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1
Shibata, S., Y. Ohtuka, M. Hattori, T. Aoshima, S. Tohyama, A. Uchiyama, H. Kashihara, et al. "Subjective Symptoms Acquisition System in a Health Promotion System for the Elderly." Methods of Information in Medicine 39, no. 03 (2000): 238–40. http://dx.doi.org/10.1055/s-0038-1634334.
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AbstractA previous report was concerned with the evaluation of quality of life using a Health Promotion System for the Elderly. In the present report, we describe one part of that system: a subjective symptoms acquisition and reporting system.The main purpose of this system is to permit any physician or nurse to uniformly employ questionnaires to acquire accurate subjective symptoms. This system is applied in three steps. First, the subjective answers to 21 questions displayed on a personal computer are obtained. These answers correspond to the basic subjective symptoms. Second, if a basic subjective symptom is “positive”, more detailed questions are automatically generated. Finally, clear sentences regarding subjective symptoms are generated and output as a “finding report”.This information is helpful to physicians and nurses in their health-counseling work. An artificial intelligence (AI) program based on “XpertRule” produces detailed questions which are generated by an interactive questionnaire using branching logical rules.
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LITHELL, M., C. BACKMAN, and Å. NYSTRÖM. "Pattern Recognition In Post-Traumatic Cold Intolerance." Journal of Hand Surgery 22, no. 6 (December 1997): 783–87. http://dx.doi.org/10.1016/s0266-7681(97)80448-2.
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The subjective symptoms called “post-traumatic cold intolerance” were analysed in a study of 40 patients with a history of digital trauma (amputation, neurovascular laceration, or comminuted fracture requiring surgical reconstruction). The patients were individually interviewed to obtain detailed information about perception of each symptom as well as the pattern of symptoms of posttraumatic cold intolerance. The study confirmed the high incidence of the condition and its potentially disabling nature. Although the individual symptoms described by the patients have a limited number of categories, the subjective expression of cold intolerance is too varied to allow an adequate definition or assessment to be based on any single symptom or group of symptoms.
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Baer, Ruth A., Martha W. Wetter, and David T. R. Berry. "Effects of Information About Validity Scales on Underreporting of Symptoms on the MMPI-2." Assessment 2, no. 2 (June 1995): 189–200. http://dx.doi.org/10.1177/107319119500200209.
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The effects of two levels of information about the validity scales of the MMPI-2 on underreporting of symptoms were investigated in a college-student population. Subjects who were instructed and offered incentives to underreport were given no information, general information, or detailed information about the validity scales and were compared to a standard-control group. Results suggested that traditional and supplementary underreporting scales of the Minnesota Multiphasic Personality Inventory—2 (MMPI-2) are effective in discriminating standard subjects from uncoached underre-porters, but are much less effective in discriminating standard subjects from subjects given either general or detailed information about the underreporting scales. The findings suggest that coaching may enable some subjects to underreport symptoms without detection, but that at least one scale ( Wsd) shows promising resistance to coaching.
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Gilmour, Donna T., Norman J. MacDonald, Steven Dukeshire, Barbara Whynot, Barry Sanders, John Thiel, Sony Singh, Craig Campbell, Krisztina Bajzak, and Gordon Flowerdew. "Diagnosis of adverse events after hysterectomy with postoperative self-care web applications: A pilot study." Health Informatics Journal 23, no. 4 (May 26, 2016): 279–90. http://dx.doi.org/10.1177/1460458216647759.
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Increased pressures from multiple sources are leading to earlier patient discharge following surgery. Our objective was to test the feasibility of self-care web applications to inform women if, when, and where to seek help for symptoms after hysterectomy. We asked 31 women recovering at home after hysterectomy at two centers to sign into a website on a schedule. For each session, the website informed them about normal postoperative symptoms and prompted them to complete an interactive symptom questionnaire that provided detailed information on flagged responses. We interviewed eight women who experienced an adverse event. Six of these women had used the web application regularly, each indicating they used the information to guide them in seeking care for their complications. These data support that self-care applications may empower patients to manage their own care and present to appropriate health care providers and venues when they experience abnormal symptoms.
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van Gils, Anne, Jon Stone, Killian Welch, Louise R. Davidson, Dean Kerslake, Dave Caesar, Laura McWhirter, and Alan Carson. "Management of mild traumatic brain injury." Practical Neurology 20, no. 3 (April 9, 2020): 213–21. http://dx.doi.org/10.1136/practneurol-2018-002087.
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Mild traumatic brain injury (TBI) is common and associated with a range of diffuse, non-specific symptoms including headache, nausea, dizziness, fatigue, hypersomnolence, attentional difficulties, photosensitivity and phonosensitivity, irritability and depersonalisation. Although these symptoms usually resolve within 3 months, 5%–15% of patients are left with chronic symptoms. We argue that simply labelling such symptoms as ‘postconcussional’ is of little benefit to patients. Instead, we suggest that detailed assessment, including investigation, both of the severity of the ‘mild’ injury and of the individual symptom syndromes, should be used to tailor a rehabilitative approach to symptoms. To complement such an approach, we have developed a self-help website for patients with mild TBI, based on neurorehabilitative and cognitive behavioural therapy principles, offering information, tips and tools to guide recovery: www.headinjurysymptoms.org.
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Keeley, Paul, Deans Buchanan, Clare Carolan, Lara Pivodic, Simon Tavabie, and Simon Noble. "Symptom burden and clinical profile of COVID-19 deaths: a rapid systematic review and evidence summary." BMJ Supportive & Palliative Care 10, no. 4 (May 28, 2020): 381–84. http://dx.doi.org/10.1136/bmjspcare-2020-002368.
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The spread of pandemic COVID-19 has created unprecedented need for information. The pandemic is the cause of significant mortality and with this the need for rapidly disseminated information for palliative care professionals regarding the prevalence of symptoms, their intensity, their resistance or susceptibility to symptom control and the mode of death for patients.MethodsWe undertook a systematic review of published evidence for symptoms in patients with COVID-19 (with a specific emphasis on symptoms at end of life) and on modes of death. Inclusion: prospective or retrospective studies detailing symptom presence and/or cause or mode of death from COVID-19.Results12 papers met the inclusion criteria and gave details of symptom burden: four of these specifically in the dying and two detailed the cause or mode of death. Cough, breathlessness, fatigue and myalgia are significant symptoms in people hospitalised with COVID-19. Dyspnoea is the most significant symptom in the dying. The mode of death was described in two papers and is predominantly through respiratory or heart failure.ConclusionsThere remains a dearth of information regarding symptom burden and mode of death to inform decisions regarding end-of-life care in patients dying with COVID-19. Rapid data gathering on the mode of death and the profile of symptoms in the dying and their prevalence and severity in areas where COVID-19 is prevalent will provide important intelligence for clinicians. This should be done urgently, within ethical norms and the practicalities of a public health, clinical and logistical emergency.
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De Young, Kyle P., and Drew A. Anderson. "An Interactive, Graphical Tool for Retrospectively Assessing Symptom Frequency and Severity: An Illustration With Eating Disorder Behaviors, Body Weight, and Stress." Assessment 24, no. 7 (September 16, 2016): 835–52. http://dx.doi.org/10.1177/1073191116668629.
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There are few assessments that gather valid, highly detailed data on short-term (i.e., weekly) symptom frequency/severity retrospectively. In particular, methodologies that provide valid data for research investigating symptom changes are typically prospective, expensive, and burdensome. The purpose of this study was to evaluate a new interactive and graphical assessment tool for gathering detailed information about eating-related symptom frequency/severity retrospectively over a 3-month period. A mixed eating disorder sample ( N = 113) recruited from the community provided symptom data once weekly for 12 weeks and completed the Interactive, Graphical Assessment Tool (IGAT) assessing eating disorder symptoms on three occasions to determine the test–retest and concurrent validity of the IGAT. The IGAT performed marginally better than other measures for retrospective symptom frequency assessment in the eating disorders and did so at a greater level of detail than other available tools. Future research should evaluate the IGAT with other behaviors of interest.
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Schürks, Markus, Julie E. Buring, and Tobias Kurth. "Migraine features, associated symptoms and triggers: A principal component analysis in the Women’s Health Study." Cephalalgia 31, no. 7 (March 11, 2011): 861–69. http://dx.doi.org/10.1177/0333102411401635.
