAIDs and analgesics.

  9. Comparing the Health Care Experiences of Medicare Beneficiaries with and without Depressive Symptoms in Medicare Managed Care versus Fee-for-Service.

    Science.gov (United States)

    Martino, Steven C; Elliott, Marc N; Haviland, Amelia M; Saliba, Debra; Burkhart, Q; Kanouse, David E

    2016-06-01

    To compare patient experiences and disparities for older adults with depressive symptoms in managed care (Medicare Advantage [MA]) versus Medicare Fee-for-Service (FFS). Data came from the 2010 Medicare CAHPS survey, to which 220,040 MA and 135,874 FFS enrollees aged 65 and older responded. Multivariate linear regression was used to test whether case-mix-adjusted associations between depressive symptoms and patient experience differed for beneficiaries in MA versus FFS. Dependent measures included four measures of beneficiaries' experiences with doctors (e.g., reports of doctor communication) and seven measures of beneficiaries' experiences with plans (e.g., customer service). Beneficiaries with depressive symptoms reported worse experiences than those without depressive symptoms regardless of coverage type. For measures assessing interactions with the plan (but not for measures assessing interactions with doctors), the disadvantage for beneficiaries with versus without depressive symptoms was larger in MA than in FFS. Disparities in care experienced by older Medicare beneficiaries with depressive symptoms tend to be more negative in managed care than in FFS. Efforts are needed to identify and address the barriers these beneficiaries encounter to help them better traverse the managed care environment. © Health Research and Educational Trust.

  10. Associations Between Changes in Depressive Symptoms and Social Support and Diabetes Management Among Low-Income, Predominantly Hispanic Patients in Patient-Centered Care.

    Science.gov (United States)

    Oh, Hyunsung; Ell, Kathleen

    2018-03-27

    This study examined whether changes in depressive symptoms and social support prospectively predicted diabetes management among Hispanic patients with probable depression in patient-centered medical homes at safety-net clinics in East Los Angeles, CA. Data were collected from 251 patients enrolled in a randomized clinical trial testing the effectiveness of a promotora-assisted self-management intervention. Cross-lagged analyses examined associations between changes in depression symptoms and social support between baseline and 6-month follow-up and self-efficacy and adherence to diabetes management at the 6- and 12-month follow-ups. Changes in depressive symptoms predicted self-efficacy and level of adherence at the 6- and 12-month follow-ups. Changes in total social support and emotional social support were correlated only with self-efficacy regarding diabetes management at 6-month follow-up. Decline in depressive symptoms is a reliable predictor of improvement in self-efficacy and adherence to diabetes management. Further studies are recommended to study psychosocial mechanisms related to social relationships other than social support that affect diabetes management. © 2018 by the American Diabetes Association.

  11. Current trends in the management of ocular symptoms in Adamantiades-Behçet’s disease

    Directory of Open Access Journals (Sweden)

    Fouad R Zakka

    2009-10-01

    Full Text Available Fouad R Zakka,1 Peter Y Chang,1 Gian P Giuliari,1 C Stephen Foster1,21Massachusetts Eye Research and Surgery institution (MERSI, Cambridge, Massachusetts, USA; 2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USAAbstract: Adamantiades-Behçet’s disease (ABD is a multisystemic vasculitic disease. It is most prevalent in the Eastern Mediterranean countries and the Eastern region of Asia. Its effect on the eye can range from mild to debilitating, resulting in total blindness. A necrotizing and obliterative vasculitis affects both arteries and veins of organs. Recurrent attacks of uveitis, oral aphthous ulcers, skin lesions, and genital ulcers are common. Topical and systemic corticosteroids have been the mainstay in the treatment of ocular inflammation for many years; however, due to the several known side effects of corticosteroids and thanks to scientific advances, more novel approaches to ABD treatment have been emerging. Antimetabolites such as methotrexate and azathioprine have been utilized with the latter showing positive results. Chlorambucil has been utilized effectively for ocular manifestations of ABD. Interferon alpha has shown encouraging results in the management of refractory ocular inflammation associated with ABD, either alone or in combination with other immunosuppressive agents. Surgical interventions to deal with complications from ABD can be safely done if adequate control of inflammation is achieved peri-operatively. Early detection and aggressive treatment, when needed, have proven to be essential in the management of this relentlessly explosive disease.Keywords: Adamantiades-Behçet’s disease, Behçet’s disease, ocular inflammation, uveitis, immunomodulatory therapy, immunosuppressive therapy

  12. Palliative Care Office Hours for Patients with Hematologic Malignancies: An Innovative Model for Symptom Management and Education.

    Science.gov (United States)

    Foxwell, Anessa M; Moyer, Mary E; Casarett, David J; O'Connor, Nina R

    2017-10-01

    Palliative care programs are experiencing rapid growth, with demand for consults surpassing staffing. Innovative models are needed to equip nonpalliative care providers to manage basic palliative care issues. To develop a novel program of palliative care office hours for hematologic oncology advanced practice providers, and to evaluate its impact on palliative care consult volume and composition. A palliative care nurse practitioner or pharmacist was available for weekday office hours to all inpatient hematologic oncology advanced practice providers at an academic medical center to offer advice on pain, nonpain symptoms, and psychosocial distress. A retrospective study looking at outcome measures after six months of office hour utilization and palliative care consults from the hematologic oncology services. Palliative care office hours had a mean duration of 16 minutes per day (range 5 to 55). A mean of 11 patients were discussed per week (range 4 to 20). Pain, nausea, and anxiety were the issues most frequently raised. Of 299 patients discussed during office hours, 44 (14.7%) subsequently required a full palliative care consult. Overall, palliative care consults from the hematologic oncology services decreased from 19.6% to 10.2% of admissions (87/445 vs. 61/594, p Office hours are an efficient way to address palliative care needs when demand for palliative care consults exceeds capacity. Office hours may serve an educational function as well, enabling primary teams to manage basic palliative care issues with increasing independence over time.

  13. Emergence of delayed posttraumatic stress disorder symptoms related to sexual trauma: patient-centered and trauma-cognizant management by physical therapists.

    Science.gov (United States)

    Dunleavy, Kim; Kubo Slowik, Amy

    2012-02-01

    Sexual violence has been identified as one of the most common predictors of posttraumatic stress disorder (PTSD). This case report describes the emergence of delayed PTSD symptoms, disclosure of history of sexual trauma, and the influence of re-experiencing, avoidance, and hyperarousal symptoms on physical therapy treatment. A 60-year-old woman was seen for treatment of low back pain. of a discord between fear of falling and no balance impairments led to disclosure of sexual assault by a physician at 19 years of age. The patient's PTSD symptoms emerged after 10 weeks of physical therapy. The physical therapists monitored somatic responses and body language closely and modified and planned treatment techniques to avoid PTSD triggers and limit hyperarousal. Collaborative communication approaches included reinforcement of cognitive-behavioral strategies introduced by her psychotherapists. Trauma-cognizant approaches supported the patient's efforts to manage PTSD symptoms sufficiently to tolerate physical therapy and participate in a back care class. Nonlinear psychological healing is illustrated. Symptoms of PTSD may emerge during physical therapy treatment, and patient-sensitive responses to disclosure are important. The trauma-cognizant approach (2-way communication, patient-centered management, and integration of psychological elements into clinical decision making) helped identify and respond to triggers. The physical therapists reinforced cognitive-behavioral strategies introduced by psychotherapists to manage PTSD symptoms. Patient-centered care with further refinement to a trauma-cognizant approach may play an important role in assisting patients with PTSD or a history of sexual trauma to manage symptoms while addressing rehabilitation needs.

  14. Symptoms of Mental Illness and Their Impact on Managing Type 2 Diabetes in Adults.

    Science.gov (United States)

    Cimo, Adriana; Dewa, Carolyn S

    2017-11-08

    People with mental illnesses are more likely to experience diabetes-related complications that can reduce life expectancy by 10 to 15 years. Diabetes management and outcomes can be improved when lifestyle interventions addressing healthful eating habits and physical activity use content tailored to the learning needs of individuals or groups. Understanding the challenges that prevent adherence to diabetes recommendations can start to inform the design of tailored diabetes education care. The purpose of this pilot study was to explore the perspectives of clients with mental illnesses and type 2 diabetes with regard to challenges faced when engaging in diabetes self-care behaviours. Focus groups were held with 17 people who had type 2 diabetes and mental illnesses, including depressive disorder, bipolar disorder, anxiety disorder, schizophrenia and schizoaffective disorder. In the groups, participants were asked to share their experiences with diabetes self-care and access to diabetes-education services. Data were transcribed verbatim, assessed for quality and saturation and coded to identify relationships and meanings among identified themes. Participants identified many challenges and unmet needs that created multidimensional and interrelated barriers to care, ultimately resulting in poor diabetes self-care behaviours. Some challenges were psychological in nature and related to emotional states, lifestyles and food habits, perceptions of affordability, health literacy and value of health information. Other challenges included the physical states of health and social environments. Multidimensional diabetes education programs that consider psychological, physical and social challenges are needed to address the needs of people with mental illnesses. Copyright © 2017. Published by Elsevier Inc.

  15. Multiple sclerosis: patients’ information sources and needs on disease symptoms and management

    Directory of Open Access Journals (Sweden)

    Albert I Matti

    2010-06-01

    Full Text Available Albert I Matti1, Helen McCarl2, Pamela Klaer2, Miriam C Keane1, Celia S Chen11Department of Ophthalmology, Flinders Medical Centre and Flinders University, Bedford Park, SA, Australia; 2The Multiple Sclerosis Society of South Australia and Northern Territory, Klemzig, SA, AustraliaObjective: To investigate the current information sources of patients with multiple sclerosis (MS in the early stages of their disease and to identify patients’ preferred source of information. The relative amounts of information from the different sources were also compared.Methods: Participants at a newly diagnosed information session organized by the Multiple Sclerosis Society of South Australia were invited to complete a questionnaire. Participants were asked to rate on a visual analog scale how much information they had received about MS and optic neuritis from different information sources and how much information they would like to receive from each of the sources.Results: A close to ideal amount of information is being provided by the MS society and MS specialist nurses. There is a clear deficit between what information patients are currently receiving and the amount of information they actually want from various sources. Patients wish to receive significantly more information from treating general practitioners, eye specialists, neurologists, and education sessions. Patients have identified less than adequate information received on optic neuritis from all sources.Conclusion: This study noted a clear information deficit regarding MS from all sources. This information deficit is more pronounced in relation to optic neuritis and needs to be addressed in the future.Practice implications: More patient information and counselling needs to be provided to MS patients even at early stages of their disease, especially in relation to management of disease relapse.Keywords: information sources, information needs, MS patients, optic neuritis

  16. Topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on nonhormonal management of vasomotor symptoms.

    Science.gov (United States)

    Carpenter, Janet S; Laine, Tei; Harrison, Blake; LePage, Meghan; Pierce, Taran; Hoteling, Nathan; Börner, Katy

    2017-10-01

    We sought to depict the topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on the nonhormonal management of menopause-associated vasomotor symptoms released on September 21, 2015, and its associated press release from September 23, 2015. Three data sources were used: online news articles, National Public Radio, and Twitter. For topical diffusion, we compared keywords and their frequencies among the position statement, press release, and online news articles. We also created a network figure depicting relationships across key content categories or nodes. For geospatial diffusion within the United States, we compared locations of the 109 National Public Radio (NPR) stations covering the statement to 775 NPR stations not covering the statement. For temporal diffusion, we normalized and segmented Twitter data into periods before and after the press release (September 12, 2015 to September 22, 2015 vs September 23, 2015 to October 3, 2015) and conducted a burst analysis to identify changes in tweets from before to after. Topical information diffused across sources was similar with the exception of the more scientific terms "vasomotor symptoms" or "vms" versus the more colloquial term "hot flashes." Online news articles indicated media coverage of the statement was mainly concentrated in the United States. NPR station data showed similar proportions of stations airing the story across the four census regions (Northeast, Midwest, south, west; P = 0.649). Release of the statement coincided with bursts in the menopause conversation on Twitter. The findings of this study may be useful for directing the development and dissemination of future North American Menopause Society position statements and/or press releases.

  17. Effect of self-administered foot reflexology for symptom management in healthy persons: a systematic review and meta-analysis.

    Science.gov (United States)

    Song, Hyun Jin; Son, Heejeong; Seo, Hyun-Ju; Lee, Heeyoung; Choi, Sun Mi; Lee, Sanghun

    2015-02-01

    Self-administered foot reflexology is unrestricted by time and space, economical, and practical because it is easy to learn and apply. This study estimated the effectiveness of self-foot reflexology for symptom management in healthy persons through a systematic review and meta-analysis. The participants were healthy persons not diagnosed with a specific disease. The intervention was foot reflexology administered by participants, not by practitioners or healthcare providers. The comparative studies either between groups or within group comparison were included. Our search utilized core databases (MEDLINE, EMBASE, Cochrane, and CINAHL). We also searched Chinese (CNKI), Japanese (J-STAGE), and Korean databases (KoreaMed, KMbase, KISS, NDSL, KISTI, and OASIS). The search was used MeSH terminology and key words (foot reflexology, foot massage, and self). Analysis of three non-randomized trials and three before-and-after studies showed that self-administered foot reflexology resulted in significant improvement in subjective outcomes such as perceived stress, fatigue, and depression. However, there was no significant improvement in objective outcomes such as cortisol levels, blood pressure, and pulse rate. We did not find any randomized controlled trial. This study presents the effectiveness of self-administered foot reflexology for healthy persons' psychological and physiological symptoms. While objective outcomes showed limited results, significant improvements were found in subjective outcomes. However, owing to the small number of studies and methodological flaws, there was insufficient evidence supporting the use of self-performed foot reflexology. Well-designed randomized controlled trials are needed to assess the effect of self-administered foot reflexology in healthy people. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Development and validation of a medical chart review checklist for symptom management performance of oncologists in the routine care of patients with advanced cancer.

    Science.gov (United States)

    Blum, David; Rosa, Daniel; deWolf-Linder, Susanne; Hayoz, Stefanie; Ribi, Karin; Koeberle, Dieter; Strasser, Florian

    2014-12-01

    Oncologists perform a range of pharmacological and nonpharmacological interventions to manage the symptoms of outpatients with advanced cancer. The aim of this study was to develop and test a symptom management performance checklist (SyMPeC) to review medical charts. First, the content of the checklist was determined by consensus of an interprofessional team. The SyMPeC was tested using the data set of the SAKK 96/06 E-MOSAIC (Electronical Monitoring of Symptoms and Syndromes Associated with Cancer) trial, which included six consecutive visits from 247 patients. In a test data set (half of the data) of medical charts, two people extracted and quantified the definitions of the parameters (content validity). To assess the inter-rater reliability, three independent researchers used the SyMPeC on a random sample (10% of the test data set), and Fleiss's kappa was calculated. To test external validity, the interventions retrieved by the SyMPeC chart review were compared with nurse-led assessment of patient-perceived oncologists' palliative interventions. Five categories of symptoms were included: pain, fatigue, anorexia/nausea, dyspnea, and depression/anxiety. Interventions were categorized as symptom specific or symptom unspecific. In the test data set of 123 patients, 402 unspecific and 299 symptom-specific pharmacological interventions were detected. Nonpharmacological interventions (n = 242) were mostly symptom unspecific. Fleiss's kappa for symptom and intervention detections was K = 0.7 and K = 0.86, respectively. In 1003 of 1167 visits (86%), there was a match between SyMPeC and nurse-led assessment. Seventy-nine percent (195 of 247) of patients had no or one mismatch. Chart review by SyMPeC seems reliable to detect symptom management interventions by oncologists in outpatient clinics. Nonpharmacological interventions were less symptom specific. A template for documentation is needed for standardization. Copyright © 2014 American Academy of Hospice and

  19. Does Research Training During Residency Promote Scholarship and Influence Career Choice? A Cross-Sectional Analysis of a 10-Year Cohort of the UCSF-PRIME Internal Medicine Residency Program.

    Science.gov (United States)

    Kohlwes, Jeffrey; O'Brien, Bridget; Stanley, Marion; Grant, Ross; Shunk, Rebecca; Connor, Denise; Cornett, Patricia; Hollander, Harry

    2016-01-01

    The Association of Program Directors in Internal Medicine, the Accreditation Council for Graduate Medical Education, the Alliance for Academic Internal Medicine, and the Carnegie Foundation report on medical education recommend creating individualized learning pathways during medical training so that learners can experience broader professional roles beyond patient care. Little data exist to support the success of these specialized pathways in graduate medical education. We present the 10-year experience of the Primary Care Medicine Education (PRIME) track, a clinical-outcomes research pathway for internal medicine residents at the University of California San Francisco (UCSF). We hypothesized that participation in an individualized learning track, PRIME, would lead to a greater likelihood of publishing research from residency and accessing adequate career mentorship and would be influential on subsequent alumni careers. We performed a cross-sectional survey of internal medicine residency alumni from UCSF who graduated in 2001 through 2010. We compared responses of PRIME and non-PRIME categorical alumni. We used Pearson's chi-square and Student's t test to compare PRIME and non-PRIME alumni on categorical and continuous variables. Sixty-six percent (211/319) of alumni responded to the survey. A higher percentage of PRIME alumni published residency research projects compared to non-PRIME alumni (64% vs. 40%; p = .002). The number of PRIME alumni identifying research as their primary career role was not significantly different from non-PRIME internal medicine residency graduates (35% of PRIME vs. 29% non-PRIME). Process measures that could explain these findings include adequate access to mentors (M 4.4 for PRIME vs. 3.6 for non-PRIME alumni, p medicine residency programs.

  20. A group-based approach to stabilisation and symptom management in a phased treatment model for refugees and asylum seekers

    Directory of Open Access Journals (Sweden)

    Mary E. A. Robertson

    2013-12-01

    Full Text Available Background: Traumatised asylum seekers and refugees may present with significant and complex mental health problems as a result of prolonged, extreme, and multiple traumatic events. This is further complicated by ongoing complex social circumstances. Concepts: In our work at the Traumatic Stress Clinic (TSC, the understanding afforded by the concept of complex posttraumatic stress disorder (PTSD together with the related notion of a phased treatment model, provides a useful framework for organising our work with this population. Clinical Applications: An explication of complex PTSD as it applies to our client group is presented, followed by a description of our phased treatment model and an outline of the core principles, which guide our clinical approach. Our symptom management and stabilisation groups have been developed and refined over time and draw on techniques from a variety of cognitive behavioural therapies. These are described in some detail with illustrative clinical case vignettes. Conclusion: This paper concludes with some reflections on the challenges inherent to working with this complex client group.

  1. Integrative medicine for managing the symptoms of lupus nephritis: A protocol for systematic review and meta-analysis.

    Science.gov (United States)

    Choi, Tae-Young; Jun, Ji Hee; Lee, Myeong Soo

    2018-03-01

    Integrative medicine is claimed to improve symptoms of lupus nephritis. No systematic reviews have been performed for the application of integrative medicine for lupus nephritis on patients with systemic lupus erythematosus (SLE). Thus, this review will aim to evaluate the current evidence on the efficacy of integrative medicine for the management of lupus nephritis in patients with SLE. The following electronic databases will be searched for studies published from their dates of inception February 2018: Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as 6 Korean medical databases (Korea Med, the Oriental Medicine Advanced Search Integrated System [OASIS], DBpia, the Korean Medical Database [KM base], the Research Information Service System [RISS], and the Korean Studies Information Services System [KISS]), and 1 Chinese medical database (the China National Knowledge Infrastructure [CNKI]). Study selection, data extraction, and assessment will be performed independently by 2 researchers. The risk of bias (ROB) will be assessed using the Cochrane ROB tool. This systematic review will be published in a peer-reviewed journal and disseminated both electronically and in print. The review will be updated to inform and guide healthcare practice and policy. PROSPERO 2018 CRD42018085205.

  2. Adherence to Report and Patient Perception of an Interactive App for Managing Symptoms During Radiotherapy for Prostate Cancer: Descriptive Study of Logged and Interview Data.

    Science.gov (United States)

    Langius-Eklöf, Ann; Christiansen, Mats; Lindström, Veronica; Blomberg, Karin; Hälleberg Nyman, Maria; Wengström, Yvonne; Sundberg, Kay

    2017-10-31

    Patients undergoing radiotherapy for prostate cancer experience symptoms related to both the cancer itself and its treatment, and it is evident that patients with prostate cancer have unmet supportive care needs related to their disease. Over the past decade, there has been an increase in the amount of research within the field of mobile health and the use of apps as tools for managing illness. The main challenge is to develop a mobile technology to its full potential of being interactive in real time. The interactive app Interaktor, which aims to identify and manage symptoms in real time includes (1) a function for patients' assessment of the occurrence, frequency, and distress of symptoms; (2) a connection to a monitoring Web interface; (3) a risk assessment model that sends alerts via text message to health care providers; (4) continuous access to evidence-based self-care advice and links to relevant websites for more information; and (5) graphs for the patients and health care providers to view the history of symptom reporting. The aim of the study was to investigate user behavior, adherence to reporting, and the patients' experiences of using Interaktor during radiotherapy for localized advanced prostate cancer. The patients were instructed to report daily during the time of treatment and then for an additional 3 weeks. Logged data from patients' use of the app were analyzed with descriptive statistics. Interview data about experiences of using the app were analyzed with content analysis. A total of 66 patients participated in the study. Logged data showed that adherence to daily reporting of symptoms was high (87%). The patients used all the symptoms included in the app. Of the reports, 15.6% generated alerts to the health care providers. Overall, the patients found that it was easy and not particularly time-consuming to send a daily report, and many described it as becoming a routine. Reporting symptoms facilitated reflection on their symptoms and gave them

  3. Understanding medical symptoms

    DEFF Research Database (Denmark)

    Malterud, Kirsti; Guassora, Ann Dorrit Kristiane; Graungaard, Anette Hauskov

    2015-01-01

    is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how...... to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik’s concept “situational disease” explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease...

  4. Getting what they need when they need it. Identifying barriers to information needs of family caregivers to manage dementia-related behavioral symptoms.

    Science.gov (United States)

    Werner, Nicole E; Stanislawski, Barbara; Marx, Katherine A; Watkins, Daphne C; Kobayashi, Marissa; Kales, Helen; Gitlin, Laura N

    2017-02-22

    Consumer health informatics (CHI) such as web-based applications may provide the platform for enabling the over 15 million family caregivers of patients with Alzheimer's Disease or related dementias the information they need when they need it to support behavioral symptom management. However, for CHI to be successful, it is necessary that it be designed to meet the specific information needs of family caregivers in the context in which caregiving occurs. A sociotechnical systems approach to CHI design can help to understand the contextual complexities of family caregiving and account for those complexities in the design of CHI for family caregivers. This study used a sociotechnical systems approach to identify barriers to meeting caregivers' information needs related to the management of dementia-related behavioral symptoms, and to derive design implications that overcome barriers for caregiver-focused web-based platforms. We have subsequently used these design implications to inform the development of a web-based platform, WeCareAdvisor,TM which provides caregivers with information and an algorithm by which to identify and manage behavioral symptoms for which they seek management strategies. We conducted 4 focus groups with family caregivers (N=26) in a Midwestern state. Qualitative content analysis of the data was guided by a sociotechnical systems framework. We identified nine categories of barriers that family caregivers confront in obtaining needed information about behavioral symptom management from which we extrapolated design implications for a web-based platform. Based on interactions within the sociotechnical system, three critical information needs were identified: 1) timely access to information, 2) access to information that is tailored or specific to caregiver's needs and contexts, and 3) usable information that can directly inform how caregivers' manage behaviors. The sociotechnical system framework is a useful approach for identifying information

  5. Parent and Child Independent Report of Emotional Responses to Asthma-Specific Vignettes: The Relationship Between Emotional States, Self-Management Behaviors, and Symptoms.

    Science.gov (United States)

    Conn, Kelly M; Fisher, Susan G; Rhee, Hyekyun

    2016-01-01

    Little is known about the emotional intelligence (EI) of parents and their children with asthma. Objectives of this study were to assess: 1) parent's and children's report of emotions in response to an asthma vignette (proxy for EI) and 2) the relationship between emotions, self-management behaviors, and symptoms. We conducted a descriptive, mixed methods study of children 7-12 years old with asthma. Parent-Child dyads (n=104) responded to an asthma vignette to gain insight into emotions, symptoms, and self-management behaviors. Additional questions assessed confidence and worry using a 5-point Likert scale. Thematic analyses and descriptive statistics were used to assess qualitative and quantitative outcomes. Children were predominantly male (58%), 7-9 (58%), and White (46%). The most common negative emotions reported by children were scared and sad. Children who sought help from an adult were less likely to report using medications compared to children who did not seek help (39.5% vs. 62.3%, p=.029). Children with low worry and high confidence had fewer symptoms compared to children reporting high worry and low confidence (symptoms: days 3.24 vs. 6.77, p=.012, nights 2.71 vs. 5.36, p=.004). Children provided appropriate emotional responses to the asthma vignette; emotions were related to self-management behaviors and symptoms. More studies are needed to specifically assess EI in this population. Parents and children with greater EI may be better able to understand their needs, engage in self-management behaviors, and communicate with their nurses, to improve their support network and ability to access services. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Mothers' Reports of Parenting in Families of Children with Symptoms of Attention-Deficit/ Hyperactivity Disorder: Relations to Impression Management

    Science.gov (United States)

    Johnson, Charlotte; Scoular, Douglas J.; Ohan, Jeneva L.

    2004-01-01

    We investigated the relations between a tendency to respond in a socially desirable manner and mothers' reports of their parenting behaviors, and the influence of social desirability on the associations among parenting practices and mothers' and children's symptoms. Forty-two mothers of 7 to 12 year old boys with symptoms of…

  7. Glaucoma Symptoms

    Science.gov (United States)

    ... up You can help find a cure for glaucoma Give now Signs & Symptoms The most common types ... have completely different symptoms. Symptoms of Open-Angle Glaucoma Most people who develop open-angle glaucoma don’ ...

  8. Effective use of the built environment to manage behavioural and psychological symptoms of dementia: a systematic review.

    Science.gov (United States)

    Soril, Lesley J J; Leggett, Laura E; Lorenzetti, Diane L; Silvius, James; Robertson, Duncan; Mansell, Lynne; Holroyd-Leduc, Jayna; Noseworthy, Tom W; Clement, Fiona M

    2014-01-01

    To determine the effectiveness of built environment interventions in managing behavioural and psychological symptoms of dementia (BPSD) among residents in long-term care settings. Systematic review of literature published from 1995-2013. Studies were included if they: were randomized controlled trials, quasi-experimental trials, or comparative cohort studies; were in long-term or specialized dementia care; included residents with dementia and BPSD; and examined effectiveness of a built environment intervention on frequency and/or severity of BPSD. Quality of included studies was assessed using the Downs and Black Checklist. Study design, patient population, intervention, and outcomes were extracted and narratively synthesized. Five low to moderate quality studies were included. Three categories of interventions were identified: change/redesign of existing physical space, addition of physical objects to environment, and type of living environment. One of the two studies that examined change/redesign of physical spaces reported improvements in BPSD. The addition of physical objects to an existing environment (n = 1) resulted in no difference in BPSD between treatment and control groups. The two studies that examined relocation to a novel living environment reported decreased or no difference in the severity and/or frequency of BPSD post-intervention. No studies reported worsening of BPSD following a built environment intervention. The range of built environment interventions is broad, as is the complex and multi-dimensional nature of BPSD. There is inconclusive evidence to suggest a built environment intervention which is clinically superior in long-term care settings. Further high-quality methodological and experimental studies are required to demonstrate the feasibility and effectiveness of such interventions.

  9. A modified Delphi survey on the signs and symptoms of low back pain: indicators for an interventional management approach.

    Science.gov (United States)

    Cid, José; De La Calle, José L; López, Esther; Del Pozo, Cristina; Perucho, Alfredo; Acedo, María Soledad; Bedmar, Dolores; Benito, Javier; De Andrés, Javier; Díaz, Susana; García, Juan Antonio; Gómez-Caro, Leticia; Gracia, Adolfo; Hernández, José María; Insausti, Joaquín; Madariaga, María; Moñino, Pedro; Ruiz, Manuel; Uriarte, Estrella; Vidal, Alfonso

    2015-01-01

    Low back pain (LBP) symptoms and signs are nonspecific. If required, diagnostic blocks may find the source of pain, but indicators of suspect diagnosis must be defined to identify anatomical targets. To reach a consensus from an expert panel on the indicators for the most common causes of LBP. A 3-round (2 telematic and 1 face-to-face) modified Delphi survey with a questionnaire on 78 evidence-based indicators of 7 LBP etiologies was completed by 23 experts. 98.7% of the questionnaire was consensuated. The most accepted indicators were for zygapophysial joint pain, painful ipsilateral paravertebral palpation, worsening with trunk extension, paravertebral musculature spasm on the affected articulation, and referred pain above the knee, without radicular pattern. For sacroiliac joint pain, unilateral pain when seating, with at least 3 described provoking tests: Approximation; gapping; Patrick's; Gaenslen's; thigh thrust; Fortin finger; and Gillet's tests. For discogenic pain, midline pain that may be provoked by pressure on the spinal processes at the affected level; for quadratus lumborum muscle, painful palpation on both the L1 level paravertebral region, referred to iliac crest, and the iliac crest, referred to greater trochanter. For iliopsoas muscle, pain elicited by thigh flexion, referred to buttock, inguinal region, and anterior thigh. For pyramidal muscle, pain while sitting on the affected side and positive Freiberg's test. For radicular pain, paresthesias and positive Lassègue's test at 60°. Seventy-seven diagnostic suspect indicators of LBP conditions were consensuated. These may facilitate conservative or interventional pain management decision-making. © 2013 World Institute of Pain.

  10. A one-year economic evaluation of six alternative strategies in the management of uninvestigated upper gastrointestinal symptoms in Canadian primary care.

    Science.gov (United States)

    Barkun, Alan N; Crott, Ralph; Fallone, Carlo A; Kennedy, Wendy A; Lachaine, Jean; Levinton, Carey; Armstrong, David; Chiba, Naoki; Thomson, Alan; Veldhuyzen van Zanten, Sander; Sinclair, Paul; Escobedo, Sergio; Chakraborty, Bijan; Smyth, Sandra; White, Robert; Kalra, Helen; Nevin, Krista

    2010-08-01

    The cost-effectiveness of initial strategies in managing Canadian patients with uninvestigated upper gastrointestinalsymptoms remains controversial. To assess the cost-effectiveness of six management approaches to uninvestigated upper gastrointestinal symptoms in the Canadian setting. The present study analyzed data from four randomized trials assessing homogeneous and complementary populations of Canadian patients with uninvestigated upper gastrointestinal symptoms with comparable outcomes. Symptom-free months, qualityadjusted life-years (QALYs) and direct costs in Canadian dollars of two management approaches based on the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool, and four additional strategies (two empirical antisecretory agents, and two prompt endoscopy) were examined and compared. Prevalence data, probabilities, utilities and costs were included in a Markov model, while sensitivity analysis used Monte Carlo simulations. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were determined. Empirical omeprazole cost $226 per QALY ($49 per symptom-free month) per patient. CanDys omeprazole and endoscopy approaches were more effective than empirical omeprazole, but more costly. Alternatives using H2-receptor antagonists were less effective than those using a proton pump inhibitor. No significant differences were found for most incremental cost-effectiveness ratios. As willingness to pay (WTP) thresholds rose from $226 to $24,000 per QALY, empirical antisecretory approaches were less likely to be the most costeffective choice, with CanDys omeprazole progressively becoming a more likely option. For WTP values ranging from $24,000 to $70,000 per QALY, the most clinically relevant range, CanDys omeprazole was the most cost-effective strategy (32% to 46% of the time), with prompt endoscopy-proton pump inhibitor favoured at higher WTP values. Although no strategy was the indisputable cost effective option, Can

  11. Patient and caregiver perspectives on decision support for symptom and quality of life management during cancer treatment: Implications for eHealth.

    Science.gov (United States)

    Cooley, Mary E; Nayak, Manan M; Abrahm, Janet L; Braun, Ilana M; Rabin, Michael S; Brzozowski, Jane; Lathan, Christopher; Berry, Donna L

    2017-08-01

    Adequate symptom and quality-of-life (SQL) management is a priority during cancer treatment. eHealth is a timely way to enhance patient-engagement, facilitate communication, and improve health outcomes. The objectives of this study were to describe patient and caregivers' perspectives for providing, processing, and managing SQL data to enhance communication and identify desired components for decision support. Data were collected from 64 participants through questionnaires and focus groups. Analysis was conducted using NVivo. Open and axial coding was completed, grouping commonalities and large constructs into nodes to identify and synthesize themes. Face-to-face meetings with clinicians were the prime time to communicate, and patients strove to understand treatment options and the effect on SQL by bringing caregivers to their visits, taking notes, tracking symptoms, and creating portable health records. Patients/caregivers struggled to self-manage their symptoms and were uncertain when to contact clinicians when experiencing uncontrolled symptoms. Most participants identified eHealth solutions for decision support. However, 38% of participants (n = 24) rarely used computers and identified non-eHealth options for decision support. Core components for both eHealth and non-eHealth systems were access to (1) cancer information, (2) medical records, (3) peer support, and (4) improved support and understanding on when to contact clinicians. Patients were faced with an overwhelming amount of information and relied on their caregivers to help navigate the complexities of cancer care and self-manage SQL. Health technologies can provide informational support; however, decision support needs to span multiple venues to avoid increasing disparities caused by a digital divide. Copyright © 2017 John Wiley & Sons, Ltd.

  12. Diagnostic yield of MRI for audiovestibular dysfunction using contemporary referral criteria: correlation with presenting symptoms and impact on clinical management

    Energy Technology Data Exchange (ETDEWEB)

    Vandervelde, C. [Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust (United Kingdom)], E-mail: clivevandervelde@gmail.com; Connor, S E.J. [Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust (United Kingdom); Department of Neuroradiology, King' s College Hospital NHS Foundation Trust, London (United Kingdom)

    2009-02-15

    Aim: To investigate the diagnostic yield of T2-weighted magnetic resonance imaging (MRI) screening for vestibular schwannoma and other relevant conditions in the setting of audiovestibular symptoms, given the more liberal contemporary referral criteria. To determine whether presenting clinical symptoms correlate with imaging outcome in order to guide future protocols for MRI referral. Materials and methods: Eight hundred and eighty-one consecutive MRI examinations performed in patients with audiovestibular dysfunction were reviewed. Clinical indications and findings were recorded. Case notes were reviewed in patients with positive imaging findings. Two-way, cross-tabulation, Chi-square analysis was performed to assess the relationship between presenting symptoms and imaging outcome. Results: Twelve of the 881 (1.4%) were positive for vestibular schwannoma. A further four of 881 (0.4%) revealed other relevant conditions. Incidental conditions, felt to be irrelevant to the presenting symptoms, were noted in 12 of the 881 (1.4%). In all 12 cases that were positive for vestibular schwannoma, either tinnitus or hearing loss was present. Conclusion: The yield for T2-weighted MRI to diagnose vestibular schwannoma and other relevant retrocochlear conditions was lower than for previous studies, which is likely to reflect trends in referral criteria. No single audiovestibular symptom or combination of symptoms is a statistically significant predictor of imaging outcome.

  13. Diagnostic yield of MRI for audiovestibular dysfunction using contemporary referral criteria: correlation with presenting symptoms and impact on clinical management

    International Nuclear Information System (INIS)

    Vandervelde, C.; Connor, S.E.J.

    2009-01-01

    Aim: To investigate the diagnostic yield of T2-weighted magnetic resonance imaging (MRI) screening for vestibular schwannoma and other relevant conditions in the setting of audiovestibular symptoms, given the more liberal contemporary referral criteria. To determine whether presenting clinical symptoms correlate with imaging outcome in order to guide future protocols for MRI referral. Materials and methods: Eight hundred and eighty-one consecutive MRI examinations performed in patients with audiovestibular dysfunction were reviewed. Clinical indications and findings were recorded. Case notes were reviewed in patients with positive imaging findings. Two-way, cross-tabulation, Chi-square analysis was performed to assess the relationship between presenting symptoms and imaging outcome. Results: Twelve of the 881 (1.4%) were positive for vestibular schwannoma. A further four of 881 (0.4%) revealed other relevant conditions. Incidental conditions, felt to be irrelevant to the presenting symptoms, were noted in 12 of the 881 (1.4%). In all 12 cases that were positive for vestibular schwannoma, either tinnitus or hearing loss was present. Conclusion: The yield for T2-weighted MRI to diagnose vestibular schwannoma and other relevant retrocochlear conditions was lower than for previous studies, which is likely to reflect trends in referral criteria. No single audiovestibular symptom or combination of symptoms is a statistically significant predictor of imaging outcome

  14. Constructing an adaptive care model for the management of disease-related symptoms throughout the course of multiple sclerosis--performance improvement CME.

    Science.gov (United States)

    Miller, Aaron E; Cohen, Bruce A; Krieger, Stephen C; Markowitz, Clyde E; Mattson, David H; Tselentis, Helen N

    2014-01-01

    Symptom management remains a challenging clinical aspect of MS. To design a performance improvement continuing medical education (PI CME) activity for better clinical management of multiple sclerosis (MS)-related depression, fatigue, mobility impairment/falls, and spasticity. Ten volunteer MS centers participated in a three-stage PI CME model: A) baseline assessment; B) practice improvement CME intervention; C) reassessment. Expert faculty developed performance measures and activity intervention tools. Designated MS center champions reviewed patient charts and entered data into an online database. Stage C data were collected eight weeks after implementation of the intervention and compared with Stage A baseline data to measure change in performance. Aggregate data from the 10 participating MS centers (405 patient charts) revealed performance improvements in the assessment of all four MS-related symptoms. Statistically significant improvements were found in the documented assessment of mobility impairment/falls (p=0.003) and spasticity (pmodel (available at www.achlpicme.org/ms/toolkit) offers a new perspective on enhancing symptom management in patients with MS.

  15. Gender differences in use of prayer as a self-care strategy for managing symptoms in African Americans living with HIV/AIDS.