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Aims: Migraine has a wide clinical spectrum. Our aim was to group information on migraine characteristics into meaningful components and to identify key components of the migraine phenotype. Methods: We performed two principal component analyses, one among participants in the Women’s Health Study enrollment cohort and one in a sub-cohort with additional migraine-specific information. Results: Among the 9427 women with migraine attack–related information at enrollment, the three most important components pertained to central nervous system (CNS) sensitization, attack frequency/pain location and aura/visual phenomena. In the subgroup of 1675 women with more detailed information, food triggers and unspecific symptoms constituted two principal components that explain more of the variance of the migraine phenotype than the three attack–related components. Conclusions: Our results indicate that information on migraine-associated features, symptoms and triggers is highly correlated, allowing the extraction of principal components. Migraine attack–related symptoms are best summarized by symptoms related to CNS sensitization, attack frequency/pain location and aura/visual phenomena. Taking a more general view, unspecific symptoms and food triggers appear to carry stronger importance in characterizing the migraine phenotype. These components are useful for future research on the pathophysiology and genetics of migraine and may have implications for diagnosing and treating patients.
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Rarrick, Christine, and Amy Hebbard. "Creation and implementation of a urinary tract infection diagnostic and treatment algorithm for psychiatric inpatients with a communication barrier." Mental Health Clinician 10, no. 2 (March 1, 2020): 64–69. http://dx.doi.org/10.9740/mhc.2020.03.064.
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Abstract Background Urinary tract infection (UTI) is considered a common cause of mental status changes, particularly in elderly patients and patients with a psychiatric condition. Genitourinary symptoms are essential to confirm UTI diagnosis but may be unobtainable in patients with a communication barrier. Sparse guidance suggests assessing specific symptoms that do not rely on patient report. The primary objective of this project was to provide assistance in diagnosis and treatment of UTIs in noncommunicative patients through the creation of an algorithm. Algorithm Creation and Implementation Through extensive interdisciplinary collaboration, the authors developed criteria to identify UTI symptoms that do not require communication. In order to make the algorithm comprehensive, we chose to include general information related to UTI diagnosis and treatment. The algorithm was implemented within the psychiatric emergency department as this is where patients are evaluated to determine need for psychiatric admission. Providers in the psychiatric emergency department were provided with detailed education on the algorithm as well as information about UTI diagnosis and treatment. Discussion Creating an algorithm within our institution required significant interdisciplinary collaboration. Providers were receptive to and appreciative of a comprehensive resource to assist in this difficult clinical situation. The authors plan to study the effects of algorithm implementation, specifically assessing changes in symptom documentation and antibiotic use.
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Kerns, James P., and Lane P. Tredway. "Pythium Root Dysfunction of Creeping Bentgrass." Plant Health Progress 11, no. 1 (January 2010): 40. http://dx.doi.org/10.1094/php-2010-0125-01-dg.
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Pythium root dysfunction (PRD), a disease of relatively young stands of creeping bentgrass turf, is commonly misdiagnosed as take-all patch. Symptoms of PRD typically appear during the summer months when creeping bentgrass is subjected to heat and drought stress, but patches may develop in the spring, fall, and winter during periods of warm and dry weather. This guide provides detailed information on PRD taxonomy, symptoms, range and distribution, isolation and storage, and more. Accepted for publication 29 October 2009. Published 25 January 2010.
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Mann, Katrina L., Janet Y. Wu, and Sneha S. Shah. "Implementation of a Pharmacist-Driven Detailed Penicillin Allergy Interview." Annals of Pharmacotherapy 54, no. 4 (November 8, 2019): 364–70. http://dx.doi.org/10.1177/1060028019884874.
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Background: Self-reported penicillin allergies may be outdated or inaccurate, leading to the use of alternative antimicrobials that may be less effective, more toxic, and/or more expensive. Although penicillin skin tests can provide accurate assessments of penicillin allergies, these procedures are not feasible at all institutions. Another solution is to conduct a detailed penicillin allergy interview (DPAI), which can potentially lead to optimization of antimicrobial therapy. Objective: The purpose of this study was to assess the impact of a pharmacist-driven DPAI protocol. The primary objective was to measure the number of patients requiring a change to their allergy profile following DPAI. Secondary objectives included characterizing allergy profile updates and measuring the number of recommendations to switch to a β-lactam agent, provider acceptance rate, and patient tolerance. Methods: Standardized pharmacist-driven DPAIs were conducted prospectively on adult patients admitted with a documented penicillin allergy. The allergy profile within the electronic health record (EHR) was updated and a recommendation to switch to noncarbapenem β-lactam therapy was made when indicated by a decision algorithm. Results: A total of 175 (37.5%) patients received a DPAI. Of these, 133 (76.0%) required a change to their allergy profile. Additionally, 135 (77.1%) patients interviewed were on antimicrobial therapy, with 42 (31.1%) meeting criteria to switch to noncarbapenem β-lactam therapy; of which 31 (73.8%) patients were successfully transitioned, with no signs or symptoms of intolerance. Conclusions and Relevance: Implementation of pharmacist-driven DPAIs can provide updated and corrected allergy information within the EHR, allowing for de-escalation and/or optimization of antimicrobial therapy.
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Westermann, Amy, Lynn McCormick Matrisian, and Lola Rahib. "The need for improvement in the management of fatigue, depression and pain in pancreatic cancer." Journal of Clinical Oncology 37, no. 4_suppl (February 1, 2019): 429. http://dx.doi.org/10.1200/jco.2019.37.4_suppl.429.
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429 Background: Pancreatic cancer (PC) and its treatment(s) results in symptom and side effect burden and can impact patient’s overall quality of life (QOL). Methods: Patient reported information on management of side effects and symptoms were collected using PanCAN’s Patient Registry (01/2016 – 07/2018). Results: Patient reported information on side effects, pain and depression is detailed in the table. Side effects: 94% reported fatigue and 8% reported taking anti-fatigue medication. 72% reported nausea or vomiting during treatment and 83% reported taking anti-nausea medication. Pain: Of the 90% of patients who reported pain related to PC, 27% did not take pain medication, 47% visited the ER and 32% were hospitalized due to pain. Depression: Of the 83% of users reported feeling depressed during PC, 46% were diagnosed with depression, 37% prescribed anti-depressant, and 48% did not see a therapist. Conclusions: Nausea was reported as most managed. Fatigue, pain and depression were generally unmanaged. ER visits and hospitalizations due to pain were frequently reported. An improvement in the management of these side effects and symptoms is needed as it can affect patient’s ability to tolerate treatment, improve overall QOL, and may lower overall healthcare costs. [Table: see text]
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Will, R. G., G. Stewart, M. Zeidler, M. A. Macleod, and R. S. G. Knight. "Psychiatric features of new variant Creutzfeldt-Jakob disease." Psychiatric Bulletin 23, no. 5 (May 1999): 264–67. http://dx.doi.org/10.1192/pb.23.5.264.
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Aims and methodNew variant Creutzfeldt–Jakob disease is a novel prion disease of humans that may be causally linked to bovine spongiform encephalopathy. Psychiatric symptoms occur in the early stages of the illness and may be difficult to distinguish from the symptoms of more common psychiatric disorders. Cases of new variant Creutzfeldt–Jakob disease are identified through the national surveillance system. Information on psychiatric features has been obtained by review of case notes and, in the majority of cases, by interview of relatives by a member of the surveillance staff.ResultsThirty-five cases of new variant Creutzfeldt–Jakob disease have been identified in the UK and detailed information on the clinical features and investigations is currently available in 33 of these cases. All but one of the cases exhibited prominent early psychiatric symptomatology, but the diagnosis of an underlying neurological disease was not possible in the majority of cases until the development of neurological symptoms and signs. Early indications of an underlying neurological disorder included cognitive impairment, persistent sensory symptoms or limb pain and, in a minority, gait imbalance, dysarthria or visual symptoms. Limited evidence suggests that investigations such as electroencephalogram or brain imaging are unlikely to provde useful diagnostic information during the ‘psychiatric’ phase of the illness.Clinical implicationsThe early recognition of an underlying neurological disorder may be impossible in the early psychiatric phase of new variant Creutzfeldt–Jakob disease, but the suspicion of this diagnosis may be raised by the occurrence of associated neurological symptoms. The development of early diagnostic markers is an important objective.
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Zamarina, T. V., E. V. Pimenova, N. P. Khrapova, and A. A. Baturin. "Current state of chikungunya fever laboratory diagnosis (review of literature)." Russian Clinical Laboratory Diagnostics 66, no. 9 (September 10, 2021): 558–64. http://dx.doi.org/10.51620/0869-2084-2021-66-9-558-564.
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The article is about methods of chikungunya fever laboratory diagnosis. An algorithm for the study of biological material for the presence of antibodies against chikungunya virus and virus antigens is presented. The overview describes the information about commercial immunodiagnostic and genodiagnostic kits and their detailed specifications. The information presented in the review will be useful for doctors of clinical laboratory diagnostics to choose a method and an acceptable test system for laboratory confirmation of Chikungunya fever diagnosis, as well as differential diagnosis with other fevers, which have similar symptoms, common geographical distribution and carriers of infection.
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Antonio, Papagni, Rossella Fonte, and Luca Benzoni. "Pre-lens tear film evaluation scale: a tool for analyzing the tear film-lens interaction with respect to the material used." Optometry Reports 2, no. 1 (November 29, 2012): 7. http://dx.doi.org/10.4081/optometry.2012.e7.
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In clinical practice, to avoid or reduce the failure rate among users of contact lenses, it is necessary to obtain a detailed patient case history, information concerning symptoms, and a complete eye examination. In addition, application of an auxiliary photographic reference scale might increase the chances of improving initial success or, for existing contact lens wearers, provide insight into the extent or severity of symptoms. Patient symptoms are often directly related to contact lens failure, which in turn is related to the quality of the pre-corneal tear film as well as the <em>wettability</em> of the contact lens surface. We describe the relationship between the quality of the tear film, with particular attention to pre-contact lens tear film, variability in contact tolerance, and the material of which the contact lens is made.
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Martin, A. K., and B. Mowry. "Increased rare duplication burden genomewide in patients with treatment-resistant schizophrenia." Psychological Medicine 46, no. 3 (September 9, 2015): 469–76. http://dx.doi.org/10.1017/s0033291715001701.
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BackgroundA significant number of patients with schizophrenia fail to respond to antipsychotic medication. Although several studies have investigated associated patient characteristics, the emerging findings from genetic studies offer further scope for study.MethodIn 612 schizophrenia patients with detailed clinical information, common genetic variants indexed by polygenic risk scores, and rare variants indexed by deletion and duplication burden genomewide, we explored potential genetic predictors alongside other established risk factors for treatment resistance. Clinical outcomes of treatment resistance were also calculated using lifetime measures of positive, negative/disorganized and mood symptoms as well as number of hospitalizations and suicide attempts.ResultsLogistic regression models identified a significant relationship between treatment resistance and total duplication burden genomewide, years of formal schooling and age at onset. Clinically, treatment-resistant patients were characterized by greater negative/disorganized and positive symptoms and greater number of hospitalizations.ConclusionsTaken together, these findings suggest genetic information, specifically the genomewide burden of rare copy number variants, may increase our understanding and clinical management of patients with treatment-resistant schizophrenia.
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Andrews, Gavin. "Treatment Outlines for the Management of the Somatoform Disorders." Australian & New Zealand Journal of Psychiatry 19, no. 4 (December 1985): 397–407. http://dx.doi.org/10.1080/00048678509158848.
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The Quality Assurance Project is developing explicit and detailed treatment outlines for each of the major psychiatric disorders. Three sources of information are used: the treatment outcome literature, the opinions of a sample of practising psychiatrists and the views of a panel of nominated experts. The recommendations for the treatment of somatoform disorders were as follows: brief dynamic psychotherapy, family therapy and excellent medical consultation are the basis for the treatment of hypochondriasis. Limited long-term supportive psychotherapy and good medical consultation are important in somatization disorder. Symptom relief, psychotherapeutic support and meticulous collaboration with physicians are the keys to managing psychogenic pain disorder. Physiotherapy to improve physical functioning and patient education to facilitate the distinction between normal symptoms and abnormal illness behaviours are important in all three conditions. Neither the benzodiazepines nor behaviour therapy appear to be of use in these conditions.
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Ghizzani, Anna, Valentina Di Sabatino, Anna Lisa Suman, Giovanni Biasi, Enrica Laura Santarcangelo, and Giancarlo Carli. "Pain Symptoms in Fibromyalgia Patients with and without Provoked Vulvodynia." Pain Research and Treatment 2014 (January 29, 2014): 1–6. http://dx.doi.org/10.1155/2014/457618.
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Objective. The aim of the study was to compare the pain symptoms of fibromyalgia patients exhibiting (FMS+PVD) and not exhibiting (FMS) comorbidity with provoked vulvodynia. Study Design. The case control study was performed in 39 patients who had been diagnosed with FMS and accepted to undergo gynaecological examination and in 36 healthy women (C). All patients completed standardized questionnaires for pain intensity, pain area, and psychological functioning. The gynaecological examination included vulvar pain pressure reactivity (Q-tip), pelvic tone assessment (Kegel manoeuver), and a semistructured interview collecting detailed information about pelvic symptoms and sexual function. Results. FMS+PVD patients displayed a higher number of associated symptoms than FMS patients. The vulvar excitability was significantly higher in FMS+PVD than in FMS and in both groups than in Controls. Half of FMS+PVD patients were positive to Kegel manoeuver and displayed higher scores in widespread pain intensity, STAI-Y2, and CESD levels than Kegel negative patients. Conclusions. The study reveals that increased vulvar pain excitability may occur in FMS patients independently of the presence of coital pain. Results suggest that coital pain develops in patients with higher FMS symptoms severity due to the cooperative effects of peripheral and central sensitization mechanisms.
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Stevanovic, Oliver, and Drago Nedic. "Clinical presentation of bluetongue and the malignant form of contagious ecthyma in sheep: Description of cases." Veterinarski glasnik 73, no. 1 (2019): 57–63. http://dx.doi.org/10.2298/vetgl181127012s.
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Bluetongue and contagious ecthyma are sheep diseases that have very similar clinical presentation, thus, making it difficult to distinguish between the two based on clinical symptoms. In practice, a detailed clinical examination of sheep is underestimated and rarely is carried out. The paper presents and describes clinical cases of bluetongue and the malignant form of contagious ecthyma. The differences in the clinical presentation and diagnostic procedures for the two diseases are described in detail, as this information is necessary in order to establish correct disease control measures.
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Jørgensen, D., J. L. Poulsen, A. E. Olesen, C. Brock, T. H. Sandberg, K. Krogh, and A. M. Drewes. "The impact of opioid treatment on regional gastrointestinal transit." Scandinavian Journal of Pain 12, no. 1 (July 1, 2016): 126. http://dx.doi.org/10.1016/j.sjpain.2016.05.029.
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AbstractAimsTo employ a human experimental model of opioid-induced bowel dysfunction (OIBD) in healthy volunteers, and evaluate the impact of opioid treatment compared to placebo on gastrointestinal (GI) symptoms and motility, assessed by questionnaires and regional GI transit times.MethodsTwenty-five healthy males were randomly assigned to oxycodone or placebo for five days in a double-blind, crossover design. Adverse GI effects were measured with bowel function index, gastrointestinal symptom rating scale, patient assessment of constipation symptoms questionnaire, and bristol stool form scale. Regional GI transit times were determined using the 3D-Transit system and segmental colonic transit times were determined using a custom Matlab® graphical user interface.ResultsGI symptom scores increased significantly across all applied questionnaires during opioid treatment. Oxycodone increased median total GI transit time from 22.2 to 43.9 h (P< 0.01), segmental transit times in the cecum and ascending colon from 5.7 to 9.9 h (P<0.05), rectosigmoid transit time from 2.7 to 9.0 h (P<0.05), and colorectal transit time from 18.6 to 38.6 h (P<0.01). No association between questionnaire scores and segmental transit times were detected.ConclusionsSelf-assessed adverse GI effects and increased GI transit times in different segments were induced during oxycodone treatment. This detailed information about segmental changes in motility has great potential for future interventional head-to-head trials of different laxative regimes for prevention and treatment of OIBD.
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Abeysundera, Hesitha, Bailey Craig, and Zelle Pullich. "Promethazine-induced delirium with perceptual abnormalities: are we thinking broadly when assessing patients?" BMJ Case Reports 14, no. 4 (April 2021): e241784. http://dx.doi.org/10.1136/bcr-2021-241784.
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There is limited information about promethazine-induced delirium with psychotic symptoms. The aim is to highlight the importance of taking a detailed history including medication use/abuse of both prescribed, illicit and over-the-counter preparations. This paper describes a patient who presented with delirium in the context of overuse of promethazine (Phenergan) which was initially missed. The patient was treated successfully, following the diagnosis of promethazine-induced delirium. Clinicians should be aware of assessing patients presenting with delirium to explore the possibility of over-the-counter medication misuse.
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Tamang, Suzanne, Manali I. Patel, Sam Finlayson, Xuemei Chen, Julie Lawrence Kuznetsov, Douglas W. Blayney, and Nigam Shah. "Assessing the true nature of unplanned cancer care." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 183. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.183.