    Science.gov (United States)

    Coleman, Christopher Lance; Holzemer, William L; Eller, Lucille Sanzero; Corless, Inge; Reynolds, Nancy; Nokes, Kathleen M; Kemppainen, Jeanne K; Dole, Pam; Kirksey, Kenn; Seficik, Liz; Nicholas, Patrice; Hamilton, Mary Jane

    2006-01-01

    The objective of this study was to explore the association of gender to use of prayer as a self-care strategy for managing the HIV-related symptoms of fatigue, nausea, depression, and anxiety among African American men and women who are HIV-seropositive. To accomplish this, data were determined using convenience sampling from a sample of 448 African American men and women from the United States who were participants in a national study on self-care symptom management of HIV/AIDS. Chi-square analyses were used to examine the potential relationships between gender and the use of prayer for managing the four symptoms. The mean age of the sample was 42.69 +/- 7.93 years (range, 20-66). Results showed the following gender differences in the use of prayer as a self-care strategy: fatigue-men 46% (n = 62), women 54% (n = 74); nausea-men 52% (n = 33), women 48% (n = 30); depression-men 55% (n = 90), women 45% (n = 73); and anxiety-men 77% (n = 83), women 87% (n = 73). Chi-square analyses determined that significant differences exist between African American men and women in the frequency of the use of prayer for managing HIV-related fatigue (chi(2) = 14.81, 1 df, p = .000), nausea (chi(2) = 4.10, 1 df, p =.043), and depression (chi(2) = 5.21, 1 df, p = .022). There was no gender difference in the use of prayer to manage anxiety. Prayer was reported as a self-care strategy by over 50% of the respondents for three of the four symptoms and was rated highly efficacious. The authors conclude that the African American men and women differed in their selection of prayer as a self-care strategy for managing HIV-related depression, fatigue, and nausea. A higher proportion of women than men used prayer to manage fatigue, and more men than women reported using prayer to manage nausea and depression.

  16. Symptoms of anxiety and depression in type 2 diabetes: Associations with clinical diabetes measures and self-management outcomes in the Norwegian HUNT study.

    Science.gov (United States)

    Naicker, Kiyuri; Øverland, Simon; Johnson, Jeffrey A; Manuel, Douglas; Skogen, Jens C; Sivertsen, Børge; Colman, Ian

    2017-10-01

    To determine if symptoms of depression and anxiety are differentially associated with clinical diabetes measures and self-management behaviours in individuals with Type 2 diabetes, and whether these associations vary by patient sex. A cross-sectional analysis using data from 2035 adults with Type 2 diabetes in the Nord-Trøndelag Health Study. Multivariate logistic regression was used to explore associations between symptoms of depression and anxiety and waist girth, HDL cholesterol, systolic blood pressure, triglycerides, c-reactive protein, glycemic control, diet adherence, exercise, glucose monitoring, foot checks for ulcers, and the subjective patient experience. Analyses were stratified by sex. Depression was associated with a lower likelihood of avoiding saturated fats (OR=0.20 [95% CI: 0.06, 0.68]) and increased odds of physical inactivity (OR=1.69 [95% CI: 1.37, 2.72]). Anxiety was associated with increased odds of eating vegetables (OR=1.66 [95% CI: 1.02, 2.73]), and an over two-fold increase of feeling that having diabetes is difficult. In women, anxiety was associated with elevated c-reactive protein levels (OR=1.57 [95% CI: 1.05, 2.34]). In men, depressive symptoms were associated with elevated HbA1c (OR=5.00 [95% CI: 1.15, 8.23). Symptoms of depression and anxiety were differentially associated with some key diabetes-related measures. Our results suggest sex-specific differences with respect to two important clinical outcomes (i.e., anxiety and CRP in women and depression and glycemic control in men). These findings should alert practitioners to the importance of detection and management of psychological symptoms in individuals with Type 2 diabetes. Copyright © 2017. Published by Elsevier Ltd.

  17. National Institutes of Health State-of-the-Science Conference Statement: Symptom management in cancer: pain, depression, and fatigue, July 15-17, 2002.

    Science.gov (United States)

    Patrick, Daniel L; Ferketich, Sandra L; Frame, Paul S; Harris, Jesse J; Hendricks, Carolyn B; Levin, Bernard; Link, Michael P; Lustig, Craig; McLaughlin, Joseph; Reid, L Douglas; Turrisi, Andrew T; Unützer, Jürgen; Vernon, Sally W

    2004-01-01

    Despite advances in early detection and effective treatment, cancer remains one of the most feared diseases. Among the most common side effects of cancer and treatments for cancer are pain, depression, and fatigue. Although research is producing increasingly hopeful insights into the causes and cures for cancer, efforts to manage the side effects of the disease and its treatments have not kept pace. The challenge that faces us is how to increase awareness of the importance of recognizing and actively addressing cancer-related distress. The National Institutes of Health (NIH) convened a State-of-the-Science Conference on Symptom Management in Cancer: Pain, Depression, and Fatigue to examine the current state of knowledge regarding the management of pain, depression, and fatigue in individuals with cancer and to identify directions for future research. Specifically, the conference examined how to identify individuals who are at risk for cancer-related pain, depression, and/or fatigue; what treatments work best to address these symptoms when they occur; and what is the best way to deliver interventions across the continuum of care. STATE-OF-THE-SCIENCE PROCESS: A non-advocate, non-Federal, 14-member panel of experts representing the fields of oncology, radiology, psychology, nursing, public health, social work, and epidemiology prepared the statement. In addition, 24 experts in medical oncology, geriatrics, pharmacology, psychology, and neurology presented data to the panel and to the conference audience during the first 1.5 days of the conference. The panel then prepared its statement, addressing the five predetermined questions and drawing on submitted literature, the speakers' presentations, and discussions held at the conference. The statement was presented to the conference audience, followed by a press conference to allow the panel to respond to questions from the media. After its release at the conference, the draft statement was made available on the Internet

  18. An algorithm for management of deep brain stimulation battery replacements: devising a web-based battery estimator and clinical symptom approach.

    Science.gov (United States)

    Montuno, Michael A; Kohner, Andrew B; Foote, Kelly D; Okun, Michael S

    2013-01-01

    Deep brain stimulation (DBS) is an effective technique that has been utilized to treat advanced and medication-refractory movement and psychiatric disorders. In order to avoid implanted pulse generator (IPG) failure and consequent adverse symptoms, a better understanding of IPG battery longevity and management is necessary. Existing methods for battery estimation lack the specificity required for clinical incorporation. Technical challenges prevent higher accuracy longevity estimations, and a better approach to managing end of DBS battery life is needed. The literature was reviewed and DBS battery estimators were constructed by the authors and made available on the web at http://mdc.mbi.ufl.edu/surgery/dbs-battery-estimator. A clinical algorithm for management of DBS battery life was constructed. The algorithm takes into account battery estimations and clinical symptoms. Existing methods of DBS battery life estimation utilize an interpolation of averaged current drains to calculate how long a battery will last. Unfortunately, this technique can only provide general approximations. There are inherent errors in this technique, and these errors compound with each iteration of the battery estimation. Some of these errors cannot be accounted for in the estimation process, and some of the errors stem from device variation, battery voltage dependence, battery usage, battery chemistry, impedance fluctuations, interpolation error, usage patterns, and self-discharge. We present web-based battery estimators along with an algorithm for clinical management. We discuss the perils of using a battery estimator without taking into account the clinical picture. Future work will be needed to provide more reliable management of implanted device batteries; however, implementation of a clinical algorithm that accounts for both estimated battery life and for patient symptoms should improve the care of DBS patients. © 2012 International Neuromodulation Society.

  19. Diagnosis and management of transthyretin familial amyloid polyneuropathy in Japan: red-flag symptom clusters and treatment algorithm.

    Science.gov (United States)

    Sekijima, Yoshiki; Ueda, Mitsuharu; Koike, Haruki; Misawa, Sonoko; Ishii, Tomonori; Ando, Yukio

    2018-01-17

    Hereditary ATTR (ATTRm) amyloidosis (also called transthyretin-type familial amyloid polyneuropathy [ATTR-FAP]) is an autosomal-dominant, adult-onset, rare systemic disorder predominantly characterized by irreversible, progressive, and persistent peripheral nerve damage. TTR gene mutations (e.g. replacement of valine with methionine at position 30 [Val30Met (p.Val50Met)]) lead to destabilization and dissociation of TTR tetramers into variant TTR monomers, which form amyloid fibrils that deposit in peripheral nerves and various organs, giving rise to peripheral and autonomic neuropathy and several non-disease specific symptoms.Phenotypic and genetic variability and non-disease-specific symptoms often delay diagnosis and lead to misdiagnosis. Red-flag symptom clusters simplify diagnosis globally. However, in Japan, types of TTR variants, age of onset, penetrance, and clinical symptoms of Val30Met are more varied than in other countries. Hence, development of a Japan-specific red-flag symptom cluster is warranted. Presence of progressive peripheral sensory-motor polyneuropathy and ≥1 red-flag sign/symptom (e.g. family history, autonomic dysfunction, cardiac involvement, carpal tunnel syndrome, gastrointestinal disturbances, unexplained weight loss, and immunotherapy resistance) suggests ATTR-FAP. Outside of Japan, pharmacotherapeutic options are first-line therapy. However, because of positive outcomes (better life expectancy and higher survival rates) with living donor transplant in Japan, liver transplantation remains first-line treatment, necessitating a Japan-specific treatment algorithm.Herein, we present a consolidated review of the ATTR-FAP Val30Met landscape in Japan and summarize findings from a medical advisory board meeting held in Tokyo on 18th August 2016, at which a Japan-specific ATTR-FAP red-flag symptom cluster and treatment algorithm was developed. Beside liver transplantation, a TTR-stabilizing agent (e.g. tafamidis) is a treatment option. Early

  20. Impact of a disease-management program on symptom burden and health-related quality of life in patients with idiopathic pulmonary fibrosis and their care partners.

    Science.gov (United States)

    Lindell, Kathleen Oare; Olshansky, Ellen; Song, Mi-Kyung; Zullo, Thomas G; Gibson, Kevin F; Kaminski, Naftali; Hoffman, Leslie A

    2010-01-01

    Patients were recruited from the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, located within the University of Pittsburgh Medical Center. Idiopathic pulmonary fibrosis results in scarring of the lung and respiratory failure, and has a median survival of 3 to 5 years from the time of diagnosis. The purpose of this study was to determine whether patients with idiopathic pulmonary fibrosis and their care partners could be more optimally managed by a disease-management intervention entitled "Program to Reduce Idiopathic Pulmonary Fibrosis Symptoms and Improve Management," which nurses delivered using the format of a support group. We hypothesized that participation would improve perceptions of health-related quality of life (HRQoL) and decrease symptom burden. Subjects were 42 participants randomized to an experimental (10 patient/care partner dyads) or control (11 patient/care partner dyads) group. Experimental group participants attended the 6-week program, and controls received usual care. Before and after the program, all participants completed questionnaires designed to assess symptom burden and HRQoL. Patients and care partners in the intervention group were also interviewed in their home to elicit information on their experience after participating in the Program to Reduce Idiopathic Pulmonary Fibrosis Symptoms and Improve Management. After the intervention, experimental group patients rated their HRQoL less positively (P = .038) and tended to report more anxiety (P = .077) compared with controls. Care partners rated their stress at a lower level (P = .018) compared with controls. Course evaluations were uniformly positive. Post-study qualitative interviews with experimental group participants suggested benefits not exemplified by these scores. Patient participants felt less isolated, were able to put their disease into perspective, and valued participating in research and helping others. Further exploration of the impact of disease-management

  1. Review and Analysis of Existing Mobile Phone Apps to Support Heart Failure Symptom Monitoring and Self-Care Management Using the Mobile Application Rating Scale (MARS).

    Science.gov (United States)

    Masterson Creber, Ruth M; Maurer, Mathew S; Reading, Meghan; Hiraldo, Grenny; Hickey, Kathleen T; Iribarren, Sarah

    2016-06-14

    Heart failure is the most common cause of hospital readmissions among Medicare beneficiaries and these hospitalizations are often driven by exacerbations in common heart failure symptoms. Patient collaboration with health care providers and decision making is a core component of increasing symptom monitoring and decreasing hospital use. Mobile phone apps offer a potentially cost-effective solution for symptom monitoring and self-care management at the point of need. The purpose of this review of commercially available apps was to identify and assess the functionalities of patient-facing mobile health apps targeted toward supporting heart failure symptom monitoring and self-care management. We searched 3 Web-based mobile app stores using multiple terms and combinations (eg, "heart failure," "cardiology," "heart failure and self-management"). Apps meeting inclusion criteria were evaluated using the Mobile Application Rating Scale (MARS), IMS Institute for Healthcare Informatics functionality scores, and Heart Failure Society of America (HFSA) guidelines for nonpharmacologic management. Apps were downloaded and assessed independently by 2-4 reviewers, interclass correlations between reviewers were calculated, and consensus was met by discussion. Of 3636 potentially relevant apps searched, 34 met inclusion criteria. Most apps were excluded because they were unrelated to heart failure, not in English or Spanish, or were games. Interrater reliability between reviewers was high. AskMD app had the highest average MARS total (4.9/5). More than half of the apps (23/34, 68%) had acceptable MARS scores (>3.0). Heart Failure Health Storylines (4.6) and AskMD (4.5) had the highest scores for behavior change. Factoring MARS, functionality, and HFSA guideline scores, the highest performing apps included Heart Failure Health Storylines, Symple, ContinuousCare Health App, WebMD, and AskMD. Peer-reviewed publications were identified for only 3 of the 34 apps. This review suggests

  2. Current status of 5alpha-reductase inhibitors in the management of lower urinary tract symptoms and BPH

    NARCIS (Netherlands)

    Gravas, Stavros; Oelke, Matthias

    2010-01-01

    Benign prostatic hyperplasia (BPH) is a progressive disease that is commonly associated with bothersome lower urinary tract symptoms (LUTS) and might result in complications, such as acute urinary retention and BPH-related surgery. Therefore, the goals of therapy for BPH are not only to improve LUTS

  3. Current status of 5 alpha-reductase inhibitors in the management of lower urinary tract symptoms and BPH

    NARCIS (Netherlands)

    Gravas, S.; Oelke, M.

    2010-01-01

    Benign prostatic hyperplasia (BPH) is a progressive disease that is commonly associated with bothersome lower urinary tract symptoms (LUTS) and might result in complications, such as acute urinary retention and BPH-related surgery. Therefore, the goals of therapy for BPH are not only to improve LUTS

  4. Managing cancer pain and symptoms of outpatients by rotation to sustained-release hydromorphone: a prospective clinical trial

    NARCIS (Netherlands)

    Wirz, Stefan; Wartenberg, Hans Christian; Elsen, Christian; Wittmann, Maria; Diederichs, Marta; Nadstawek, Joachim

    2006-01-01

    PURPOSE: In this prospective clinical trial we examined the technique of opioid rotation to oral sustained-release hydromorphone for controlling pain and symptoms in outpatients with cancer pain. METHODS: Before and after rotation, 50 patients were assessed by Numerical Analog Scales [Numerical

  5. The management of sexuality, intimacy, and menopause symptoms (SIMS) after prophylactic bilateral salpingo-oophorectomy: How to maintain sexual health in "previvors".

    Science.gov (United States)

    Alexandre, Mehida; Black, Jonathan; Whicker, Margaret; Minkin, Mary Jane; Ratner, Elena

    2017-11-01

    "Previvors", or "pre-survivors", are individuals who do not have cancer but have a genetic predisposition to cancer. One such example is women with BRCA mutations. As a result of their predisposition to cancer, many will undergo a bilateral salpingo-oophorectomy when they are premenopausal. For premenopausal women, the removal of ovaries results in the depletion of estrogen, immediate menopause, and, in many cases, resultant Sexuality, Intimacy, and Menopausal Symptoms (SIMS). Furthermore, they may undergo changes in body image. SIMS are underreported by patients and underdiagnosed by practitioners. At the time of diagnosis or at preoperative visits, women should be informed of the potential physiologic, hormonal, and psychosocial effects of their risk-reducing surgery. There are many modalities for management of these symptoms. Successful treatment requires the provider's awareness of the problem, ability to identify it, and willingness to treat it. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Evaluation of a Web-based intervention providing tailored advice for self-management of minor respiratory symptoms: exploratory randomized controlled trial.

    Science.gov (United States)

    Yardley, Lucy; Joseph, Judith; Michie, Susan; Weal, Mark; Wills, Gary; Little, Paul

    2010-12-15

    There has been relatively little research on the role of web-based support for self-care in the management of minor, acute symptoms, in contrast to the wealth of recent research into Internet interventions to support self-management of long-term conditions. This study was designed as an evaluation of the usage and effects of the "Internet Doctor" website providing tailored advice on self-management of minor respiratory symptoms (eg, cough, sore throat, fever, runny nose), in preparation for a definitive trial of clinical effectiveness. The first aim was to evaluate the effects of using the Internet Doctor webpages on patient enablement and use of health services, to test whether the tailored, theory-based advice provided by the Internet Doctor was superior to providing a static webpage providing the best existing patient information (the control condition). The second aim was to gain an understanding of the processes that might mediate any change in intentions to consult the doctor, by comparing changes in relevant beliefs and illness perceptions in the intervention and control groups, and by analyzing usage of the Internet Doctor webpages and predictors of intention change. Participants (N = 714) completed baseline measures of beliefs about their symptoms and self-care online, and were then automatically randomized to the Internet Doctor or control group. These measures were completed again by 332 participants after 48 hours. Four weeks later, 214 participants completed measures of enablement and health service use. The Internet Doctor resulted in higher levels of satisfaction than the control information (mean 6.58 and 5.86, respectively; P = .002) and resulted in higher levels of enablement a month later (median 3 and 2, respectively; P = .03). Understanding of illness improved in the 48 hours following use of the Internet Doctor webpages, whereas it did not improve in the control group (mean change from baseline 0.21 and -0.06, respectively, P = .05). Decline

  7. The role of transdermal estrogen sprays and estradiol topical emulsion in the management of menopause-associated vasomotor symptoms

    Directory of Open Access Journals (Sweden)

    Amy M Egras

    2010-05-01

    Full Text Available Amy M Egras, Elena M UmlandJefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USAAbstract: Vasomotor symptoms (VMS are among the most bothersome complaints of postmenopausal women. To date, the most widely studied and effective treatment for VMS is hormone replacement therapy, consisting of estrogen (in women without a uterus or estrogen plus progestin (in women with a uterus. Traditionally, oral estrogens have been used for treatment. However, over the years, additional estrogen formulations have been developed including transdermal patches; vaginal rings, creams, and tablets; and injectable preparations. Two newer formulations are transdermal estrogen spray and estradiol topical emulsion. This review evaluates the current literature assessing the use of these two newer formulations for the treatment of VMS associated with menopause.Keywords: menopause, vasomotor symptoms, transdermal estrogen spray, estradiol topical emulsion

  8. Current and investigational non-dopaminergic agents for management of motor symptoms (including motor complications) in Parkinson's disease.

    Science.gov (United States)

    Müller, Thomas

    2017-10-01

    Parkinson's disease is characterized by a heterogeneous combination of motor and non motor symptoms. The nigrostriatal dopamine deficit is one of its essential pathophysiologic features. Areas covered: This invited narrative review provides an overlook over current available and future promising non dopaminergic therapeutics to modulate altered dopaminergic neurotransmission in Parkinson's disease. Current research strategies aim to proof clinical efficacy by amelioration of motor symptoms and preponderant levodopa related movement fluctuations. These so-called motor complications are characterized by involuntary movements as a result of an overstimulation of the nigrostriatal dopaminergic system or by temporary recurrence of motor symptoms, when beneficial effects of dopamine substituting drugs vane. Expert opinion: Non dopaminergic modulation of dopamine replacement is currently mostly investigated in well defined and selected patients with motor complications to get approval. However, the world of daily maintenance of patients with its individually adapted, so-called personalised, therapy will determine the real value of these therapeutics. Here the clinical experience of the treating neurologists and the courage to use unconventional drug combinations are essential preconditions for successful treatments of motor and associated non motor complications in cooperation with the patients and their care giving surroundings.

  9. Beyond symptom management: Family relations, unmet needs of persons living with severe mental illnesses, and potential implications for social work in South Africa.

    Science.gov (United States)

    Tomita, Andrew; Burns, Jonathan K; King, Howard; Baumgartner, Joy Noel; Davis, Glen P; Mtshemla, Sisanda; Nene, Siphumelele; Susser, Ezra

    2016-01-01

    This study examined the quality of family relationships and its associations with the severity of unmet needs of individuals admitted to a tertiary psychiatric hospital in South Africa. The quality of family relations and perceived unmet needs were assessed using the Lehman Quality of Life Interview and Camberwell Assessment of Needs, respectively. The results show that higher total unmet needs were associated with lower quality of family relations. The main areas of serious unmet needs included accessing government benefits and information, and establishing social relations. The results have implications for hospital-based social workers beyond managing psychiatric symptoms in South Africa.

  10. Shortcomings in safety management: symptoms, examples and recovery processes. Omission of Operational Culture can be fatal for the power utility

    International Nuclear Information System (INIS)

    Hezoucky, F.; )

    2006-01-01

    During recent years, many utilities and their nuclear branches have undergone substantial change. The effectiveness of management in handling the change varies considerably from utility to utility. At the extreme, the way the change is managed and nuclear safety and operational performance aspects are integrated can either help lead a plant to operational excellence or destroy what was once an effective organisation. (author)

  11. [Privatization in healthcare management: an adverse effect of the economic crisis and a symptom of bad governance. SESPAS report 2014].

    Science.gov (United States)

    Sánchez-Martínez, Fernando I; Abellán-Perpiñán, José María; Oliva-Moreno, Juan

    2014-06-01

    It is often asserted that public management of healthcare facilities is inefficient. On the basis of that unproven claim, it is argued that privatization schemes are needed. In this article we review the available evidence, in Spain and other countries, on the application of private management mechanisms to publicly funded systems similar to the Spanish national health system. The evidence suggests that private management of healthcare services is not necessarily better than public management, nor vice versa. Ownership-whether public or private-of health care centers does not determine their performance which, on the contrary, depends on other factors, such as the workplace culture or the practice of suitable monitoring by the public payer. Promoting competition among centers (irrespective of the specific legal form of the management arrangements), however, could indeed lead to improvements under some circumstances. Therefore, it is advisable to cease the narrow-minded debate on the superiority of one or other model in order to focus on improving healthcare services management per se. Understanding that good governance affects health policies, the management of health care organizations, and clinical practice is, undoubtedly, an essential requirement but may not necessarily lead to policies that stimulate the solvency of the system. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  12. Ebola Virus Disease Outbreak in Isiro, Democratic Republic of the Congo, 2012: Signs and Symptoms, Management and Outcomes.

    Directory of Open Access Journals (Sweden)

    Thomas Kratz

    Full Text Available Data collected during the 2012 Ebola virus disease (EVD epidemic in the Democratic Republic of the Congo were analysed for clinical signs, symptoms and case fatality of EVD caused by Bundibugyo virus (BDBV, establishment of differential diagnoses, description of medical treatment and evaluation of the quality of clinical documentation. In a quantitative observational prospective study, global epidemiological data from 52 patients (34 patients within the community, 18 patients treated in the Ebola Treatment Centre were entered anonymously into a database, subsequently matched and analysed. Relevant findings include an over-representation of females among community EVD cases (85.3% and of community EVD cases in the age group of 15-54 years (82.4%. All ETC patients had fever (55.6% of all 18 ETC patients during their hospital stay or self-reported fever (88.2% upon admission at some point of time during their illness. Major symptoms of ETC patients during hospital stay included asthenia (82.4%, anorexia (82.4%, myalgia (70.6%, sore throat/difficulty swallowing (70.6%, arthralgia (76.5% and nausea (70.6%. Gastrointestinal signs and symptoms (nausea, diarrhoea, vomiting (76.4% as well as general pain (94.1% were frequent in ETC patients. The median duration of EVD was 18 days, while the mean incubation period was 11.3 days. Differential diagnosis of EVD included malaria (28.3%, intestinal parasitosis (10.9%, and infectious syndrome (10.9%. There was also an important variation in clinical evolvement. Quality of documentation was adversely affected by the way patient file contents were transferred from inside to outside the high-risk zone, entailing a mean mismatch value of 27.3% between patient file contents inside vs. outside the high-risk zone. This study adds further description of EVD (frequently non-specific signs and symptoms, non frequent bleeding, a long incubation period, long duration of disease and emphasizes the need for improving

  13. The role of Cucurbita pepo in the management of patients affected by lower urinary tract symptoms due to benign prostatic hyperplasia: A narrative review.

    Science.gov (United States)

    Damiano, Rocco; Cai, Tommaso; Fornara, Paolo; Franzese, Corrado Antonio; Leonardi, Rosario; Mirone, Vincenzo

    2016-07-04

    Phytotherapeutic compounds are largely used in the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) due to low side-effect profiles and costs, high level of acceptance by patients and a low rate of dropout. Here, we aimed to analyze all available evidence on the role of Cucurbita pepo in the treatment of LUTS-BPH. In May 2016 a systematic search was carried out thorough National Library of Medicine Pubmed, Scopus database and the ISI Web of Knowledge official website in order to identify all published studies on Cucurbita pepo and BPH. The following search strings were used: "Cucurbita pepo" OR "pumpkin seed" AND "prostate"; "Cucurbita pepo" AND "antiandrogen" OR "antiproliferative" OR "anti-inflammatory" OR "antioxidant activities"; "cucurbita pepo" OR "pumpkin seed" AND "LUTS" AND "symptoms improvement" OR "quality of life". We consider for the present analysis only studies related to LUTS-BPH. Among all 670 screened, 16 were related to LUTSBPH and finally analyzed. Among all, ten of them were performed in "in vitro setting" showing anti-inflammatory and antiandrogen effect, and a reduction in prostate growth and detrusor activity, while six were clinical studies. In all studies an improvement in International Prostatic Symptoms Score (IPSS) and uroflowmetry parameters has been reported. In 4 studies, an improvement in quality of life has been reported. On the basis of our narrative review, the use of Cucurbita pepo in the management of patients affected by LUTS-BPH seems to be useful for improving symptoms and quality of life. However, future clinical trials are requested to confirm these promising results.

  14. Statin-associated muscle symptoms: impact on statin therapy—European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management

    Science.gov (United States)

    Stroes, Erik S.; Thompson, Paul D.; Corsini, Alberto; Vladutiu, Georgirene D.; Raal, Frederick J.; Ray, Kausik K.; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G.; Bruckert, Eric; De Backer, Guy; Krauss, Ronald M.; Laufs, Ulrich; Santos, Raul D.; Hegele, Robert A.; Hovingh, G. Kees; Leiter, Lawrence A.; Mach, Francois; März, Winfried; Newman, Connie B.; Wiklund, Olov; Jacobson, Terry A.; Catapano, Alberico L.; Chapman, M. John; Ginsberg, Henry N.; Stroes, Erik; Thompson, Paul D.; Corsini, Alberto; Vladutiu, Georgirene D.; Raal, Frederick J.; Ray, Kausik K.; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G.; Bruckert, Eric; Krauss, Ronald M.; Laufs, Ulrich; Santos, Raul D.; März, Winfried; Newman, Connie B.; John Chapman, M.; Ginsberg, Henry N.; John Chapman, M.; Ginsberg, Henry N.; de Backer, Guy; Catapano, Alberico L.; Hegele, Robert A.; Kees Hovingh, G.; Jacobson, Terry A.; Leiter, Lawrence; Mach, Francois; Wiklund, Olov

    2015-01-01

    Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of statin-associated myopathy, and provides guidance for diagnosis and management of SAMS. Statin-associated myopathy, with significant elevation of serum creatine kinase (CK), is a rare but serious side effect of statins, affecting 1 per 1000 to 1 per 10 000 people on standard statin doses. Statin-associated muscle symptoms cover a broader range of clinical presentations, usually with normal or minimally elevated CK levels, with a prevalence of 7–29% in registries and observational studies. Preclinical studies show that statins decrease mitochondrial function, attenuate energy production, and alter muscle protein degradation, thereby providing a potential link between statins and muscle symptoms; controlled mechanistic and genetic studies in humans are necessary to further understanding. The Panel proposes to identify SAMS by symptoms typical of statin myalgia (i.e. muscle pain or aching) and their temporal association with discontinuation and response to repetitive statin re-challenge. In people with SAMS, the Panel recommends the use of a maximally tolerated statin dose combined with non-statin lipid-lowering therapies to attain recommended low-density lipoprotein cholesterol targets. The Panel recommends a structured work-up to identify individuals with clinically relevant SAMS generally to at least three different statins, so that they can be offered therapeutic regimens to satisfactorily address their cardiovascular risk. Further research into the underlying pathophysiological mechanisms may offer future therapeutic potential. PMID:25694464

  15. Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management.

    Science.gov (United States)

    Stroes, Erik S; Thompson, Paul D; Corsini, Alberto; Vladutiu, Georgirene D; Raal, Frederick J; Ray, Kausik K; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G; Bruckert, Eric; De Backer, Guy; Krauss, Ronald M; Laufs, Ulrich; Santos, Raul D; Hegele, Robert A; Hovingh, G Kees; Leiter, Lawrence A; Mach, Francois; März, Winfried; Newman, Connie B; Wiklund, Olov; Jacobson, Terry A; Catapano, Alberico L; Chapman, M John; Ginsberg, Henry N

    2015-05-01

    Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of statin-associated myopathy, and provides guidance for diagnosis and management of SAMS. Statin-associated myopathy, with significant elevation of serum creatine kinase (CK), is a rare but serious side effect of statins, affecting 1 per 1000 to 1 per 10 000 people on standard statin doses. Statin-associated muscle symptoms cover a broader range of clinical presentations, usually with normal or minimally elevated CK levels, with a prevalence of 7-29% in registries and observational studies. Preclinical studies show that statins decrease mitochondrial function, attenuate energy production, and alter muscle protein degradation, thereby providing a potential link between statins and muscle symptoms; controlled mechanistic and genetic studies in humans are necessary to further understanding. The Panel proposes to identify SAMS by symptoms typical of statin myalgia (i.e. muscle pain or aching) and their temporal association with discontinuation and response to repetitive statin re-challenge. In people with SAMS, the Panel recommends the use of a maximally tolerated statin dose combined with non-statin lipid-lowering therapies to attain recommended low-density lipoprotein cholesterol targets. The Panel recommends a structured work-up to identify individuals with clinically relevant SAMS generally to at least three different statins, so that they can be offered therapeutic regimens to satisfactorily address their cardiovascular risk. Further research into the underlying pathophysiological mechanisms may offer future therapeutic potential. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  16. Mindfulness-Based Symptom and Stress Management Apps for Adults With Chronic Lung Disease: Systematic Search in App Stores.

    Science.gov (United States)

    Owens, Otis L; Beer, Jenay M; Reyes, Ligia I; Gallerani, David G; Myhren-Bennett, Amanda R; McDonnell, Karen K

    2018-05-15

    Up to 70% of lung cancer survivors are affected by chronic obstructive pulmonary disease (COPD), a common, debilitating, comorbid disease. Lung cancer and COPD are both characterized by symptoms such as breathlessness, fatigue, and psychological distress. These distressing chronic symptoms are exacerbated by stress and detract from an individual's quality of life. The aim of this study was to identify and evaluate evidence-based, commercially available apps for promoting mindfulness-based strategies among adults with a COPD or lung cancer history (ie, chronic lung disease). For this review, an interdisciplinary research team used 19 keyword combinations in the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on the apps' (1) content, (2) usability heuristics, (3) grade-level readability, and (4) cultural sensitivity. The search resulted in 768 apps (508 in iOS and 260 in Google stores). A total of 9 apps met the inclusion criteria and received further evaluation. Only 1 app had below an eighth-grade reading level; the ninth one did not have enough text to calculate a readability score. None of the 9 apps met the cultural sensitivity evaluation criteria. This systematic review identified critical design flaws that may affect the ease of using the apps in this study. Few mobile apps promote mindfulness-based strategies among adults with chronic lung disease (ie, COPD or lung cancer or both), but those that exist, overall, do not meet the latest scientific evidence. Recommendations include more stringent regulation of health-related apps, use of evidence-based frameworks and participatory design processes, following evidence-based usability practices, use of culturally sensitive language and images, and ensuring that content is written in plain language. ©Otis L Owens, Jenay M Beer, Ligia I Reyes, David G Gallerani, Amanda R Myhren-Bennett, Karen K McDonnell. Originally published in JMIR Mhealth and Uhealth (http

  17. Effectiveness of cognitive behavioral stress management on depression and anxiety symptoms of patients with epilepsy and migraine

    Directory of Open Access Journals (Sweden)

    Mohammad Dehghanifiroozabadi

    2015-01-01

    Conclusion: According to the results of this study, cognitive behavioral stress management was effective on the depression and anxiety of epileptic and migraine patients, and chronic disease has no effect on this effectiveness. This method can be used in combination with drug therapy.

  18. Management of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia by general practitioners in Jakarta

    Directory of Open Access Journals (Sweden)

    Faisal Abdi Matondang

    2014-06-01

    Conclusions: Our study provides evidence that the management of male LUTS suggestive of BPH by GPs in Jakarta suggests referral in part to available guidelines in terms of diagnostic methods and initial therapy. However, several aspects of the guidelines, such as PSA level measurement, renal function assessment, urinalysis, ultrasound examination, and prescription of combination therapies, are still infrequently performed.

  19. Episodic abiotic stress and Phytophthora ramorum blight in rhododendron: impacts on root infection, symptom expression and chemical management

    Science.gov (United States)

    Tatiana Roubtsova; Richard Bostock

    2013-01-01

    Of concern for disease management and certification programs in nursery ornamentals is that roots, when colonized by Phytophthora ramorum, may serve as a potential reservoir of inoculum. An additional complication is that the above ground portion of plants with root infections may be asymptomatic. Our central hypothesis is that mild abiotic...

  20. Medicine use practices in management of symptoms of acute upper respiratory tract infections in children (≤12 years in Kampala city, Uganda

    Directory of Open Access Journals (Sweden)

    Moses Ocan

    2017-09-01

    Full Text Available Abstract Background Medicines are commonly accessed and used for management of illness in children without a prescription. This potentially increases the risk of unwanted treatment outcomes. We investigated medicine use practices in management of symptoms of acute upper respiratory tract infections among children (≤12 years in households in Nakawa division, Kampala city. Methods This was a cross-sectional study conducted among 390 randomly selected children. Data on use of medicines in children (≤12 years during recent episode of acute upper respiratory tract infection was collected from their care takers using an interviewer administered questionnaire. A recall period of two weeks (14 days was used in during data collection. Results The prevalence of giving children non-prescription antimicrobial medicines was 44.8% (38.3-52.2. The most common disease symptoms that the children reportedly had included flu, 84.9% (331/390, cough, 83.1% (324/390, and undefined fever, 69.7% (272/390. Medicines commonly given to children included, paracetamol 53.1% (207/390, Coartem 29.7% (116/390, cough linctus 20.8% (81/390, amoxicillin 18.9% (74/390, Co-trimoxazole 18.5% (72/390, and diphenhydramine 15.4% (60/390. The major sources of medicines given to the children was hospital/clinic, 57.26% (223/390. Most of the children, 81% were given more than one medicine at a time. The majority, 62.3% (243/390 of the care takers who gave the children medicine during the recent illness were not aware of any medicine (s that should not be given to children. The predictors of non-prescription use of antimicrobial medicines in managing symptoms of acute upper respiratory tract infections in children included, medicines obtained from drug shop (PR: 1.45, CI: 1.14-1.85, medicines at home (PR: 1.8, CI: 0.83-1.198 and type of medicine (antimalarial (PR: 2.8, CI: 1.17-6.68. Conclusion Children are commonly given multiple medicines during episodes of acute upper respiratory

  1. Medicine use practices in management of symptoms of acute upper respiratory tract infections in children (≤12 years) in Kampala city, Uganda.

    Science.gov (United States)

    Ocan, Moses; Aono, Mary; Bukirwa, Clare; Luyinda, Emmanuel; Ochwo, Cathy; Nsambu, Elastus; Namugonza, Stella; Makoba, Joseph; Kandaruku, Enock; Muyende, Hannington; Nakawunde, Aida

    2017-09-21

    Medicines are commonly accessed and used for management of illness in children without a prescription. This potentially increases the risk of unwanted treatment outcomes. We investigated medicine use practices in management of symptoms of acute upper respiratory tract infections among children (≤12 years) in households in Nakawa division, Kampala city. This was a cross-sectional study conducted among 390 randomly selected children. Data on use of medicines in children (≤12 years) during recent episode of acute upper respiratory tract infection was collected from their care takers using an interviewer administered questionnaire. A recall period of two weeks (14 days) was used in during data collection. The prevalence of giving children non-prescription antimicrobial medicines was 44.8% (38.3-52.2). The most common disease symptoms that the children reportedly had included flu, 84.9% (331/390), cough, 83.1% (324/390), and undefined fever, 69.7% (272/390). Medicines commonly given to children included, paracetamol 53.1% (207/390), Coartem 29.7% (116/390), cough linctus 20.8% (81/390), amoxicillin 18.9% (74/390), Co-trimoxazole 18.5% (72/390), and diphenhydramine 15.4% (60/390). The major sources of medicines given to the children was hospital/clinic, 57.26% (223/390). Most of the children, 81% were given more than one medicine at a time. The majority, 62.3% (243/390) of the care takers who gave the children medicine during the recent illness were not aware of any medicine (s) that should not be given to children. The predictors of non-prescription use of antimicrobial medicines in managing symptoms of acute upper respiratory tract infections in children included, medicines obtained from drug shop (PR: 1.45, CI: 1.14-1.85), medicines at home (PR: 1.8, CI: 0.83-1.198) and type of medicine (antimalarial) (PR: 2.8, CI: 1.17-6.68). Children are commonly given multiple medicines during episodes of acute upper respiratory tract infections with most antimicrobial

  2. Melatoninergic System in Parkinson’s Disease: From Neuroprotection to the Management of Motor and Nonmotor Symptoms

    Directory of Open Access Journals (Sweden)

    Josiel Mileno Mack

    2016-01-01

    Full Text Available Melatonin is synthesized by several tissues besides the pineal gland, and beyond its regulatory effects in light-dark cycle, melatonin is a hormone with neuroprotective, anti-inflammatory, and antioxidant properties. Melatonin acts as a free-radical scavenger, reducing reactive species and improving mitochondrial homeostasis. Melatonin also regulates the expression of neurotrophins that are involved in the survival of dopaminergic neurons and reduces α-synuclein aggregation, thus protecting the dopaminergic system against damage. The unbalance of pineal melatonin synthesis can predispose the organism to inflammatory and neurodegenerative diseases such as Parkinson’s disease (PD. The aim of this review is to summarize the knowledge about the potential role of the melatoninergic system in the pathogenesis and treatment of PD. The literature reviewed here indicates that PD is associated with impaired brain expression of melatonin and its receptors MT1 and MT2. Exogenous melatonin treatment presented an outstanding neuroprotective effect in animal models of PD induced by different toxins, such as 6-hydroxydopamine (6-OHDA, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP, rotenone, paraquat, and maneb. Despite the neuroprotective effects and the improvement of motor impairments, melatonin also presents the potential to improve nonmotor symptoms commonly experienced by PD patients such as sleep and anxiety disorders, depression, and memory dysfunction.