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183 Background: Unplanned care can result in poor outcomes that are potentially preventable. The design of effective interventions to improve outcomes for cancer patients requires a better understanding of the true nature of unplanned care. Although cancer care teams document each patient’s care trajectory in detailed free-text notes, care outcomes are typically measured from structured patient record data and do not contain key information necessary for quality improvement efforts, such as the etiology of emergent events, or events that occur at outside facilities. To inform clinical effectiveness work at Stanford’s Cancer Institute, we describe our application of text-mining to improve the assessment of post-diagnosis morbidity outcomes. Methods: We conducted a retrospective study of unplanned care among 3,318 patients with a new diagnosis of breast, gastrointestinal, or thoracic cancer during 2010-13. Using a validated framework for clinical text-mining, we analyzed 308,000 notes for two tasks. First, we extract information on external unplanned events that are documented by providers. Second, we profile symptom mentions in Emergency Department (ED) notes. Results: For all cancer patients, text-mining detected over 400 unplanned events (93% PPV) at outside facilities, resulting in patient rates of 5% in the first 30 days, and 11% up to one year post-diagnosis. Among breast cancer patients, the top three symptoms reported in ED notes are pain (89%), nausea (37%) and fever (18%). Pain is consistently the most prevalent symptom up to one year after diagnosis, other symptoms exhibit more dynamic trends; wound related disorders and nausea are more prevalent among ED admissions in the first three months, whereas fever, cognitive impairment and mental health issues become more prevalent among admissions after the first three months of cancer care. Conclusions: The application of text-mining methods can improve the quantification of morbidity outcomes by improving the estimation of unplanned care rates and by providing continued learning for symptom-driven interventions to mitigate preventable emergent care. Although additional information gaps in care trajectories may continue to exist, text-mining can aid in assessing the true nature of unplanned care.
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Ogle, Nikki R., and Shawn R. Akkerman. "Guidance for the Discontinuation or Switching of Antidepressant Therapies in Adults." Journal of Pharmacy Practice 26, no. 4 (March 4, 2013): 389–96. http://dx.doi.org/10.1177/0897190012467210.
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Antidepressants (ADs) are commonly used for the treatment of various psychological and other medical disorders. Patient response and regimen duration with individual agents varies, necessitating discontinuation (DC) and/or switching between ADs. However, withdrawal symptoms may occur upon DC of the AD, and clinical symptom control may be compromised if the change to a new AD agent is not initiated appropriately. The purpose of this evaluation was to review the available literature and resources to compile documented methods for discontinuing or changing AD regimens in the clinical setting into a single guidance document. The results of this evaluation have yielded both detailed and general recommendations for practitioners to use and consider in discontinuing an AD and making changes between AD agents. The information provided herein is intended to provide useful guidance for clinicians and other health care professionals in their management of patients discontinuing or switching between selected AD agents.
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Scaccabarozzi, Gianlorenzo, Emanuele Amodio, Luca Riva, Oscar Corli, Marco Maltoni, Grazia Di Silvestre, Adriana Turriziani, Piero Morino, Giacomo Pellegrini, and Matteo Crippa. "Clinical Care Conditions and Needs of Palliative Care Patients from Five Italian Regions: Preliminary Data of the DEMETRA Project." Healthcare 8, no. 3 (July 20, 2020): 221. http://dx.doi.org/10.3390/healthcare8030221.
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In order to plan the right palliative care for patients and their families, it is essential to have detailed information about patients’ needs. To gain insight into these needs, we analyzed five Italian local palliative care networks and assessed the clinical care conditions of patients facing the complexities of advanced and chronic disease. A longitudinal, observational, noninterventional study was carried out in five Italian regions from May 2017 to November 2018. Patients who accessed the palliative care networks were monitored for 12 months. Sociodemographic, clinical, and symptom information was collected with several tools, including the Necesidades Paliativas CCOMS-ICO (NECPAL) tool, the Edmonton Symptom Assessment System (ESAS), and interRAI Palliative Care (interRAI-PC). There were 1013 patients in the study. The majority (51.7%) were recruited at home palliative care units. Cancer was the most frequent diagnosis (85.4%), and most patients had at least one comorbidity (58.8%). Cancer patients reported emotional stress with severe symptoms (38.7% vs. 24.3% in noncancer patients; p = 0.001) and were less likely to have clinical frailty (13.3% vs. 43.9%; p < 0.001). Our study confirms that many patients face the last few months of life with comorbidities or extreme frailty. This study contributes to increasing the general knowledge on palliative care needs in a high-income country.
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Mei, Guang, Weisheng Xu, Li Li, Zhen Zhao, Hao Li, Wenqing Liu, and Yueming Jiao. "The Role of Campus Data in Representing Depression Among College Students: Exploratory Research." JMIR Mental Health 7, no. 1 (January 27, 2020): e12503. http://dx.doi.org/10.2196/12503.
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Background Depression is a predominant feature of many psychological problems leading to extreme behaviors and, in some cases, suicide. Campus information systems keep detailed and reliable student behavioral data; however, whether these data can reflect depression and we know the differences in behavior between depressive and nondepressive students are still research problems. Objective The purpose of this paper is to investigate the behavioral patterns of depressed students by using multisource campus data and exploring the link between behavioral preferences and depressive symptoms. The campus data described in this paper include basic personal information, academic performance, poverty subsidy, consumption habit, daily routine, library behavior, and meal habit, totaling 121 features. Methods To identify potentially depressive students, we developed an online questionnaire system based on a standard psychometric instrument, the Zung Self-Rating Depression Scale (SDS). To explore the differences in behavior of depressive and nondepressive students, the Mann-Whitney U test was applied. In order to investigate the behavioral features of different depressive symptoms, factor analysis was used to divide the questionnaire items into different symptom groups and then correlation analysis was employed to study the extrinsic characteristics of each depressive symptom. Results The correlation between these factors and the features were computed. The results indicated that there were 25 features correlated with either 4 factors or SDS score. The statistical results indicated that depressive students were more likely to fail exams, have poor meal habits, have increased night activities and decreased morning activities, and engage less in social activities (eg, avoiding meal times with friends). Correlation analysis showed that the somatic factor 2 (F4) was negatively correlated with the number of library visits (r=–.179, P<.001), and, compared with other factors, had the greatest impact on students’ daily schedule, eating and social habits. The biggest influencing factor to poor academic performance was cognitive factor F1, and its score was found to be significantly positively correlated with fail rate (r=.185, P=.02). Conclusions The results presented in this study indicate that campus data can reflect depression and its symptoms. By collecting a large amount of questionnaire data and combining machine learning algorithms, it is possible to realize an identification method of depression and depressive symptoms based on campus data.
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Baek, Hyeongi, and Mun Koo Kang. "A study on the ontology building methodology for diseases of mind diagnosis." Journal of Systems and Information Technology 17, no. 2 (May 11, 2015): 102–12. http://dx.doi.org/10.1108/jsit-11-2013-0059.
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Purpose – The purpose of this study was to construct a mind counseling ontology to efficiently facilitate the diagnosis of the diseases of mind. To determine the structure of mind counseling ontology, this study conducted analysis on structural forms available in counseling books and other related fields and adopted essential ones in the explanation of counseling. The processing of the diseases of mind was divided into three stages: cause, symptoms and counseling. The stages were analyzed one by one in terms of process, functional elements and relevant technique necessary at each stage. Design/methodology/approach – In the mind counseling list, there are 12 different diagnoses of diseases of mind that are classified into four classes. Thus, the causes, symptoms, prescription and medical history for 12 diseases of mind are defined as a higher rank concept of mind counseling ontology. The causes, symptoms, prescription and medical history consist of definition, affective characteristics and related factors, while the potential diagnosis consists of definition and risk factor. This information does specify detailed notions in the diagnosis of diseases of mind, but considering the limitation of not being able to represent all the diseases, this study enables a counseling center to give and use individual definitions of diagnostic terminology of their own. Findings – This study adopted the top-down approach, in which mind counseling ontology defines a higher rank concept, the terminology in diagnosing diseases of mind, based on the list of terms from the counseling record that specifies the abstract concepts of the diagnosis. The bottom-up approach was also incorporated, which defines the diagnostic terms extracted from the counseling record as a subordinate concept of the mind counseling ontology. Thus, the development of the mind counseling ontology involves the combination of top-down and bottom-up approaches to the construction of ontology. Originality/value – This research has significance in that it deals with the fundamental problem of the mind aiming for a true change and healing of it, which is the ultimate purpose of this ontology, especially in the circumstances where research on ontology in diagnosing the diseases of mind is unprecedented.
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Hunter, Laurie, Laralin Roland, and Ayesha Ferozpuri. "Emotional Expression Processing and Depressive Symptomatology: Eye-Tracking Reveals Differential Importance of Lower and Middle Facial Areas of Interest." Depression Research and Treatment 2020 (January 6, 2020): 1–7. http://dx.doi.org/10.1155/2020/1049851.