  3. Reduction of Cancer-Specific Thought Intrusions and Anxiety Symptoms With a Stress Management Intervention Among Women Undergoing Treatment for Breast Cancer

    Science.gov (United States)

    Antoni, Michael H.; Wimberly, Sarah R.; Lechner, Suzanne C.; Kazi, Aisha; Sifre, Tammy; Urcuyo, Kenya R.; Phillips, Kristin; Smith, Roselyn G.; Petronis, Vida M.; Guellati, Sophie; Wells, Kurrie A.; Blomberg, Bonnie; Carver, Charles S.

    2017-01-01

    Objective After surgery for breast cancer, many women experience anxiety relating to the cancer that can adversely affect quality of life and emotional functioning during the year postsurgery. Symptoms such as intrusive thoughts may be ameliorated during this period with a structured, group-based cognitive behavior intervention. Method A 10-week group cognitive behavior stress management intervention that included anxiety reduction (relaxation training), cognitive restructuring, and coping skills training was tested among 199 women newly treated for stage 0-III breast cancer. They were then followed for 1 year after recruitment. Results The intervention reduced reports of thought intrusion, interviewer ratings of anxiety, and emotional distress across 1 year significantly more than was seen with the control condition. The beneficial effects were maintained well past the completion of adjuvant therapy. Conclusions Structured, group-based cognitive behavior stress management may ameliorate cancer-related anxiety during active medical treatment for breast cancer and for 1 year following treatment. Group-based cognitive behavior stress management is a clinically useful adjunct to offer to women treated for breast cancer. PMID:17012691

  4. Efficacy of the Punica granatum peels aqueous extract for symptom management in ulcerative colitis patients. A randomized, placebo-controlled, clinical trial.

    Science.gov (United States)

    Kamali, Mohammadali; Tavakoli, Hamid; Khodadoost, Mahmoud; Daghaghzadeh, Hamed; Kamalinejad, Mohammad; Gachkar, Latif; Mansourian, Marjan; Adibi, Payman

    2015-08-01

    To investigate the effects of the Punica granatum peel extract on symptoms of patients with ulcerative colitis (UC). Patients with UC were randomized to receive an aqueous extract of the P. granatum peel (6 g of dry peel/day) or placebo for four weeks complementary to standard medications. Symptoms were assessed using the Lichtiger Colitis Activity Index (LCAI) at baseline, week 4, and week 10 (follow-up). Clinical response was defined by ≥ 3 point decrease in LCAI. The LCAI score was similarly reduced in both the P. granatum (-1.68 ± 3.85, P = 0.019) and placebo groups (-1.39 ± 2.41, P = 0.002). Clinical response was higher with P. granatum compared with placebo at week 4 (41.4% vs. 18.2%, P = 0.055), but not at week 10 (48.3% vs. 36.4%, P = 0.441). The P. granatum peel extract seems effective in complementary management of UC. Further studies in a larger sample of patients are warranted. IRCT2014040617156N1. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. A pilot study investigating the feasibility of symptom assessment manager (SAM), a Web-based real-time tool for monitoring challenging behaviors.

    Science.gov (United States)

    Loi, Samantha M; Wanasinghage, Sangeeth; Goh, Anita; Lautenschlager, Nicola T; Darby, David G; Velakoulis, Dennis

    2018-04-01

    Improving and minimizing challenging behaviors seen in psychiatric conditions, including behavioral and psychological symptoms of dementia are important in the care of people with these conditions. Yet there is a lack of systematic evaluation of these as a part of routine clinical care. The Neuropsychiatric Inventory is a validated and reliable tool for rating the severity and disruptiveness of challenging behaviors. We report on the evaluation of a Web-based symptom assessment manager (SAM), designed to address the limitation of previous tools using some of the Neuropsychiatric Inventory functions, to monitor behaviors by staff caring for people with dementia and other psychiatric conditions in inpatient and residential care settings. The SAM was piloted in an 8-bed inpatient neuropsychiatry unit over 5 months. Eleven nurses and 4 clinicians were trained in usage of SAM. Primary outcomes were usage of SAM and perceived usability, utility, and acceptance of SAM. Secondary outcomes were the frequencies of documented behavior. Usage data were analyzed using chi-square and logistic regression analyses. The SAM was used for all admitted patients regardless of diagnosis, with a usage rate of 64% for nurses regularly employed in the unit. Staff provided positive feedback regarding the utility of SAM. The SAM appeared to offer individualized behavior assessment by providing a quick, structured, and standardized platform for assessing behavior in a real-world setting. Further research would involve trialing SAM with more staff in alternative settings such as in home or residential care settings. Copyright © 2017 John Wiley & Sons, Ltd.

  6. Plague Symptoms

    Science.gov (United States)

    ... Search Form Controls Cancel Submit Search the CDC Plague Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Plague Home Ecology & Transmission Symptoms Diagnosis & Treatment Maps & Statistics ...

  7. Recognizing Symptoms

    Science.gov (United States)

    ... helpful, please consider supporting IFFGD with a small tax- deductible donation. Make Donation Signs and Symptoms Overview ... arises requiring an expert’s care. © Copyright 1998-2018 International Foundation for Functional Gastrointestinal Disorders, Inc. (IFFGD). All ...

  8. Rotavirus Symptoms

    Science.gov (United States)

    ... Search Form Controls Cancel Submit Search The CDC Rotavirus Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Rotavirus Home About Rotavirus Symptoms Transmission Treatment Photos Vaccination ...

  9. Randomized Trial of Hypnosis as a Pain and Symptom Management Strategy in Adults with Sickle Cell Disease

    Science.gov (United States)

    Wallen, Gwenyth R; Middleton, Kimberly R; Ames, Nancy; Brooks, Alyssa T; Handel, Daniel

    2014-01-01

    Sickle cell disease (SCD) is the most common genetic disease in African-Americans, characterized by recurrent painful vaso-occlusive crises. Medical therapies for controlling or preventing crises are limited because of efficacy and/or toxicity. This is a randomized, controlled, single-crossover protocol of hypnosis for managing pain in SCD patients. Participants receive hypnosis from a trained hypnosis therapist followed by six weeks of self-hypnosis using digital media. Those in the control arm receive SCD education followed by a six-week waiting period before crossing over to the hypnosis arm of the study. Outcome measures include assessments of pain (frequency, intensity and quality), anxiety, coping strategies, sleep, depression, and health care utilization. To date, there are no published randomized, controlled trials evaluating the efficacy of hypnosis on SCD pain modulation in adults. Self-hypnosis for pain management may be helpful in modulating chronic pain, improving sleep quality, and decreasing use of narcotics in patients with SCD. TRIAL REGISTRATION ClinicalTrials.gov: NCT00393250 PMID:25520557

  10. Randomized Trial of Hypnosis as a Pain and Symptom Management Strategy in Adults with Sickle Cell Disease

    Directory of Open Access Journals (Sweden)

    Gwenyth R. Wallen

    2014-01-01

    Full Text Available Sickle cell disease (SCD is the most common genetic disease in African-Americans, characterized by recurrent painful vaso-occlusive crises. Medical therapies for controlling or preventing crises are limited because of efficacy and/or toxicity. This is a randomized, controlled, single-crossover protocol of hypnosis for managing pain in SCD patients. Participants receive hypnosis from a trained hypnosis therapist followed by six weeks of self-hypnosis using digital media. Those in the control arm receive SCD education followed by a six-week waiting period before crossing over to the hypnosis arm of the study. Outcome measures include assessments of pain (frequency, intensity and quality, anxiety, coping strategies, sleep, depression, and health care utilization. To date, there are no published randomized, controlled trials evaluating the efficacy of hypnosis on SCD pain modulation in adults. Self-hypnosis for pain management may be helpful in modulating chronic pain, improving sleep quality, and decreasing use of narcotics in patients with SCD. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00393250

  11. Chronic Diseases in North-West Tanzania and Southern Uganda. Public Perceptions of Terminologies, Aetiologies, Symptoms and Preferred Management.

    Directory of Open Access Journals (Sweden)

    Soori Nnko

    Full Text Available Research has shown that health system utilization is low for chronic diseases (CDs other than HIV. We describe the knowledge and perceptions of CDs identified from rural and urban communities in north-west Tanzania and southern Uganda.Data were collected through a quantitative population survey, a quantitative health facility survey and focus group discussions (FGDs and in-depth interviews (IDIs in subgroups of population survey participants. The main focus of this paper is the findings from the FGDs and IDIs.We conducted 24 FGDs, involving approximately 180 adult participants and IDIs with 116 participants (≥18 years. CDs studied included: asthma/chronic obstructive lung disease (COPD, diabetes, epilepsy, hypertension, cardiac failure and HIV- related disease. The understanding of most chronic conditions involved a combination of biomedical information, gleaned from health facility visits, local people who had suffered from a complaint or knew others who had and beliefs drawn from information shared in the community. The biomedical contribution shows some understanding of the aetiology of a condition and the management of that condition. However, local beliefs for certain conditions (such as epilepsy suggest that biomedical treatment may be futile and therefore work counter to biomedical prescriptions for management.Current perceptions of selected CDs may represent a barrier that prevents people from adopting efficacious health and treatment seeking behaviours. Interventions to improve this situation must include efforts to improve the quality of existing health services, so that people can access relevant, reliable and trustworthy services.

  12. Cost-effectiveness of providing patients with information on managing mild low-back symptoms in an occupational health setting

    Directory of Open Access Journals (Sweden)

    J. Rantonen

    2016-04-01

    Full Text Available Abstract Background Evidence shows that low back specific patient information is effective in sub-acute low back pain (LBP, but effectiveness and cost-effectiveness (CE of information in early phase symptoms is not clear. We assessed effectiveness and CE of patient information in mild LBP in the occupational health (OH setting in a quasi-experimental study. Methods A cohort of employees (N = 312, aged <57 with non-specific, mild LBP (Visual Analogue Scale between 10–34 mm was selected from the respondents of an employee survey (N = 2480; response rate 71 %. A random sample, representing the natural course of LBP (NC, N = 83; no intervention, was extracted as a control group. Remaining employees were invited (181 included, 47 declined, one excluded into a randomised controlled study with two 1:1 allocated parallel intervention arms (“Booklet”, N = 92; “Combined”, N = 89. All participants received the “Back Book” patient information booklet and the Combined also an individual verbal review of the booklet. Physical impairment (PHI, LBP, health care (HC utilisation, and all-cause sickness absence (SA were assessed at two years. CE of the interventions on SA days was analysed by using direct HC costs in one year, two years from baseline. Multiple imputation was used for missing values. Results Compared to NC, the Booklet reduced HC costs by 196€ and SA by 3.5 days per year. In 81 % of the bootstrapped cases the Booklet was both cost saving and effective on SA. Compared to NC, in the Combined arm, the figures were 107€, 0.4 days, and 54 %, respectively. PHI decreased in both interventions. Conclusions Booklet information alone was cost-effective in comparison to natural course of mild LBP. Combined information reduced HC costs. Both interventions reduced physical impairment. Mere booklet information is beneficial for employees who report mild LBP in the OH setting, and is also cost saving for the health care

  13. Mindfulness-Based Stress Reduction in Advanced Nursing Practice: A Nonpharmacologic Approach to Health Promotion, Chronic Disease Management, and Symptom Control.

    Science.gov (United States)

    Williams, Hants; Simmons, Leigh Ann; Tanabe, Paula

    2015-09-01

    The aim of this article is to discuss how advanced practice nurses (APNs) can incorporate mindfulness-based stress reduction (MBSR) as a nonpharmacologic clinical tool in their practice. Over the last 30 years, patients and providers have increasingly used complementary and holistic therapies for the nonpharmacologic management of acute and chronic diseases. Mindfulness-based interventions, specifically MBSR, have been tested and applied within a variety of patient populations. There is strong evidence to support that the use of MBSR can improve a range of biological and psychological outcomes in a variety of medical illnesses, including acute and chronic pain, hypertension, and disease prevention. This article will review the many ways APNs can incorporate MBSR approaches for health promotion and disease/symptom management into their practice. We conclude with a discussion of how nurses can obtain training and certification in MBSR. Given the significant and growing literature supporting the use of MBSR in the prevention and treatment of chronic disease, increased attention on how APNs can incorporate MBSR into clinical practice is necessary. © The Author(s) 2015.

  14. Enhancing Survivorship Care Planning for Patients With Localized Prostate Cancer Using a Couple-Focused mHealth Symptom Self-Management Program: Protocol for a Feasibility Study.

    Science.gov (United States)

    Song, Lixin; Dunlap, Kaitlyn L; Tan, Xianming; Chen, Ronald C; Nielsen, Matthew E; Rabenberg, Rebecca L; Asafu-Adjei, Josephine K; Koontz, Bridget F; Birken, Sarah A; Northouse, Laurel L; Mayer, Deborah K

    2018-02-26

    This project explores a new model of care that enhances survivorship care planning and promotes health for men with localized prostate cancer transitioning to posttreatment self-management. Survivorship care planning is important for patients with prostate cancer because of its high incidence rate in the United States, the frequent occurrence of treatment-related side effects, and reduced quality of life (QOL) for both men and their partners. A key component of comprehensive survivorship care planning is survivorship care plans (SCPs), documents that summarize cancer diagnosis, treatment, and plans for follow-up care. However, research concerning the effectiveness of SCPs on patient outcomes or health service use has thus far been inconclusive. SCPs that are tailored to individual patients' needs for information and care may improve effectiveness. This study aims to examine the feasibility of an enhanced survivorship care plan (ESCP) that integrates a symptom self-management mHealth program called Prostate Cancer Education and Resources for Couples (PERC) into the existing standardized SCP. The specific aims are to (1) examine the feasibility of delivering ESCPs and (2) to estimate the magnitude of benefit of ESCPs. We will use a two-group randomized controlled pretest-posttest design and collect data at baseline (T1) and 4 months later (T2) among 50 patients completing initial treatment for localized prostate cancer and their partners. First, we will assess the feasibility of ESCP by recruitment, enrollment, and retention rates; program satisfaction with the ESCP; and perceived ease of use of the ESCP. To achieve the secondary aim, we will compare the ESCP users with the standardized SCP users and assess their primary outcomes of QOL (overall, physical, emotional, and social QOL); secondary outcomes (reduction in negative appraisals and improvement in self-efficacy, social support, and health behaviors to manage symptoms); and number of visits to posttreatment

  15. Norovirus Symptoms

    Science.gov (United States)

    ... many times a day. This can lead to dehydration, especially in young children, older adults, and people with other illnesses. Symptoms of dehydration— decrease in urination dry mouth and throat feeling dizzy when standing up Children who are dehydrated may cry with few or ...

  16. Silodosin in the management of lower urinary tract symptoms as a result of benign prostatic hyperplasia: who are the best candidates.

    Science.gov (United States)

    Capitanio, U; Salonia, A; Briganti, A; Montorsi, F

    2013-06-01

    As the clinical effects of the available α1-adrenoceptors (ARs) blockers are usually considered comparable for treatment in patients suffering from lower urinary tract symptoms (LUTS) secondary to prostatic enlargement, officially recognised guidelines do not make specific recommendations regarding the choice of which agent should be considered according to the patient's characteristics. To analyse data supporting the use of silodosin, a highly selective once-daily dosing α1-ARs blocker, in different daily clinical practice scenarios. A structured literature review was performed using data retrieved from articles assessing the role of silodosin in the management of LUTS secondary to benign prostatic hyperplasia (BPH). A literature search of English language publications was performed using MEDLINE(®) and Web of Science from 2000 to 2012 using the terms LUTS; BPH; silodosin; α1-ARs blockers. The papers with the highest level of evidence were identified and represent the basis of the present review. Available data coming from basic research analyses, randomised trials and prospective studies showed that silodosin is efficacious for the initial management of patients with LUTS. Clinical developmental safety data from patients receiving silodosin with concomitant antihypertensive therapy do not indicate an increase in risk of orthostatic hypotension. In this context, a recent study demonstrated that silodosin can be safely administered to patients who are consensually assuming phosphodiesterase type 5 inhibitors. A recent randomised crossover study comparing the efficacy of silodosin and tamsulosin in patients with LUTS showed that further significant improvement was observed after switching to silodosin treatment, while worsening or little improvement was observed after switching to tamsulosin treatment. Preliminary results seem to demonstrate a potential role of silodosin in the treatment of chronic prostatitis/chronic pelvic pain syndrome and to facilitate

  17. Impact of in-home behavioral management versus telephone support to reduce depressive symptoms and perceived stress in Chinese caregivers: results of a pilot study.

    Science.gov (United States)

    Gallagher-Thompson, Dolores; Gray, Heather L; Tang, Paulette C Y; Pu, Chun Yu; Leung, Laurie Y L; Wang, Peng-Chih; Tse, Collins; Hsu, Shannon; Kwo, Elizabeth; Tong, Hui-Qi; Long, James; Thompson, Larry W

    2007-05-01

    Recent work has shown that Chinese Americans caring for a family member with dementia experience considerable psychological distress. However, few studies evaluate treatments for them. This study evaluated the efficacy of in-home intervention, based on cognitive behavior therapy principles, to relieve stress and depression in female Chinese American caregivers (CGs). Fifty-five CGs who met inclusion criteria were randomly assigned to a telephone support condition (TSC) or to an in-home behavioral management program (IHBMP) for 4 months. In the TSC, biweekly calls were made and relevant material was mailed. In the IHBMP, specific psychological skills were taught to deal with caregiving stress. CGs were assessed before and after treatment. Outcome measures evaluated overall perceived stress, caregiving-specific stress, and depressive symptoms. CGs in IHBMP were less bothered by caregiving-specific stressors and had lower depression levels than CGs in TSC. There was no difference in overall stress. CGs with low baseline level of self-efficacy for obtaining respite benefited from IHBMP, but showed little improvement in the TSC. CGs with higher self-efficacy benefited from both treatments. This intervention is promising and warrants replication in future studies. Additional research is needed to evaluate longer-term effects and to identify individual differences associated with improvement.

  18. Endotyping early childhood asthma by quantitative symptom assessment

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Pipper, Christian Bressen; Bønnelykke, Klaus

    2011-01-01

    Asthmatic symptoms in young children reflect a heterogeneous group of diseases. Symptoms remain the primary end-point in both research and clinical management, but there is a need for standardized symptom assessment.......Asthmatic symptoms in young children reflect a heterogeneous group of diseases. Symptoms remain the primary end-point in both research and clinical management, but there is a need for standardized symptom assessment....

  19. Symptoms and Symptom Clusters Identified by Adolescents and Young Adults With Cancer Using a Symptom Heuristics App.

    Science.gov (United States)

    Ameringer, Suzanne; Erickson, Jeanne M; Macpherson, Catherine Fiona; Stegenga, Kristin; Linder, Lauri A

    2015-12-01

    Adolescents and young adults (AYAs) with cancer experience multiple distressing symptoms during treatment. Because the typical approach to symptom assessment does not easily reflect the symptom experience of individuals, alternative approaches to enhancing communication between the patient and provider are needed. We developed an iPad-based application that uses a heuristic approach to explore AYAs' cancer symptom experiences. In this mixed-methods descriptive study, 72 AYAs (13-29 years old) with cancer receiving myelosuppressive chemotherapy used the Computerized Symptom Capture Tool (C-SCAT) to create images of the symptoms and symptom clusters they experienced from a list of 30 symptoms. They answered open-ended questions within the C-SCAT about the causes of their symptoms and symptom clusters. The images generated through the C-SCAT and accompanying free-text data were analyzed using descriptive, content, and visual analyses. Most participants (n = 70) reported multiple symptoms (M = 8.14). The most frequently reported symptoms were nausea (65.3%), feeling drowsy (55.6%), lack of appetite (55.6%), and lack of energy (55.6%). Forty-six grouped their symptoms into one or more clusters. The most common symptom cluster was nausea/eating problems/appetite problems. Nausea was most frequently named as the priority symptom in a cluster and as a cause of other symptoms. Although common threads were present in the symptoms experienced by AYAs, the graphic images revealed unique perspectives and a range of complexity of symptom relationships, clusters, and causes. Results highlight the need for a tailored approach to symptom management based on how the AYA with cancer perceives his or her symptom experience. © 2015 Wiley Periodicals, Inc.

  20. Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management

    NARCIS (Netherlands)

    Stroes, Erik S.; Thompson, Paul D.; Corsini, Alberto; Vladutiu, Georgirene D.; Raal, Frederick J.; Ray, Kausik K.; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G.; Bruckert, Eric; de Backer, Guy; Krauss, Ronald M.; Laufs, Ulrich; Santos, Raul D.; Hegele, Robert A.; Hovingh, G. Kees; Leiter, Lawrence A.; Mach, Francois; März, Winfried; Newman, Connie B.; Wiklund, Olov; Jacobson, Terry A.; Catapano, Alberico L.; Chapman, M. John; Ginsberg, Henry N.; Leiter, Lawrence

    2015-01-01

    Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of

  1. Electronic patient self-assessment and management (SAM): a novel framework for cancer survivorship.

    Science.gov (United States)

    Vickers, Andrew J; Salz, Talya; Basch, Ethan; Cooperberg, Matthew R; Carroll, Peter R; Tighe, Foss; Eastham, James; Rosen, Raymond C

    2010-06-17

    We propose a novel framework for management of cancer survivorship: electronic patient Self-Assessment and Management (SAM). SAM is a framework for transfer of information to and from patients in such a way as to increase both the patient's and the health care provider's understanding of the patient's progress, and to help ensure that patient care follows best practice. Patients who participate in the SAM system are contacted by email at regular intervals and asked to complete validated questionnaires online. Patient responses on these questionnaires are then analyzed in order to provide patients with real-time, online information about their progress and to provide them with tailored and standardized medical advice. Patient-level data from the questionnaires are ported in real time to the patient's health care provider to be uploaded to clinic notes. An initial version of SAM has been developed at Memorial Sloan-Kettering Cancer Center (MSKCC) and the University of California, San Francisco (UCSF) for aiding the clinical management of patients after surgery for prostate cancer. Pilot testing at MSKCC and UCSF suggests that implementation of SAM systems are feasible, with no major problems with compliance (> 70% response rate) or security. SAM is a conceptually simple framework for passing information to and from patients in such a way as to increase both the patient's and the health care provider's understanding of the patient's progress, and to help ensure that patient care follows best practice.

  2. Electronic patient self-assessment and management (SAM: a novel framework for cancer survivorship

    Directory of Open Access Journals (Sweden)

    Tighe Foss

    2010-06-01

    Full Text Available Abstract Background We propose a novel framework for management of cancer survivorship: electronic patient Self-Assessment and Management (SAM. SAM is a framework for transfer of information to and from patients in such a way as to increase both the patient's and the health care provider's understanding of the patient's progress, and to help ensure that patient care follows best practice. Methods Patients who participate in the SAM system are contacted by email at regular intervals and asked to complete validated questionnaires online. Patient responses on these questionnaires are then analyzed in order to provide patients with real-time, online information about their progress and to provide them with tailored and standardized medical advice. Patient-level data from the questionnaires are ported in real time to the patient's health care provider to be uploaded to clinic notes. An initial version of SAM has been developed at Memorial Sloan-Kettering Cancer Center (MSKCC and the University of California, San Francisco (UCSF for aiding the clinical management of patients after surgery for prostate cancer. Results Pilot testing at MSKCC and UCSF suggests that implementation of SAM systems are feasible, with no major problems with compliance (> 70% response rate or security. Conclusion SAM is a conceptually simple framework for passing information to and from patients in such a way as to increase both the patient's and the health care provider's understanding of the patient's progress, and to help ensure that patient care follows best practice.

  3. Characteristics of refractory gastroesophageal reflux disease (GERD) symptoms -is switching proton pump inhibitors based on the patient's CYP2C19 genotype an effective management strategy?

    Science.gov (United States)

    Takeuchi, Toshihisa; Oota, Kazuhiro; Harada, Satoshi; Edogawa, Shoko; Kojima, Yuichi; Sanomura, Makoto; Sakaguchi, Masahiro; Hayashi, Katsuyoshi; Hongoh, Yasushi; Itabashi, Tsukasa; Kitae, Hidehiro; Hoshimoto, Masahiro; Takeuchi, Nozomi; Higuchi, Kazuhide

    2015-01-01

    We investigated factors related to proton pump inhibitor (PPI) -refractory gastroesophageal reflux disease (GERD) symptoms, particularly with respect to acid, the CYP2C19 genotype and psychological aspects. Patients with an Frequency Scale for the Symptoms of GERD (FSSG) score of ≥8 after the initial treatment were switched to therapy with rabeprazole at a dose of 20 mg once daily for eight weeks. We investigated the rate of improvement in PPI-refractory GERD symptoms, background factors, the Hospital Anxiety and Depression Scale (HADS) score and the CYP2C19 genotype. Patients Sixty patients endoscopically diagnosed with reflux esophagitis within the past six months who had received omeprazole at a dose of 20 mg once daily for eight weeks or longer were enrolled. In 71.6% of the patients, the FSSG score decreased to GERD symptoms. Significant factors related to omeprazole-refractory GERD symptoms included a longer disease duration (p=0.0004) and higher HADS score (p=0.01). Among the omeprazole-refractory cases, only 23.5% of the patients showed symptom improvement after switching to rabeprazole. There were no significant differences in the average scores for FSSG (p=0.089) or HADS (p=0.182), before or after the drug change. A total of 92% of the rabeprazole poor responders were homo/hetero extensive metabolizers for the CYP2C19 genotype. Our findings suggest that switching the PPI from omeprazole (20 mg once daily) to rabeprazole (20 mg once daily) is not a significant effective therapeutic strategy for improving PPI-refractory GERD symptoms, taking into consideration possible psychometric factors and patients who require stronger acid suppression than that achieved with a double dose of PPIs for PPI-refractory GERD symptoms.

  4. Use of a SmartPhone/Tablet-Based Bidirectional Telemedicine Disease Management Program Facilitates Early Detection and Treatment of COPD Exacerbation Symptoms.

    Science.gov (United States)

    Smith, Heidi S; Criner, Andrew J; Fehrle, Dolores; Grabianowski, Carla L; Jacobs, Michael R; Criner, Gerard J

    2016-05-01

    Early treatment of worsening chronic obstructive pulmonary disease (COPD) symptoms speeds recovery, improves quality of life, and reduces the need for hospitalization. Patients may fail to recognize worsening symptoms leading to delays in treatment. A telemedicine application could facilitate detection and treatment of worsening symptoms. To work, such an application requires consistent use by patients and quick responses from healthcare providers. We conducted a quality assurance assessment of our system to see if we were meeting these goals. Thirty patients were provided a smartphone application for daily COPD symptom reporting. Reports between November 2012 and September 2013 were reviewed. Symptoms reports and interventions were time-stamped by the application. Adherence reporting was calculated as the number of reports made divided by the number of days enrolled in the program for each patient. Time to intervention was calculated as the time a report was submitted to the time a treatment recommendation was sent to the patient. There were 4,434 symptom reports made over 5,178 patient-days of observation for an average reporting compliance of 85.6%. Median reporting compliance was 90.7% (interquartile range, 83.8-98%). Four hundred seventy-five symptom reports resulted in an alert. The average response time for all alerts was 6.64 h, with a median response time of 5.75 h. From this quality assessment we were able to conclude that patient adherence to the reporting system exceeded 90% for over half of the participants. Furthermore, over 50% of worsening COPD symptom reports were responded to in less than 6 h with patient-specific treatment recommendations.

  5. Nature-Based Stress Management Course for Individuals at Risk of Adverse Health Effects from Work-Related Stress—Effects on Stress Related Symptoms, Workability and Sick Leave

    Directory of Open Access Journals (Sweden)

    Eva Sahlin

    2014-06-01

    Full Text Available Sick leave due to stress-related disorders is increasing in Sweden after a period of decrease. To avoid that individuals living under heavy stress develop more severe stress-related disorders, different stress management interventions are offered. Self-assessed health, burnout-scores and well-being are commonly used as outcome measures. Few studies have used sick-leave to compare effects of stress interventions. A new approach is to use nature and garden in a multimodal stress management context. This study aimed to explore effects on burnout, work ability, stress-related health symptoms, and sick leave for 33 women participating in a 12-weeks nature based stress management course and to investigate how the nature/garden activities were experienced. A mixed method approach was used. Measures were taken at course start and three follow-ups. Results showed decreased burnout-scores and long-term sick leaves, and increased work ability; furthermore less stress-related symptoms were reported. Tools and strategies to better handle stress were achieved and were widely at use at all follow-ups. The garden and nature content played an important role for stress relief and for tools and strategies to develop. The results from this study points to beneficial effects of using garden activities and natural environments in a stress management intervention.

  6. Nature-Based Stress Management Course for Individuals at Risk of Adverse Health Effects from Work-Related Stress—Effects on Stress Related Symptoms, Workability and Sick Leave

    Science.gov (United States)

    Sahlin, Eva; Ahlborg, Gunnar; Vega Matuszczyk, Josefa; Grahn, Patrik

    2014-01-01

    Sick leave due to stress-related disorders is increasing in Sweden after a period of decrease. To avoid that individuals living under heavy stress develop more severe stress-related disorders, different stress management interventions are offered. Self-assessed health, burnout-scores and well-being are commonly used as outcome measures. Few studies have used sick-leave to compare effects of stress interventions. A new approach is to use nature and garden in a multimodal stress management context. This study aimed to explore effects on burnout, work ability, stress-related health symptoms, and sick leave for 33 women participating in a 12-weeks nature based stress management course and to investigate how the nature/garden activities were experienced. A mixed method approach was used. Measures were taken at course start and three follow-ups. Results showed decreased burnout-scores and long-term sick leaves, and increased work ability; furthermore less stress-related symptoms were reported. Tools and strategies to better handle stress were achieved and were widely at use at all follow-ups. The garden and nature content played an important role for stress relief and for tools and strategies to develop. The results from this study points to beneficial effects of using garden activities and natural environments in a stress management intervention. PMID:25003175

  7. Non-drug treatments for symptoms in dementia: an overview of systematic reviews of non-pharmacological interventions in the management of neuropsychiatric symptoms and challenging behaviours in patients with dementia

    OpenAIRE

    Erens, B; Dickson, Kelly; Lafortune, Louise; Kavanagh, Josephine; Thomas, James; Mays, N

    2012-01-01

    In order to fill this gap in evidence, PIRU was commissioned by the Department of Health to carry out a systematic review of the effectiveness of non-pharmacological treatments or therapies for managing neuropsychiatric and challenging behaviours in patients with dementia. Given the vast literature on this topic, PIRU carried out an ‘overview’ of reviews which involved examining thirty recent systematic reviews\\ud in order to summarise their results on the effectiveness of alternative treatme...

  8. The current state of the science for active self-care complementary and integrative medicine therapies in the management of chronic pain symptoms: lessons learned, directions for the future.

    Science.gov (United States)

    Crawford, Cindy; Lee, Courtney; Buckenmaier, Chester; Schoomaker, Eric; Petri, Richard; Jonas, Wayne

    2014-04-01

    Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. A systematic review was conducted, using Samueli Institute's rapid evidence assessment of the literature methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A working group of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities. Following key database searches, 146 randomized controlled trials were included in the review. This article summarizes the current state of the science, lessons learned from the gaps exposed by the review, as well as suggestions for next steps toward translation for the field. Although the review's entire scope is detailed throughout the current Pain Medicine supplement, the authors encourage the use of this report as a guide for future ACT-CIM research. Wiley Periodicals, Inc.

  9. An analysis of the various chronic pain conditions captured in a systematic review of active self-care complementary and integrative medicine therapies for the management of chronic pain symptoms.

    Science.gov (United States)

    Lee, Courtney; Crawford, Cindy; Teo, Lynn; Spevak, Christopher

    2014-04-01

    Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures that are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM therapies (ACT-CIM) allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. A systematic review was conducted, using Samueli Institute's rapid evidence assessment of the literature (REAL©) methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A working group of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities. Following key database searches, 146 randomized controlled trials, covering 33 different pain conditions, were included in the review. This article categorized studies by pain condition, describing the diagnostic criteria used and modalities that seem most effective for each condition. Complexities associated with investigating chronic pain populations are also discussed. The entire scope of the review, categorized by modality rather than pain condition, is detailed throughout the current Pain Medicine supplement. Wiley Periodicals, Inc.

  10. The effects of lifestyle interventions on (long-term) weight management, cardiometabolic risk and depressive symptoms in people with psychotic disorders : A meta-analysis

    NARCIS (Netherlands)

    Bruins, Jojanneke; Jörg, Frederike; Bruggeman, Richard; Slooff, C. J.; Corpeleijn, Eva; Pijnenborg, Marieke

    2014-01-01

    AIMS: The aim of this study was to estimate the effects of lifestyle interventions on bodyweight and other cardiometabolic risk factors in people with psychotic disorders. Additionally, the long-term effects on body weight and the effects on depressive symptoms were examined. MATERIAL AND METHODS:

  11. Comorbid Mental Health Symptoms and Heart Diseases: Can Health Care and Mental Health Care Professionals Collaboratively Improve the Assessment and Management?

    Science.gov (United States)

    Ai, Amy L.; Rollman, Bruce L.; Berger, Candyce S.

    2010-01-01

    On the basis of current epidemiological and clinical research, this article describes how mental health symptoms are associated with heart disease, a major chronic condition that occurs primarily in middle and late life. The article describes the culturally and historically important link between heart and mind. It then describes depression and…

  12. The short-term effects of a body awareness program : better self-management of health problems for individuals with chronic a-specific psychosomatic symptoms

    NARCIS (Netherlands)

    Landsman-Dijkstra, Jeanet J. A.; van Wijck, R; Groothoff, JW; Rispens, P

    A three-day residential Body Awareness Program (BAP) was developed to teach people with Chronic A-specific Psychosomatic Symptoms (CAPS) to react adequately to disturbances of the balance between a daily workload and the capacity to deal with it. The short-term effects of the program for people with

  13. The short-term effects of a body awareness program : better self-management of health problems for individuals with chronic a-specific psychosomatic symptoms

    NARCIS (Netherlands)

    Landsman-Dijkstra, Jeanet J. A.; van Wijck, R; Groothoff, JW; Rispens, P

    2004-01-01

    A three-day residential Body Awareness Program (BAP) was developed to teach people with Chronic A-specific Psychosomatic Symptoms (CAPS) to react adequately to disturbances of the balance between a daily workload and the capacity to deal with it. The short-term effects of the program for people with

  14. An open-label study to elucidate the effects of standardized Bacopa monnieri extract in the management of symptoms of attention-deficit hyperactivity disorder in children.

    Science.gov (United States)

    Dave, Usha Pinakin; Dingankar, Sunila Rajeev; Saxena, Vinod Swaroop; Joseph, Joshua Allan; Bethapudi, Bharathi; Agarwal, Amit; Kudiganti, Venkateshwarlu

    2014-01-01

    Attention-deficit hyperactivity disorder (ADHD) is a clinically heterogeneous disorder of inattention, hyperactivity, and impulsivity or difficulty in controlling behavior. Psychostimulant medications remain the mainline treatment for children with ADHD; however, the average response rate to these medications is 70%, and up to 30% of children do not respond to these medications or are unable to tolerate such potential adverse effects as nausea, insomnia, and weight loss. The study investigated the effectiveness of standardized Bacopa monnieri extract (SBME) in ameliorating the severity of the symptoms of ADHD in children. The clinical trial was conducted as an open-label study. The study was conducted at the Center for Research in Mental Retardation (CREMERE) in Mumbai, India, from 2008 to 2010. Thirty-one children were participants in the trial. They were 6-12 y of age, with an age of onset of ADHD before 7 y of age, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for ADHD. The children received SBME at a dose of 225 mg/d for a period of 6 mo. The specific SBME used in the study was BacoMind (M/s Natural Remedies, Bangalore, India). Subsequent to the screening of participants, the research team administered the Parent Rating Scale to assess the ADHD symptom scores at baseline, and the team administered it again at the end of the 6 mo of treatment. SBME significantly reduced the subtests scores of ADHD symptoms, except for social problems. The symptom scores for restlessness were reduced in 93% of children, whereas improvement in self-control was observed in 89% of the children. The attention-deficit symptoms were reduced in 85% of children. Similarly, symptom scores for learning problems, impulsivity, and psychiatric problems were reduced for 78%, 67%, and 52% of children, respectively. It was observed that 74% of the children exhibited up to a 20% reduction, while 26% of children showed between a 21% and a 50% reduction

  15. Accounting for the effect of GERD symptoms on patients' health-related quality of life: supporting optimal disease management by primary care physicians.

    Science.gov (United States)

    Flook, N W; Wiklund, I

    2007-12-01

    To review, from a primary care physician (PCP) perspective, the use of patient-reported outcome (PRO) instruments for assessment of gastro-oesophageal reflux disease (GERD) symptoms, their impact on health-related quality of life (HRQL) and the effectiveness of therapy. While generic and disease-specific PRO instruments have been used in the assessment of GERD, the latter can be considered to be more appropriate as they focus only on problems relevant to the disease in question (and therefore tend to be more responsive to change). Such instruments include the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire and the Gastrointestinal Symptom Rating Scale and the Reflux Disease Questionnaire (RDQ). Their use indicates that GERD symptoms are troublesome and significantly reduce patients' HRQL, and that effective treatment of GERD improves HRQL. The GERD Impact Scale (GIS) questionnaire, primarily developed for use within primary care, can also help to determine the impact of symptoms on patients' everyday lives and, in turn, the benefit of appropriately targeted therapy. Notably, these PRO instruments were developed from focus groups of GERD patients, and only aspects rated of highest importance are used in the final instruments. Consequently, PCPs can feel confident that these questionnaires encompass the most relevant points that they are likely to ask in terms of how symptoms affect patients' everyday lives. Primary care physicians are encouraged to make wider use of PRO instruments within routine practice to improve communication with their GERD patients that, in turn, could lead to improved clinical outcomes and greater patient satisfaction.