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The current study explored the eye-tracking patterns of individuals with nonclinical levels of depressive symptomatology when processing emotional expressions. Fifty-three college undergraduates were asked to label 80 facial expressions of five emotions (anger, fear, happiness, neutral, and sadness) while an eye-tracker measured visit duration. We argue visit duration provides more detailed information for evaluating which features of the face are used more often for processing emotional faces. Our findings indicated individuals with nonclinical levels of depressive symptomatology process emotional expressions very similarly to individuals with little to no depressive symptoms, with one noteworthy exception. In general, individuals in our study visited the “T” region, lower and middle AOIs (Area of Interest), more often than upper and noncore areas, but the distinction between the lower and middle AOIs appears for happiness only when individuals are higher in depressive symptoms.
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Hof, J. R., B. Kremer, and J. J. Manni. "Mould constituents in the middle ear, a hearing-aid complication." Journal of Laryngology & Otology 114, no. 1 (January 2000): 50–52. http://dx.doi.org/10.1258/0022215001903663.
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During the placement of a mould for a hearing-aid by a hearing-aid dispenser, moulding material entered the middle ear through pre-existent perforations in the tympanic membrane in both ears. Besides hearing loss, there were no other symptoms. Surgical removal of the moulding material by tympanotomy was necessary, and was complicated by encirclement of the ossicles by the material. All the material could be removed and the hearing was saved. Recommendations for an improved procedure of mould-making are made including more detailed information of the otoscopic findings at the prescriptions for hearing-aid moulds.
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Staszewska, Jolanta. "BURNOUT AMONG EMPLOYEES OF SMALL AND MEDIUM-SIZED ENTERPRISES." Zeszyty Naukowe Wyższej Szkoły Humanitas Zarządzanie 21, no. 4 (December 31, 2020): 187–96. http://dx.doi.org/10.5604/01.3001.0014.7992.
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The article indicates the importance of the problem of burnout in the SME service sector, pointing to the goal of analyzing burnout in small and medium-sized enterprises. The structure of the article is expressed on the theoretical and empirical levels. Through empirical verification of the thesis, it has been shown that over 50% of workers in the sector in question have symptoms of burnout, pointing to the causes and effects of burnout. The article indicates the problem without a detailed discussion of it, because the author’s presentation is preliminary and will be successively enriched with information from extended research
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Stuart, Beth L., Louise EN Grebel, Christopher C. Butler, Kerenza Hood, Theo J. M. Verheij, and Paul Little. "Comparison between treatment effects in a randomised controlled trial and an observational study using propensity scores in primary care." British Journal of General Practice 67, no. 662 (July 31, 2017): e643-e649. http://dx.doi.org/10.3399/bjgp17x692153.
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BackgroundAlthough randomised controlled trials (RCTs) are considered ‘gold standard’ evidence, they are not always feasible or appropriate, and may represent a select population. Observational studies provide a useful alternative to enhance applicability, but results can be biased due to confounding.AimTo explore the utility of propensity scores for causal inference in an observational study.Design and settingComparison of the effect of amoxicillin on key outcomes in an international RCT and observational study of lower respiratory tract infections.MethodPropensity scores were calculated and applied as probability weights in the analyses. The adjusted results were compared with the effects reported in the RCT.ResultsGroups were well balanced in the RCT but significantly imbalanced in the observational study, with evidence of confounding by indication: patients receiving antibiotics tended to be older and more unwell at baseline consultation. In the trial duration of symptoms (hazard ratio 1.06, 95% CI = 0.96 to 1.18) and symptom severity (−0.07, 95% CI = −0.15 to 0.007) did not differ between groups. Weighting by propensity score in the observational study resulted in very similar estimates of effect: duration of symptoms (hazard ratio 1.06, 95% CI = 0.80 to 1.40) and difference for symptom severity (−0.07, 95% CI = −0.34 to 0.20).ConclusionThe observational study, after conditioning on propensity score, echoed the trial results. Provided that detailed information is available on potential sources of confounding, effects of interventions can probably be assessed reasonably well in observational datasets, allowing them to be more directly compared with the results of RCTs.
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Riffin, Catherine, Sylvia Lee, M. Cary Reid, Keela Herr, and Karl Pillemer. "Caregiver-Provider Communication About Pain in Persons With Dementia." Innovation in Aging 4, Supplement_1 (December 1, 2020): 71. http://dx.doi.org/10.1093/geroni/igaa057.233.
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Abstract Pain in older persons with dementia (PWD) is severely under-detected and under-managed. Family caregivers can play an important role in addressing these disparities by acquiring the requisite skills to communicate PWD’s pain symptoms and behaviors to health care providers, but little is known about how caregivers of dementia patients and their providers approach such pain-related discussions. We employed qualitative methods to explore the perspectives of family caregivers of PWD (n=18) and health care providers (geriatricians, general internists, neurologists, emergency room physicians) involved in PWD’s treatment (n=16) regarding pain communication. We specifically focused on participants’: 1) priorities and expectations for communicating about pain and dementia, 2) challenges to communicating about pain and dementia, and 3) strategies and recommendations for optimizing communication about pain and dementia. Analyses revealed that caregivers and health care providers expected to receive accurate, detailed information from one another, but uncertainty in both groups around differentiating pain behaviors from dementia symptoms acted as a barrier to effective information exchange. Additional challenges to productive pain-related discussions were identified by caregivers, including provider fatalism and lack of interpersonal skills, and by providers, including patient-caregiver disagreement about pain symptoms and unreliable caregiver reporting. Participants endorsed using practical approaches, such as pain scales and logs, as well as rapport-building strategies, such as affirmation of caregivers’ input, to facilitate collaborative discussions.
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Andrews, Gavin. "Treatment Outlines for the Management of Obsessive-Compulsive Disorders." Australian & New Zealand Journal of Psychiatry 19, no. 3 (September 1985): 240–53. http://dx.doi.org/10.3109/00048678509158829.
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The Quality Assurance Project is developing explicit and detailed treatment outlines for each of the major psychiatric disorders. Three sources of information are used: a meta-analysis of the treatment outcome literature, the opinions of a sample of practising psychiatrists, and the views of a panel of nominated experts. The recommendations for the treatment of obsessive-compulsive disorder were as follows: for those patients who have no significant personality disorder, either short-term dynamic psychotherapy or cognitive behaviour therapy is indicated if the illness has lasted less than a year or if obsessions are the predominant symptoms. When compulsions predominate, particularly when they have been present for more than a year, response prevention is the treatment of choice. Tricyclic antidepressants and cingulo-tractomy are also worthy of consideration in patients with persisting symptoms. Psychotherapy or cognitive behaviour therapy are the approaches recommended for compulsive personality disorder.
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Chang, Chiu-Hua, Tai-Hsiang Chen, Lan-Lung (Luke) Chiang, Chiao-Lin Hsu, Hsien-Chung Yu, Guang-Yuan Mar, and Chen-Chung Ma. "Associations between Lifestyle Habits, Perceived Symptoms and Gastroesophageal Reflux Disease in Patients Seeking Health Check-Ups." International Journal of Environmental Research and Public Health 18, no. 7 (April 6, 2021): 3808. http://dx.doi.org/10.3390/ijerph18073808.
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Gastroesophageal reflux disease (GERD) is one of the most common diseases. It mainly causes the stomach contents to flow back to the esophagus, thereby stimulating the esophagus and causing discomfort. From the results of our research, we intend to provide the general public with information related to preventing gastroesophageal reflux disease and medical personnel with information on the treatment and care of patients with gastroesophageal reflux disease. This study aimed to investigate the association of lifestyle habits and perceived symptoms on GERD in patients who underwent routine health check-ups. This study was conducted as a retrospective cross-sectional design to collect GERD cases from the medical records containing the health questionnaires and the report of endoscopic findings on the day of the health check-up. A total of 5653 patients were enrolled between 1 January 2016, and 31 December 2018. About 60.2% (n = 3404) of patients with GERD were diagnosed based on endoscopic findings. Descriptive and multivariate logistic regression analyses were performed to identify the risk factors of the development of GERD. The results of the multivariate logistic regression analysis showed that age, sex, waist circumference, Areca catechu chewing habit, sleep disorders, otolaryngology symptoms, and hepatobiliary and gastrointestinal symptoms were significantly associated with GERD. In this study, our results can be used as a reference for public health care and clinicians. Because most GERD cases can be controlled and prevented by lifestyle modifications, health professionals should always obtain a detailed history regarding symptoms and lifestyle habits associated with GERD.
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Takis, Panteleimon, Antonio Taddei, Riccardo Pini, Stefano Grifoni, Francesca Tarantini, Paolo Bechi, and Claudio Luchinat. "Fingerprinting Acute Digestive Diseases by Untargeted NMR Based Metabolomics." International Journal of Molecular Sciences 19, no. 11 (October 23, 2018): 3288. http://dx.doi.org/10.3390/ijms19113288.