  16. The second Symptom Management Research Trial in Oncology (SMaRT Oncology-2): a randomised trial to determine the effectiveness and cost-effectiveness of adding a complex intervention for major depressive disorder to usual care for cancer patients.

    Science.gov (United States)

    Walker, Jane; Cassidy, Jim; Sharpe, Michael

    2009-03-30

    Depression Care for People with Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. In a 'proof of concept' trial (Symptom Management Research Trials in Oncology-1) Depression Care for People with Cancer improved depression more than usual care alone. The second Symptom Management Research Trial in Oncology (SMaRT Oncology-2 Trial) will test its effectiveness and cost-effectiveness in a 'real world' setting. A two arm parallel group multi-centre randomised controlled trial. TRIAL PROCEDURES: 500 patients will be recruited through established systematic Symptom Monitoring Services, which screen patients for depression. Patients will have: a diagnosis of cancer (of various types); an estimated life expectancy of twelve months or more and a diagnosis of Major Depressive Disorder. Patients will be randomised to usual care or usual care plus Depression Care for People with Cancer. Randomisation will be carried out by telephoning a secure computerised central randomisation system or by using a secure web interface. The primary outcome measure is 'treatment response' measured at 24 week outcome data collection. 'Treatment response' will be defined as a reduction of 50% or more in the patient's baseline depression score, measured using the 20-item Symptom Checklist (SCL-20D). Secondary outcomes include remission of major depressive disorder, depression severity and patients' self-rated improvement of depression. Current controlled trials ISRCTN40568538 TRIAL HYPOTHESES: (1) Depression Care for People with Cancer as a supplement to usual care will be more effective than usual care alone in achieving a 50% reduction in baseline SCL-20D score at 24 weeks. (2) Depression Care for People with Cancer as a supplement to usual care will cost more than usual care alone but will be

  17. Enabling symptom self-management via use of an electronic patient-reported outcomes (ePRO system to increase self-efficacy of patients with cancer receiving active chemotherapy treatment

    Directory of Open Access Journals (Sweden)

    Grigorios Kotronoulas

    2015-10-01

    Full Text Available Background: In recent years, the shift in cancer services from traditional tertiary care to care delivered within communities has increased the need for patients to engage in self-care activities in order to prevent or reduce the severity of numerous and complex-side effects (McCorkle et al., 2011 and make important health decisions when at home in the absence of clinicians (Butow et al., 2012. The actual degree of engagement in self-management may be dependent on patients’ perceived competence or self-efficacy to perform such activities (Fenlon et al., 2015. Self-efficacy has been defined as “a person’s belief to execute courses of action required to deal with a prospective situation” (Bandura, 1977, 2001. One’s beliefs in their capability to successfully manage tasks and consequently influence situations that impact their lives constitutes a central part of human agency, and can be influenced by performance accomplishments (Bandura, 1989, 2001. Whilst self-efficacy can enable engagement in self-management, actual participation in self-management activities can further increase one’s perceived ability to undertake such activities; it is thus obvious that a bi-directional association between self-management and self-efficacy exists. Supporting a shift in clinical practice with innovative technological systems affords a solution to the increasing demands placed on acute care by enabling the delivery of care in the home and community setting (Basch et al., 2011; Carpenter et al., 2008. Such remote monitoring systems facilitate the provision of clear lines of real-time communication between patients and their health care providers (Basch et al., 2011, and can deliver organised self-management advice tailored to the individual’s clinical characteristics and severity/distress of symptoms of anti-cancer treatment. Aim(s: Funded by the European Union (FP7 programme, a multi-centre European project (the eSMART study has been designed to

  18. Management of Behavioral and Psychological Symptoms of Dementia (BPSD)-no easy solution%痴呆的精神行为症状的管理——并非易事

    Institute of Scientific and Technical Information of China (English)

    Helen F.K. CHIU; S.W.LI

    2011-01-01

    @@ Management of the behavioral and psychological symptoms of dementia (BPSD) is a hot topic because these commonly seen symptoms in persons with dementia are quite difficult to manage.As highlighted in the comments by Xiao[1],the administration of antipsychotics is controversial because the use of antipsychotic medications in persons with dementia is associated with increased mortality,increased risk of stroke and worsened cognitive function[2,3].Xiao recommends that more long-term follow-up studies on the management of the BPSD be conducted to give clinicians better guidance on the treatment of this complex condition.This recommendation is particularly pertinent for Chinese populations.Two studies from Hong Kong showed that patients with the BPSD who were treated with antipsychotic medications did not have an increased risk of cerebrovascular accidents[4]or mortality[5].Clearly,more studies should be conducted in populations of different ethnicity to confirm or disprove the presumed risks of antipsychotic medications in patients with dementia.

  19. Research Protocol: Development, implementation and evaluation of a cognitive behavioural therapy-based intervention programme for the management of anxiety symptoms in South African children with visual impairments

    Directory of Open Access Journals (Sweden)

    Lisa Visagie

    2015-07-01

    Objectives: The main aim of this study is to develop, implement and evaluate a specifically tailored anxiety intervention programme for use with South African children with visual impairments. Method: A specifically tailored cognitive-behavioural therapy-based anxiety intervention, for 9–13 year old South African children with visual impairments, will be evaluated in two special schools. The study will employ a randomised wait-list control group design with pre- postand follow-up intervention measures, with two groups each receiving a 10 session anxiety intervention programme. The main outcome measure relates to the participants’ symptoms of anxiety as indicated on the Revised Child Anxiety and Depression Scale. Conclusion: If the anxiety intervention programme is found to be effective in reducing symptoms of anxiety, this universal intervention will lay down the foundation upon which future contextually sensitive (South African anxiety intervention programmes can be built.

  20. "Negative symptoms"secondary to intracranial tumor

    Directory of Open Access Journals (Sweden)

    Natasha Kate

    2014-01-01

    Full Text Available Intracranial tumors are increasingly common in the elderly population. They may present with varied symptoms, some of which may be psychiatric in nature. In patients with known psychiatric disorders, these symptoms may be misattributed resulting in a delay in diagnosis and management. We present a case of an elderly female with paranoid schizophrenia and new onset symptoms secondary to intracranial tumor, which were initially misdiagnosed.

  1. Inhibitory activities of venom alkaloids of Red Imported Fire Ant against Clavibacter michiganensis subsp. michiganensis in vitro and the application of piperidine alkaloids to manage symptom development..

    Science.gov (United States)

    Bacterial canker of tomato caused by Clavibacter michiganensis subsp. michiganensis (CMM) is a highly destructive disease and has caused major economic losses in tomato production worldwide. There are limited methods available to manage this disease. In searching for disease management alternatives,...

  2. An overview of menopause associated Vaso Motor Symptoms and ...

    African Journals Online (AJOL)

    BACKGROUND: Vasomotor Symptoms are the most common and distressing menopausal complaint, for which women seek advice from their physician. OBJECTIVE: To review menopausal associated vasomotor symptoms and options available in its management. METHODS: Pertinent literature on menopause associated ...

  3. Prevalence of postmenopausal symptoms in gynaecological ...

    African Journals Online (AJOL)

    Background: menopausal symptoms can be a nuisance and affect the quality of life if not properly managed. Ethnic variations in the severity of symptoms and incidence have little been studied. The perspective of gynaecologist practising in Nigeria based on the number of cases and common complaints is germaine to ...

  4. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey

    Science.gov (United States)

    Price, David; Fletcher, Monica; van der Molen, Thys

    2014-01-01

    Background: Asthma is one of the most common chronic diseases in the world, and previous studies have reported low levels of control. Recent developments in the availability and use of online sources of information about asthma might add to patients’ knowledge and help improve control. Aims: To investigate whether asthma control has improved by assessing levels of symptoms, exacerbations and Global Initiative for Asthma-defined control in a real-life population of patients who use the Internet and social media, as well as evaluate patient perception of control and attitudes to asthma. Methods: Online surveys were conducted among 8,000 patients with asthma (aged 18–50 years, ⩾2 prescriptions in the previous 2 years, use of social media) from 11 European countries. Results: Levels of asthma control were low: 45% of respondents had uncontrolled asthma. Acute exacerbations were common: 44% of respondents reported having used oral steroids for asthma in the previous 12 months, 24% had visited an emergency department and 12% had been hospitalised. More than 80% of respondents (overall, and among those with a history of exacerbations) considered their asthma to be controlled. Of those who had an exacerbation requiring oral steroids, 75% regarded their asthma as not serious. Conclusions: Asthma control in Europe remains poor; symptoms and exacerbations are common. Many patients regard their asthma as controlled and not serious despite experiencing symptoms and exacerbations. There is a need to assess patients’ control, risk and inhaler technique, and to ensure that patients are prescribed, and take, appropriate treatments. PMID:24921985

  5. National surveys: a way to manage treatment strategies in Parkinson's disease? Pharmaceutical prescribing patterns and patient experiences of symptom control and their impact on disease

    Directory of Open Access Journals (Sweden)

    Skogar Ö

    2013-07-01

    Full Text Available Örjan Skogar,1,2 Mats Nilsson,1 Carl-Johan Törnhage,3 Johan Lökk2 1Futurum Health Care Academy, Jönköping, 2Institution of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, 3Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden Background: The purpose of this study was to draw conclusions from patient-reported experiences in two national surveys from Scandinavia with the intention of comparing treatment strategies and increasing our knowledge of factors that affect the experiences of patients with Parkinson's disease (PD. Methods: A total of 2000 individuals in Sweden and 1300 in Norway were invited to complete postal surveys covering PD-related issues. Patient experiences of diagnostic procedures, symptom control, and follow-up in PD and the effects on symptom-related quality of life were collected. Pharmaceutical prescription data on anti-PD drugs and administrative data were collected from national registries. Results: The surveys were completed by 1553 (78% of the Swedish cohort and 1244 (96% of the Norwegian cohort. Only small differences were seen in disease duration and age distribution. Statistically as well as clinically significant differences in symptom control, diagnostic, and follow-up procedures, as well as in pharmacological treatment and impact on quality of life, were found between the national cohorts independent of disease duration. Conclusion: Information from separate national surveys has the potential to increase our knowledge of patient experiences in PD and can be used to compare, evaluate, educate, and guide health care staff and administrators in optimizing health care for patients with the disease. Keywords: parkinson's disease, diagnosis, follow-up, pharmaceutical prescription, quality of life, survey

  6. Menopausal Symptoms and Complementary Health Practices

    Science.gov (United States)

    ... with historical origins in ancient Indian philosophy. Various styles of yoga typically combine physical postures and movement, ... Obstetricians and Gynecologists. ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstetrics and Gynecology. 2014;123( ...

  7. Side Effects (Management)

    Science.gov (United States)

    ... cancer care is relieving side effects, called symptom management, palliative care, or supportive care. It is important ... treat them. To learn about the symptoms and management of the long-term side effects of cancer ...

  8. Multiple somatic symptoms in primary care patients: a cross-sectional study of consultation content, clinical management strategy and burden of encounter

    DEFF Research Database (Denmark)

    Rask, Mette Trøllund; Carlsen, Anders Helles; Budtz-Lilly, Anna

    2016-01-01

    Bodily distress syndrome (BDS) er en ny forskningsdiagnose for medicinsk uforklarede symptomer. Denne artikel præsenterer et tværsnitsstudie, som har undersøgt konsultationens indhold, de valgte kliniske strategier, tidsforbruget og den praktiserende læges opfattelse af tyngden af konsultationer...... med patienter med BDS. Resultaterne viser, at patienter med BDS generelt har sammensatte og komplekse behov relateret til både det psykosociale og det biomedicinske område. Lægerne synes at sikre kontinuitet i behandlingen af denne patientgruppe gennem strategier som at se an med henvendelse ved behov...

  9. Availability of essential drugs for managing HIV-related pain and symptoms within 120 PEPFAR-funded health facilities in East Africa: a cross-sectional survey with onsite verification.

    Science.gov (United States)

    Harding, Richard; Simms, Victoria; Penfold, Suzanne; Downing, Julia; Powell, Richard A; Mwangi-Powell, Faith; Namisango, Eve; Moreland, Scott; Gikaara, Nancy; Atieno, Mackuline; Kataike, Jennifer; Nsubuga, Clare; Munene, Grace; Banga, Geoffrey; Higginson, Irene J

    2014-04-01

    World Health Organization's essential drugs list can control the highly prevalent HIV-related pain and symptoms. Availability of essential medicines directly influences clinicians' ability to effectively manage distressing manifestations of HIV. To determine the availability of pain and symptom controlling drugs in East Africa within President's Emergency Plan for AIDS Relief-funded HIV health care facilities. Directly observed quantitative health facilities' pharmacy stock review. We measured availability, expiration and stock-outs of specified drugs required for routine HIV management, including the World Health Organization pain ladder. A stratified random sample in 120 President's Emergency Plan for AIDS Relief-funded HIV care facilities (referral and district hospitals, health posts/centres and home-based care providers) in Kenya and Uganda. Non-opioid analgesics (73%) and co-trimoxazole (64%) were the most commonly available drugs and morphine (7%) the least. Drug availability was higher in hospitals and lower in health centres, health posts and home-based care facilities. Facilities generally did not use minimum stock levels, and stock-outs were frequently reported. The most common drugs had each been out of stock in the past 6 months in 47% of facilities stocking them. When a minimum stock level was defined, probability of a stock-out in the previous 6 months was 32.6%, compared to 45.5% when there was no defined minimum stock level (χ (2) = 5.07, p = 0.024). The data demonstrate poor essential drug availability, particularly analgesia, limited by facility type. The lack of strong opioids, isoniazid and paediatric formulations is concerning. Inadequate drug availability prevents implementation of simple clinical pain and symptom control protocols, causing unnecessary distress. Research is needed to identify supply chain mechanisms that lead to these problems.

  10. Symptom monitoring in treatment of cancer patients

    Institute of Scientific and Technical Information of China (English)

    Yao Wanxia; Lin Miao; Lü Ye; Yang Biao; Yao Cong; Liu Juan; Wang Wenru

    2008-01-01

    Objective To examine self-reported symptoms by the patients receiving cancer therapy, and find out the symptoms that should be coped with and managed during the treatment. Methods A pilot study was conducted on self-reported symptoms on 185 patients receiving chemotherapy and/or radiotherapy for different cancers. The Therapy-Related Symptoms Checklist (TRSC) was used. Results Severe symptoms on the TRSC subscales: loss of appetite,feeling sluggish, weight loss, nausea and hair loss, were reported by the patients. The frequently reported symptoms by those on chemotherapy were nausea, feeling sluggish, weight loss, vomiting, and taste change. The frequently reported symptoms by those on radiotherapy were feeling sluggish, weight loss, loss of appetite, difficult sleeping, and changing taste. The symptoms of loss of appetite, feeling sluggish, weight loss, hair loss, and nausea were both frequently reported by those on radiotherapy and those on chemotherapy. Conclusion Symptom monitoring may be facilitated by TRSC, based on the severity and frequency of reported symptoms, more patients and caregivers could know which symptoms should be preferential interventions.

  11. Identifying Symptom Patterns in People Living With HIV Disease

    Science.gov (United States)

    Wilson, Natalie L.; Azuero, Andres; Vance, David E.; Richman, Joshua S.; Moneyham, Linda D.; Raper, James L.; Heath, Sonya L.; Kempf, Mirjam-Colette

    2016-01-01

    Symptoms guide disease management, and patients frequently report HIV-related symptoms, but HIV symptom patterns reported by patients have not been described in the era of improved antiretroviral treatment. The objectives of our study were to investigate the prevalence and burden of symptoms in people living with HIV and attending an outpatient clinic. The prevalence, burden, and bothersomeness of symptoms reported by patients in routine clinic visits during 2011 were assessed using the 20-item HIV Symptom Index. Principal component analysis was used to identify symptom clusters and relationships between groups using appropriate statistic techniques. Two main clusters were identified. The most prevalent and bothersome symptoms were muscle aches/joint pain, fatigue, and poor sleep. A third of patients had seven or more symptoms, including the most burdensome symptoms. Even with improved antiretroviral drug side-effect profiles, symptom prevalence and burden, independent of HIV viral load and CD4+ T cell count, are high. PMID:26790340

  12. Frailty and Lower Urinary Tract Symptoms.

    Science.gov (United States)

    Suskind, Anne M

    2017-09-01

    The incidence of both frailty and lower urinary tract symptoms, including urinary incontinence, overactive bladder, underactive bladder, and benign prostatic hyperplasia, increases with age. However, our understanding of the relationship between frailty and lower urinary tract symptoms, both in terms of pathophysiology and in terms of the evaluation and management of such symptoms, is greatly lacking. This brief review will summarize definitions and measurement tools associated with frailty and will also review the existing state of the literature on frailty and lower urinary tract symptoms in older individuals.

  13. A Structural Equation Model of HIV-related Symptoms, Depressive Symptoms, and Medication Adherence.

    Science.gov (United States)

    Yoo-Jeong, Moka; Waldrop-Valverde, Drenna; McCoy, Katryna; Ownby, Raymond L

    2016-05-01

    Adherence to combined antiretroviral therapy (cART) remains critical in management of HIV infection. This study evaluated depression as a potential mechanism by which HIV-related symptoms affect medication adherence and explored if particular clusters of HIV symptoms are susceptible to this mechanism. Baseline data from a multi-visit intervention study were analyzed among 124 persons living with HIV (PLWH). A bifactor model showed two clusters of HIV-related symptom distress: general HIV-related symptoms and gastrointestinal (GI) symptoms. Structural equation modeling showed that both general HIV-related symptoms and GI symptoms were related to higher levels of depressive symptoms, and higher levels of depressive symptoms were related to lower levels of medication adherence. Although general HIV-related symptoms and GI symptoms were not directly related to adherence, they were indirectly associated with adherence via depression. The findings highlight the importance of early recognition and evaluation of symptoms of depression, as well as the underlying physical symptoms that might cause depression, to improve medication adherence.

  14. Self-administered acupressure for symptom management among Chinese family caregivers with caregiver stress: a randomized, wait-list controlled trial.

    Science.gov (United States)

    Tiwari, Agnes; Lao, Lixing; Wang, Amy Xiao-Min; Cheung, Denise Shuk Ting; So, Mike Ka Pui; Yu, Doris Sau Fung; Lum, Terry Yat Sang; Yuk Fung, Helina Yin King; Yeung, Jerry Wing Fai; Zhang, Zhang-Jin

    2016-10-28

    Caregiving can be stressful, potentially creating physical and psychological strain. Substantial evidence has shown that family caregivers suffer from significant health problems arising from the demands of caregiving. Although there are programs supporting caregivers, there is little evidence regarding their effectiveness. Acupressure is an ancient Chinese healing method designed to restore the flow of Qi (vital energy) by applying external pressure to acupoints. A randomized, wait-list controlled trial was developed to evaluate the effectiveness of a self-administered acupressure intervention on caregiver stress (primary objective) and stress-related symptoms of fatigue, insomnia, depression, and health-related quality of life (secondary objectives) in Chinese caregivers of older family members. Two hundred Chinese participants, aged ≥ 21 years, who are the primary caregivers of an older family member and screen positive for caregiver stress and symptoms of fatigue/insomnia/depression will be recruited from a community setting in Hong Kong. Subjects will be randomized to receive either an immediate treatment condition (self-administered acupressure intervention) or a wait-list control condition. The self-administered acupressure intervention will include (i) an individual learning and practice session twice a week for 2 weeks, (ii) a home follow-up visit once a week for 2 weeks, and (iii) 15-min self-practice twice a day for 6 weeks. The wait-list control group will receive the same acupressure training after the intervention group has completed the intervention. We hypothesize that Chinese family caregivers in the intervention group will have lower levels of caregiver stress, fatigue, insomnia, depression, and higher health-related quality of life after completion of the intervention than participants in the wait-list control group. This study will provide evidence for the effectiveness of self-administered acupressure in reducing stress and improving

  15. Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials.

    Science.gov (United States)

    Calixtre, L B; Moreira, R F C; Franchini, G H; Alburquerque-Sendín, F; Oliveira, A B

    2015-11-01

    There is a lack of knowledge about the effectiveness of manual therapy (MT) on subjects with temporomandibular disorders (TMD). The aim of this systematic review is to synthetise evidence regarding the isolated effect of MT in improving maximum mouth opening (MMO) and pain in subjects with signs and symptoms of TMD. MEDLINE(®) , Cochrane, Web of Science, SciELO and EMBASE(™) electronic databases were consulted, searching for randomised controlled trials applying MT for TMD compared to other intervention, no intervention or placebo. Two authors independently extracted data, PEDro scale was used to assess risk of bias, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) was applied to synthetise overall quality of the body of evidence. Treatment effect size was calculated for pain, MMO and pressure pain threshold (PPT). Eight trials were included, seven of high methodological quality. Myofascial release and massage techniques applied on the masticatory muscles are more effective than control (low to moderate evidence) but as effective as toxin botulinum injections (moderate evidence). Upper cervical spine thrust manipulation or mobilisation techniques are more effective than control (low to high evidence), while thoracic manipulations are not. There is moderate-to-high evidence that MT techniques protocols are effective. The methodological heterogeneity across trials protocols frequently contributed to decrease quality of evidence. In conclusion, there is widely varying evidence that MT improves pain, MMO and PPT in subjects with TMD signs and symptoms, depending on the technique. Further studies should consider using standardised evaluations and better study designs to strengthen clinical relevance. © 2015 John Wiley & Sons Ltd.

  16. Development and validation of an instrument for rapidly assessing symptoms: the general symptom distress scale.

    Science.gov (United States)

    Badger, Terry A; Segrin, Chris; Meek, Paula

    2011-03-01

    Symptom assessment has increasingly focused on the evaluation of total symptom distress or burden rather than assessing only individual symptoms. The challenge for clinicians and researchers alike is to assess symptoms, and to determine the symptom distress associated with the symptoms and the patient's ability for symptom management without a lengthy and burdensome assessment process. The objective of this article was to discuss the psychometric evaluation of a brief general symptom distress scale (GSDS) developed to assess specific symptoms and how they rank in relation to each other, the overall symptom distress associated with the symptom schema, and provide an assessment of how well or poorly that symptom schema is managed. Results from a pilot study about the initial development of the GSDS with 76 hospitalized patients are presented, followed by a more complete psychometric evaluation of the GSDS using three samples of cancer patients (n=190) and their social network members, called partners in these studies (n=94). Descriptive statistics were used to describe the GSDS symptoms, symptom distress, and symptom management. Point biserial correlations indexed the associations between dichotomous symptoms and continuous measures, and conditional probabilities were used to illustrate the substantial comorbidities of this sample. Internal consistency was examined using the KR-20 coefficient, and test-retest reliability was examined. Construct validity and predictive validity also were examined. The GSDS demonstrated satisfactory internal consistency and test-retest reliability, and good construct validity and predictive validity. The total score on the GSDS, symptom distress, and symptom management correlated significantly with related constructs of depression, positive and negative affect, and general health. The GSDS was able to demonstrate its ability to distinguish between those with or without chronic illness, and was able to significantly predict scores on

  17. Glaucoma: Symptoms, Diagnosis & Treatment

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Glaucoma Symptoms, Treatment and Research Past Issues / Spring 2015 ... vision, without any pain. Photo courtesy of NEI Glaucoma Symptoms At first, open-angle glaucoma has no ...

  18. A Structural Equation Model of HIV-related Symptoms, Depressive Symptoms, and Medication Adherence

    OpenAIRE

    Yoo-Jeong, Moka; Waldrop-Valverde, Drenna; McCoy, Katryna; Ownby, Raymond L

    2016-01-01

    Adherence to combined antiretroviral therapy (cART) remains critical in management of HIV infection. This study evaluated depression as a potential mechanism by which HIV-related symptoms affect medication adherence and explored if particular clusters of HIV symptoms are susceptible to this mechanism. Baseline data from a multi-visit intervention study were analyzed among 124 persons living with HIV (PLWH). A bifactor model showed two clusters of HIV-related symptom distress: general HIV-rela...

  19. Measuring bothersome menopausal symptoms

    DEFF Research Database (Denmark)

    Lund, Kamma Sundgaard; Siersma, Volkert Dirk; Christensen, Karl Bang

    2018-01-01

    BACKGROUND: The experience of menopausal symptoms is common and an adequate patient-reported outcome measure is crucial in studies where women are treated for these symptoms. The aims of this study were to identify a patient-reported outcome measure for bothersome menopausal symptoms and, in the ...

  20. Symptom clusters and quality of life in China patients with lung ...

    African Journals Online (AJOL)

    Identifying symptom clusters helped clarify possible inter-relationships which may lead to the establishment of more effective symptom management interventions for patients with lung cancer in order to improve the quality of life. Keywords: symptom clusters, lung cancer, factor analysis, symptom management, quality of life

  1. Supporting Regional Aged Care Nursing Staff to Manage Residents' Behavioural and Psychological Symptoms of Dementia, in Real Time, Using the Nurses' Behavioural Assistant (NBA): A Pilot Site 'End-User Attitudes' Trial.

    Science.gov (United States)

    Klein, Britt; Clinnick, Lisa; Chesler, Jessica; Stranieri, Andrew; Bignold, Adam; Dazeley, Richard; McLaren, Suzanne; Lauder, Sue; Balasubramanian, Venki

    2018-01-01

    This regional pilot site 'end-user attitudes' study explored nurses' experiences and impressions of using the Nurses' Behavioural Assistant (NBA) (a knowledge-based, interactive ehealth system) to assist them to better respond to behavioural and psychological symptoms of dementia (BPSD) and will be reported here. Focus groups were conducted, followed by a four-week pilot site 'end-user attitudes' trial of the NBA at a regional aged care residential facility (ACRF). Brief interviews were conducted with consenting nursing staff. Focus group feedback (N = 10) required only minor cosmetic changes to the NBA prototype. Post pilot site end-user interview data (N = 10) indicated that the regional ACRF nurses were positive and enthusiastic about the NBA, however several issues were also identified. Overall the results supported the utility of the NBA to promote a person centred care approach to managing BPSD. Slight modifications may be required to maximise its uptake across all ACRF nursing staff.

  2. OnabotulinumtoxinA 100U provides significant improvements in overactive bladder symptoms in patients with urinary incontinence regardless of the number of anticholinergic therapies used or reason for inadequate management of overactive bladder.

    Science.gov (United States)

    Sievert, K-D; Chapple, C; Herschorn, S; Joshi, M; Zhou, J; Nardo, C; Nitti, V W

    2014-10-01

    A prespecified pooled analysis of two placebo-controlled, phase 3 trials evaluated whether the number of prior anticholinergics used or reason for their discontinuation affected the treatment response to onabotulinumtoxinA 100U in overactive bladder (OAB) patients with urinary incontinence (UI). Patients with symptoms of OAB received intradetrusor injections of onabotulinumtoxinA 100U or placebo, sparing the trigone. Change from baseline at week 12 in UI episodes/day, proportion of patients reporting a positive response ('greatly improved' or 'improved') on the treatment benefit scale (TBS), micturition and urgency were evaluated by number of prior anticholinergics (1, 2 or ≥ 3) and reason for their discontinuation (insufficient efficacy or side effects). Adverse events (AE) were assessed. Patients had taken an average of 2.4 anticholinergics before study enrolment. OnabotulinumtoxinA reduced UI episodes/day from baseline vs. placebo, regardless of the number of prior anticholinergics (-2.82 vs. -1.52 for one prior anticholinergic; -2.58 vs. -0.58 for two prior anticholinergics; and -2.92 vs. -0.73 for three or more prior anticholinergics; all p reason for discontinuation. OnabotulinumtoxinA reduced the episodes of urgency and frequency of micturition vs. placebo in all groups. AEs were well tolerated, with a comparable incidence in all groups. In patients with symptoms of OAB who were inadequately managed by one or more anticholinergics, onabotulinumtoxinA 100U provided significant and similar treatment benefit and safety profile regardless of the number of prior anticholinergics used or reason for inadequate management of OAB. ClinicalTrials.gov: NCT00910845, NCT00910520. © 2014 The Authors. International Journal of Clinical Practice published by John Wiley & Sons Ltd.

  3. [Consensus document on the management and follow-up of the male with lower urinary tract symptoms secondary to benign prostate hyperplasia].

    Science.gov (United States)

    Brenes Bermúdez, F J; Brotons Muntó, F; Castiñeiras Fernández, J; Cozar Olmo, J M; Fernández-Pro Ledesma, A; Martín Jiménez, J A; Martínez-Berganza Asensio, M L; Miñana López, B; Molero García, J M

    Benign prostate hyperplasia (BPH) is a high-incidence condition. Its diagnosis and treatment is shared between urologists and Primary Care physicians. Its management uses up a significant amount of resources. The Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of General Practitioners and Family Doctors (SEMG), the Spanish Society of Family and Community Medicine (semFYC), and the Spanish Association of Urology (AEU) have prepared a document on the management and monitoring of BPH, in which the aim is to incorporate the latest evidence in order to update the previously published guidelines, and present them here in condensed form. The main objective of these new recommendations is to raise the awareness of Primary Care physicians and assist them in its diagnostic evaluation, treatment and monitoring, as well as providing unified consensus criteria for referral to the secondary care level. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Symptom Characteristics and Medical History of an Online Sample of Women Who Experience Symptoms of Persistent Genital Arousal.

    Science.gov (United States)

    Jackowich, Robyn; Pink, Leah; Gordon, Allan; Poirier, Évéline; Pukall, Caroline F

    2018-02-17

    Persistent genital arousal disorder (PGAD; Leiblum & Nathan, 2001 ) is characterized by distressing symptoms suggestive of genital arousal in the absence of subjective feelings of arousal. Although awareness of PGAD is growing, there continues to be a lack of systematic research on it. This study characterized an online sample of women with symptoms of persistent genital arousal (PGA) in terms of their symptom characteristics, medical comorbidities, symptom triggers, management strategies, and predictors of distress. Women reported diverse PGA symptoms, with almost half reporting painful symptoms, and most reported very high distress and negative emotions. Further research and awareness of PGA are needed to provide effective care for this population.

  5. Early psychosis symptoms

    International Nuclear Information System (INIS)

    Naqvi, H.A.; Hussain, S.; Islam, M.

    2014-01-01

    Objective: To determine the prodromal symptoms of schizophrenia in the pathways to help-seeking. Study Design: A cross-sectional study. Place and Duration of Study: The Department of Psychiatry, the Aga Khan University, Karachi, from 2008 to 2009. Methodology: A total of 93 patients were interviewed in the pathways to care of schizophrenia. The diagnosis was based on ICD-10 criteria. The pathways to care were assessed through a semi-structured questionnaire. The onset, course and symptoms of psychosis were assessed through Interview for Retrospective Assessment at Age at Onset of Psychosis (IROAS). Results: Fifty five (59%) participants were male while 41% (n=38%) were female. Using IROAS, 108 symptoms were identified as concerning behaviour. Alternatively, 60 (55%) concerning behaviours were reported in the open-ended inquiry of the reasons for help seeking as assessed by the pathways to care questionnaire with a statistically significant difference between most symptoms category. The difference was most pronounced (p < 0.001) for depressed mood (66%), worries (65%), tension (63%), withdrawal/mistrust (54%) and loss of self-confidence (53%). Thought withdrawal (22%) and passivity (15%) were elicited only through structured interview (IROAS). When symptoms were categorized together, about 83% of the subjects presented with affective and non-specific prodromal symptoms. Roughly, 10% of the subjects presented with positive symptoms and 3% presented with the negative symptoms of psychosis. The non-specific, affective symptoms appear to predominate the prodromal phase of the illness. Conclusion: Prodromal symptoms of schizophrenia include non-specific, affective symptoms. Attention needs to be paid on identifying the prodromal symptoms and change in social functioning in order to identify those who are at risk of long term psychosis. (author)

  6. Somatic symptom disorder

    Science.gov (United States)

    ... related disorders; Somatization disorder; Somatiform disorders; Briquet syndrome; Illness anxiety disorder References American Psychiatric Association. Somatic symptom disorder. Diagnostic and Statistical Manual of Mental Disorders . ...

  7. A self-management approach using self-initiated action plans for symptoms with ongoing nurse support in patients with Chronic Obstructive Pulmonary Disease (COPD) and comorbidities: the COPE-III study protocol.

    Science.gov (United States)

    Lenferink, Anke; Frith, Peter; van der Valk, Paul; Buckman, Julie; Sladek, Ruth; Cafarella, Paul; van der Palen, Job; Effing, Tanja

    2013-09-01

    Chronic Obstructive Pulmonary Disease (COPD) frequently coexists with other diseases. Whereas COPD action plans are currently part of usual care, they are less suitable and potentially unsafe for use in the presence of comorbidities. This study evaluates whether an innovative treatment approach directed towards COPD and frequently existing comorbidities can reduce COPD exacerbation days. We hypothesise that this approach, which combines self-initiated action plans and nurse support, will accelerate proper treatment actions and lead to better control of deteriorating symptoms. In this multicenter randomised controlled trial we aim to include 300 patients with COPD (GOLD II-IV), and with at least one comorbidity (cardiovascular disease, diabetes, anxiety and/or depression). Patients will be recruited from hospitals in the Netherlands (n = 150) and Australia (n = 150) and will be assigned to an intervention or control group. All patients will learn to complete daily symptom diaries for 12-months. Intervention group patients will participate in self-management training sessions to learn the use of individualised action plans for COPD and comorbidities, linked to the diary. The primary outcome is the number of COPD exacerbation days. Secondary outcomes include hospitalisations, quality of life, self-efficacy, adherence, patient's satisfaction and confidence, health care use and cost data. Intention-to-treat analyses (random effect negative binomial regression and random effect mixed models) and cost-effectiveness analyses will be performed. Prudence should be employed before extrapolating the use of COPD specific action plans in patients with comorbidities. This study evaluates the efficacy of tailored action plans for both COPD and common comorbidities. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Betahistine for symptoms of vertigo.

    Science.gov (United States)

    Murdin, Louisa; Hussain, Kiran; Schilder, Anne G M

    2016-06-21

    diagnoses, the dose of betahistine and the length of time it was taken for, the study methods and the way any improvement in vertigo symptoms was measured. Using the GRADE system, we judged the quality of evidence overall to be low for two outcomes (proportion of patients with improvement and proportion with adverse events).Pooled data showed that the proportion of patients reporting an overall reduction in their vertigo symptoms was higher in the group treated with betahistine than the placebo group: risk ratio (RR) 1.30, 95% confidence interval (CI) 1.05 to 1.60; 606 participants; 11 studies). This result should be interpreted with caution as the test for statistical heterogeneity as measured by the I(2) value was high.Adverse effects (mostly gastrointestinal symptoms and headache) were common but medically serious events in the study were rare and isolated: there was no difference in the frequency of adverse effects between the betahistine and placebo groups, where the rates were 16% and 15% respectively (weighted values, RR 1.03, 95% CI 0.76 to 1.40; 819 participants; 12 studies).Sixteen per cent of patients from both the betahistine and the placebo groups withdrew (dropped out) from the studies (RR 0.96, 95% CI 0.65 to 1.42; 481 participants; eight studies).Three studies looked at objective vestibular function tests as an outcome; the numbers of participants were small, techniques of measurement very diverse and reporting details sparse, so analysis of this outcome was inconclusive.We looked for information on generic quality of life and falls, but none of the studies reported on these outcomes. Low quality evidence suggests that in patients suffering from vertigo from different causes there may be a positive effect of betahistine in terms of reduction in vertigo symptoms. Betahistine is generally well tolerated with a low risk of adverse events. Future research into the management of vertigo symptoms needs to use more rigorous methodology and include outcomes that

  9. Bell's Palsy Symptoms

    Science.gov (United States)

    ... Stories Español Eye Health / Eye Health A-Z Bell's Palsy Sections What Is Bell's Palsy? Bell's Palsy Symptoms Bell's Palsy Treatment Bell's Palsy Symptoms Leer en Español: Síntomas de la parálisis ...

  10. Symptoms, Diagnosis & Treatment

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Cover Story: Leukemia/Lymphoma Symptoms, Diagnosis & Treatment Past Issues / Summer 2008 Table of Contents For an enhanced version of this page please turn Javascript on. Leukemia Symptoms Frequent infections Fever and chills Anemia Easy ...

  11. Effects of socioeconomic factors on cardiovascular-related symptoms among residents in Fukushima after the Great East Japan Earthquake: a cross-sectional study using data from the Fukushima Health Management Survey.

    Science.gov (United States)

    Zhang, Wen; Ohira, Tetsuya; Yasumura, Seiji; Maeda, Masaharu; Otsuru, Akira; Harigane, Mayumi; Horikoshi, Naoko; Suzuki, Yuriko; Yabe, Hirooki; Nagai, Masato; Nakano, Hironori; Hirosaki, Mayumi; Uemura, Mayu; Takahashi, Hideto; Kamiya, Kenji; Yamashita, Shunichi; Abe, Masafumi

    2017-06-23

    To investigate the association between socioeconomic factors and the exacerbation of cardiovascular symptoms among evacuees after the Great East Japan Earthquake. A sample of 73 433 individuals was included in the Fukushima Health Management Survey. Self-report questionnaires were used to determine the influence of socioeconomic factors including living arrangements, loss of employment and decreased income on the exacerbation of headache, dizziness, palpitations and shortness of breath. Odds ratios (ORs) and 95% CIs of the effect of socioeconomic factors were estimated for each symptom using multiple logistic regression analyses. Exacerbation of headaches was reported by 1893 individuals, dizziness by 1229, palpitations by 1085 and shortness of breath by 626 individuals. Evacuation accommodation was associated with all of these symptoms. Compared with participants living in their own home (OR=1.00), individuals living in relatives' homes had increased probability of experiencing exacerbation of headache (1.58; 95% CI 1.19 to 2.09) and dizziness (1.42; 95% CI 1.02 to 1.98); those living in rental housing or apartments experienced exacerbation of headache (1.54; 95% CI 1.32 to 1.80), dizziness (1.45; 95% CI 1.20 to 1.75), palpitations (1.25; 95% CI 1.03 to 1.51) and shortness of breath (1.76; 95% CI 1.35 to 2.28); participants living in evacuation shelters experienced exacerbation of headache (1.80; 95% CI 1.09 to 2.96); and refugees living in temporary housing also experienced exacerbation of headache (1.42; 95% CI 1.15 to 1.72), dizziness (1.40; 95% CI 1.09 to 1.79) and shortness of breath (1.49; 95% CI 1.07 to 2.08). Compared with the evacuees who retained their jobs, unemployed individuals showed increased probability of exacerbation of headache (1.28, 95% CI 1.12 to 1.46), dizziness (1.26, 95% CI 1.07 to 1.48) and palpitations (1.21, 95% CI 1.01 to 1.45). Decreased income was associated with exacerbation of headache (1.39, 95% CI 1

  12. Final Report - Molecular Mechanisms of Bacterial Mercury Transformation - UCSF

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Susan M. [UCSF

    2014-04-24

    The bacterial mercury resistance (mer) operon functions in Hg biogeochemistry and bioremediation by converting reactive inorganic Hg(II) and organic [RHg(II)]1+ mercurials to relatively inert monoatomic mercury vapor, Hg(0). Its genes regulate operon expression (MerR, MerD, MerOP), import Hg(II) (MerT, MerP, and MerC), and demethylate (MerB) and reduce (MerA) mercurials. We focus on how these components interact with each other and with the host cell to allow cells to survive and detoxify Hg compounds. Understanding how this ubiquitous detoxification system fits into the biology and ecology of its bacterial host is essential to guide interventions that support and enhance Hg remediation. In the current overall project we focused on two aspects of this system: (1) investigations of the energetics of Hg(II)-ligand binding interactions, and (2) both experimental and computational approaches to investigating the molecular mechanisms of Hg(II) acquisition by MerA and intramolecular transfer of Hg(II) prior to reduction within the MerA enzyme active site. Computational work was led by Prof. Jeremy Smith and took place at the University of Tennessee, while experimental work on MerA was led by Prof. Susan Miller and took place at the University of California San Francisco.

  13. $10M Gift Supports "Data Recycling" at UCSF.

    Science.gov (United States)

    2017-10-01

    The University of California, San Francisco's Institute for Computational Health Sciences has received a $10 million gift to support "data recycling" investigations. The approach to medical research involves mining existing data to potentially uncover new uses for existing drugs and help improve clinical care. ©2017 American Association for Cancer Research.

  14. [Treatment of multiple sclerosis symptoms and exacerbations].

    Science.gov (United States)

    Prieto González, José María

    2014-12-01

    In the last few years, there has been an explosion of new drugs acting on the clinical course of multiple sclerosis (MS) but less attention has been paid to better knowledge of the symptoms of this disease and their pathogenesis and treatment, which is essential to improve patients' quality of life. Because many patients have numerous concurrent symptoms during their clinical course, their management is complex and consequently it is important to know which symptoms are a direct result of the degenerative lesions of MS. The present article describes all the therapeutic options available for spasticity and its associated pain, paroxystic symptoms, fatigue, genitourinary disorders and sexual dysfunction, tremor, ataxia, gait disorder and cognitive impairment, with special emphasis on novel treatments. The article also defines exacerbations, how to recognize them and the available treatments, mainly oral administration of high-dose methylprednisolone and plasmapheresis. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  15. Sleep disorders as core symptoms of depression.

    Science.gov (United States)

    Nutt, David; Wilson, Sue; Paterson, Louise

    2008-01-01

    Links between sleep and depression are strong. About three quarters of depressed patients have insomnia symptoms, and hypersomnia is present in about 40% of young depressed adults and 10% of older patients, with a preponderance in females. The symptoms cause huge distress, have a major impact on quality of life, and are a strong risk factor for suicide. As well as the subjective experience of sleep symptoms, there are well-documented changes in objective sleep architecture in depression. Mechanisms of sleep regulation and how they might be disturbed in depression are discussed. The sleep symptoms are often unresolved by treatment, and confer a greater risk of relapse and recurrence. Epidemiological studies have pointed out that insomnia in nondepressed subjects is a risk factor for later development of depression. There is therefore a need for more successful management of sleep disturbance in depression, in order to improve quality of life in these patients and reduce an important factor in depressive relapse and recurrence.

  16. Social Sensations of Symptoms

    DEFF Research Database (Denmark)

    Meinert, Lotte; Whyte, Susan Reynolds

    2017-01-01

    The interpretation of sensations and the recognition of symptoms of a sickness, as well as the movement to seek treatment, have long been recognized in medical anthropology as inherently social processes. Based on cases of HIV and trauma (PTSD) in Uganda, we show that even the first signs....../symptoms; differential recognition of symptoms; and the embodied sociality of treatment....... and sensations of sickness can be radically social. The sensing body can be a ‘social body’ – a family, a couple, a network – a unit that transcends the individual body. In this article we focus on four aspects of the sociality of sensations and symptoms: mode of transmission; the shared experience of sensations...

  17. Flu Symptoms & Complications

    Science.gov (United States)

    ... Influenza Types Seasonal Avian Swine Variant Pandemic Other Flu Symptoms & Complications Language: English (US) Español Recommend on ... not everyone with flu will have a fever. Flu Complications Most people who get influenza will recover ...

  18. Prostate Cancer Symptoms

    Science.gov (United States)

    ... Fundraise for PCF: Many vs Cancer Contact Us Prostate Cancer Symptoms and Signs Prostate Cancer Basics Risk Factors ... earlier. So what are the warning signs of prostate cancer? Unfortunately, there usually aren’t any early warning ...

  19. Medically Unexplained Symptoms

    Science.gov (United States)

    ... overview of three specific MUS’s: Chronic Fatigue Syndrome, Fibromyalgia, and Irritable Bowel Syndrome and discusses things you can do to minimize the symptoms and improve your quality of life. It is possible that these syndromes can all ...

  20. Cholera Illness and Symptoms

    Science.gov (United States)

    ... Share Compartir Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae and is spread by ingestion of contaminated food or water. The infection is often mild or without symptoms, ...

  1. Premonitory symptoms in migraine

    DEFF Research Database (Denmark)

    Laurell, Katarina; Artto, Ville; Bendtsen, Lars

    2016-01-01

    AIM: To describe the frequency and number of premonitory symptoms (PS) in migraine, the co-occurrence of different PS, and their association with migraine-related factors. METHODS: In this cross-sectional study, a validated questionnaire was sent to Finnish migraine families between 2002 and 2013...... to obtain data on 14 predefined PS, migraine diagnoses, demographic factors, and migraine characteristics. The estimated response rate was 80%. RESULTS: Out of 2714 persons, 2223 were diagnosed with migraine. Among these, 77% reported PS, with a mean number of 3.0 symptoms compared to 30% (p ....5 symptoms (p migraine headaches. Yawning was the most commonly reported symptom (34%) among migraineurs. Females reported PS more frequently than males (81 versus 64%, p 

  2. Gynecological cancer alarm symptoms:

    DEFF Research Database (Denmark)

    Balasubramaniam, Kirubakaran; Ravn, Pernille; dePont Christensen, René

    2016-01-01

    INTRODUCTION: To determine the proportion of patients who were referred to specialist care after reporting gynecological cancer alarm symptoms to their general practitioner. To investigate whether contact with specialist care was associated with lifestyle factors or socioeconomic status. MATERIAL...... and odds ratios (ORs) for associations between specialist care contact, lifestyle factors and socioeconomic status. RESULTS: The study included 25 866 non-pregnant women; 2957 reported the onset of at least one gynecological cancer alarm symptom, and 683 of these (23.1%) reported symptoms to their general......: Educational level influence contact with specialist care among patients with gynecological cancer alarm symptoms. Future studies should investigate inequalities in access to the secondary healthcare system. This article is protected by copyright. All rights reserved....

  3. Relaxation Techniques to Manage IBS Symptoms

    Science.gov (United States)

    ... for 15–20 seconds and then begin again. Progressive Muscle Relaxation This method of relaxation focuses on ... helpful, please consider supporting IFFGD with a small tax- deductible donation. Make Donation Adapted from IFFGD Publication # ...

  4. Management of respiratory symptoms in ALS.

    LENUS (Irish Health Repository)

    Hardiman, Orla

    2012-02-01

    Respiratory insufficiency is a frequent feature of ALS and is present in almost all cases at some stage of the illness. It is the commonest cause of death in ALS. FVC is used as important endpoint in many clinical trials, and in decision-making events for patients with ALS, although there are limitations to its predictive utility. There are multiple causes of respiratory muscle failure, all of which act to produce a progressive decline in pulmonary function. Diaphragmatic fatigue and weakness, coupled with respiratory muscle weakness, lead to reduced lung compliance and atelectasis. Increased secretions increase the risk of aspiration pneumonia, which further compromises respiratory function. Bulbar dysfunction can lead to nutritional deficiency, which in turn increases the fatigue of respiratory muscles. Early recognition of respiratory decline and symptomatic intervention, including non-invasive ventilation can significantly enhance both quality of life and life expectancy in ALS. Patients with respiratory failure should be advised to consider an advance directive to avoid emergency mechanical ventilation.

  5. Management of respiratory symptoms in ALS.

    LENUS (Irish Health Repository)

    Hardiman, Orla

    2011-03-01

    Respiratory insufficiency is a frequent feature of ALS and is present in almost all cases at some stage of the illness. It is the commonest cause of death in ALS. FVC is used as important endpoint in many clinical trials, and in decision-making events for patients with ALS, although there are limitations to its predictive utility. There are multiple causes of respiratory muscle failure, all of which act to produce a progressive decline in pulmonary function. Diaphragmatic fatigue and weakness, coupled with respiratory muscle weakness, lead to reduced lung compliance and atelectasis. Increased secretions increase the risk of aspiration pneumonia, which further compromises respiratory function. Bulbar dysfunction can lead to nutritional deficiency, which in turn increases the fatigue of respiratory muscles. Early recognition of respiratory decline and symptomatic intervention, including non-invasive ventilation can significantly enhance both quality of life and life expectancy in ALS. Patients with respiratory failure should be advised to consider an advance directive to avoid emergency mechanical ventilation.

  6. Peripheral Neuropathy: Symptoms and Signs

    Science.gov (United States)

    ... Utah Research News Make a Difference Symptoms of Peripheral Neuropathy Print This Page Peripheral Neuropathy symptoms usually start ... more slowly over many years. The symptoms of peripheral neuropathy often include: A sensation of wearing an invisible “ ...

  7. Management

    OpenAIRE

    Daft, Richard L.; Kendrick, Martyn; Vershinina, Natalia

    2010-01-01

    The market-leading textbook for principles of management courses reaches a new level with Richard L. Daft being joined by Martyn Kendrick and Natalia Vershinina (both Leicester Business School) to provide an unparalleled resource for students in Europe, the Middle East and Africa (EMEA). After listening to the requirements of lecturers, the authors have maintained the same comprehensive coverage and structure of the original work but carefully threaded in new EMEA and wider global examples an...

  8. Prevalence of obsessive compulsive symptoms among patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Smita Hemrom

    2009-01-01

    Full Text Available Background: Obsessive compulsive symptoms in schizophrenia are well recognized but are a less-researched entity. These symptoms have important implications for management and prognosis. Aim: To find out the prevalence of obsessive compulsive symptoms among patients with schizophrenia. Materials and Methods: A total of 90 hospitalized patients with schizophrenia diagnosed according to DCR of ICD-10 criteria were selected for the study. Padua inventory and Yale-Brown Obsessive Compulsive Scale were applied to find out the prevalence and nature of obsessive compulsive symptoms . Results: It was found that 10% of schizophrenic patients had obsessive compulsive symptoms. Conclusion: Obsessive compulsive symptoms are prevalent in patients with schizophrenia. The presence of comorbidity should be explored for adequate management.

  9. Successful Teaching of Radiobiology Students in the Medical Management of Acute Radiation Effects From Real Case Histories Using Clinical Signs and Symptoms and Taking Advantage of Recently Developed Software Tools.

    Science.gov (United States)

    Majewski, Matthäus; Combs, Stephanie E; Trott, Klaus-Rüdiger; Abend, Michael; Port, Matthias

    2018-07-01

    In 2015, the Bundeswehr Institute of Radiobiology organized a North Atlantic Treaty Organization exercise to examine the significance of clinical signs and symptoms for the prediction of late-occurring acute radiation syndrome. Cases were generated using either the Medical Treatment Protocols for Radiation Accident Victims (METREPOL, n = 167) system or using real-case descriptions extracted from a database system for evaluation and archiving of radiation accidents based on case histories (SEARCH, n = 24). The cases ranged from unexposed [response category 0 (RC 0, n = 89)] to mild (RC 1, n = 45), moderate (RC 2, n = 19), severe (RC 3, n = 20), and lethal (RC 4, n = 18) acute radiation syndrome. During the previous exercise, expert teams successfully predicted hematological acute radiation syndrome severity, determined whether hospitalization was required, and gave treatment recommendations, taking advantage of different software tools developed by the North Atlantic Treaty Organization teams. The authors provided the same data set to radiobiology students who were introduced to the medical management of acute effects after radiation exposure and the software tools during a class lasting 15 h. Corresponding to the previous results, difficulties in the discrimination between RC 0/RC 1 and RC 3/RC 4, as well as a systematic underestimation of RC 1 and RC 2, were observed. Nevertheless, after merging reported response categories into clinically relevant groups (RC 0-1, RC 2-3, and RC 3-4), it was found that the majority of cases (95.2% ± 2.2 standard deviations) were correctly identified and that 94.7% (±2.6 standard deviations) developing acute radiation syndrome and z96.4% (±1.6 standard deviations) requiring hospitalization were identified correctly. Two out of three student teams also provided a dose estimate. These results are comparable to the best-performing team of the 2015 North Atlantic Treaty Organization exercise (response category: 92.5%; acute

  10. Association between burnout and depressive symptoms among Turkish dentists

    Directory of Open Access Journals (Sweden)

    Meral Huri

    2016-12-01

    Conclusion: Dentists may face burnout and depressive symptoms during their professional life. Increased burnout level can give an idea on depressive symptoms, and may provide an opportunity to identify depression earlier. Creating and raising awareness about burnout are important to avoid and prevent depression among dentists. Further longitudinal studies analyzing the effects of interdisciplinary client-centered self-management programs for dentists on depressive symptoms and burnout must be planned.

  11. Seasonal Allergies: Symptoms, Diagnosis, and Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... this page please turn Javascript on. Feature: Managing Allergies Seasonal Allergies: Symptoms, Diagnosis, and Treatment Past Issues / Summer 2011 ... of Contents Is It a Cold or an Allergy? Symptoms Cold Airborne Allergy Cough Common Sometimes General ...

  12. Advancing Symptom Science Through Use of Common Data Elements.

    Science.gov (United States)

    Redeker, Nancy S; Anderson, Ruth; Bakken, Suzanne; Corwin, Elizabeth; Docherty, Sharron; Dorsey, Susan G; Heitkemper, Margaret; McCloskey, Donna Jo; Moore, Shirley; Pullen, Carol; Rapkin, Bruce; Schiffman, Rachel; Waldrop-Valverde, Drenna; Grady, Patricia

    2015-09-01

    Use of common data elements (CDEs), conceptually defined as variables that are operationalized and measured in identical ways across studies, enables comparison of data across studies in ways that would otherwise be impossible. Although healthcare researchers are increasingly using CDEs, there has been little systematic use of CDEs for symptom science. CDEs are especially important in symptom science because people experience common symptoms across a broad range of health and developmental states, and symptom management interventions may have common outcomes across populations. The purposes of this article are to (a) recommend best practices for the use of CDEs for symptom science within and across centers; (b) evaluate the benefits and challenges associated with the use of CDEs for symptom science; (c) propose CDEs to be used in symptom science to serve as the basis for this emerging science; and (d) suggest implications and recommendations for future research and dissemination of CDEs for symptom science. The National Institute of Nursing Research (NINR)-supported P20 and P30 Center directors applied published best practices, expert advice, and the literature to identify CDEs to be used across the centers to measure pain, sleep, fatigue, and affective and cognitive symptoms. We generated a minimum set of CDEs to measure symptoms. The CDEs identified through this process will be used across the NINR Centers and will facilitate comparison of symptoms across studies. We expect that additional symptom CDEs will be added and the list will be refined in future work. Symptoms are an important focus of nursing care. Use of CDEs will facilitate research that will lead to better ways to assist people to manage their symptoms. © 2015 Sigma Theta Tau International.

  13. Asthma Symptoms in Early Childhood: A public health perspective

    NARCIS (Netherlands)

    E.H.D. Hafkamp-De Groen (Esther)

    2014-01-01

    markdownabstract__Abstract__ This thesis focuses on asthma symptoms in early childhood. From a public health perspective, we aim to improve health and health-related quality of life through the prevention of asthma symptoms and by signaling, counselling or management of children who are at a high

  14. The value of international prostate symptom scoring system in the ...

    African Journals Online (AJOL)

    IPSS) system in management of patients with benign prostatic hyperplasia (BPH) in Jos, Nigeria. Materials and Methods: This was a prospective study of 104 newly diagnosed patients with BPH from June 2006 to July 2007. Patients' symptoms ...

  15. Minimally Invasive Treatment of Male Lower Urinary Tract Symptoms

    NARCIS (Netherlands)

    de La Rosette, Jean J. M. C. H.; Gravas, Stavros; Fitzpatrick, John M.

    2008-01-01

    During the past decade, increasing numbers of minimally invasive treatments for managing male lower urinary tract symptoms caused by urinary tract obstruction have been positioned. On one hand, transurethral needle ablation and transurethral microwave thermotherapy bridge the gap between medical

  16. Respiratory Symptoms in Firefighters

    NARCIS (Netherlands)

    Greven, Frans E.; Rooyackers, Jos M.; Kerstjens, Huib A. M.; Heederik, Dick J.

    Background The aim of the present study was to determine the prevalence and risk factors associated with respiratory symptoms in common firefighters in the Netherlands. Methods A total of 1,330 firefighters from the municipal fire brigades of three provinces of the Netherlands were included in the

  17. Bullying and PTSD Symptoms

    Science.gov (United States)

    Idsoe, Thormod; Dyregrov, Atle; Idsoe, Ella Cosmovici

    2012-01-01

    PTSD symptoms related to school bullying have rarely been investigated, and never in national samples. We used data from a national survey to investigate this among students from grades 8 and 9 (n = 963). The prevalence estimates of exposure to bullying were within the range of earlier research findings. Multinomial logistic regression showed that…

  18. Polymyositis: Medical Management

    Science.gov (United States)

    ... Donate Search MDA.org Close Polymyositis (PM) Medical Management Polymyositis (PM) is a highly treatable disease. Some ... PM) Signs and Symptoms Diagnosis Causes/Inheritance Medical Management Research Find your MDA Care Center Grants at ...

  19. How Is Pain Managed?

    Science.gov (United States)

    ... Detection- Goggins Lab Sol Goldman Center Discussion Board Pain Management Pain is a very common symptom in patients ... of pain. Pain Assessment The first step in pain management is a thorough assessment. Your healthcare provider will ...

  20. Lay Consultations in Heart Failure Symptom Evaluation.

    Science.gov (United States)

    Reeder, Katherine M; Sims, Jessica L; Ercole, Patrick M; Shetty, Shivan S; Wallendorf, Michael

    2017-01-01

    Lay consultations can facilitate or impede healthcare. However, little is known about how lay consultations for symptom evaluation affect treatment decision-making. The purpose of this study was to explore the role of lay consultations in symptom evaluation prior to hospitalization among patients with heart failure. Semi-structured interviews were conducted with 60 patients hospitalized for acute decompensated heart failure. Chi-square and Fisher's exact tests, along with logistic regression were used to characterize lay consultations in this sample. A large proportion of patients engaged in lay consultations for symptom evaluation and decision-making before hospitalization. Lay consultants provided attributions and advice and helped make the decision to seek medical care. Men consulted more often with their spouse than women, while women more often consulted with adult children. Findings have implications for optimizing heart failure self-management interventions, improving outcomes, and reducing hospital readmissions.

  1. Understanding medical symptoms: a conceptual review and analysis.

    Science.gov (United States)

    Malterud, Kirsti; Guassora, Ann Dorrit; Graungaard, Anette Hauskov; Reventlow, Susanne

    2015-12-01

    The aim of this article is to present a conceptual review and analysis of symptom understanding. Subjective bodily sensations occur abundantly in the normal population and dialogues about symptoms take place in a broad range of contexts, not only in the doctor's office. Our review of symptom understanding proceeds from an initial subliminal awareness by way of attribution of meaning and subsequent management, with and without professional involvement. We introduce theoretical perspectives from phenomenology, semiotics, social interactionism, and discourse analysis. Drew Leder's phenomenological perspectives deal with how symptom perception occurs when any kind of altered balance brings forward a bodily attention. Corporeality is brought to explicit awareness and perceived as sensations. Jesper Hoffmeyer's biosemiotic perspectives provide access to how signs are interpreted to attribute meaning to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik's concept "situational disease" explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how language constructs social interaction. Symptoms are situated in culture and context, and trends in modern everyday life modify symptom understanding continuously. Our analysis suggests that a symptom can only be understood by attention to the social context in which the symptom emerges and the dialogue through which it is negotiated.

  2. Quality of Life for Adults with Asthma in a Military Setting

    Science.gov (United States)

    1998-05-01

    Tilley, Havstead, & Zoratti, 1997). More recently, van der Molen , et al. (1997) conducted a study comparing discriminative aspects of two generic...Symptom Management Faculty Group, UCSF. (1994). IMAGE: Journal of Nursing Scholarship, 26(4), 272-276. van der Molen , T., Postma, D., Schreuers, A...the most important (Earwood, 1996, Rutten- Van Molken, Van Doorslaer, & Rutten, 1992). Purpose of the Study When patients clarify their perceptions of

  3. Behavioral and Psychological Symptoms of Dementia

    Directory of Open Access Journals (Sweden)

    Joaquim eCerejeira

    2012-05-01

    Full Text Available Behavioral and psychological symptoms of dementia (BPSD, also known as neuropsychiatric symptoms, represent a heterogeneous group of non-cognitive symptoms and behaviors occurring in subjects with dementia. BPSD constitute a major component of the dementia syndrome irrespective of its subtype. They are as clinically relevant as cognitive symptoms as they strongly correlate with the degree of functional and cognitive impairment. BPSD include agitation, aberrant motor behavior, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes. It is estimated that BPSD affect up to 90% of all dementia subjects over the course of their illness, and is independently associated with poor outcomes, including distress among patients and caregivers, long term hospitalization, misuse of medication and increased health care costs. Although these symptoms can be present individually it is more common that various psychopathological features co-occur simultaneously in the same patient. Thus, categorization of BPSD in clusters taking into account their natural course, prognosis and treatment response may be useful in the clinical practice. The pathogenesis of BPSD has not been clearly delineated but it is probably the result of a complex interplay of psychological, social and biological factors. Recent studies have emphasized the role of neurochemical, neuropathological and genetic factors underlying the clinical manifestations of BPSD. A high degree of clinical expertise is crucial to appropriately recognize and manage the neuropsychiatric symptoms in a patient with dementia. Combination of non-pharmacological and careful use of pharmacological interventions is the recommended therapeutic for managing BPSD. Given the modest efficacy of current strategies, there is an urgent need to identify novel pharmacological targets and develop new non-pharmacological approaches to improve the adverse outcomes

  4. Emotional symptoms among adolescents

    DEFF Research Database (Denmark)

    Meilstrup, Charlotte; Ersbøll, Annette K; Nielsen, Line

    2015-01-01

    level. RESULTS: Schoolchildren from low (odds ratio (OR) 1.70, 95% CI: 1.33-2.17) and medium (OR 1.50, 95% CI: 1.22-1.85) occupational social class (OSC), girls (OR 1.32, 95% CI: 1.13-1.56) and schoolchildren exposed to bullying (OR 3.82, 95% CI: 2.71-5.40), had increased odds for emotional symptoms....... A negative classroom climate was associated with emotional symptoms (OR 1.29, 95% CI: 0.99-1.69) and so was being part of classrooms with a high prevalence of bullying (OR 1.28, 95% CI: 1.0-1.60). CONCLUSION: Female sex, low OSC, single parent family, exposure to bullying and a high prevalence of bullying...

  5. Hearing symptoms personal stereos.

    Science.gov (United States)

    da Luz, Tiara Santos; Borja, Ana Lúcia Vieira de Freitas

    2012-04-01

     Practical and portable the personal stereos if had become almost indispensable accessories in the day the day. Studies disclose that the portable players of music can cause auditory damages in the long run for who hear music in high volume for a drawn out time.  to verify the prevalence of auditory symptoms in users of amplified players and to know its habits of use  Observational prospective study of transversal cut carried through in three institutions of education of the city of Salvador BA, being two of public net and one of the private net. 400 students had answered to the questionnaire, of both the sex, between 14 and 30 years that had related the habit to use personal stereos.  The symptoms most prevalent had been hyperacusis (43.5%), auricular fullness (30.5%) and humming (27.5), being that the humming is the symptom most present in the population youngest. How much to the daily habits: 62.3% frequent use, 57% in raised intensities, 34% in drawn out periods. An inverse relation between exposition time was verified and the band of age (p = 0,000) and direct with the prevalence of the humming.  Although to admit to have knowledge on the damages that the exposition the sound of high intensity can cause the hearing, the daily habits of the young evidence the inadequate use of the portable stereos characterized by long periods of exposition, raised intensities, frequent use and preference for the insertion phones. The high prevalence of symptoms after the use suggests a bigger risk for the hearing of these young.

  6. Hearing symptoms personal stereos

    Directory of Open Access Journals (Sweden)

    Tiara Santos da Luz1

    2012-01-01

    Full Text Available Introduction: Practical and portable the personal stereos if had become almost indispensable accessories in the day the day. Studies disclose that the portable players of music can cause auditory damages in the long run for who hear music in high volume for a drawn out time. Objective: to verify the prevalence of auditory symptoms in users of amplified players and to know its habits of use. Method: Observational prospective study of transversal cut carried through in three institutions of education of the city of Salvador BA, being two of public net and one of the private net. 400 students had answered to the questionnaire, of both the sex, between 14 and 30 years that had related the habit to use personal stereos. Results: The symptoms most prevalent had been hyperacusis (43.5%, auricular fullness (30.5% and humming (27.5, being that the humming is the symptom most present in the population youngest. How much to the daily habits: 62.3% frequent use, 57% in raised intensities, 34% in drawn out periods. An inverse relation between exposition time was verified and the band of age (p=0,000 and direct with the prevalence of the humming. Conclusion: Although to admit to have knowledge on the damages that the exposition the sound of high intensity can cause the hearing, the daily habits of the young evidence the inadequate use of the portable stereos characterized by long periods of exposition, raised intensities, frequent use and preference for the insertion phones. The high prevalence of symptoms after the use suggests a bigger risk for the hearing of these young.

  7. Efficacy and safety of combination therapy with tamsulosin, dutasteride and imidafenacin for the management of overactive bladder symptoms associated with benign prostatic hyperplasia: A multicenter, randomized, open-label, controlled trial (DIrecT Study).

    Science.gov (United States)

    Yamanishi, Tomonori; Asakura, Hirotaka; Seki, Narihito; Tokunaga, Shoji

    2017-07-01

    To evaluate the efficacy and safety of a combination therapy with dutasteride and imidafenacin in patients with benign prostatic hyperplasia and persistent overactive bladder symptoms. A total of 163 patients presenting an enlarged prostate (volume >30 mL) and persistent overactive bladder symptoms despite at least 8 weeks of tamsulosin were randomized to receive tamsulosin and dutasteride, or tamsulosin, dutasteride and imidafenacin at a 1:1 ratio. The primary end-point was the mean change from baseline to week 24 in total overactive bladder symptom score. The mean change in total overactive bladder symptom score from baseline at week 24 was -1.99 (95% confidence interval -2.57 to -1.41) in the tamsulosin and dutasteride group, and -3.12 (95% confidence interval -3.72 to -2.52) in the tamsulosin, dutasteride and imidafenacin group. The tamsulosin, dutasteride and imidafenacin group significantly improved total overactive bladder symptom score at week 24 as compared with the tamsulosin and dutasteride group; the mean difference was -1.18 (-2.02 to -0.34). The between-group difference was statistically significant as early as week 4. The total International Prostate Symptom Score, storage subscore, quality of life index, and benign prostatic hyperplasia impact index also significantly improved in the tamsulosin, dutasteride and imidafenacin group. Tamsulosin, dutasteride and imidafenacin combination therapy improves overactive bladder symptoms and quality of life without causing serious adverse drug reactions in patients with enlarged prostate not responding to tamsulosin. This combination therapy seems to represent a promising therapeutic option in these patients. © 2017 The Japanese Urological Association.

  8. Respiratory symptoms of megaesophagus

    Directory of Open Access Journals (Sweden)

    Fabio Di Stefano

    2013-03-01

    Full Text Available Megaesophagus as the end result of achalasia is the consequence of disordered peristalsis and the slow decompensation of the esophageal muscular layer. The main symptoms of achalasia are dysphagia, regurgitation, chest pain and weight loss, but respiratory symptoms, such as coughing, particularly when patients lie in a horizontal position, may also be common due to microaspiration. A 70-year old woman suffered from a nocturnal cough and shortness of breath with stridor. She reported difficulty in swallowing food over the past ten years, but had adapted by eating a semi-liquid diet. Chest X-ray showed right hemithorax patchy opacities projecting from the posterior mediastinum. Chest computed tomography scan showed a marked dilatation of the esophagus with abundant food residues. Endoscopy confirmed the diagnosis of megaesophagus due to esophageal achalasia, excluding other causes of obstruction, such as secondary esophagitis, polyps, leiomyoma or leiomyosarcoma. In the elderly population, swallowing difficulties due to esophageal achalasia are often underestimated and less troublesome than the respiratory symptoms that are caused by microaspiration. The diagnosis of esophageal achalasia, although uncommon, should be considered in patients with nocturnal chronic coughs and shortness of breath with stridor when concomitant swallowing difficulties are present.

  9. Neurobiology Underlying Fibromyalgia Symptoms

    Directory of Open Access Journals (Sweden)

    Marta Ceko

    2012-01-01

    Full Text Available Fibromyalgia is characterized by chronic widespread pain, clinical symptoms that include cognitive and sleep disturbances, and other abnormalities such as increased sensitivity to painful stimuli, increased sensitivity to multiple sensory modalities, and altered pain modulatory mechanisms. Here we relate experimental findings of fibromyalgia symptoms to anatomical and functional brain changes. Neuroimaging studies show augmented sensory processing in pain-related areas, which, together with gray matter decreases and neurochemical abnormalities in areas related to pain modulation, supports the psychophysical evidence of altered pain perception and inhibition. Gray matter decreases in areas related to emotional decision making and working memory suggest that cognitive disturbances could be related to brain alterations. Altered levels of neurotransmitters involved in sleep regulation link disordered sleep to neurochemical abnormalities. Thus, current evidence supports the view that at least some fibromyalgia symptoms are associated with brain dysfunctions or alterations, giving the long-held “it is all in your head” view of the disorder a new meaning.

  10. Symptoms after hospital discharge following hematopoietic stem cell transplantation

    Directory of Open Access Journals (Sweden)

    Gamze Oguz

    2014-01-01

    Full Text Available Aims: The purposes of this study were to assess the symptoms of hematopoietic stem cell transplant patients after hospital discharge, and to determine the needs of transplant patients for symptom management. Materials and Methods: The study adopted a descriptive design. The study sample comprised of 66 hematopoietic stem cell transplant patients. The study was conducted in Istanbul. Data were collected using Patient Information Form and Memorial Symptom Assessment Scale (MSAS. Results: The frequency of psychological symptoms in hematopoietic stem cell transplant patients after discharge period (PSYCH subscale score 2.11 (standard deviation (SD = 0.69, range: 0.93-3.80 was higher in hematopoietic stem cell transplant patients than frequency of physical symptoms (PHYS subscale score: 1.59 (SD = 0.49, range: 1.00-3.38. Symptom distress caused by psychological and physical symptoms were at moderate level (Mean = 1.91, SD = 0.60, range: 0.95-3.63 and most distressing symptoms were problems with sexual interest or activity, difficulty sleeping, and diarrhea. Patients who did not have an additional chronic disease obtained higher MSAS scores. University graduates obtained higher Global Distress Index (GDI subscale and total MSAS scores with comparison to primary school graduates. Total MSAS, MSAS-PHYS subscale, and MSAS-PSYCH subscale scores were higher in patients with low level of income (P < 0.05. The patients (98.5% reported to receive education about symptom management after hospital discharge. Conclusions: Hematopoietic stem cell transplant patients continue to experience many distressing physical or psychological symptoms after discharge and need to be supported and educated for the symptom management.

  11. Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory.

    Science.gov (United States)

    Fagundes, Christopher P; Shi, Qiuling; Vaporciyan, Ara A; Rice, David C; Popat, Keyuri U; Cleeland, Charles S; Wang, Xin Shelley

    2015-09-01

    Measuring patient-reported outcomes (PROs) has become increasingly important for assessing quality of care and guiding patient management. However, PROs have yet to be integrated with traditional clinical outcomes (such as length of hospital stay), to evaluate perioperative care. This study aimed to use longitudinal PRO assessments to define the postoperative symptom recovery trajectory in patients undergoing thoracic surgery for lung cancer. Newly diagnosed patients (N = 60) with stage I or II non-small cell lung cancer who underwent either standard open thoracotomy or video-assisted thoracoscopic surgery lobectomy reported multiple symptoms from before surgery to 3 months after surgery, using the MD Anderson Symptom Inventory. We conducted Kaplan-Meier analyses to determine when symptoms returned to presurgical levels and to mild-severity levels during recovery. The most-severe postoperative symptoms were fatigue, pain, shortness of breath, disturbed sleep, and drowsiness. The median time to return to mild symptom severity for these 5 symptoms was shorter than the time to return to baseline severity, with fatigue taking longer. Recovery from pain occurred more quickly for patients who underwent lobectomy versus thoracotomy (8 vs 18 days, respectively; P = .022). Patients who had poor preoperative performance status or comorbidities reported higher postoperative pain (all P < .05). Assessing symptoms from the patient's perspective throughout the postoperative recovery period is an effective strategy for evaluating perioperative care. This study demonstrates that the MD Anderson Symptom Inventory is a sensitive tool for detecting symptomatic recovery, with an expected relationship among surgery type, preoperative performance status, and comorbid conditions. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  12. Symptoms and Causes of Celiac Disease

    Science.gov (United States)

    ... Symptoms & Causes of Celiac Disease What are the symptoms of celiac disease? Most people with celiac disease have one or ... the rash and no other symptoms. Why are celiac disease symptoms so varied? Symptoms of celiac disease vary from ...

  13. Symptom distress in older adults following cancer surgery.

    Science.gov (United States)

    Van Cleave, Janet H; Egleston, Brian L; Ercolano, Elizabeth; McCorkle, Ruth

    2013-01-01

    Symptom distress remains a significant health problem among older adults with cancer following surgery. Understanding factors influencing older adults' symptom distress may lead to early identification and interventions, decreasing morbidity and improving outcomes. We conducted this study to identify factors associated with symptom distress following surgery among 326 community-residing patients 65 years or older with a diagnosis of thoracic, digestive, gynecologic, and genitourinary cancers. This secondary analysis used combined subsets of data from 5 nurse-directed intervention clinical trials targeting patients after surgery at academic cancer centers in northwest and northeastern United States. Symptom distress was assessed by the Symptom Distress Scale at baseline and at 3 and 6 months. A multivariable analysis, using generalized estimating equations, showed that symptom distress was significantly less at 3 and 6 months (3 months: P psychological, treatment, and function covariates. Thoracic cancer, comorbidities, worse mental health, and decreased function were, on average, associated with increased symptom distress (all P cancer, comorbidities, mental health, and function may influence older adults' symptom distress following cancer surgery. Older adults generally experience decreasing symptom distress after thoracic, abdominal, or pelvic cancer surgery. Symptom management over time for those with thoracic cancer, comorbidities, those with worse mental health, those with decreased function, and those 75 years or older may prevent morbidity and improve outcomes of older adults following surgery.

  14. Symptom clusters in patients with nasopharyngeal carcinoma during radiotherapy.

    Science.gov (United States)

    Xiao, Wenli; Chan, Carmen W H; Fan, Yuying; Leung, Doris Y P; Xia, Weixiong; He, Yan; Tang, Linquan

    2017-06-01

    Despite the improvement in radiotherapy (RT) technology, patients with nasopharyngeal carcinoma (NPC) still suffer from numerous distressing symptoms simultaneously during RT. The purpose of the study was to investigate the symptom clusters experienced by NPC patients during RT. First-treated Chinese NPC patients (n = 130) undergoing late-period RT (from week 4 till the end) were recruited for this cross-sectional study. They completed a sociodemographic and clinical data questionnaire, the Chinese version of the M. D. Anderson Symptom Inventory - Head and Neck Module (MDASI-HN-C) and the Chinese version of the Functional Assessment of Cancer Therapy - Head and Neck Scale (FACT-H&N-C). Principal axis factor analysis with oblimin rotation, independent t-test, one-way analysis of variance (ANOVA) and Pearson product-moment correlation were used to analyze the data. Four symptom clusters were identified, and labelled general, gastrointestinal, nutrition impact and social interaction impact. Of these 4 types, the nutrition impact symptom cluster was the most severe. Statistically positive correlations were found between severity of all 4 symptom clusters and symptom interference, as well as weight loss. Statistically negative correlations were detected between the cluster severity and the QOL total score and 3 out of 5 subscale scores. The four clusters identified reveal the symptom patterns experienced by NPC patients during RT. Future intervention studies on managing these symptom clusters are warranted, especially for the nutrition impact symptom cluster. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Celiac Disease: Symptoms, Diagnosis & Treatment

    Science.gov (United States)

    ... Table of Contents What are some of the symptoms of celiac disease? Some people with celiac disease may not feel ... skin rash with blisters slowed growth Why are celiac disease symptoms so varied? Researchers are studying the reasons celiac ...

  16. Throat Problems (Symptom Checker)

    Science.gov (United States)

    ... Kids and Teens Pregnancy and Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life Issues Insurance & Bills Self Care Working With Your Doctor Drugs, Procedures & Devices Over-the- ...

  17. Behavior and Evolution of Young ONset Dementia part 2 (BEYOND-II) study : an intervention study aimed at improvement in the management of neuropsychiatric symptoms in institutionalized people with young onset dementia

    NARCIS (Netherlands)

    van Duinen-van den IJssel, J C L; Appelhof, B; Zwijsen, S A; Smalbrugge, M; Verhey, F R J; de Vugt, M E; Zuidema, S U; Koopmans, R T C M; Bakker, C

    BACKGROUND: Both neuropsychiatric symptoms (NPS) and psychotropic drug use (PDU) are common in institutionalized People with Young Onset Dementia (PwYOD) and can produce negative outcomes such as reduced quality of life and high workload. In community-dwelling PwYOD, NPS are found to be associated

  18. Behavior and Evolution of Young ONset Dementia part 2 (BEYOND-II) study: an intervention study aimed at improvement in the management of neuropsychiatric symptoms in institutionalized people with young onset dementia

    NARCIS (Netherlands)

    Duinen-van den IJssel, J.C.L. van; Appelhof, B.; Zwijsen, S.A.; Smalbrugge, M.; Verhey, F.R.J.; Vugt, M.E. de; Zuidema, S.U.; Koopmans, R.T.C.M.; Bakker, C.