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Precision medicine may significantly contribute to rapid disease diagnosis and targeted therapy, but relies on the availability of detailed, subject specific, clinical information. Proton nuclear magnetic resonance (1H–NMR) spectroscopy of body fluids can extract individual metabolic fingerprints. Herein, we studied 64 patients admitted to the Florence main hospital emergency room with severe abdominal pain. A blood sample was drawn from each patient at admission, and the corresponding sera underwent 1H–NMR metabolomics fingerprinting. Unsupervised Principal Component Analysis (PCA) analysis showed a significant discrimination between a group of patients with symptoms of upper abdominal pain and a second group consisting of patients with diffuse abdominal/intestinal pain. Prompted by this observation, supervised statistical analysis (Orthogonal Partial Least Squares–Discriminant Analysis (OPLS-DA)) showed a very good discrimination (>90%) between the two groups of symptoms. This is a surprising finding, given that neither of the two symptoms points directly to a specific disease among those studied here. Actually herein, upper abdominal pain may result from either symptomatic gallstones, cholecystitis, or pancreatitis, while diffuse abdominal/intestinal pain may result from either intestinal ischemia, strangulated obstruction, or mechanical obstruction. Although limited by the small number of samples from each of these six conditions, discrimination of these diseases was attempted. In the first symptom group, >70% discrimination accuracy was obtained among symptomatic gallstones, pancreatitis, and cholecystitis, while for the second symptom group >85% classification accuracy was obtained for intestinal ischemia, strangulated obstruction, and mechanical obstruction. No single metabolite stands up as a possible biomarker for any of these diseases, while the contribution of the whole 1H–NMR serum fingerprint seems to be a promising candidate, to be confirmed on larger cohorts, as a first-line discriminator for these diseases.
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Gadbail, Amol Ramchandra, Ravi Dande, Sachin C. Sarode, Shailesh Gondivkar, Lalita Belekar, Mugdha Mankar-Gadbail, Gargi S. Sarode, Shankargouda Patil, and Monal Yuwanati. "Patients with oral submucous fibrosis who visit dental hospitals have nonspecific chief complaints." Translational Research in Oral Oncology 4 (January 1, 2019): 2057178X1985845. http://dx.doi.org/10.1177/2057178x19858453.
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Background: The first consultation with a health-care professional is crucial to make the correct diagnosis particularly with respect to narrating the symptoms encountered by the patient. Yet, currently, no information is available concerning the primary symptoms documented by patients with oral submucous fibrosis (OSF). Materials and Methods: A total of 158 OSF patients visiting outdoor patient departments (OSF-OPDs) and 104 pan shop customers (PSCs) were investigated. OSF-OPD cases and relevant PSCs cases were investigated to discover the chief complaints (CCs) leading to dental visits. Detailed demographic data, patient histories concerning relevant habits (with duration), and socioeconomic status were recorded. OSF cases were graded based on the degree of mouth opening. Results: Out of 158 OSF-OPD patients, only 43 (26.58%) reported relevant disease symptoms of OSF: in stage III, 28.57%, or stage IV, 38.09%. One hundred and sixteen patients (73.41%) reported CCs unrelated to OSF, and all of these cases were diagnosed with an early stage of OSF (stage I: 47.05% and stage II: 22.5%). Out of the total 104 PSCs, 66 PSCs have had prior dental consultations, but only five (4.80%) individuals had visited a health-care professional due to OSF-related CCs. Conclusion: A significant number of CCs made by OSF patients were unrelated to their disease signs and symptoms. There is a lack of awareness of OSF symptoms by pan chewers, thus hindering early detection.
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Chowdhary, Sajeel A., Barbara Ann Given, Charles W. Given, Cindy Majeske, Paul D. Decker, and Brian Decker. "Small business technology transfer (STTR) phase I study (1 R41 MD006148-01) of an automated voice response (AVR) system to improve symptom management in neuro-oncology patients." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e12500-e12500. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e12500.
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e12500 Background: This STTR Phase 1 study focused on enhancing and improving the technology of a prior AVR system (Grant #R01 CA30724) to manage symptoms in cancer patients. Neuro-Oncology patients were enrolled to test our proof of concept (POC). Methods: Previous AVR function was replicated using Asterisk software enhancing the branching logic, configurability and operational capacity on multiple operating systems; limitations of the previous AVR. Eligibility criteria: access to a telephone; actively on chemotherapy. Nurse recruiters provided detailed information about the study and answered questions. Following signed consent patients provided a preferred phone number and chose a day and time of the week to receive AVR calls. Patients received a Symptom Management Guide (SMG) at time of consent. Patients were contacted a total of 4 times over a 4 week period by the AVR. At each contact patients were asked to rate 17 symptoms on a scale of 1-9 for severity and interference with 4 domains of quality of life on a 1-5 scale. Patient’s reporting a 4 or higher severity level were directed by the AVR to reference their SMG for self-care strategies to manage their symptoms. At the end of the study patients completed a satisfaction survey. Results: Ten patients were enrolled. The AVR placed 38 of 40 scheduled calls. No errors in survey branching were evident with confirmation. Patient satisfaction surveys were completed with 70% of patients. One patient did not complete any scheduled calls and was not contacted, two patients were unreachable. All patients reported satisfaction. 86% reported they would recommend this system to their oncology provider. 71% felt it was helpful in individualized monitoring of symptoms between visits. 57% liked knowing their symptom(s) were being checked regularly. One indicated the system was too overwhelming. Complaints included: not being able to change responses (1) and not allowing them to answer questions as fast as they wanted (2). Conclusions: Patient satisfaction results and system performance confirmed that the POC was feasible and that this system should be studied in larger groups of oncology patients.
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Drageset, Jorunn, Geir Egil Eide, and Solveig Hauge. "Symptoms of depression, sadness and sense of coherence (coping) among cognitively intact older people with cancer living in nursing homes—a mixed-methods study." PeerJ 4 (June 9, 2016): e2096. http://dx.doi.org/10.7717/peerj.2096.
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Background:Symptoms of depression are often reported among patients with a cancer diagnosis. Strong sense of coherence (SOC) is shown to be associated with less depression in the general older population and among nursing homes (NH) residents in particular. Knowledge about mixed-methods perspectives that examine symptoms of depression and SOC among cognitively intact NH residents with cancer is scarce.Aim:To investigate symptoms of depression and SOC among NH residents who are cognitively intact and have cancer.Methods:We used a quantitatively driven mixed-methods design with sequential supplementary qualitative components. We facilitated the collection of quantitative survey data of 60 NH residents (≥ 65 years) with cancer using the Geriatric Depression Scale (GDS) and SOC scale. The supplementary psychosocial component comprised qualitative research interviews about experiences related to depression with nine respondents from the same cohort.Results:In fully adjusted multiple regression analysis of the sociodemographic variables, the GDS was significantly correlated with SOC (P< 0.001). The experience of sadness was identified by the following theme: sadness. Coping with the experience of symptoms of depression was dominated by coping with sadness.Conclusion:More than half the NH residents reported symptoms of depression, and the SOC was associated with reduced symptoms. A mixed-methods design contributed to nuanced and detailed information about the meaning of depression, and the supplementary component informs and supports the core component. To improve the situation of NH residents with cancer, more attention should be paid to the residents’ experience of symptoms of depression and their SOC.
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Hobbs, Jonathan G., Jacob S. Young, and Julian E. Bailes. "Sports-related concussions: diagnosis, complications, and current management strategies." Neurosurgical Focus 40, no. 4 (April 2016): E5. http://dx.doi.org/10.3171/2016.1.focus15617.
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Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7–10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.
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Ferguson, James J., Fedro S. Zaueta, and Juan I. Valiente. "CITPATH: Diagnostic and Hypertext Software for Fungal Diseases of Citrus Foliage and Fruit." HortTechnology 5, no. 3 (July 1995): 277–78. http://dx.doi.org/10.21273/horttech.5.3.277.
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CITPATH, a computerized diagnostic key and information system, was developed to identify the major fungal diseases of citrus foliage and fruit in Florida. This software provides hypertext-linked descriptions and graphic displays of symptoms, maps of geographic occurrence, diagrams of disease development, and management strategies, with reference to chemical control methods detailed in the current Florida Citrus Pest Management Guide. Reciprocal lists of citrus cultivars susceptible to specific diseases and diseases affecting specific cultivars are included. Developed for commercial growers, county extension programs, citrus horticulture classes, and master gardeners, this software is available for MS-DOS-based computers and on CD-ROM disks containing other citrus databases.
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Uddin, F. J., C. Nogueira, and A. Sama. "An unusual presentation of epilepsy." Journal of Laryngology & Otology 125, no. 6 (March 28, 2011): 633–34. http://dx.doi.org/10.1017/s0022215110002847.