    2018-01-01

    ABSTRACTBackground:Both neuropsychiatric symptoms (NPS) and psychotropic drug use (PDU) are common in institutionalized People with Young Onset Dementia (PwYOD) and can produce negative outcomes such as reduced quality of life and high workload. In community-dwelling PwYOD, NPS are found to be

  19. Management research

    International Nuclear Information System (INIS)

    Berry, M.

    1988-01-01

    The 1988 progress report of the Management Research center (Polytechnic School, France), is presented. The Center research programs include the management of different organizations, such as industry, administrative systems, hospitals and cultural systems. The investigations performed concern the improvement and better knowledge of the new methods of analysis: the role of the speech, the logic conflicts; the crisis development, symptoms and effects; the relationship between the management practices and the prevailing ideas or theories. The approach adopted by the scientists involves the accurate analysis of the essential management activities. The investigations carried out in 1988 are summarized. The published papers, the congress communications and the thesis are listed [fr

  20. Symptom Clusters and Quality of Life in Hospice Patients with Cancer

    Science.gov (United States)

    Omran, Suha; Khader, Yousef; McMillan, Susan

    2017-09-27

    Background: Symptom control is an important part of palliative care and important to achieve optimal quality of life (QOL). Studies have shown that patients with advanced cancer suffer from diverse and often severe physical and psychological symptoms. The aim is to explore the influence of symptom clusters on QOL among patients with advanced cancer. Materials and Methods: 709 patients with advanced cancer were recruited to participate in a clinical trial focusing on symptom management and QOL. Patients were adults newly admitted to hospice home care in one of two hospices in southwest Florida, who could pass mental status screening. The instruments used for data collection were the Demographic Data Form, Memorial Symptom Assessment Scale (MSAS), and the Hospice Quality of Life Index-14. Results: Exploratory factor analysis and multiple regression were used to identify symptom clusters and their influence on QOL. The results revealed that the participants experienced multiple concurrent symptoms. There were four symptom clusters found among these cancer patients. Individual symptom distress scores that were the strongest predictors of QOL were: feeling pain; dry mouth; feeling drowsy; nausea; difficulty swallowing; worrying and feeling nervous. Conclusions: Patients with advanced cancer reported various concurrent symptoms, and these form symptom clusters of four main categories. The four symptoms clusters have a negative influence on patients’ QOL and required specific care from different members of the hospice healthcare team. The results of this study should be used to guide health care providers’ symptom management. Proper attention to symptom clusters should be the basis for accurate planning of effective interventions to manage the symptom clusters experienced by advanced cancer patients. The health care provider needs to plan ahead for these symptoms and manage any concurrent symptoms for successful promotion of their patient’s QOL. Creative Commons

  1. Sleep apnea in patients reporting insomnia or restless legs symptoms.

    Science.gov (United States)

    Bianchi, M T; Goparaju, B; Moro, M

    2016-01-01

    Insomnia and restless legs syndrome (RLS) are defined by self-reported symptoms, and polysomnography (PSG) is not routinely indicated. Occult obstructive sleep apnea (OSA), common even in asymptomatic adults, may complicate management of patients presenting with insomnia or restless legs. To this end, we investigated objective sleep apnea metrics in a large retrospective cohort according to self-reported symptom profiles. We compared sleep apnea findings in patients referred to our center according to self-reported symptoms associated with insomnia, sleep apnea, and restless legs. The cohort included over 1900 adults who underwent diagnostic (n = 1418) or split-night (n = 504) PSGs and completed a symptom and medical history questionnaire. More than 30% of patients who did not endorse any OSA symptoms, but did endorse insomnia or restless legs symptoms, were found to have OSA based on apnea-hypopnea index (AHI) >5 during overnight laboratory testing. Regression models of the full cohort showed that the risk of OSA was related, as expected, to older age, male sex, elevated body mass index, and presence of OSA symptoms. The presence of insomnia symptoms did not alter the risk of OSA. The presence of restless legs symptoms showed a small odds ratio for lowered OSA risk. Objective evidence of OSA occurs similarly in those with insomnia or restless legs symptoms, even among those without self-reported OSA symptoms. Providers should be aware of the potential for occult OSA in populations with insomnia and restless legs, which may complicate their management in addition to presenting an independent medical risk itself. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Musculoskeletal symptoms in pharmaceutical sales representatives.

    Science.gov (United States)

    Sang, Katherine; Gyi, Diane; Haslam, Cheryl

    2010-03-01

    Musculoskeletal disorders (MSDs) are a leading cause of work-related ill health. Existing literature indicates that pharmaceutical sales representatives (PSRs) report a high prevalence of MSDs, possibly exacerbated by the nature of work (prolonged driving and manual handling). In addition, they experience difficulty in accessing occupational health services. To assess the prevalence of musculoskeletal symptoms and associated risk factors among PSRs in order to assist their occupational health management through raising risk awareness. A self-completed questionnaire distributed to 205 PSRs within a UK pharmaceutical company was used to assess the prevalence of musculoskeletal symptoms, psychosocial factors, work tasks undertaken and company car use. To assist understanding of work tasks and organizational factors, semi-structured interviews were undertaken with a sample of 12 key personnel. The questionnaire response rate was 68%. PSRs reported high mileage and 100% reported working from the car in a typical day. Forty-seven per cent reported both manual handling for > or = 4 h/day and 'often' or 'sometimes' working from the car. Fifty-seven per cent reported low back symptoms in the last 12 months. Interview data revealed issues relating to car choice, storage in the boot and working from the car, which should be considered when developing priorities for preventive management of MSDs. Musculoskeletal symptoms appear to be a problem for PSRs, with risk factors reported as prolonged driving, sitting in the car, working from the car and manual handling. Interventions to facilitate their occupational health management should focus on raising awareness of the risks of prolonged driving and working from the car.

  3. Outpatient management of schizophrenia.

    Science.gov (United States)

    Martin, R L

    1991-03-01

    As effective antipsychotic pharmacotherapy has become available, patients with schizophrenia are increasingly managed in an outpatient setting by primary care physicians. Pharmacotherapy is generally effective in treating "positive," or psychotic, symptoms and lessening the risks of relapse, but ineffective in improving "negative," or deficit, symptoms. Aggressive attempts to totally control positive symptoms and to ameliorate negative symptoms tend to increase side effects and may be detrimental to the patient. Intensive psychotherapeutic and rehabilitative approaches are generally unproductive. Attempting to obtain a cure is unrealistic. A moderate approach is recommended, taking into consideration the limitations of existing treatments, achieving control of extreme symptoms and minimizing social and occupational limitations.

  4. Definition and symptoms of underactive bladder.

    Science.gov (United States)

    Uren, Alan D; Drake, Marcus J

    2017-12-01

    Underactive bladder (UAB) is a symptom syndrome reflecting the urodynamic observation of detrusor underactivity (DU), a voiding contraction of reduced strength and/or duration, leading to prolonged or incomplete bladder emptying. An International Continence Society Working Group has described UAB as characterised by a slow urinary stream, hesitancy and straining to void, with or without a feeling of incomplete bladder emptying and dribbling, often with storage symptoms. Since DU often coexists with bladder outlet obstruction, or storage dysfunction (detrusor overactivity or incontinence), the exact contribution of the DU to the presenting complaints can be difficult to establish. The presence of voiding and post voiding lower urinary tract symptoms (LUTS) is implicitly expected in UAB, but a reduced sensation of fullness is reported by some patients, and storage LUTS are also an important factor in many affected patients. These may result from a postvoid residual, but often they do not. The storage LUTS are often the key driver in leading the patient to seek healthcare input. Nocturia is particularly common and bothersome, but what the role of DU is in all the range of influences on nocturia has not been established. Qualitative research has established a broad impact on everyday life as a result of these symptoms. In general, people appear to manage the voiding LUTS relatively well, but the storage LUTS may be problematic.

  5. Prospectively surveying health-related quality of life and symptom relief in a lot-based sample of medical cannabis-using patients in urban Washington State reveals managed chronic illness and debility.

    Science.gov (United States)

    Aggarwal, S K; Carter, G T; Sullivan, M D; Zumbrunnen, C; Morrill, R; Mayer, J D

    2013-09-01

    To characterize health-related quality of life (HRQoL) in medical cannabis patients. Short Form 36 (SF-36) Physical Health Component Score and Mental Health Component Score (MCS) surveys as well has CDC (Centers for Disease Control) HRQoL-14 surveys were completed by 37 qualified patients. Mean SF-36 PCS and MCS, normalized at 50, were 37.4 and 44.2, respectively. Eighty percent of participants reported activity/functional limitations secondary to impairments or health problems. Patients reported using medical cannabis to treat a wide array of symptoms across multiple body systems with relief ratings consistently in the 7-10/10 range. The HRQoL results in this sample of medical cannabis-using patients are comparable with published norms in other chronically ill populations. Data presented provide insight into medical cannabis-using patients' self-rated health, HRQoL, disease incidences, and cannabis-related symptom relief.

  6. Youth Codesign of a Mobile Phone App to Facilitate Self-Monitoring and Management of Mood Symptoms in Young People With Major Depression, Suicidal Ideation, and Self-Harm

    OpenAIRE

    Hetrick, Sarah Elisabeth; Robinson, Jo; Burge, Eloise; Blandon, Ryan; Mobilio, Bianca; Rice, Simon M; Simmons, Magenta B; Alvarez-Jimenez, Mario; Goodrich, Simon; Davey, Christopher G

    2018-01-01

    Background Effective treatment of depression in young people is critical, given its prevalence, impacts, and link to suicide. Clinical practice guidelines point to the need for regular monitoring of depression symptom severity and the emergence of suicidal ideation to track treatment progress and guide intervention delivery. Yet, this is seldom integrated in clinical practice. Objective The objective of this study was to address the gap between guidelines about monitoring and real-world pract...

  7. A hopelessness model of depressive symptoms in youth with epilepsy.

    Science.gov (United States)

    Wagner, Janelle L; Smith, Gigi; Ferguson, Pamela L; Horton, Stephanie; Wilson, Erin

    2009-01-01

    To test the cognitive diathesis-stress and mediational components of the theory of learned hopelessness in youth with epilepsy. Seventy-seven participants ages 9-17 (35 girls, 42 boys) completed measures of depressive symptoms, hopelessness, self-efficacy for seizure management, and attitude toward epilepsy. Caregivers provided information on seizure activity. Diagnostic and treatment information was obtained via medical record review. Regression analyses revealed that hopelessness mediated the attitude towards epilepsy-depressive symptom relationship. While attitude toward epilepsy and self-efficacy were independent predictors of depressive symptoms, the relationship of attitudes toward epilepsy and depressive symptoms was not enhanced with low self-efficacy for seizure management. Findings support the mediation component of the learned hopelessness theory in youth with epilepsy, suggesting the importance of interventions that assist youth in identifying epilepsy-related aspects of functioning over which they can realistically exercise control and challenging negative thoughts about situations they cannot control.

  8. What Are the Symptoms of Endometriosis?

    Science.gov (United States)

    ... Pinterest Email Print What are the symptoms of endometriosis? The primary symptoms of endometriosis are pain and ... symptoms, may cause these endometriosis symptoms to continue. Endometriosis-Related Pain Researchers know that pain is a ...

  9. Symptom rating scale for assessing hyperthyroidism.

    Science.gov (United States)

    Klein, I; Trzepacz, P T; Roberts, M; Levey, G S

    1988-02-01

    A hyperthyroid symptom scale (HSS) was designed and administered to ten subjects with untreated Graves' disease. All subjects had clinical and chemical evidence of hyperthyroidism and reproducible HSS scores of 20 or more points. During sequential treatments with propranolol hydrochloride (phase 2) followed by propylthiouracil (phase 3) there was a significant decline in the HSS scores at each phase. Accompanying the decrease in HSS scores was a decrease in heart rate, but there was no change in thyroid function test results at phase 2 and a decrease in heart rate, thyroid function test results, and goiter size at phase 3. This new scale includes ten categories of symptoms, it is sensitive to changes in both the adrenergic and metabolic components of hyperthyroidism, and it is useful in the clinical assessment and management of patients with thyrotoxicosis.

  10. Patients with persistent medically unexplained physical symptoms

    DEFF Research Database (Denmark)

    A, Aamland; Malterud, Kirsti; Werner, E.

    2014-01-01

    for all variables and split analysis on gender and age. RESULTS: The GPs registered 526 patients among their total of 17 688 consultations, giving a consultation prevalence of persistent MUPS of 3%. The mean age of patients was 46 years, and 399 (76%) were women. The most frequent group of symptoms...... was musculoskeletal problems, followed by asthenia/fatigue. There was no significant gender difference in symptom pattern. Almost half of the patients were currently working (45%), significantly more men. The major GP management strategy was supportive counseling. CONCLUSION: A consultation prevalence rate of 3......% implies that patients with persistent MUPS are common in general practice. Our study disclosed heterogeneity among the patients such as differences in employment status, which emphasizes the importance of personalized focus rather than unsubstantiated stereotyping of "MUPS patients" as a group....

  11. The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3: a randomised trial to determine the efficacy of adding a complex intervention for major depressive disorder (Depression Care for People with Lung Cancer to usual care, compared to usual care alone in patients with lung cancer

    Directory of Open Access Journals (Sweden)

    Sharpe Michael

    2009-09-01

    Full Text Available Abstract Background Depression Care for People with Lung Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3 Trial will test its efficacy when compared to usual care alone. Design A two arm parallel group multi-centre randomised controlled trial. 200 patients will be recruited through established systematic Symptom Monitoring Services, which screen patients for depression. Patients will have: a diagnosis of lung cancer; an estimated life expectancy of three months or more and a diagnosis of Major Depressive Disorder. Patients will be randomised to usual care or usual care plus Depression Care for People with Lung Cancer. Randomisation will be carried out by telephoning a secure computerised central randomisation system or by using a secure web interface. The primary outcome measure is average depression severity. This will be assessed using scores on the 20-item Symptom Hopkins Checklist (SCL-20D, collected every four weeks over 32 weeks. Secondary outcomes include severity of anxiety, pain and fatigue; self-rated improvement of depression; quality of life and satisfaction with depression care. Trial Registration Current controlled trials ISRCTN75905964

  12. Symptom clustering and quality of life in patients with ovarian cancer undergoing chemotherapy.

    Science.gov (United States)

    Nho, Ju-Hee; Reul Kim, Sung; Nam, Joo-Hyun

    2017-10-01

    The symptom clusters in patients with ovarian cancer undergoing chemotherapy have not been well evaluated. We investigated the symptom clusters and effects of symptom clusters on the quality of life of patients with ovarian cancer. We recruited 210 ovarian cancer patients being treated with chemotherapy and used a descriptive cross-sectional study design to collect information on their symptoms. To determine inter-relationships among symptoms, a principal component analysis with varimax rotation was performed based on the patient's symptoms (fatigue, pain, sleep disturbance, chemotherapy-induced peripheral neuropathy, anxiety, depression, and sexual dysfunction). All patients had experienced at least two domains of concurrent symptoms, and there were two types of symptom clusters. The first symptom cluster consisted of anxiety, depression, fatigue, and sleep disturbance symptoms, while the second symptom cluster consisted of pain and chemotherapy-induced peripheral neuropathy symptoms. Our subgroup cluster analysis showed that ovarian cancer patients with higher-scoring symptoms had significantly poorer quality of life in both symptom cluster 1 and 2 subgroups, with subgroup-specific patterns. The symptom clusters were different depending on age, age at disease onset, disease duration, recurrence, and performance status of patients with ovarian cancer. In addition, ovarian cancer patients experienced different symptom clusters according to cancer stage. The current study demonstrated that there is a specific pattern of symptom clusters, and symptom clusters negatively influence the quality of life in patients with ovarian cancer. Identifying symptom clusters of ovarian cancer patients may have clinical implications in improving symptom management. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Frequency of Medically Unexplained Symptoms in Homeopathy References of

    Directory of Open Access Journals (Sweden)

    Yavari M

    2011-06-01

    Full Text Available Background and Objectives: 25-50 percent of all patients who are visited by GPs, have complains that are not medically explained. Their management is a challenge for GPs. In homeopathy (a method of alternative medicine these symptoms are important for selection of remedies and in an effort to treat them. This study aimed at describing this existing situation by investigating the frequency of such complaints in the patients under study.Methods: This study is a cross-sectional study conducted in Isfahan in 2008 on 240 Patients who were visited in some of the clinics affiliated to Isfahan university of medical sciences. The patients were selected by convenient method. Data were gathered by the questionnaire and analyzed via SPSS 13.5 software using Chi-Square test.Results: Out of 240 patients, 150 were women (%65.4 and 90 were men(34.6%. 75.4 percent were 20-40 years old. 1.7 percent had no symptoms, 31.3 had 1-5 symptoms and 40.8 percent had 6-10 symptoms. The females had more symptoms than males. Symptoms of mind, GI, sleep and miscellaneous ones were 81.3, 80.4, 72.1 and 87.1 percent, respectively. The most frequent symptoms in each group were intrusive thought, salivation in sleep, waking frequently and dyspnea wearing tight collared clothes. Only 10.97 percent of patient referred to the physicians for these symptoms.Conclusion: The symptoms registered in homeopathy references have notable prevalence in the society but most of people with such symptoms will not go to a doctor for examination and treatment Therefore, it is very important to carry out more research regarding these symptoms. General population should receive more information and physicians, in turn, should use appropriate methods of therapy for treating these patients.

  14. Post-fundoplication symptoms and complications: Diagnostic approach and treatment.

    Science.gov (United States)

    Sobrino-Cossío, S; Soto-Pérez, J C; Coss-Adame, E; Mateos-Pérez, G; Teramoto Matsubara, O; Tawil, J; Vallejo-Soto, M; Sáez-Ríos, A; Vargas-Romero, J A; Zárate-Guzmán, A M; Galvis-García, E S; Morales-Arámbula, M; Quiroz-Castro, O; Carrasco-Rojas, A; Remes-Troche, J M

    Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  15. Betahistine for symptoms of vertigo

    NARCIS (Netherlands)

    Murdin, Louisa; Hussain, Kiran; Schilder, Anne G M

    2016-01-01

    BACKGROUND: Vertigo is a symptom in which individuals experience a false sensation of movement. This type of dizziness is thought to originate in the inner ear labyrinth or its neural connections. It is a commonly experienced symptom and can cause significant problems with carrying out normal

  16. Menopause. How Exercise Mitigates Symptoms.

    Science.gov (United States)

    Hargarten, Kathleen M.

    1994-01-01

    During menopause and the climacteric, women experience many changes that can affect nearly every organ system and cause psychological symptoms. This article reviews the specific changes and explains how exercise can address each symptom; outlines a practical approach physicians can use to help menopausal patients improve their quality of life. (SM)

  17. Impact of ADHD symptoms on autism spectrum disorder symptom severity.

    Science.gov (United States)

    Sprenger, Linda; Bühler, Eva; Poustka, Luise; Bach, Christiane; Heinzel-Gutenbrunner, Monika; Kamp-Becker, Inge; Bachmann, Christian

    2013-10-01

    Despite the official exclusion criteria for autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) in the DSM-IV and ICD-10, patients with ASD often show ADHD symptoms. We aimed to examine the potential influence of ADHD symptoms on autistic psychopathology in a large sample of patients with ASD. We tested the hypothesis that patients with ASD and an additional ADHD (ASD+) would show a higher severity of autistic symptoms than those with ASD only (ASD-). We measured autistic symptoms using the autism diagnostic observation schedule (ADOS-G), the autism diagnostic interview (ADI-R), and the social responsiveness scale (SRS). To measure overall psychopathology and ADHD symptoms, we used the child behavior checklist (CBCL) and the ADHD rating scale (FBB-ADHS), respectively. Group differences between the ASD+ and the ASD- group (group division was conducted according to the results of the FBB-ADHS) were calculated using a univariate analysis of variance (ANOVA). The ASD+ group showed a greater severity of autistic symptoms than the ASD- group, measured by the SRS and the ADI-R. Especially in the social interaction subscale (ADI-R), a significantly higher symptom severity was found in the ASD+ group. No significant group differences were found regarding autistic symptoms measured by the ADOS-G. Patients with ASD and an additional ADHD expressed a stronger severity of autistic symptoms than patients with ASD only. According to our results, the possibility of a co-diagnosis of ADS and ADHD, as is being planned in the DSM-5, is in line with earlier studies, is highly reasonable, will simplify research, and have therapeutic implications. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Neuropathic sensory symptoms: association with pain and psychological factors

    Directory of Open Access Journals (Sweden)

    Shaygan M

    2014-05-01

    Full Text Available Maryam Shaygan,1 Andreas Böger,2 Birgit Kröner-Herwig11Department of Clinical Psychology and Psychotherapy, University of Göttingen, Germany; 2Pain Management Clinic at the Red Cross Hospital, Kassel, GermanyBackground: A large number of population-based studies of chronic pain have considered neuropathic sensory symptoms to be associated with a high level of pain intensity and negative affectivity. The present study examines the question of whether this association previously found in non-selected samples of chronic pain patients can also be found in chronic pain patients with underlying pathology of neuropathic sensory symptoms.Methods: Neuropathic sensory symptoms in 306 patients with chronic pain diagnosed as typical neuropathic pain, radiculopathy, fibromyalgia, or nociceptive back pain were assessed using the Pain DETECT Questionnaire. Two separate cluster analyses were performed to identify subgroups of patients with different levels of self-reported neuropathic sensory symptoms and, furthermore, to identify subgroups of patients with distinct patterns of neuropathic sensory symptoms (adjusted for individual response bias regarding specific symptoms.Results: ANOVA (analysis of variance results in typical neuropathic pain, radiculopathy, and fibromyalgia showed no significant differences between the three levels of neuropathic sensory symptoms regarding pain intensity, pain chronicity, pain catastrophizing, pain acceptance, and depressive symptoms. However, in nociceptive back pain patients, significant differences were found for all variables except pain chronicity. When controlling for the response bias of patients in ratings of symptoms, none of the patterns of neuropathic sensory symptoms were associated with pain and psychological factors.Conclusion: Neuropathic sensory symptoms are not closely associated with higher levels of pain intensity and cognitive-emotional evaluations in chronic pain patients with underlying pathology of

  19. Role of radiation therapy in the management of ocular reticulum cell sarcoma

    International Nuclear Information System (INIS)

    Margolis, L.; Fraser, R.; Lichter, A.; Char, D.H.

    1980-01-01

    Nine patients with ocular lymphomas were seen in the Department of Ophthalmology and the Division of Radiation Oncology at UCSF and Ralph K. Davies Medical Center, San Francisco, from 1968 through 1974. Six of the 9 patients had visual symptoms as the first manifestation of their disease. Eight of the 9 patients developed intracranial lymphoma at some time during the course of the disease. Despite lymphoma work-up including bone marrow biopsies and lymphangiogram, only 1 patient was found to have documented systemic involvement. The diagnosis of ocular lymphoma was based on pathologic material from the eye in 5 cases or from central nervous system biopsy in 4 patients in association with tumor cell infiltrates in the retina and vitreous clouding. Radiation therapy to the eyes improved vision in 10 of 13 eyes treated in 8 patients. The usual dose was in the range of 3500 to 4500 rads given over 4 to 5 weeks. In addition, 7 patients received central nervous system irradiation. Review of the literature reinforced the findings of this series showing the frequent association of ocular lymphoma with intracranial lymphoma and the rare systemic dissemination. This disease process has previously been referred to as ocular reticulum cell sarcoma

  20. The PHQ-12 Somatic Symptom scale as a predictor of symptom severity and consulting behaviour in patients with irritable bowel syndrome and symptomatic diverticular disease

    OpenAIRE

    Spiller , Robin; Humes , David; Campbell , Eugene; Hastings , Margaret; Neal , Keith; Dukes , George; Whorwell , Peter

    2010-01-01

    Abstract BACKGROUND Anxiety, depression and non-gastrointestinal symptoms are often prominent in IBS but their relative value in patient management has not been quantitatively assessed. We modified the Patient Health Questionnaire 15 (PHQ-15) by excluding the 3 gastrointestinal items to create the PHQ-12 Somatic Symptom scale (PHQ-12 SS). AIMS To compare the value of the PHQ-12 SS scale to the Hospital Anxiety and Depression (HAD) scale in predicting symptoms and patient beha...

  1. Completion of Multidisciplinary Treatment for Persistent Postconcussive Symptoms Is Associated With Reduced Symptom Burden.

    Science.gov (United States)

    Janak, Jud C; Cooper, Douglas B; Bowles, Amy O; Alamgir, Abul H; Cooper, Sharon P; Gabriel, Kelley P; Pérez, Adriana; Orman, Jean A

    To investigate the pre- to posttreatment changes in both posttraumatic stress disorder (PTSD) and persistent postconcussive symptoms (PPCSs). We studied 257 active-duty patients with a history of mild traumatic brain injury (mTBI) who completed multidisciplinary outpatient treatment at Brooke Army Medical Center TBI Clinic from 2008 to 2013. This treatment program included cognitive rehabilitation; vestibular interventions; headache management; and integrated behavioral healthcare to address co-occurring psychiatric conditions such as PTSD, depression, and sleep disturbance. A 1-group; preexperimental, pre- to posttreatment study. The Neurobehavioral Symptom Inventory (NSI) was used to assess PPCSs, and the PTSD Checklist-Military Version (PCL-M) was used to asses PTSD symptoms. Global PPCS resolution (mean NSI: 35.0 pre vs 23.8 post; P < .0001; d = 0.72) and PTSD symptom resolution (mean PCL-M: 43.2 pre vs 37.7 post; P < .0001; d = 0.34) were statistically significant. Compared with those with only mTBI, patients with mTBI and PTSD reported greater global PPCS impairment both pretreatment (mean NSI: 48.7 vs 27.9; P < .0001) and posttreatment (mean NSI: 36.2 vs 17.4; P < .0001). After adjusting for pretreatment NSI scores, patients with comorbid PTSD reported poorer PPCS resolution than those with mTBI alone (mean NSI: 27.9 pre vs 21.7 post; P = .0009). We found a reduction in both self-reported PPCSs and PTSD symptoms; however, future studies are needed to identify specific components of care associated with symptom reduction.

  2. Creutzfeldt-Jakob Disease and Psychiatric Symptoms

    Directory of Open Access Journals (Sweden)

    Soner Cakmak

    2013-08-01

    Full Text Available Creutzfeldt-Jakob disease is a rapidly progressive, degenerative slow virus infection disease of central nervous system. Based on etiologic origins, four different Creutzfeldt-Jakob disease subtypes have been identified: sporadic, genetic, iatrogenic and variant. The clinical course generally begin with apathy, irritability, behavioral changes, speech problems, memory deterioration, rapidly progresses and concludes with death over a period of 3-12 months. Symptoms are observed secondary to brain cortex, cerebellum, corticospinal tracts, spinal anterior horn cells and basal ganglia damage. Unusual (%5-10 cases can survive up to 2 years. The initial symptoms of disease can be sudden which resultsin adjustment problems leading patients to seek psychiatric help. Patients could receive different diagnosis such as psychosis, depression with psychotic features, and treatments at this stages. Early diagnosis is crucial because of management of the disease and treatment approaches. In this article diagnosis and clinical features of Creutzfeldt-Jakob Disease and related psychiatric symptoms have been briefly reviewed. [Archives Medical Review Journal 2013; 22(4.000: 631-643

  3. ''Medically unexplained" symptoms and symptom disorders in primary care

    DEFF Research Database (Denmark)

    Rosendal, Marianne; Hartman, Tim C. Olde; Aamland, Aase

    2017-01-01

    that better supports clinical decision-making, creates clearer communication and provides scientific underpinning of research to ensure effective interventions. Discussion: We propose a classification of symptoms that places greater emphasis on prognostic factors. Prognosis-based classification aims...

  4. Sildenafil citrate in combination with tamsulosin versus tamsulosin monotherapy for management of male lower urinary tract symptoms due to benign prostatic hyperplasia: A randomised, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Fawzi, Amr; Kamel, Mostafa; Salem, Emad; Desoky, Esam; Omran, Mohamed; Elgalaly, Hazem; Sakr, Ahmed; Maarouf, Aref; Khalil, Salem

    2017-03-01

    To assess the additive effect of sildenafil citrate to tamsulosin in the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) in men with or without erectile dysfunction (ED). In all, 150 men with untreated LUTS/BPH with or without ED were randomised to receive sildenafil 25 mg once daily (OD) or placebo OD (night time) combined with tamsulosin 0.4 mg OD (day time) for 6 months. Changes from pre-treatment scores in International Prostate Symptom Score (IPSS), IPSS-quality of life (QoL) score, maximum urinary flow rate ( Q max ), and the five-item version of the International Index of Erectile Function questionnaire (IIEF-5) were assessed at 3 and 6 months. Safety profiles were assessed by physical examination and monitoring clinical adverse events. Group A comprised of men who received tamsulosin and sildenafil (75 men), whilst those in Group B received tamsulosin and placebo (75). The IPSS was significantly improved in Group A compared to Group B, at -29.3% vs -13.7% ( P  = 0.039) at 3 months and -37% vs -19.6% ( P  = 0.043) at 6 months after treatment. Q max significantly improved in both groups compared with before treatment ( P  tamsulosin improved LUTS, erectile function, and patient QoL more than tamsulosin monotherapy with the merit of a comparable safety profile in patients with LUTS/BPH.

  5. Immediate effects of the Fukushima nuclear power plant disaster on depressive symptoms among mothers with infants: a prefectural-wide cross-sectional study from the Fukushima Health Management Survey.

    Science.gov (United States)

    Goto, Aya; Bromet, Evelyn J; Fujimori, Kenya

    2015-03-26

    Mothers of young children are at high-risk for developing adverse mental health effects following a nuclear accident. Using the Japanese pregnancy registration system, the prefecture of Fukushima launched a population-based survey of women who were pregnant at the time of the Fukushima nuclear accident in order to assess their and their newborns' health. In this paper, we focus on the results of a screen for depressive symptoms among new mothers and its association with geographical region and interruption of obstetrical care after the Fukushima nuclear accident, which occurred after the Great East Japan Earthquake on March 11, 2011. The survey targeted women who lived in Fukushima prefecture and who had registered their pregnancies between August 1, 2010 and July 31, 2011. Among the 16,001 women targeted, 9,321 returned the questionnaires (response proportion = 58.3%) and data from 8,196 women with singleton live births were analyzed. The main outcome measure was a standard two-item depression screen. Regional radiation levels were determined from the prefecture's periodical reports, and interruption in obstetrical care after the Fukushima nuclear accident was determined from mothers' individual responses to the questionnaire. Among the 8,196 women, 2,262 (28%) screened positive for depressive symptoms. After adjusting for maternal and infant characteristics, both mothers in Soso, the region in which the nuclear power plant is located, and mothers that had changed obstetrical care facilities were significantly more likely to screen positive for depression. In contrast, mothers in Iwaki and Aizu, regions with relatively low radiation levels, were significantly less likely to screen positive for depression. Our findings suggest that improving mental health support for mothers with infants should be a high priority in the acute phase of nuclear disaster response. We further recommend that in the strategic provisioning of parental support, close attention should

  6. Post-traumatic stress disorder symptoms may explain poor mental health in patients with fibromyalgia.

    Science.gov (United States)

    Toussaint, Loren L; Whipple, Mary O; Vincent, Ann

    2017-05-01

    Symptoms of post-traumatic stress disorder are common in fibromyalgia patients. This study compared post-traumatic stress disorder symptoms in fibromyalgia patients and healthy controls and determined whether patient-control differences in post-traumatic stress disorder symptoms mediated differences in mental health. In all, 30 patients and 30 healthy controls completed questionnaires assessing symptoms of post-traumatic stress disorder and mental health. Fibromyalgia patients had greater symptoms of post-traumatic stress disorder and mental health than controls. Patient-control differences in mental health symptoms were fully or partially mediated by differences in post-traumatic stress disorder symptoms. Healthcare providers should understand the role of trauma as management of trauma symptoms may be one strategy for improving mental health.

  7. [Negative symptoms, emotion and cognition in schizophrenia].

    Science.gov (United States)

    Fakra, E; Belzeaux, R; Azorin, J-M; Adida, M

    2015-12-01

    For a long time, treatment of schizophrenia has been essentially focussed on positive symptoms managing. Yet, even if these symptoms are the most noticeable, negative symptoms are more enduring, resistant to pharmacological treatment and associated with a worse prognosis. In the two last decades, attention has shift towards cognitive deficit, as this deficit is most robustly associated to functional outcome. But it appears that the modest improvement in cognition, obtained in schizophrenia through pharmacological treatment or, more purposely, by cognitive enhancement therapy, has only lead to limited amelioration of functional outcome. Authors have claimed that pure cognitive processes, such as those evaluated and trained in lots of these programs, may be too distant from real-life conditions, as the latter are largely based on social interactions. Consequently, the field of social cognition, at the interface of cognition and emotion, has emerged. In a first part of this article we examined the links, in schizophrenia, between negative symptoms, cognition and emotions from a therapeutic standpoint. Nonetheless, investigation of emotion in schizophrenia may also hold relevant premises for understanding the physiopathology of this disorder. In a second part, we propose to illustrate this research by relying on the heuristic value of an elementary marker of social cognition, facial affect recognition. Facial affect recognition has been repeatedly reported to be impaired in schizophrenia and some authors have argued that this deficit could constitute an endophenotype of the illness. We here examined how facial affect processing has been used to explore broader emotion dysfunction in schizophrenia, through behavioural and imaging studies. In particular, fMRI paradigms using facial affect have shown particular patterns of amygdala engagement in schizophrenia, suggesting an intact potential to elicit the limbic system which may however not be advantageous. Finally, we

  8. Symptoms and side effects in chronic non-cancer pain: patient report vs. systematic assessment

    DEFF Research Database (Denmark)

    Jonsson, Torsten; Christrup, Lona Louring; Højsted, J

    2011-01-01

    relieving distressing symptoms and managing the side effects of analgesics are essential in order to improve quality of life and functional capacity in chronic non-cancer pain patients. A quick, reliable and valid tool for assessing symptoms and side effects is needed in order to optimize treatment....... We aimed to investigate the symptoms reported by chronic non-cancer pain patients after open-ended questioning vs. a systematic assessment using a list of symptoms, and to assess whether the patients could distinguish between the symptoms and the side effects induced by analgesics....

  9. Symptoms and side effects in chronic non-cancer pain:patient report vs. systematic assessment

    DEFF Research Database (Denmark)

    Jonsson, Torsten; Christrup, Lona Louring; Højsted, Jette

    2011-01-01

    relieving distressing symptoms and managing the side effects of analgesics are essential in order to improve quality of life and functional capacity in chronic non-cancer pain patients. A quick, reliable and valid tool for assessing symptoms and side effects is needed in order to optimize treatment....... We aimed to investigate the symptoms reported by chronic non-cancer pain patients after open-ended questioning vs. a systematic assessment using a list of symptoms, and to assess whether the patients could distinguish between the symptoms and the side effects induced by analgesics....

  10. The Role of Inflammation in the Pain, Fatigue, and Sleep Disturbance Symptom Cluster in Advanced Cancer.

    Science.gov (United States)

    Kwekkeboom, Kristine L; Tostrud, Lauren; Costanzo, Erin; Coe, Christopher L; Serlin, Ronald C; Ward, Sandra E; Zhang, Yingzi

    2018-05-01

    Symptom researchers have proposed a model of inflammatory cytokine activity and dysregulation in cancer to explain co-occurring symptoms including pain, fatigue, and sleep disturbance. We tested the hypothesis that psychological stress accentuates inflammation and that stress and inflammation contribute to one's experience of the pain, fatigue, and sleep disturbance symptom cluster (symptom cluster severity, symptom cluster distress) and its impact (symptom cluster interference with daily life, quality of life). We used baseline data from a symptom cluster management trial. Adult participants (N = 158) receiving chemotherapy for advanced cancer reported pain, fatigue, and sleep disturbance on enrollment. Before intervention, participants completed measures of demographics, perceived stress, symptom cluster severity, symptom cluster distress, symptom cluster interference with daily life, and quality of life and provided a blood sample for four inflammatory biomarkers (interleukin-1β, interleukin-6, tumor necrosis factor-α, and C-reactive protein). Stress was not directly related to any inflammatory biomarker. Stress and tumor necrosis factor-α were positively related to symptom cluster distress, although not symptom cluster severity. Tumor necrosis factor-α was indirectly related to symptom cluster interference with daily life, through its effect on symptom cluster distress. Stress was positively associated with symptom cluster interference with daily life and inversely with quality of life. Stress also had indirect effects on symptom cluster interference with daily life, through its effect on symptom cluster distress. The proposed inflammatory model of symptoms was partially supported. Investigators should test interventions that target stress as a contributing factor in co-occurring pain, fatigue, and sleep disturbance and explore other factors that may influence inflammatory biomarker levels within the context of an advanced cancer diagnosis and treatment

  11. Statin-associated muscle symptoms: impact on statin therapy

    DEFF Research Database (Denmark)

    Stroes, Erik S; Thompson, Paul D; Corsini, Alberto

    2015-01-01

    degradation, thereby providing a potential link between statins and muscle symptoms; controlled mechanistic and genetic studies in humans are necessary to further understanding. The Panel proposes to identify SAMS by symptoms typical of statin myalgia (i.e. muscle pain or aching) and their temporal......Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of statin......-associated myopathy, and provides guidance for diagnosis and management of SAMS. Statin-associated myopathy, with significant elevation of serum creatine kinase (CK), is a rare but serious side effect of statins, affecting 1 per 1000 to 1 per 10 000 people on standard statin doses. Statin-associated muscle symptoms...

  12. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... Information Health Information Home Mental Health Information Statistics Consumer Health Publications Help for Mental Illnesses Clinical Trials ... Symptoms and Treatment of Depression February 1, 2010 People with depression discuss how they got help. & ...