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AbstractObjective:To report a case of fluctuating hearing due to auditory aura, as an unusual presentation of temporal lobe epilepsy.Methods:Case report and review of English language literature on temporal lobe epilepsy and auditory aura.Results:A 31-year-old man presented with intermittent symptoms of bilateral fullness in the ears associated with deafness. He was subsequently diagnosed with temporal lobe epilepsy. Further enquiry revealed a family history of epilepsy.Conclusion:Auditory aura as a presentation of temporal lobe epilepsy is rarely encountered in otolaryngological practice. This case highlights the importance of obtaining detailed information on epilepsy, including any family history of epilepsy, as a routine part of history-taking in patients presenting with fluctuating hearing loss.
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Kirnaz, Sertac, Rodrigo Navarro-Ramirez, Jiaao Gu, Christoph Wipplinger, Ibrahim Hussain, Joshua Adjei, Eliana Kim, et al. "Indirect Decompression Failure After Lateral Lumbar Interbody Fusion—Reported Failures and Predictive Factors: Systematic Review." Global Spine Journal 10, no. 2_suppl (April 2020): 8S—16S. http://dx.doi.org/10.1177/2192568219876244.
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Background: In patients with symptomatic lumbar stenosis undergoing lateral transpsoas approach for lumbar interbody fusion (LLIF) surgery, it is not always clear when indirect decompression is sufficient in order to achieve symptom resolution. Indirect decompression failure (IDF), defined as “postoperative persistent symptoms of nerve compression with or without a second direct decompression surgery to reach adequate symptom resolution,” is not widely reported. This information, however, is critical to better understand the indications, the potential, and the limitations of indirect decompression. Objective: The purpose of this study was to systematically review the current literature on IDF after LLIF. Methods: A literature search was performed on PubMed. We included randomized controlled trials and prospective, retrospective, case-control studies, and case reports. Information on sample size, demographics, procedure, number and location of involved levels, follow-up time, and complications were extracted. Results: After applying the exclusion criteria, we included 9 of the 268 screened articles that reported failure. A total of 632 patients were screened in these articles and detailed information was provided. Average follow-up time was 21 months. Overall reported incidence of IDF was 9%. Conclusion: Failures of decompression via LLIF are inconsistently reported and the incidence is approximately 9%. IDF failure in LLIF may be underreported or misinterpreted as a complication. We propose to include the term “IDF” as described in this article to differentiate them from complications for future studies. A better understanding of why IDF occurs will allow surgeons to better plan surgical intervention and will avoid revision surgery.
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Zhu, Daofang, Xianming Dou, Liang Tang, Dongdong Tang, Guiyi Liao, Weihua Fang, and Xiansheng Zhang. "Prevalence of Prostatitis-Like Symptoms and Outcomes of NIH-CPSI in Outpatients with Lifelong and Acquired PE: Based on a Large Cross-Sectional Study in China." BioMed Research International 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/3473796.
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Premature ejaculation (PE) is one of the most common sexual dysfunctions, which were associated with prostatitis-like symptoms (PLS). We intended to explore the prevalence of prostatitis-like symptoms and outcomes of National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scores in outpatients with lifelong (LPE) and acquired premature ejaculation (APE). From December 2013 to December 2015, a total of 498 consecutive heterosexual men with PE and 322 male healthy subjects without PE were enrolled. Each of them completed a detailed questionnaire on demographics information, sexual and medical histories, and the NIH-CPSI. Assessment of NIH-CPSI and definition of PLS and PE were used to measure the PLS and NIH-CPSI scores and ejaculatory function for all subjects. Finally, a total of 820 subjects (including 498 men in PE group and 322 men in control group) were enrolled in our study. The mean ages were significantly different between PE and no PE groups. Men with PE reported worse PLS and higher NIH-CPSI scores (P < 0.001 for all). Similar findings were also observed between men with LPE and APE. Men with APE also reported higher rates of PLS and scores of NIH-CPSI (P < 0.001 for all). Multivariate analysis showed that PLS and NIH-CPSI scores were significantly associated with PE.
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Trojan, Andreas, Basil Bättig, Meinrad Mannhart, Burkhardt Seifert, Mathis N. Brauchbar, and Marco Egbring. "Effect of Collaborative Review of Electronic Patient-Reported Outcomes for Shared Reporting in Breast Cancer Patients: Descriptive Comparative Study." JMIR Cancer 7, no. 1 (March 17, 2021): e26950. http://dx.doi.org/10.2196/26950.
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Background Digital monitoring of treatment-related symptoms and self-reported patient outcomes is important for the quality of care among cancer patients. As mobile devices are ubiquitous nowadays, the collection of electronic patient-reported outcomes (ePROs) is gaining momentum. So far, data are lacking on the modalities that contribute to the quantity and quality of ePROs. Objective The objective of our study was to compare the utilization of two versions of a subsequently employed mobile app for electronic monitoring of PROs and to test our hypothesis that a shared review of symptoms in patient-physician collaboration has an impact on the number of data entries. Methods The Consilium Care app engages cancer patients to standardize reporting of well-being and treatment-related symptoms in outpatient settings. For descriptive comparison of the utilization of two slightly different app versions, data were obtained from an early breast cancer trial (version 1 of the app, n=86) and an ongoing study including patients with advanced disease (version 2 of the app, n=106). In both app versions, patients and doctors were allowed to share the information from data entries during consultations. Version 2 of the app, however, randomly selected symptoms that required a detailed and shared regular patient-doctor review in order to focus on the collection and appropriate interpretation regarding awareness and guidance for severity grading. The numbers and types of symptom entries, satisfaction with both app versions, and patients’ perceived effects during consultations were included for analysis. Results Symptom severity grading was performed according to the Common Terminology Criteria for Adverse Events (CTCAE) using a horizontal slider and was indicated in descriptive terminology in both apps, while a graphical display facilitated the illustration of symptom history charts. In total, 192 patients electronically reported 11,437 data entries on well-being and 33,380 data entries on individual symptoms. Overall, 628 (of 872 intended) requested patient-doctor symptom reviews were performed in version 2 of the app. Both the amount of data entries per patient and day for well-being (version 1 vs version 2: 0.3 vs 1.0; P<.001) and symptoms (version 1 vs version 2: 1.3 vs 1.9; P=.04) appeared significantly increased in version 2 of the app. Overall satisfaction with both app versions was high, although version 2 of the app was perceived to be more helpful in general. Conclusions Version 2 of the app showed much better results than version 1 of the app. A request for collaborative patient-doctor symptom review is likely to affect the number of digital symptom data entries. This app shows high potential to improve the patient-doctor experience. Trial Registration ClinicalTrials.gov NCT02004496; https://clinicaltrials.gov/ct2/show/NCT02004496 and ClinicalTrials.gov NCT03578731; https://clinicaltrials.gov/ct2/show/NCT03578731
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Tsyganenko, Oksana. "SOMATO-PSYCHIC DISORDER CLINICAL CASE IN A FEMALE PATIENT WITH MULTINODULAR EUTHYROID GOITER." EUREKA: Health Sciences 1 (January 29, 2016): 3–8. http://dx.doi.org/10.21303/2504-5679.2016.00013.
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The article presents a clinical case of somato-psychic disorder in a patient with multinodular euthyroid goiter. The patient was diagnosed with thyroid cancer on outpatient basis and was suggested urgent surgical treatment. After receiving information about cancer pathology the patient developed symptoms of hypernosognostic neurotic syndrome with manifestations of obsessions and hystero-hypohondriasis. The patient was focused on the rigid hypochondria with detailed statement of the slightest signs of bodily distress. Therefore, the above example demonstrates difficulty in selecting the tactics of management for such patients due to development of symptoms primarily determined by psycho-emotional tension. This category of patients should be followed not only by endocrinologists, surgeons, but the multidisciplinary team, including psychiatrists, and psychotherapists, since in case of combined impact of a number of adverse factors, the reaction to the disease can become so extreme that its management in the early stages of therapy seems no less important than the direct treatment of somatic condition.
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Birmingham, Karen, Steven Gregory, Yasmin Iles-Caven, Abigail Fraser, Deborah Lawlor, Andrew Boyd, Kate Northstone, and Jean Golding. "The mother during pregnancy and the puerperium: Detailed data abstracted from the clinical obstetric records of ALSPAC pregnancies." Wellcome Open Research 6 (February 23, 2021): 41. http://dx.doi.org/10.12688/wellcomeopenres.16603.1.