  13. Heart Attack Symptoms in Women

    Science.gov (United States)

    ... fat, cholesterol and other substances (plaque). Watch an animation of a heart attack . Many women think the ... Support Network Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

  14. Understanding ADHD: Symptoms in Children

    Science.gov (United States)

    ... this page please turn JavaScript on. Feature: Understanding ADHD Symptoms In Children Past Issues / Spring 2014 Table ... hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be ...

  15. Neuropsychiatric symptoms and celiac disease.

    Science.gov (United States)

    Urban-Kowalczyk, Małgorzata; OEmigielski, Janusz; Gmitrowicz, Agnieszka

    2014-01-01

    Neuropsychiatric symptoms may represent an atypical manifestation of celiac disease that occur before a gastroenterological diagnosis is made. Some studies suggest that a gluten-free diet is effective in treating the depression, anxiety, and neurological complications associated with celiac disease. The article describes the case of a patient suffering from chronic, treatment-resistant symptoms of depression and anxiety. The diagnosis of celiac disease and introduction of an elimination diet caused a significant improvement in mental state and everyday functioning in the presenting patient. The presence of persistent anxiety and depressive symptoms, with a poor reaction to pharmacological treatment, indicates a need to identify somatic reasons for the underlying condition. It is important to remember that celiac disease can occur at any age, not only in childhood. The presence of this somatic cause of persistent depressive and anxiety symptoms should be considered in the diagnostic process in adults.

  16. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... give up. Read more about depression on this Web page. If the symptoms fit, get help now. ... Contact Us U.S. Department of Health and Human Services National Institutes of Health USA.gov The National ...

  17. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... Symptoms and Treatment of Depression February 1, 2010 People with depression discuss how they got help. & ... I felt like I was such an awful person that there was no real reason for me ...

  18. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... for Mental Illnesses Clinical Trials Outreach Outreach Home Stakeholder Engagement Outreach Partnership Program Alliance for Research Progress ... Symptoms can vary, but many depressed people lose interest in activities they normally enjoyed, have feelings of ...

  19. Symptoms of Lewy Body Dementia

    Science.gov (United States)

    ... the fight against LBD! Donate Symptoms Lewy body dementia (LBD) has variable presentations that include cognitive difficulties ... wake cycle alterations. Cognitive impairment in Lewy body dementia (LBD) is often misdiagnosed as Alzheimer’s disease (AD). ...

  20. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... a serious illness that affects many people. Symptoms can vary, but many depressed people lose interest in ... lot of weight. NARRATOR : A person with depression can feel irritable and restless, and have sleep problems. ...

  1. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... items) Training (1 item) Other Treatments (15 items) Alzheimer’s Disease (2 items) Coping with Traumatic Events (3 items) Institute Announcements (24 items) Symptoms and Treatment of Depression February 1, 2010 People with depression discuss how ...

  2. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... give up. Read more about depression on this Web page. If the symptoms fit, get help now. Share ... Research Portfolio Online Reporting Tool Expenditures and Results Recommendations for Reporting on Suicide ...

  3. Hearing Loss: Symptoms, Diagnosis & Treatment

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Hearing Loss Symptoms, Devices, Prevention & Research Past Issues / Spring ... a disease. It can accompany any type of hearing loss. It can be a side effect of ...

  4. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... a minute really to do anything that took deep concentration. I tried a journal and I tried ... give up. Read more about depression on this Web page. If the symptoms fit, get help now. ...

  5. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... few days. It is a serious illness that affects many people. Symptoms can vary, but many depressed ... suffer from depression trying to learn why it affects some people but not others. Treatments for depression ...

  6. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... 3 items) Institute Announcements (24 items) Symptoms and Treatment of Depression February 1, 2010 People with depression ... why it affects some people but not others. Treatments for depression do work. One type of effective ...

  7. Hope, Symptoms, and Palliative Care.

    Science.gov (United States)

    Davis, Mellar P; Lagman, Ruth; Parala, Armida; Patel, Chirag; Sanford, Tanya; Fielding, Flannery; Brumbaugh, Anita; Gross, James; Rao, Archana; Majeed, Sumreen; Shinde, Shivani; Rybicki, Lisa A

    2017-04-01

    Hope is important to patients with cancer. Identifying factors that influence hope is important. Anxiety, depression, fatigue, and pain are reported to impair hope. The objective of this study was to determine whether age, gender, marital status, duration of cancer, symptoms, or symptom burden measured by the sum of severity scores on the Edmonton Symptom Assessment Scale (ESAS) correlated with hope measured by the Herth Hope Index (HHI). Patients with advanced cancer in a palliative care unit participated. Demographics including age, gender, marital status, cancer site, and duration of cancer were collected. Individuals completed the ESAS and HHI. Spearman correlation and linear regression were used to assess associations adjusting for gender (male vs female), age ( 12 months). One hundred and ninety-seven were participated in the study, of which 55% were female with a mean age of 61 years (standard deviation 11). Hope was not associated with gender, age, marital status, or duration of cancer. In univariable analysis, hope inversely correlated with ESAS score (-0.28), lack of appetite (-0.22), shortness of breath (-0.17), depression (-0.39), anxiety (-0.32), and lack of well-being (-0.33); only depression was clinically relevant. In multivariable analysis, total symptom burden weakly correlated with hope; only depression remained clinically significant. This study found correlation between symptom burden and hope was not clinically relevant but was so for depression. Among 9 ESAS symptoms, only depression had a clinically relevant correlation with hope.

  8. Adenomyosis and urinary system symptoms.

    Science.gov (United States)

    Aydin, Gultekin Adanas; Yavuz, Arzu

    2018-05-01

    This study aims to investigate the presence and incidence of overactive bladder (OAB) syndrome in patients diagnosed with adenomyosis and to evaluate the impacts of urinary symptoms on the quality of life of the patients. A total of 108 individuals including 50 patients with adenomyosis and 58 controls who were admitted to the Obstetrics and Gynecology Department of Bursa, Cekirge State Hospital and Derince Training and Research Hospital between April 2015 and December 2015 were included. The Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were used to evaluate symptoms. Irritative urinary symptoms such as nocturia and frequency were seen more frequently in the adenomyosis group (p = 0.001 and p = 0.035). Overactive bladder symptoms were more common in the adenomyosis group (p = 0.0001). Our study showed that symptoms of urinary tract symptoms are common in patients with adenomyosis, which adversely affect the quality of life. Copyright © 2018 Elsevier B.V. All rights reserved.

  9. Vasomotor Symptoms Monitoring with a Commercial Activity Tracking Watch

    Science.gov (United States)

    2017-12-31

    Endocrinology and management. The Journal of Steroid Biochemistry and Molecular Biology 142, 121‐131, doi:http...dx.doi.org/10.1016/j.jsbmb.2013.08.015 (2014). 3 Freedman, R. R. Menopausal hot flashes: Mechanisms, endocrinology , treatment. The Journal of Steroid...8986.2008.00770.x (2009). 7 Santoro, N., Epperson, C. N. & Mathews, S. B. Menopausal Symptoms and Their Management. Endocrinology and Metabolism

  10. Effects of web-based interventions on cancer patients' symptoms: review of randomized trials.

    Science.gov (United States)

    Fridriksdottir, N; Gunnarsdottir, S; Zoëga, S; Ingadottir, B; Hafsteinsdottir, E J G

    2018-02-01

    Symptom management is of high priority in cancer care. Information and communication technology allows interventions to be provided through the internet to enhance the delivery of care. This study aimed to review the effects of web-based interventions on cancer patients' symptoms. MEDLINE, PSychINFO, PubMed, CINAHL, and Cochrane databases were systematically searched. Included were randomized controlled trials (RCTs), pilot RCTs, or quasi-experimental (QE) studies focusing on web-based interventions in adult cancer patients with at least one outcome primary or secondary, in terms of symptoms, treatment side effects, or distress. Data were analyzed study by study. Twenty studies were identified. All web interventions included information, 16 included self-management support, 14 included self-monitoring, 13 included feedback/tailored information, 12 used communication with health-care professionals, and eight used communication with other patients. Overall, 13 studies reported positive symptom outcomes. Psychological distress was reported in eight studies with positive intervention effects in three. Symptoms of anxiety/depression were reported in ten studies with positive intervention effects in five. Somatic symptom severity was reported in ten studies with intervention effects found in six, and symptom distress was reported in six studies with intervention effects found in all. This review shows the promising potential of web-based interventions for cancer symptom management, although it was limited by considerable heterogeneity in the interventions tested and targeted outcomes. The multidimensional nature of symptoms was partly addressed; only one study was guided by a comprehensive theoretical model of cancer symptom management. It can only be speculated which web elements are important for effective symptom outcomes. Further testing is needed for web-based cancer symptom management.

  11. Daytime napping associated with increased symptom severity in fibromyalgia syndrome

    NARCIS (Netherlands)

    Theadom, Alice; Cropley, Mark; Kantermann, Thomas

    2015-01-01

    Background: Previous qualitative research has revealed that people with fibromyalgia use daytime napping as a coping strategy for managing symptoms against clinical advice. Yet there is no evidence to suggest whether daytime napping is beneficial or detrimental for people with fibromyalgia. The

  12. Hyponatraemia as the cause of severe cerebral symptoms

    DEFF Research Database (Denmark)

    Sonne, David P; Overgaard-Steensen, Christian

    2013-01-01

    to increase the plasma [Na+]/reveal the symptoms and 2) coma treated successfully with infusions of hypertonic saline boluses. Effective treatment is simple and involves management of airway, breathing and circulation together with bolus infusions of hypertonic saline to ensure controllable plasma [Na...

  13. Knowledge, attitudes and Practices of mothers on symptoms and ...

    African Journals Online (AJOL)

    of integrated management of childhood Illnesses (IMcI) strategy at ... Assessment of mothers' knowledge, attitude and practices on symptoms and signs of IMCI strategy addressed ... improvements in family and community practices ... organisms (germs) and absence of water however .... in Hidalgo, Mexico, PhD Thesis.

  14. Prevalence of physical symptoms of itch, pain and fatigue in patients with skin diseases in general practice.

    NARCIS (Netherlands)

    Verhoeven, E.W.M.; Kraaimaat, F.W.; Kerkhof, P.C.M. van de; Weel, C. van; Duller, P.; Valk, P.G.M. van der; Hoogen, H.J.M. van den; Bor, J.H.J.; Schers, H.J.; Evers, A.W.M.

    2007-01-01

    BACKGROUND: Physical symptoms of skin diseases have been shown to negatively affect patients' wellbeing. Although insight into physical symptoms accompanying skin diseases is relevant for the management and treatment of skin diseases, the prevalence of physical symptoms among patients with skin

  15. Symptoms, Diagnosis and Treatment of Pneumonia

    Science.gov (United States)

    ... Lung Health and Diseases > Lung Disease Lookup > Pneumonia Pneumonia Symptoms, Causes, and Risk Factors Anyone can get ... risk for pneumonia. What Are the Symptoms of Pneumonia? Pneumonia symptoms can vary from mild to severe, ...

  16. What Are the Symptoms of Turner Syndrome?

    Science.gov (United States)

    ... Pinterest Email Print What are the symptoms of Turner syndrome? Turner syndrome causes a variety of symptoms in girls and ... some people, symptoms are mild, but for others, Turner syndrome can cause serious health problems. In general, women ...

  17. Orchid: a novel management, annotation and machine learning framework for analyzing cancer mutations.

    Science.gov (United States)

    Cario, Clinton L; Witte, John S

    2018-03-15

    As whole-genome tumor sequence and biological annotation datasets grow in size, number and content, there is an increasing basic science and clinical need for efficient and accurate data management and analysis software. With the emergence of increasingly sophisticated data stores, execution environments and machine learning algorithms, there is also a need for the integration of functionality across frameworks. We present orchid, a python based software package for the management, annotation and machine learning of cancer mutations. Building on technologies of parallel workflow execution, in-memory database storage and machine learning analytics, orchid efficiently handles millions of mutations and hundreds of features in an easy-to-use manner. We describe the implementation of orchid and demonstrate its ability to distinguish tissue of origin in 12 tumor types based on 339 features using a random forest classifier. Orchid and our annotated tumor mutation database are freely available at https://github.com/wittelab/orchid. Software is implemented in python 2.7, and makes use of MySQL or MemSQL databases. Groovy 2.4.5 is optionally required for parallel workflow execution. JWitte@ucsf.edu. Supplementary data are available at Bioinformatics online.

  18. Stability and Priority of Symptoms and Symptom Clusters Among Allogeneic HSCT Patients Within a 5-Year Longitudinal Study

    DEFF Research Database (Denmark)

    Esser, Peter; Kuba, Katharina; Scherwath, Angela

    2017-01-01

    loading on the same factor across all time points. Priority in symptom management was derived from a combination of severity and predictive power for quality of life (QoL). RESULTS: Two hundred thirty-nine patients participated at T0, 150 (63%) at T1, 102 (43%) at T2, and 45 (19%) at T3. We identified...

  19. Retrospective application of Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure criteria for the remote management of patients with cardiac resynchronisation therapy.

    Science.gov (United States)

    Brasca, Francesco Ma; Franzetti, Jessica; Rella, Valeria; Malfatto, Gabriella; Brambilla, Roberto; Facchini, Mario; Parati, Gianfranco; Perego, Giovanni B

    2017-05-01

    Aim The Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure (PARTNERS HF) trial elaborated a multiparametric model for prediction of acute decompensation in advanced heart failure patients, based on periodical in office data download from cardiac resynchronisation devices. In this study, we evaluated the ability of the PARTNERS HF criteria to detect initial decompensation in a population of moderate heart failure patients under remote monitoring. Methods We retrospectively applied the PARTNERS HF criteria to 1860 transmissions from 104 patients (median follow up 21 months; range 1-67 months), who were enrolled in our programme of telemedicine after cardiac resynchronisation therapy. We tested the ability of a score based on these criteria to predict any acute clinical decompensation occurring in the 15 days following a transmission. Results In 441 cases, acute heart failure was diagnosed after the index transmission. The area under the curve (AUC) of the score for the diagnosis of acute decompensation was 0.752 (confidence interval (CI) 95% 0.728-0.777). The best score cut-off was consistent with the results of PARTNERS HF: with a score ≥2, sensitivity was 75% and specificity 68%. The odds ratio for events was 6.24 (CI 95% 4.90-7.95; p < 0.001). Conclusions When retrospectively applied to remote monitoring transmissions and arranged in a score, PARTNERS HF criteria could identify HF patients who subsequently developed acute decompensation. These results warrant prospective studies applying PARTNERS HF criteria to remote monitoring.

  20. The resource utilisation of medically unexplained physical symptoms

    Directory of Open Access Journals (Sweden)

    Kimberley Lee

    2016-08-01

    Full Text Available Objectives: As patients with medically unexplained physical symptoms may present frequently to hospital settings and receive potentially unnecessary investigations and treatments, we aimed to assess the frequency and type of medically unexplained physical symptoms presentations to clinical services and estimate the associated direct healthcare costs. Methods: This study was undertaken at the largest district health board in New Zealand. All patients with a diagnosed presentation of medically unexplained physical symptoms in 2013 were identified using the district health board’s clinical coding system. The clinical records (medical and psychiatric of 49 patients were examined in detail to extricate all medically unexplained physical symptoms–related secondary care activity within 6 months before or after their medically unexplained physical symptoms presentation. Standardised national costing methodology was used to calculate the associated healthcare costs. Results: In all, 49% of patients attended hospital settings at least twice during 2013. The majority of presentations were for neurological or respiratory concerns. The total cost for the sample was GBP89,636 (median: GBP1,221. Costs were most significant in the areas of inpatient admissions and emergency care. Conclusion: Medically unexplained physical symptoms result in frequent presentations to hospital settings. The costs incurred are substantial and comparable to the costs of chronic medical conditions with identifiable pathology. Improving recognition and management of medically unexplained physical symptoms has potential to offer more appropriate and cost-effective healthcare outcomes.

  1. The effect of soy intake on menopausal symptoms

    Directory of Open Access Journals (Sweden)

    Andrea Pérez-Rovira

    2014-05-01

    Full Text Available The menopause is characterized by a reduction in ovarian function and estrogen production. Altogether, these changes together lead to a series of disorders that may affect the woman’s life style. Currently, medicine, influenced by the pharmaceutical industry, is prone to act aggressively against any symptoms, resulting in. polymedicated population. Doctors usually prescribe treatments such as hormone replacement therapy (HRT, to help them manage menopause symptoms. However, recently, several studies have reported adverse effects associated with this treatment. The influence of diet on several chronic diseases in western societies is currently well known. Therefore, dietary therapies, including dietary soy and isoflavone supplements, have been proposed for the reduction of menopause symptoms. Several published studies have suggested isoflavones, which have a great estrogenic power, as an HRT alternative for the relief of menopause symptoms. However, our current understanding on the effects of isoflavone supplements on the menopause symptoms is limited, and scientific publications show heterogenous results. Due to those arguments, the objective of this review is to address some of the mechanisms of isoflavones and their role in the menopausal period, postulating that, as food supplements, they could be used as a complementary therapy for menopause symptoms.

  2. Symptoms Experienced and Information Needs of Women Receiving Chemotherapy.

    Science.gov (United States)

    Uysal, Neşe; Toprak, Filiz Ünal; Kutlutsürkan, Sevinç; Erenel, Ayten Şentürk

    2018-01-01

    This study is carried out to determine the symptoms and information necessity on chemotherapy (CT) treatment of the women with breast cancer. A total of 170 women older than 18 years old, who receive CT with breast cancer diagnosis, are volunteered to participate in the study. Mixed method was used in the study. Data are collected using Descriptive Data Form, Interview Form and Memorial Symptom Assessment Scale. As a result of the cluster analysis, four clusters and the symptoms within have been obtained. These are: pain, lack of energy, feeling drowsy, sweat, swelling of hands, and feet in the first cluster; feeling nervous, difficulty sleeping, feeling sad, worrying in the second cluster; nausea, feeling bloating, change in the way food tastes, hair loss, constipation in the third cluster; vomiting, diarrhea, problems with sexual interest, lack of appetite, dizziness, and weight loss in the forth cluster. Women's information necessity related to the CT are follows: the effects of CT, other treatment options beyond CT, complementary methods, the effect of the CT treatment on reproductive health and sexuality, nutrition, and symptom control. The results of this study will enable determination of symptom clusters, which health professionals are easier to focus on these symptoms. An understanding information need of patients can help to ensure that individual's coping strategies and self-management.

  3. The importance of behavioural and pyschological symptoms in Alzheimer's disease.

    Science.gov (United States)

    Pérez Romero, A; González Garrido, S

    2016-04-26

    Behavioral and psychological symptoms of dementia (BPSD), present in the vast majority of patients with Alzheimer's disease (AD), cause extensive impairment in all areas, including functionality. Early diagnosis and management are critical, especially since these symptoms are not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as a diagnostic criterion of AD, but only as specific features of some patients. The main purpose of this review is to highlight the importance of these behavioural and psychological symptoms of dementia, particularly in AD. In addition, we discuss why these symptoms have not been included in the latest DSM-V. We conducted a literature search through various databases to gather data about BPSD in AD, and found a total of 12 articles. BPSD are present in almost all patients and result in cognitive and functional impairment. The prevalence of these symptoms varies depending on the study and the symptom in question. In our view, BPSD should be included among the DSM diagnostic criteria for AD. Copyright © 2016 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Wind turbines and idiopathic symptoms

    DEFF Research Database (Denmark)

    Blanes-Vidal, Victoria; Schwartz, Joel

    2016-01-01

    Whether or not wind turbines pose a risk to human health is a matter of heated debate. Personal reactions to other environmental exposures occurring in the same settings as wind turbines may be responsible of the reported symptoms. However, these have not been accounted for in previous studies. We...... investigated whether there is an association between residential proximity to wind turbines and idiopathic symptoms, after controlling for personal reactions to other environmental co-exposures. We assessed wind turbine exposures in 454 residences as the distance to the closest wind turbine (Dw) and number...... of wind turbines

  5. Impact of symptom burden in post-surgical non-small cell lung cancer survivors.

    Science.gov (United States)

    Lowery, Amy E; Krebs, Paul; Coups, Elliot J; Feinstein, Marc B; Burkhalter, Jack E; Park, Bernard J; Ostroff, Jamie S

    2014-01-01

    Pain, fatigue, dyspnea, and distress are commonly reported cancer-related symptoms, but few studies have examined the effects of multiple concurrent symptoms in longer-term cancer survivors. We examined the impact of varying degrees of symptom burden on health-related quality of life (HRQOL) and performance status in surgically treated non-small cell lung cancer (NSCLC) survivors. A sample of 183 NSCLC survivors 1-6 years post-surgical treatment completed questionnaires assessing five specific symptoms (pain, fatigue, dyspnea, depression, and anxiety), HRQOL, and performance status. The number of concurrent clinically significant symptoms was calculated as an indicator of symptom burden. Most survivors (79.8 %) had some degree of symptom burden, with 30.6 % reporting one clinically significant symptom, 27.9 % reporting two symptoms, and 21.3 % reporting three or more symptoms. Physical HRQOL significantly decreased as the degree of symptom burden increased, but mental HRQOL was only significantly decreased in those with three or more symptoms. Receiver-operating characteristic (ROC) curves showed that having multiple concurrent symptoms (two or more) was most likely associated with limitations in functioning (area under a ROC curve = 0.75, sensitivity = 0.81, specificity = 0.54). Two or more clinically significant symptoms are identified as the "tipping point" for showing adverse effects on HRQOL and functioning. This highlights the need for incorporating multiple-symptom assessment into routine clinical practice. Comprehensive symptom management remains an important target of intervention for improved post-treatment HRQOL and functioning among lung cancer survivors.

  6. Dealing with chemotherapy-related symptoms at home: a qualitative study in adult patients with cancer.

    Science.gov (United States)

    Coolbrandt, A; Dierckx de Casterlé, B; Wildiers, H; Aertgeerts, B; Van der Elst, E; van Achterberg, T; Milisen, K

    2016-01-01

    Given that chemotherapy treatments are done mostly in an outpatient setting, patients with cancer must deal with treatment-related symptoms mainly at home. Evidence suggests that they often feel left alone or unprepared to do so. This qualitative study explores how patients deal with chemotherapy-related symptoms in their home, which factors and ideas influence their self-management and what role professional caregivers play. One-off, semi-structured interviews were held with 28 adult patients with cancer being treated with chemotherapy. Using a Grounded Theory approach, we cyclically collected and analysed data to come to a thorough understanding of the major conceptual themes and their interconnections. Dealing with chemotherapy-related symptoms involves a process of experiencing and learning how side effects unfold over time and how to deal with them. Patients express very personal symptom experiences and symptom-management styles, which are shaped by personal factors (e.g. coping with cancer and cancer treatment, perceived level of control) and environmental factors (e.g. professionals' attitude, information resources). Improving symptom self-management support requires active exploration of the personal symptom experience and symptom-management style. Professional care should be tailored to the patient's perspective and should address personal and environmental determinants of their behaviour. © 2015 John Wiley & Sons Ltd.

  7. Benefits of Walking on Menopausal Symptoms and Mental Health Outcomes among Chinese Postmenopausal Women

    Directory of Open Access Journals (Sweden)

    Liang Hu

    2017-09-01

    Conclusion: Walking could be recommended for post-menopausal women to manage menopausal symptoms and promote psychological well-being. Life satisfaction may be enhanced through the improvement of mental and physical parameters (e.g., menopausal symptoms, BMI and depression.

  8. Recommended patient-reported core set of symptoms to measure in adult cancer treatment trials

    NARCIS (Netherlands)

    Reeve, B.B.; Mitchell, S.A.; Dueck, A.C.; Basch, E.; Cella, D.; Miller Reilly, C.; Minasian, L.M.; Denicoff, A.M.; O'Mara, A.M.; Fisch, M.J.; Chauhan, C.; Aaronson, N.K.; Coens, C.; Watkins Bruner, D.

    2014-01-01

    Background: The National Cancer Institute’s Symptom Management and Health-Related Quality of Life Steering Committee held a clinical trials planning meeting (September 2011) to identify a core symptom set to be assessed across oncology trials for the purposes of better understanding treatment

  9. Asthma Symptoms in Early Childhood: A public health perspective [Astmasymptomen bij jonge kinderen: een volksgezondheids perspectief

    NARCIS (Netherlands)

    Hafkam-de Groen, E.

    2014-01-01

    This thesis focuses on asthma symptoms in early childhood. From a public health perspective, we aim to improve health and health-related quality of life through the prevention of asthma symptoms and by signaling, counselling or management of children who are at a high risk of developing asthma. The

  10. The Technostress: definition, symptoms and risk prevention

    Directory of Open Access Journals (Sweden)

    Marta Chiappetta

    2017-04-01

    Full Text Available With the advent of Web 2.0 and Social media, a radical change in the world of communication and information flows has occurred, that have crossed space and time limits. The new technology, with its rapid evolution marked by the access to the digital world through the Smartphone invention, resulted in a sharp acceleration of the rhythms of life and work. On the other hand a massive pervasiveness of digital technology in the professional and personal rhythms has been recorded. Technostress, defined for the first time in 1984, is a syndrome that occurs when the person, subjected to information overload and continuous contact with most digital devices, develops a state of stress, or an abnormal response characterized by specific symptoms at the cardiocirculatory, mental and neurological levels. The repercussions of Technostress invest business and relational sphere causing absenteeism, loss of professional effectiveness, conflict and isolation. In 2007, the syndrome has been recognized as an occupational disease: this requires that in all workplace where a frequently use of digital technologies (ICT, publishing etc. does exist, there is the needto include Technostress in the document of work-related risk assessment. This application is essential to put in place adequate protection and prevention measures, such as increased training of employees on the harmful effect of Technostress and implementation of specific strategies for managing symptoms.

  11. Time to Talk: 4 Things to Know about Menopausal Symptoms and Complementary Health Practices

    Science.gov (United States)

    ... menopausal symptoms: Mind and body practices such as hypnosis, mindfulness meditation, and tai chi may help improve ... joint pain. There is also some evidence that hypnotherapy may help women manage hot flashes. Many natural ...

  12. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... to recovery. Depression treatment can take time to work, so don't give up. Read more about depression on this Web page. If the symptoms fit, get help ... Mental Health Information Summaries of Scientific Meetings Information about NIMH ...

  13. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... few days. It is a serious illness that affects many people. Symptoms can vary, but many depressed people lose interest in ... I did have depression. NARRATOR : Medications called antidepressants can ... to figuring out exactly how these medications work, who benefits from them the ...

  14. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... to recovery. Depression treatment can take time to work, so don't give up. Read more about depression on this Web page. If the symptoms fit, get help now. ... of Scientific Meetings Information about NIMH RePORTER : Research Portfolio Online ...

  15. Symptoms as the main problem

    DEFF Research Database (Denmark)

    Rosendal, Marianne; Carlsen, Anders Helles; Rask, Mette Troellund

    2016-01-01

    Dette studie undersøger tilfredsheden hos patienter, der blev afsluttet i almen praksis uden specifik diagnose, dvs. hvor lægen efter afsluttet konsultation kun kunne anføre "symptom" eller "problem" som slutdiagnose. Det drejer sig om ca. 1/3 af alle helbredsrelaterede konsultationer i almen...

  16. Stroke Risk Factors and Symptoms

    Science.gov (United States)

    ... » [ pdf, 433 kb ] Order Materials » Stroke Risk Factors and Symptoms Risk Factors for a Stroke Stroke prevention is still ... it. Treatment can delay complications that increase the risk of stroke. Transient ischemic attacks (TIAs). Seek help. ...

  17. Prodromal symptoms in hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Ring, H C; Theut Riis, P; Zarchi, K

    2017-01-01

    %), paraesthesia (63%) and itching (20%). the majority of the patients stated that the prodromes usually occurred > 24 h (45%) or 12-24 h (20%) before the eruption. CONCLUSION: Our data suggest that the majority of patients with HS experience prodromal symptoms, heralding a flare of their HS. The findings may give...

  18. Symptoms

    Science.gov (United States)

    ... Rights Employment Discrimination Health Care Professionals Law Enforcement Driver's License For Lawyers Food & Fitness Home Food MyFoodAdvisor ... Fit Types of Activity Weight Loss Assess Your Lifestyle Getting Started Food Choices In My Community Home ...

  19. Symptoms

    Science.gov (United States)

    ... for an epinephrine auto-injector? Take this survey. Food Allergy Research & Education Toggle navigation Menu Donate Search Search Life with Food Allergies Life with Food Allergies If you or someone ...

  20. Clinical utility of the Neurobehavioral Symptom Inventory validity scales to screen for symptom exaggeration following traumatic brain injury.

    Science.gov (United States)

    Lange, Rael T; Brickell, Tracey A; Lippa, Sara M; French, Louis M

    2015-01-01

    The purpose of this study was to examine the clinical utility of three recently developed validity scales (Validity-10, NIM5, and LOW6) designed to screen for symptom exaggeration using the Neurobehavioral Symptom Inventory (NSI). Participants were 272 U.S. military service members who sustained a mild, moderate, severe, or penetrating traumatic brain injury (TBI) and who were evaluated by the neuropsychology service at Walter Reed Army Medical Center within 199 weeks post injury. Participants were divided into two groups based on the Negative Impression Management scale of the Personality Assessment Inventory: (a) those who failed symptom validity testing (SVT-fail; n = 27) and (b) those who passed symptom validity testing (SVT-pass; n = 245). Participants in the SVT-fail group had significantly higher scores (pscales (range: d = 0.76 to 2.34). Similarly high sensitivity, specificity, positive predictive power (PPP), and negative predictive (NPP) values were found when using all three validity scales to differentiate SVT-fail versus SVT-pass groups. However, the Validity-10 scale consistently had the highest overall values. The optimal cutoff score for the Validity-10 scale to identify possible symptom exaggeration was ≥19 (sensitivity = .59, specificity = .89, PPP = .74, NPP = .80). For the majority of people, these findings provide support for the use of the Validity-10 scale as a screening tool for possible symptom exaggeration. When scores on the Validity-10 exceed the cutoff score, it is recommended that (a) researchers and clinicians do not interpret responses on the NSI, and (b) clinicians follow up with a more detailed evaluation, using well-validated symptom validity measures (e.g., Minnesota Multiphasic Personality Inventory-2 Restructured Form, MMPI-2-RF, validity scales), to seek confirmatory evidence to support an hypothesis of symptom exaggeration.

  1. Living with Symptoms: A Qualitative Study of Black Adults with Advanced Cancer Living in Poverty.

    Science.gov (United States)

    Yeager, Katherine A; Quest, Tammie E; Vena, Catherine; Sterk, Claire E

    2018-02-01

    Cancer is associated with disease-related and treatment-related symptoms. Little is known about the symptom experience of black individuals with advanced cancer especially those with limited financial resources. Therefore, the purpose of this study was to explore the symptom experience of black adults with advanced cancer living in poverty. This qualitative descriptive study focused on the perspectives of the participants experiencing at least two symptoms related to cancer. A purposive sample of 27 individuals receiving care at a public hospital in a southeastern city participated in the study. Semi-structured audiotaped interviews were conducted by two research interviewers. Content analysis was used to develop themes to describe the symptom experience. Two main themes emerged in terms of the participants' symptom experiences: (1) "living in pain," which included the overwhelming experience of pain, both physical and emotional, and (2) "symptoms associated with functioning in everyday life." Participants frequently used the context of activities in their daily lives to explain symptoms, including the effect of symptoms on the activities of eating, moving and doing, and communicating. People with advanced cancer work to negotiate a high frequency of multiple distressful symptoms of severe-to-moderate severity. Information gained from this study can help guide research in symptom science and provide direction for clinicians working with this minority group. Copyright © 2017 American Society for Pain Management Nursing. All rights reserved.

  2. Depression symptoms are persistent in Type 2 diabetes

    DEFF Research Database (Denmark)

    Whitworth, Stephanie; Bruce, David; Starkstein, Sergio

    2017-01-01

    Aims To describe the long‐term trajectories of depression symptom severity in people with Type 2 diabetes, and to identify predictors and associates of these trajectories. Methods A community‐dwelling cohort of 1201 individuals with Type 2 diabetes from the Fremantle Diabetes Study Phase II was f...... benefit from early and intensive depression management and ongoing follow‐up as part of routine Type 2 diabetes care.......Aims To describe the long‐term trajectories of depression symptom severity in people with Type 2 diabetes, and to identify predictors and associates of these trajectories. Methods A community‐dwelling cohort of 1201 individuals with Type 2 diabetes from the Fremantle Diabetes Study Phase II...... was followed for 5 years. The nine‐item version of the Patient Health Questionnaire was administered annually to assess depression symptoms, and biomedical and psychosocial measures were assessed at baseline and biennially. Latent class growth analysis was used to identify classes of depression severity...

  3. Factors influencing the quality of life of haemodialysis patients according to symptom cluster.

    Science.gov (United States)

    Shim, Hye Yeung; Cho, Mi-Kyoung

    2018-05-01

    To identify the characteristics in each symptom cluster and factors influencing the quality of life of haemodialysis patients in Korea according to cluster. Despite developments in renal replacement therapy, haemodialysis still restricts the activities of daily living due to pain and impairs physical functioning induced by the disease and its complications. Descriptive survey. Two hundred and thirty dialysis patients aged >18 years. They completed self-administered questionnaires of Dialysis Symptom Index and Kidney Disease Quality of Life instrument-Short Form 1.3. To determine the optimal number of clusters, the collected data were analysed using polytomous variable latent class analysis in R software (poLCA) to estimate the latent class models and the latent class regression models for polytomous outcome variables. Differences in characteristics, symptoms and QOL according to the symptom cluster of haemodialysis patients were analysed using the independent t test and chi-square test. The factors influencing the QOL according to symptom cluster were identified using hierarchical multiple regression analysis. Physical and emotional symptoms were significantly more severe, and the QOL was significantly worse in Cluster 1 than in Cluster 2. The factors influencing the QOL were spouse, job, insurance type and physical and emotional symptoms in Cluster 1, with these variables having an explanatory power of 60.9%. Physical and emotional symptoms were the only influencing factors in Cluster 2, and they had an explanatory power of 37.4%. Mitigating the symptoms experienced by haemodialysis patients and improving their QOL require educational and therapeutic symptom management interventions that are tailored according to the characteristics and symptoms in each cluster. The findings of this study are expected to lead to practical guidelines for addressing the symptoms experienced by haemodialysis patients, and they provide basic information for developing nursing

  4. Factors Related to Depressive Symptoms in Mothers of Technology-Dependent Children.

    Science.gov (United States)

    Toly, Valerie Boebel; Musil, Carol M

    2015-07-01

    Mothers caring for technology-dependent children at home often suffer clinically significant and unrecognized depressive symptoms. The study aim was to determine factors related to elevated depressive symptoms and provide information to target interventions that assists mothers in self-management of their mental health. Secondary data analysis from a descriptive, correlational study of 75 mothers was performed. Hierarchical multiple regression analysis results indicate that younger, unpartnered mothers with lower normalization efforts and personal resourcefulness, and less care hours, had increased depressive symptoms. The importance of personal resourcefulness and the potential for a resourcefulness training intervention to reduce depressive symptoms are discussed.

  5. Using the symptom monitor in a randomized controlled trial: the effect on symptom prevalence and severity

    NARCIS (Netherlands)

    Hoekstra, Johanna; de Vos, Rien; van Duijn, Nico P.; Schadé, Egbert; Bindels, Patrick J. E.

    2006-01-01

    This randomized controlled trial investigated the effect of reporting physical symptoms by using a systematic symptom monitoring instrument, the Symptom Monitor, on symptom prevalence and severity among patients with cancer in the palliative phase. The overall objective was to achieve symptom relief

  6. [Pain, from symptom to syndrome].

    Science.gov (United States)

    Piano, Virginie

    2017-05-01

    Acute pain is a symptom enabling us to implement a response when faced with an attack. Chronic pain is complex and multifactorial. The care of the patient by a multidisciplinary team comprises the diagnosis of the pain and the putting in place of a treatment for each of its components. This includes physical reconditioning, adaptation strategies and work on the psychological elements relating to the representation of the pain. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. Respiratory symptoms in insect breeders.

    Science.gov (United States)

    Harris-Roberts, J; Fishwick, D; Tate, P; Rawbone, R; Stagg, S; Barber, C M; Adisesh, A

    2011-08-01

    A number of specialist food suppliers in the UK breed and distribute insects and insect larvae as food for exotic pets, such as reptiles, amphibians and invertebrates. To investigate the extent of work-related (WR) symptoms and workplace-specific serum IgE in workers potentially exposed to a variety of biological contaminants, including insect and insect larvae allergens, endotoxin and cereal allergens at a UK specialist insect breeding facility. We undertook a study of respiratory symptoms and exposures at the facility, with subsequent detailed clinical assessment of one worker. All 32 workers were assessed clinically using a respiratory questionnaire and lung function. Eighteen workers consented to provide serum for determination of specific IgE to workplace allergens. Thirty-four per cent (11/32) of insect workers reported WR respiratory symptoms. Sensitization, as judged by specific IgE, was found in 29% (4/14) of currently exposed workers. Total inhalable dust levels ranged from 1.2 to 17.9 mg/m(3) [mean 4.3 mg/m(3) (SD 4.4 mg/m(3)), median 2.0 mg/m(3)] and endotoxin levels of up to 29435 EU/m(3) were recorded. Exposure to organic dusts below the levels for which there are UK workplace exposure limits can result in respiratory symptoms and sensitization. The results should alert those responsible for the health of similarly exposed workers to the potential for respiratory ill-health and the need to provide a suitable health surveillance programme.

  8. Cholecystic fistula with atypical symptoms

    DEFF Research Database (Denmark)

    Bang, U.C.; Hasbak, P.; From, G.

    2008-01-01

    We report a patient with spontaneous cholecystocolonis fistula secondary to cholelithiasis. A 93 year-old woman was admitted because of weight loss, diarrhoea and upper abdominal pain. Ultrasound examination revealed air in the biliary tract and cholescientigraphy revealed a fistula between the g...... the gallbladder and right colon. Using endoscopic retrograde cholangiopancreatography a calculus was extracted from the bile duct and the symptoms disappeared Udgivelsesdato: 2008/1/14...

  9. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... Funding Funding Home Opportunities & Announcements Funding Strategy for Grants Application Process Managing Grants Clinical Research Training Small Business Research Labs at ...

  10. Acute management of stones

    DEFF Research Database (Denmark)

    Jung, Helene; Osther, Palle J S

    2015-01-01

    INTRODUCTION: Stone management is often conservative due to a high spontaneous stone passage rate or non-symptomatic calyceal stones that do not necessarily require active treatment. However, stone disease may cause symptoms and complications requiring urgent intervention. MATERIAL AND METHODS: I...... with careful consideration of stone size and location, symptoms, patient comorbidity and radiation dose. CONCLUSION: In case of infective hydronephrosis, compromised renal function or persistent pain despite adequate analgesic treatment acute intervention is indicated....

  11. The symptom experience of people living with HIV and AIDS in the Eastern Cape, South Africa

    Directory of Open Access Journals (Sweden)

    Phaswana-Mafuya Nancy

    2008-12-01

    Full Text Available Abstract Background Symptom management for persons living with HIV (PLHIV or AIDS is an important part of care management. Limited information about symptom prevalence exists about HIV infected persons in South Africa, in particular in the context of antiretroviral treatment (ART. The aim of this study was to assess HIV symptoms and demographic, social and disease variables of people living with HIV in South Africa. Methods In 2007 607 PLHIV, sampled by all districts in the Eastern Cape Province and recruited through convenience sampling, were interviewed by PLHIV at health facilities, key informants in the community and support groups. Results Two-thirds of the PLHIV (66% classified themselves with being given an AIDS (advanced stage of HIV diagnosis, 48% were currently on ART, 35% were currently on a disability grant for HIV/AIDS and for 13% the disability grant had been stopped. Participants reported that on the day of the interview, they were experiencing an average of 26.1 symptoms out of a possible 64. In a regression model with demographic and social variables, higher HIV symptom levels were associated with lower educational levels, higher age, urban residence and not on a disability grant, lack of enough food and having a health insurance, and in a regression model with demographic, social and disease variables only being on ART, lack of enough food and having a health insurance were associated with HIV symptoms. Conclusion Symptom assessment provides information that may be valuable in evaluating AIDS treatment regimens and defining strategies to improve quality of life. Because of the high levels of symptoms reported, the results imply an urgent need for effective health care, home- and community-based as well as self-care symptom management to help patients and their families manage and control AIDS symptoms.

  12. Living with symptoms of attention deficit hyperactivity disorder in adulthood

    DEFF Research Database (Denmark)

    Bjerrum, Merete B; Pedersen, Preben U; Larsen, Palle

    2017-01-01

    OF PARTICIPANTS: Adults with confirmed ADHD diagnosis. PHENOMENA OF INTEREST: How adults with ADHD experience and manage the symptoms of ADHD and links between protective factors provided by relatives, friends, fellow students, mentors and colleagues. TYPES OF STUDIES: Studies based on qualitative data, including...... assessed by two reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION: Data were extracted from 10 included studies using the JBI-QARI. DATA SYNTHESIS: Qualitative research findings were......, people diagnosed with ADHD do not necessarily regard themselves as being impaired. However, it is unclear how adults with ADHD experience and manage their symptoms. OBJECTIVES: To identify and synthesize the best available evidence on how adults experience living with ADHD. INCLUSION CRITERIA TYPES...

  13. Symptom-based emergency operating procedures development for Ignalina NPP

    International Nuclear Information System (INIS)

    Kruglov, Y.

    1999-01-01

    In this paper and lecture are presented: (1) Introduction; (2) EOP project work stages and documentation; (3) Selection and justification of accident management strategy; (4) Content of EOP package; (5) Development of EOP package; (6) EOP package verification; (7) EOP package validation; (8) EOP training; (9) EOP implementation; (10) Conditions of symptom-based emergency operating producers package application and its interconnection with event-based emergency operating procedures; (11) Rules of EOP application; EOP maintenance

  14. Evaluating obesity in fibromyalgia: neuroendocrine biomarkers, symptoms, and functions

    OpenAIRE

    Okifuji, Akiko; Bradshaw, David H.; Olson, Chrisana

    2009-01-01

    The aim of this study was to investigate the associations between obesity and fibromyalgia syndrome (FMS). This study was conducted at the University of Utah Pain Management and Research Center, Salt Lake City, Utah. Thirty-eight FMS patients were included in this study. Neuroendocrine indices (catecholamines, cortisol, C-reactive protein [CRP], and interleukin-6), symptom measures (Fibromyalgia Impact Questionnaire), sleep indices (Actigraph), and physical functioning (treadmill testing) wer...

  15. CONCUSSION IN SPORT: PRACTICAL MANAGEMENT ...

    African Journals Online (AJOL)

    Enrique

    The monitoring of symptoms of concussion is important in order to manage the concussed player ... develop prolonged disability charac- terised by poor ... Feeling 'dinged', stunned or 'dazed' .... The baseline test ensures reliable com- parative ...

  16. Symptoms and side effects in chronic non-cancer pain: patient report vs. systematic assessment.

    Science.gov (United States)

    Jonsson, T; Christrup, L L; Højsted, J; Villesen, H H; Albjerg, T H; Ravn-Nielsen, L V; Sjøgren, P

    2011-01-01

    relieving distressing symptoms and managing the side effects of analgesics are essential in order to improve quality of life and functional capacity in chronic non-cancer pain patients. A quick, reliable and valid tool for assessing symptoms and side effects is needed in order to optimize treatment. We aimed to investigate the symptoms reported by chronic non-cancer pain patients after open-ended questioning vs. a systematic assessment using a list of symptoms, and to assess whether the patients could distinguish between the symptoms and the side effects induced by analgesics. patients treated with either opioids and/or adjuvant analgesics were asked to report their symptoms spontaneously, followed by a 41-item investigator-developed symptom checklist. A control group also filled in the checklist. a total of 62 patients and 64 controls participated in the study. The numbers of symptoms reported by the patients (9.9 ± 5.9) were significantly higher than those reported by the controls (3.2 ± 3.9) (Pside effects due to analgesics was: (1) Dry mouth (42%); (2) Sweating (34%); (3) Weight gain (29%); (4) Memory deficits (24%); (5) Fatigue (19%); and (6) Concentration deficits (19%). the number of symptoms reported using systematic assessment was eightfold higher than those reported voluntarily. Fatigue, cognitive dysfunction, dry mouth, sweating and weight gain were the most frequently reported. The patients reported the side effects of their analgesics to contribute substantially to the reported symptoms. 2010 The Acta Anaesthesiologica Scandinavica Foundation.

  17. HIV / AIDS: Symptoms, Diagnosis, Prevention and Treatment

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues HIV / AIDS HIV / AIDS: Symptoms , Diagnosis, Prevention and Treatment Past Issues / ... Most people who have become recently infected with HIV will not have any symptoms. They may, however, ...

  18. Women's Heart Disease: Heart Attack Symptoms

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Women's Heart Disease Heart Attack Symptoms Past Issues / Winter ... most common heart attack symptom in men and women is chest pain or discomfort. However, women also ...

  19. Modified Protein Improves Vitiligo Symptoms in Mice

    Science.gov (United States)

    ... Vitiligo Symptoms in Mice Spotlight on Research Modified Protein Improves Vitiligo Symptoms in Mice By Colleen Labbe, ... D., Ph.D., Rush University. Altering a key protein involved in the development of vitiligo may protect ...

  20. Spinal cord injury - Symptoms and causes

    Science.gov (United States)

    ... breathing, coughing or clearing secretions from your lungs Emergency signs and symptoms Emergency signs and symptoms of ... tackle using the top of your helmet in football. Use a spotter for new moves in gymnastics. ...

  1. Glaucoma: Symptoms, Diagnosis, Treatment and Latest Research

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Glaucoma Glaucoma: Symptoms, Diagnosis, Treatment and Latest Research Past Issues / Fall 2009 Table of Contents Symptoms and Diagnosis Glaucoma can develop in one or both eyes. Often ...

  2. Glucosamine: Can It Worsen Gout Symptoms?

    Science.gov (United States)

    ... symptoms? My husband takes glucosamine supplements to treat gout. But I'm wondering if glucosamine, which contains shellfish, may actually worsen gout symptoms? Answers from April Chang-Miller, M.D. ...

  3. What Are the Symptoms of Menopause?

    Science.gov (United States)

    ... Pinterest Email Print What are the symptoms of menopause? Perimenopause begins with a change in a woman's ... longer than a week. A common symptom of menopause is the appearance of hot flashes (sometimes called ...

  4. Restless Legs Syndrome -- Causes and Symptoms

    Science.gov (United States)

    ... miles): 10 25 50 Share: Essentials in Sleep Insomnia Overview & Facts Symptoms & Causes Diagnosis & Self Tests Treatment Sleep Apnea Overview & Facts ... Self Test & Diagnosis Treatment Snoring Overview and Facts Causes and Symptoms Self Tests & ... Insomnia Short Sleeper Hypersomnias Narcolepsy Insufficient ...

  5. Intensive meditation for refractory pain and symptoms.

    Science.gov (United States)

    Goyal, Madhav; Haythornthwaite, Jennifer; Levine, David; Becker, Diane; Vaidya, Dhananjay; Hill-Briggs, Felicia; Ford, Daniel

    2010-06-01

    The objective of this study was to assess patient interest in intensive meditation training for chronic symptoms. This was a cross-sectional anonymous survey among six chronic disease clinics in Baltimore including Chronic Kidney Disease, Crohn's Disease, Headache, Renal Transplant Recipients, General Rheumatology, and lupus clinic. Subjects were 1119 consecutive patients registering for their appointments at these clinics. Outcome measures were 6-month pain, global symptomatology, four-item perceived stress scale, use of complementary and alternative medicine (CAM) therapies, and attitudes toward use of meditation for managing symptoms. We then gave a scripted description of an intensive, 10-day meditation training retreat. Patient interest in attending such a retreat was assessed. Seventy-seven percent (77%) of patients approached completed the survey. Fifty-three percent (53%) of patients reported moderate to severe pain over the past 6 months. Eighty percent (80%) reported use of some CAM therapy in the past. Thirty-five percent (35%) thought that learning meditation would improve their health, and 49% thought it would reduce stress. Overall, 39% reported interest in attending the intensive 10-day meditation retreat. Among those reporting moderate to severe pain or stress, the percentages were higher (48% and 59%). In a univariate analysis, higher education, nonworking/disabled status, female gender, higher stress, higher pain, higher symptomatology, and any CAM use were all associated with a greater odds of being moderately to very interested in an intensive 10-day meditation retreat. A multivariate model that included prior use of CAM therapies as predictors of interest in the program fit the data significantly better than a model not including CAM therapies (p = 0.0013). Over 50% of patients followed in chronic disease clinics complain of moderate to severe pain. Patients with persistent pain or stress are more likely to be interested in intensive meditation.

  6. [Cavernous haemangiomas: hearing and vestibular inaugural symptoms].

    Science.gov (United States)

    Dumas, G; Schmerber, S

    2004-11-01

    Cavernous haemangiomas (cavernomas)(CH) are relatively rare (2% of cranial tumoral pathology) vascular malformations mostly observed in the central nervous system. Their most common topographical site in brain stem is midline in the pons, for which clinical course may mimic symptoms of peripheral origin (sudden deafness, fluctuating hearing loss, Meniere-like vertigo). To establish the correlation between the clinical manifestations of hearing and balance disturbance and the anatomical site within the pons of cavernous haemangiomas, and to describe their clinical features, and the findings on auditory brainstem response (ABR) and magnetic resonance imaging (MRI). To propose a literature review about CH and its implications. We made a retrospective review of the histories of three patients aged 24, 44 and 45 years, diagnosed as having cavernomas of the brainstem in which audiometric evaluation, videonystagmography (VNG), ABR and imaging techniques lead to the diagnosis of intracranial cavernoma. The clinical and radiological files were reviewed and a direct relationship between symptoms and localization was found in all 3 patients, especially in relation to our understanding of the auditory and vestibular pathways within the brainstem. The literature regarding cavernomas of the pons is reviewed and the clinical, neuroimage, pathological, natural course and management aspects of the disease are discussed. We recommend the use of cerebral MRI for initial diagnosis which shows a typical rosette-like appearance with a heterogeneous signal on T2-weighted images, along with follow-up and investigation into similar profiles among family members. At present there is no consensus about the treatment to follow when cavernomas are located in the brain stem. There is no specific medical treatment for this condition, and surgery is indicated only exceptionally. Anticoagulant therapy, platelet-dispersing medication and violent sports activities are contraindicated.

  7. Musculoskeletal System Symptoms in Goiter

    Directory of Open Access Journals (Sweden)

    Sevim Akin

    2013-04-01

    Full Text Available Aim: The aim of this study was to investigate the prevalence of musculoskeletal manifestations in patients with thyroid dysfunction. Methods: One hundred and twenty-three patients (100 female, 23 male who visited the nuclear medicine department for thyroid gland scintigraphy were included in our study. According to thyroid hormone levels, patients were allocated into five categories: hyperthyroidism, subclinical hyperthyroidism, euthyroid, subclinical hypothyroidism, and hypothyroidism. Before neurological and musculoskeletal examinations, a standardized symptom questionnaire was completed including questions about sensory symptoms, muscle weakness, restricted joint mobility, musculoskeletal pain. Neurological examination, range of motion of joints, effusion or swelling of joints was assessed. Diagnosis of osteoarthritis was done by the clinical and radiological characteristics. The diagnosis of FMS was made according to criteria of American College of Rheumatology. According to the World Health Organization (WHO, a T-score ≤ -2.5 was classified as osteoporosis, whereas a T-score between -2.5 and -1.0 was classified as osteopenia. Thyroid status was determined by serum TSH levels. Results: Eighty-one percent of the patients were female (100 and 19% were male (23. Mean age of female patients was 49.99±15.27 years (range 20-87 and mean age of male patients was 61.8±12.33 years (range 34-88. When divided according to thyroid status, 21.1% (n=26 had hyperthyroidism, 21.1% (n=26 had subclinical hyperthyroidism, 49.6% (n=61 were euthyroid, 4.9% (n=6 had subclinical hypothyroidism and 3.3% (n=4 were hypothyroid. None of 59% of patients had any musculoskeletal diagnosis. Osteoporosis was the most common problem, affecting 23.7% of patients Conclusion: The presence of musculoskeletal symptoms in patients with goiter should be considered and investigated. [Cukurova Med J 2013; 38(2.000: 261-269

  8. Trauma Symptoms in Abused Children

    Directory of Open Access Journals (Sweden)

    Parvaneh Mohammadkhani

    2003-07-01

    Full Text Available Objective: There are many traumatic events (including natural disasters, physical, psychological and sexual abuse that may befall children and there is clear evidence that such experiences can produce a plethora of negative psychological effects. Children’s exposure to such traumas has been associated with a wide variety of negative mental health outcomes, including anxiety and depression, post-traumatic stress and dissociation and anger and aggression. It seems that the impacts of traumatic events are significantly related to type and intensity of trauma. Materials & Method: Through a systematized clustral sampling 3042 male and female students from junior high school who were participated in a survey study for investigating point prevalence of child abuse, completed Trauma Symptoms Checklist for Children-Alternate Version (TSCC-A and Child Abuse Self-report Scale (CASRS. After recognition of abused children, they were compared based on trauma symptoms. TSCC-A is a self-report measure of post-traumatic distress and related psychological symptomatology in male and female children aged 8-16 years. It is useful in the evaluation of children who have experienced traumatic events, including physical and sexual assault, victimization by peers, major losses, the witnessing of violence done to others and natural disasters. TSCC-A makes no reference to sexual issues. CASRS is a self-report scale to assess child abuse and neglect with 38 items and four subscales (psychological abuse, neglect, physical and sexual abuse. Results: Considering the type of traumatic experiences, the results showed that abused children significantly received higher scores in scales and subscales of TSCC-A than nonabused group. They specially reported more symptoms (depression, anxiety, post-traumatic stress, anger and dissociation comparing normal children. Conclusion: It is concluded that the type and rate of traumatic event is related to intensity of symptomatology.

  9. Neuropsychiatric symptoms and celiac disease

    OpenAIRE

    Urban-Kowalczyk, Małgorzata; Œmigielski, Janusz; Gmitrowicz, Agnieszka

    2014-01-01

    Małgorzata Urban-Kowalczyk,1 Janusz Śmigielski,2 Agnieszka Gmitrowicz3 1Affective and Psychotic Disorders Department, Medical University of Łódź, Åódź, Poland; 2Department of Geriatric Medicine Medical University of Åódź, Åódź, Poland; 3Department of Adolescent Psychiatry, Medical University of Åódź, Åódź, Poland Background: Neuropsychiatric symptoms may represent an ...

  10. Predicting depressive symptoms in unemployed

    Directory of Open Access Journals (Sweden)

    Marić Zorica

    2005-01-01

    Full Text Available In this study we review recent research literature focused on relationship between unemployment and depression, and theories emphasizing the mechanisms by which unemployment may contribute to increased levels of depression. Our research investigated depressive symptomatology and its predictors among unemployed people (N = 453 varying in length of unemployment. Results showed that self - mastery, self - esteem, financial strain, gender, intensity of job - seek behavior and length on unemployment were significant predictors of depressive symptoms. Results are discussed in light of current theories of unemployment and mental health and recommendations are made for practice.

  11. Somatic symptom profiles in the general population

    DEFF Research Database (Denmark)

    Eliasen, Marie; Jørgensen, Torben; Schröder, Andreas

    2017-01-01

    PURPOSE: The aim of this study was to identify and describe somatic symptom profiles in the general adult population in order to enable further epidemiological research within multiple somatic symptoms. METHODS: Information on 19 self-reported common somatic symptoms was achieved from a population...

  12. Prediction of withdrawal symptoms during opioid detoxification

    NARCIS (Netherlands)

    Dijkstra, Boukje A G; Krabbe, Paul F M; De Jong, Cor A J; van der Staak, Cees P F

    2008-01-01

    OBJECTIVE: The severity of self-reported withdrawal symptoms varies during detoxification of opioid-dependent patients. The aim of this study is to identify subgroups of withdrawal symptoms within the detoxification trajectory and to predict the severity of withdrawal symptoms on the basis of

  13. Symptom attributions in patients with colorectal cancer

    DEFF Research Database (Denmark)

    Jensen, Line Flytkjær; Hvidberg, Line; Pedersen, Anette Fischer

    2015-01-01

    Størstedelen af kolorektal cancere opdages gennem patienters symptomatiske henvendelse i almen praksis. Man ved dog ikke meget om, hvordan patienter selv oplever deres symptomer. Formålet med studiet var, at undersøge om symptom attributioner er associeret med hvilket symptom man oplevede før...

  14. Psychological Symptoms in Sexually Abused Girls.

    Science.gov (United States)

    Cohen, Judith A.; Mannarino, Anthony P.

    1988-01-01

    The report examined psychological symptoms exhibited by 24 girls (ages 6-12) evaluated within six months of being sexually abused. Results showed a marked discrepancy between child and parent reports of symptoms with children not reporting as many symptoms of depression, anxiety, or low self-esteem as parents. (Author/DB)

  15. [Non-motor symptoms of Parkinson's disease

    NARCIS (Netherlands)

    Weerkamp, N.J.; Nijhof, A.; Tissingh, G.

    2012-01-01

    Parkinson's disease has traditionally been viewed as a disease with only motor features. Nowadays, a wide variety of non-motor symptoms and signs are also recognised as being characteristic of the disease. Non-motor symptoms, most importantly autonomic dysfunction, neuropsychiatric symptoms and

  16. Prediction of withdrawal symptoms during opioid detoxification

    NARCIS (Netherlands)

    Dijkstra, B.A.G.; Krabbe, P.F.M.; Jong, C.A.J. de; Staak, C.P.F. van der

    2008-01-01

    Objective: The severity of self-reported withdrawal symptoms varies during detoxification of opioid-dependent patients. The aim of this study is to identify subgroups of withdrawal symptoms within the detoxification trajectory and to predict the severity of withdrawal symptoms on the basis of

  17. Symptoms and Treatment of Depression

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    Full Text Available ... Funding Strategy for Grants Application Process Managing Grants Clinical Research Training Small Business Research Labs at NIMH Labs ... BRAIN Initiative (5 items) Basic Research (27 items) Clinical Research and Trials (3 items) Mental Health Services Research ( ...

  18. Symptoms and Treatment of Depression

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    Full Text Available ... Grants Application Process Managing Grants Clinical Research Training Small Business Research Labs at NIMH Labs at NIMH Home Research Areas Principal Investigators Administrative Oversight & Support Collaborations & Partnerships Join ...

  19. Symptoms and Treatment of Depression

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    Full Text Available ... Application Process Managing Grants Clinical Research Training Small Business Research Labs at NIMH Labs at NIMH Home ... Mental Health Office of Science Policy, Planning, and Communications 6001 Executive Boulevard, Room 6200, MSC 9663 Bethesda, ...

  20. Symptoms and Treatment of Depression

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    Full Text Available ... Application Process Managing Grants Clinical Research Training Small Business Research Labs at NIMH Labs at NIMH Home ... alone. NARRATOR : If you have depression, telling friends, family, or someone you trust, and finding a doctor ...

  1. Symptoms and Treatment of Depression

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    Full Text Available ... Home Opportunities & Announcements Funding Strategy for Grants Application Process Managing Grants Clinical Research Training Small Business Research ... are the first steps on the road to recovery. Depression treatment can take time to work, so ...

  2. Symptoms and Treatment of Depression

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    Full Text Available ... Criteria (RDoC) Funding Funding Home Opportunities & Announcements Funding Strategy for Grants Application Process Managing Grants Clinical Research Training Small Business Research Labs at NIMH Labs at NIMH Home ...

  3. Symptoms and Treatment of Depression

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  4. Symptoms and Treatment of Depression

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    Full Text Available ... Application Process Managing Grants Clinical Research Training Small Business Research Labs at NIMH Labs at NIMH Home ... Scientific Meetings Information about NIMH RePORTER : Research Portfolio Online Reporting Tool Expenditures and Results Recommendations for Reporting ...

  5. Symptoms and Treatment of Depression

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  6. Symptoms and Treatment of Depression

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    Full Text Available ... Application Process Managing Grants Clinical Research Training Small Business Research Labs at NIMH Labs at NIMH Home ... Institute of Mental Health Office of Science Policy, Planning, and Communications 6001 Executive Boulevard, Room 6200, MSC ...

  7. Symptoms and Treatment of Depression

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  8. From the Child’s Word to Clinical Intervention: Novel, New, and Innovative Approaches to Symptoms in Pediatric Palliative Care

    Directory of Open Access Journals (Sweden)

    Katharine E. Brock

    2018-03-01

    Full Text Available Despite vast improvements in disease-based treatments, many children live with life-threatening disorders that cause distressing symptoms. These symptoms can be difficult to comprehensively assess and manage. Yet, frequent and accurate symptom reporting and expert treatment is critical to preserving a patient’s physical, psychological, emotional, social, and existential heath. We describe emerging methods of symptom and health-related quality-of-life (HRQOL assessment through patient-reported outcomes (PROs tools now used in clinical practice and novel research studies. Computer-based and mobile apps can facilitate assessment of symptoms and HRQOL. These technologies can be used alone or combined with therapeutic strategies to improve symptoms and coping skills. We review technological advancements, including mobile apps and toys, that allow improved symptom reporting and management. Lastly, we explore the value of a pediatric palliative care interdisciplinary team and their role in assessing and managing distressing symptoms and minimizing suffering in both the child and family. These methods and tools highlight the way that novel, new, and innovative approaches to symptom assessment and management are changing the way that pediatrics and pediatric palliative care will be practiced in the future.

  9. Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score.

    Science.gov (United States)

    Fujimura, Tetsuya; Kume, Haruki; Nishimatsu, Hiroaki; Sugihara, Toru; Nomiya, Akira; Tsurumaki, Yuzuri; Miyazaki, Hideyo; Suzuki, Motofumi; Fukuhara, Hiroshi; Enomoto, Yutaka; Homma, Yukio

    2012-05-01

    Study Type - Therapy (symptom prevalence). Level of Evidence 2a. What's known on the subject? and What does the study add? The International Prostate Symptom Score (IPSS) has been most commonly used for the symptom assessment of men with lower urinary tract symptoms (LUTS). However, LUTS in men are so variable that they may not be fully captured by the IPSS questionnaire alone. This study has demonstrated that the Core Lower Urinary Tract Symptom Score (CLSS) questionnaire, which addresses 10 important symptoms, is an appropriate initial assessment tool for LUTS in men with various diseases/conditions. International Prostate Symptom Score (IPSS) has been commonly used to assess lower urinary tract symptoms (LUTS). We have recently developed Core Lower Urinary Tract Symptom Score (CLSS). The aim of this study is to compare IPSS and CLSS for assessing LUTS in men.  Consecutive 515 men fulfilled IPSS and CLSS questionnaires. IPSS QOL Index was used as the QOL surrogate. The clinical diagnoses were BPH (n = 116), BPH with OAB wet (n =80), prostate cancer (n = 128), prostatitis (n = 68), underactive bladder (n = 8), others (n = 72), and controls (e.g., occult blood) (n = 42). Simple statistics and predictability of poor QOL (QOL Index 4 or greater) were examined. All symptom scores were significantly increased in symptomatic men compared with controls. Scores of corresponding symptoms of two questionnaires were significantly correlated (r = 0.58-0.85, all P incontinence, slow stream, straining, incomplete emptying, bladder pain and urethral pain) as independent factors. The hazard ratios for bladder pain (2.2) and urgency incontinence (2.0) were among the highest. All the nine symptoms are addressed in CLSS, while three symptoms (urgency incontinence, bladder, and urethral pain) are dismissed in IPSS. CLSS questionnaire is more comprehensive than IPSS questionnaire for symptom assessment of men with various diseases/conditions, although both questionnaires can capture

  10. Listening to parents: The role of symptom perception in pediatric palliative home care.

    Science.gov (United States)

    Vollenbroich, René; Borasio, Gian Domenico; Duroux, Ayda; Grasser, Monika; Brandstätter, Monika; Führer, Monika

    2016-02-01

    This study analyzes symptom perception by parents and healthcare professionals and the quality of symptom management in a pediatric palliative home care setting and identifies which factors contribute to a high quality of palliative and end-of-life care for children. In this retrospective, cross-sectional study, parents were surveyed at the earliest three months after their child's death. All children were cared for by a specialized home pediatric palliative care team that provides a 24/7 medical on-call service. Questionnaires assessed symptom prevalence and intensity during the child's last month of life as perceived by parents, symptom perception, and treatment by medical staff. The responses were correlated with essential palliative care outcome measures (e.g., satisfaction with the care provided, quality-of-life of affected children and parents, and peacefulness of the dying phase). Thirty-eight parent dyads participated (return rate 84%; 35% oncological disorders). According to parental report, dyspnea (61%) and pain (58%) were the dominant symptoms with an overall high symptom load (83%). Pain, agitation, and seizures could be treated more successfully than other symptoms. Successful symptom perception was achieved in most cases and predicted the quality of symptom treatment (R 2, 0.612). Concordant assessment of symptom severity between parents and healthcare professionals (HCPs) improved the satisfaction with the care provided (p = 0.037) as well as the parental quality-of-life (p = 0.041). Even in cases with unsuccessful symptom control, parents were very satisfied with the SHPPC team's care (median 10; numeric rating scale 0-10) and rated the child's death as highly peaceful (median 9). Significance of the results: The quality and the concordance of symptom perception between parents and HCPs essentially influence parental quality-of-life as well as parental satisfaction and constitute a predictive factor for the quality of symptom treatment and

  11. Initial evaluation of an electronic symptom diary for adolescents with cancer.

    Science.gov (United States)

    Baggott, Christina; Gibson, Faith; Coll, Beatriz; Kletter, Richard; Zeltzer, Paul; Miaskowski, Christine

    2012-12-11

    The delivery of optimal care depends on accurate communication between patients and clinicians regarding untoward symptoms. Documentation of patients' symptoms necessitates reliance on memory, which is often imprecise. We developed an electronic diary (eDiary) for adolescents and young adults (AYAs) with cancer to record symptoms. The purpose of this paper is to describe the utility of an eDiary designed for AYAs with cancer, including dependability of the mobile application, the reasons for any missing recorded data, patients' adherence rates to daily symptom queries, and patients' perceptions of the usefulness and acceptability of symptom data collection via mobile phones. Our team developed an electronic symptom diary based on interviews conducted with AYAs with cancer and their clinicians. This diary included daily severity ratings of pain, nausea, vomiting, fatigue, and sleep. The occurrence of other selected physical sequelae was assessed daily. Additionally, patients selected descriptors of their mood. A 3-week trial of the eDiary was conducted with 10 AYA cancer patients. Mobile phones with service plans were loaned to patients who were instructed to report their symptoms daily. Patients completed a brief questionnaire and were interviewed to elicit their perceptions of the eDiary and any technical difficulties encountered. Overall adherence to daily symptom reports exceeded 90%. Young people experienced few technical difficulties and reported benefit from daily symptom reports. Symptom occurrence rates were high and considerable inter- and intra-patient variability was noted in symptom and mood reports. We demonstrated the utility of an eDiary that may contribute insight into patients' symptom patterns to promote effective symptom management.

  12. Upper gastrointestinal symptoms in patients with advanced cancer: relationship to nutritional and performance status.

    Science.gov (United States)

    Bovio, G; Montagna, G; Bariani, C; Baiardi, P

    2009-10-01

    The goals of the study were to determine the relationship of upper gastrointestinal symptoms with nutritional status and to assess their association with performance status in patients with advanced cancer. We studied 143 patients (50 F, 93 M, mean age 68 +/- 11 years, mean body mass index 22.39 +/- 4.3 kg/m(2)). Assessed symptoms were the following: anorexia, nausea, vomiting, dysphagia for solids, dysphagia for liquids, xerostomia, hypogeusia, dysgeusia, hiccup and chewing disturbances. We determined anthropometric parameters, daily energy intake and serum albumin, prealbumin and transferrin. The most common upper gastrointestinal symptoms were xerostomia (73%), anorexia (49%) and chewing disturbances (40%). Fifty-four percent of patients had weight loss greater than 10%. Seventy-three patients (51%) had daily energy intake lower than their resting energy expenditure. Mean serum prealbumin, albumin and transferrin were below normal range. Mean Eastern Cooperative Oncology Group performance status scale was 3.1 +/- 0.49. Symptoms were often strongly correlated, and usually, patients experienced at least three upper gastrointestinal symptoms at the same time. Anorexia, nausea and vomiting were the symptoms mostly correlated with other symptoms. A correlation was found between vomiting and hiccup. Energy intake (EI) was the nutritional parameter mostly affected by upper gastrointestinal symptoms; moreover, EI is the most predictive factor of upper gastrointestinal symptoms, particularly xerostomia, anorexia and dysphagia for solids. Upper gastrointestinal symptoms are linked to nutritional parameters: In particular, energy intake represents the most predictive variable of symptom occurrence. The performance status is not affected by upper gastrointestinal symptoms. A rigorous nutritional assessment and the managing of upper gastrointestinal symptoms are crucial in patients with advanced cancer.

  13. Vegan diet alleviates fibromyalgia symptoms.

    Science.gov (United States)

    Kaartinen, K; Lammi, K; Hypen, M; Nenonen, M; Hanninen, O; Rauma, A L

    2000-01-01

    The effect of a strict, low-salt, uncooked vegan diet rich in lactobacteria on symptoms in 18 fibromyalgia patients during and after a 3-month intervention period in an open, non-randomized controlled study was evaluated. As control 15 patients continued their omnivorous diet. The groups did not differ significantly from each other in the beginning of the study in any other parameters except in pain and urine sodium. The results revealed significant improvements in Visual analogue scale of pain (VAS) (p=0.005), joint stiffness (p=0.001), quality of sleep (p=0.0001), Health assessment questionnaire (HAQ) (p=0.031), General health questionnaire (GHQ) (p=0.021), and a rheumatologist's own questionnaire (p=0.038). The majority of patients were overweight to some extent at the beginning of the study and shifting to a vegan food caused a significant reduction in body mass index (BMI) (p=0.0001). Total serum cholesterol showed a statistically significant lowering (p=0.003). Urine sodium dropped to 1/3 of the beginning values (p=0.0001) indicating good diet compliance. It can be concluded that vegan diet had beneficial effects on fibromyalgia symptoms at least in the short run.

  14. Effect of Reiki on symptom management in oncology.

    Science.gov (United States)

    Demir, Melike; Can, Gulbeyaz; Celek, Enis

    2013-01-01

    Reiki is a form of energy therapy in which the therapist, with or without light touch, is believed to access universal energy sources that can strengthen the body's ability to heal itself, reduce inflammation, and relieve pain and stress. There is currently no licensing for Reiki nor, given its apparent low risk, is there likely to be. Reiki appears to be generally safe, and serious adverse effects have not been reported. So in this article provides coverage of how to use Reiki in oncology services.

  15. Relationship of screen-based symptoms for mild traumatic brain injury and mental health problems in Iraq and Afghanistan veterans: Distinct or overlapping symptoms?

    Science.gov (United States)

    Maguen, Shira; Lau, Karen M; Madden, Erin; Seal, Karen

    2012-01-01

    This study used factor analytic techniques to differentiate distinct from overlapping screen-based symptoms of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression in Iraq and Afghanistan veterans. These symptoms were derived from screen results of 1,549 veterans undergoing Department of Veterans Affairs postdeployment screening between April 2007 and January 2010. Veterans with positive TBI screens were approximately twice as likely to also screen positive for depression and PTSD (adjusted relative risks = 1.9 and 2.1, respectively). Irritability was a shared symptom between TBI and PTSD, and emotional numbing was a shared symptom between PTSD and depression. Symptoms unique to TBI included dizziness, headaches, memory problems, and light sensitivity. Four separate constructs emerged: TBI, PTSD, depression, and a fourth construct consisting of hypervigilance and sleep problems. These findings illuminate areas of overlap between TBI and common postdeployment mental health problems. Discriminating symptoms of TBI from mental health problems may facilitate diagnosis, triage to specialty care, and targeted symptom management. The emergence of a fourth factor consisting of sleep problems and hypervigilance highlights the need to attend to specific symptoms in the postdeployment screening process.

  16. Eating disorder symptoms and parenting styles.

    Science.gov (United States)

    Haycraft, Emma; Blissett, Jackie

    2010-02-01

    This study aimed to examine associations between symptoms of eating disorders and parenting style, in a non-clinical sample. One hundred and five mothers completed self-report measures of eating disorder symptoms and parenting style. Higher levels of eating disorder symptoms were associated with more authoritarian and permissive parenting styles. Authoritative parenting was not significantly related to eating disorder symptoms. The findings demonstrate that eating disorder symptoms in non-clinical individuals are related to less adaptive parenting styles. These findings have potential implications for clinicians working with mothers with eating disorders. 2009 Elsevier Ltd. All rights reserved.

  17. Symptom structure of PTSD following breast cancer.

    Science.gov (United States)

    Cordova, M J; Studts, J L; Hann, D M; Jacobsen, P B; Andrykowski, M A

    2000-04-01

    Identification of posttraumatic stress disorder (PTSD) symptoms and diagnoses in survivors of cancer is a growing area of research, but no published data exist regarding the symptom structure of PTSD in survivors of malignant disease. Findings from investigations of the PTSD symptom structure in other trauma populations have been inconsistent and have not been concordant with the re-experiencing, avoidance/numbing, and arousal symptom clusters specified in DSM-IV. The present study employed confirmatory factor analysis to evaluate the extent to which the implied second-order factor structure of PTSD was replicated in a sample of 142 breast cancer survivors. PTSD symptoms were measured using the PTSD Checklist--Civilian Version (PCL-C). Fit indices reflected a moderate fit of the symptom structure implied by the DSM-IV. These findings provide some tentative support for the DSM-IV clustering of PTSD symptoms and for the validity of cancer-related PTSD.

  18. TREATMENT AND REHABILITATION IN NON-MOTOR SYMPTOMS OF PARKINSON’S DISEASE

    Directory of Open Access Journals (Sweden)

    Gabriela Dogaru

    2015-12-01

    Full Text Available Parkinson's disease (PD is the second most common neurodegenerative disease. The cardinal clinical features of PD are motor and include bradykinesia, rigidity, and resting tremor with an asymmetric pattern. Apart from these, various nonmotor symptoms (NMS also occur in PD and constitute a major clinical symptoms. NMS can present at any stage of the disease including early and pre-motor phase of PD. Management of PD requires recognition of both motor and nonmotor symptoms as well as an understanding of the relationship between these symptoms and how they can be affected by treatments for PD. Therapy should be individualized for each patient, as treatments for the motor symptoms of PD can improve some nonmotor symptoms while they can worsen others. Some non-motor symptoms, including depression, constipation, pain, genitourinary problems, and sleep disorders, can be improved with antiparkinsonian drugs . Other non-motor symptoms can be more refractory and need the introduction of novel non-dopaminergic drugs in association with rehabilitation programs . In the future, development of treatments that can slow or prevent the progression of Parkinson's disease and its multicentric neurodegeneration are the best hope of ameliorating non-motor symptoms

  19. Connecting the dots: could microbial translocation explain commonly reported symptoms in HIV disease?

    Science.gov (United States)

    Wilson, Natalie L; Vance, David E; Moneyham, Linda D; Raper, James L; Mugavero, Michael J; Heath, Sonya L; Kempf, Mirjam-Colette

    2014-01-01

    Microbial translocation within the context of HIV disease has been described as one of the contributing causes of inflammation and disease progression in HIV infection. HIV-associated symptoms have been related to inflammatory markers and sCD14, a surrogate marker for microbial translocation, suggesting a plausible link between microbial translocation and symptom burden in HIV disease. Similar pathophysiological responses and symptoms have been reported in inflammatory bowel disease. We provide a comprehensive review of microbial translocation, HIV-associated symptoms, and symptoms connected with inflammation. We identify studies showing a relationship among inflammatory markers, sCD14, and symptoms reported in HIV disease. A conceptual framework and rationale to investigate the link between microbial translocation and symptoms is presented. The impact of inflammation on symptoms supports recommendations to reduce inflammation as part of HIV symptom management. Research in reducing microbial translocation-induced inflammation is limited, but needed, to further promote positive health outcomes among HIV-infected patients. Published by Elsevier Inc.

  20. Surgical management of Crohn's disease.

    Science.gov (United States)

    Lu, Kim C; Hunt, Steven R

    2013-02-01

    Although medical management can control symptoms in a recurring incurable disease, such as Crohn's disease, surgical management is reserved for disease complications or those problems refractory to medical management. In this article, we cover general principles for the surgical management of Crohn's disease, ranging from skin tags, abscesses, fistulae, and stenoses to small bowel and extraintestinal disease. Copyright © 2013 Elsevier Inc. All rights reserved.