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Background: When the Avon Longitudinal Study of Parents and Children (ALSPAC) was planned, it was assumed that the clinical obstetric data would be easily accessible from the newly developed National Health Service computerised ‘STORK’ system. Pilot studies, however, showed that, although fairly accurate in regard to aspects of labour and delivery, it was, at the time (1990-2), inadequate for identifying the full antenatal and postnatal details of clinical complications and treatments of the women in the Study. Methods: A scheme was therefore developed to train research staff to find and abstract relevant details from clinical records onto proformas designed for the purpose. Extracting such data proved very time consuming (up to six hours for complicated pregnancies) and consequently expensive. Funding for the enterprise was obtained piecemeal using specific focussed grants to extract data for subsamples of the Study, including a random sample to serve as controls. Results: To date, detailed records have been completed for 8369 pregnancies, and a further 5336 (13,705 in total) have complete details on specific prenatal areas, including serial measures of maternal blood pressure, proteinuria and weight. In this Data Note we describe the information abstracted from the obstetric medical records concerning the mother during pregnancy, labour, delivery and the first two weeks of the puerperium. Information abstracted relating to the fetus (including fetal monitoring, presentation, method of delivery) and neonate (signs of asphyxia, resuscitation, treatment and well-being) will be described in a further Data Note. Conclusions: These data add depth to ALSPAC concerning ways in which the signs and symptoms, procedures and treatments of the mother prenatally, intrapartum and postnatally, may impact on the long-term health and development of both mother and child. They augment the data collected from the mothers’ questionnaires and the ‘STORK’ digital hospital data.
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Zuidema, Sytse U., Alice Johansson, Geir Selbaek, Matt Murray, Alistair Burns, Clive Ballard, and Raymond T. C. M. Koopmans. "A consensus guideline for antipsychotic drug use for dementia in care homes. Bridging the gap between scientific evidence and clinical practice." International Psychogeriatrics 27, no. 11 (June 10, 2015): 1849–59. http://dx.doi.org/10.1017/s1041610215000745.
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ABSTRACTBackground:To produce a practice guideline that includes a set of detailed consensus principles regarding the prescription of antipsychotics (APs) amongst people with dementia living in care homes.Methods:We used a modified Delphi consensus procedure with three rounds, where we actively specified and optimized statements throughout the process, utilizing input from four focus groups, carried out in UK, Norway, and the Netherlands. This was done to identify relevant themes and a set of statement that experts agreed upon using the Research and Development/University of California at Los Angeles (RAND/UCLA) methodology.Results:A total of 72 scientific and clinical experts and 14 consumer experts reached consensus upon 150 statements covering five themes: (1) General prescription stipulations, (2) assessments prior to prescription, (3) care and treatment plan, (4) discontinuation, and (5) long-term treatment.Conclusions:In this practice guideline, novel information was provided about detailed indication and thresholds of symptoms, risk factors, circumstances at which APs should be stopped or tapered, specific criteria for justifying long-term treatment, involvement of the multidisciplinary team, and family caregiver in the process of prescription. The practice guideline is based on formal consensus of clinicians and consumer experts and provides clinicians relevant practical information that is lacking in current guidelines.
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Sestak, Ivana, Roseann Kealy, Robert Edwards, John Forbes, and Jack Cuzick. "Influence of Hormone Replacement Therapy on Tamoxifen-Induced Vasomotor Symptoms." Journal of Clinical Oncology 24, no. 24 (August 20, 2006): 3991–96. http://dx.doi.org/10.1200/jco.2005.04.3745.
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Purpose Tamoxifen is an effective drug, but its role in prevention is limited by its adverse effect profile. Non–life-threatening adverse effects, such as vasomotor symptoms, have an important influence in its use for prevention. Vasomotor symptoms were evaluated according to follow-up time, severity, and use of hormone replacement therapy (HRT) in a retrospective analysis. Patients and Methods In the International Breast Cancer Intervention Study-I study, 7,154 women at increased risk of breast cancer were randomly assigned to either tamoxifen 20 mg/d or placebo for 5 years. Women gave detailed information on any vasomotor symptoms at each 6-month follow-up visit. Results Hot flushes were reported more often in the tamoxifen group than in the placebo group (70.6% v 57.1%, respectively; odds ratio, 1.80; 95% CI, 1.63 to 1.99). Severe hot flushes were more strongly related to tamoxifen. In the tamoxifen arm, more women taking HRT at entry experienced hot flushes in the first 6 months than those who did not take HRT (60.8% v 49.2%, respectively; P = .09). In contrast, women on placebo taking HRT at entry experienced fewer hot flushes than women who stopped HRT (22.9% v 34.3%, respectively; P = .03). Furthermore, for women who first began HRT in the first 6 months of the trial compared with women who did not begin HRT, HRT seemed to be much more effective in controlling hot flushes in months 6 to 12 in the placebo arm (47.9% v 20.4%, respectively) than in the tamoxifen arm (51.4% v 39.0%, respectively). Conclusion HRT use at entry or during the trial was not effective in alleviating hot flushes for women in the tamoxifen arm. Our retrospective study suggests that estrogen-based HRT has limited effectiveness among women receiving tamoxifen.
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van der Zanden, Moniek, Laura de Kok, Willianne L. D. M. Nelen, Didi D. M. Braat, and Annemiek W. Nap. "Strengths and weaknesses in the diagnostic process of endometriosis from the patients’ perspective: a focus group study." Diagnosis 8, no. 3 (July 28, 2021): 333–39. http://dx.doi.org/10.1515/dx-2021-0043.
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Abstract Objectives Endometriosis is characterized by a long interval between onset of symptoms and diagnosis. Detailed information about the patients’ perspective on the diagnostic delay of endometriosis is scarce. The aim of this study was to identify strengths and weaknesses in the diagnostic process of endometriosis from the patients’ perspective. Methods Qualitative study with semi-structured focus groups. Participants were women between 18 and 45 years old with a recently confirmed diagnosis. The focus groups were audio recorded and fully transcribed. Grounded theory methodology was applied for data analysis. Results Six focus groups were organized, in which 23 women participated. Mean time from start of symptoms to diagnosis was 8.5 years. Dominant themes were knowledge about normal menstruation and endometriosis, being believed and acknowledged by medical staff, and collaboration between health care providers including fast referral to a gynaecologist. Barriers to a timely referral and diagnosis were young age, normalization of symptoms and a lack of awareness in general practitioners. Facilitating factors included adequate knowledge and skills of the general practitioner, a desire for pregnancy and persisting in a request for specialist consultation by the patient. Conclusions The diagnostic process of endometriosis is hampered by delayed consultation, inadequate appraisal of symptoms by general practitioners and the interaction between patients and medical professionals. Efforts should be made to increase public awareness and to provide medical staff with sufficient knowledge and skills to adequately acknowledge presented symptoms.
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Milanova, Maria Hristova, Stefan Naydenov Naydenov, Nikolay Margaritov Runev, Emil Ivanov Manov, and Plamen Krasimirov Krastev. "Analysis of prehospital care of patients with acute myocardial infarction in Bulgaria." Hong Kong Journal of Emergency Medicine 25, no. 4 (April 5, 2018): 196–201. http://dx.doi.org/10.1177/1024907918765842.
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Introduction: Acute myocardial infarction is one of the most devastating cardiovascular diseases and about 50% of all deaths due to it occur prior to hospitalization. Our study aimed to evaluate the prehospital delay in patients with acute myocardial infarction. Methods: We enrolled 682 consecutive patients with acute myocardial infarction from May 2008 to December 2014, with a mean age of 66.6 ± 12.9 years. Detailed information was collected about the symptoms, first medical contact, concomitant clinical conditions, and the socioeconomic data. We analyzed the following prehospital times: (1) onset of symptoms to emergency call, (2) onset of symptoms to first medical contact, (3) first medical contact to hospital admission, and (4) onset of symptoms to hospital admission. Results: The first medical contact was with the National Emergency Medical Service in 266 (39.0%) patients, another emergency unit 106 (15.6%), cardiologist 41 (6%), general practitioner 36 (5.3%), and others 233 (34.1%). The median time from the onset of symptoms till emergency call was 190 min, from the first contact with a team of the National Emergency Medical Service till hospital admission 60 min, and from the onset of symptoms till hospital admission 4.8 h. Conclusion: The total prehospital delay in our study was unacceptably prolonged, with patient’s decision time as the major contributor. The delay could be substantially shortened by (1) increased awareness of the general population, particularly of individuals at high cardiovascular risk and (2) continuous medical education and regular practical training of the primary care providers about coping with medical emergencies.
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Taub, Chloe J., John A. Sturgeon, Mandeep K. Chahal, Ming-Chih Kao, Sean C. Mackey, and Beth D. Darnall. "Self-reported traumatic etiology of pain and psychological function in tertiary care pain clinic patients: a collaborative health outcomes information registry (CHOIR) study." Scandinavian Journal of Pain 20, no. 3 (July 28, 2020): 499–509. http://dx.doi.org/10.1515/sjpain-2019-0154.
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AbstractBackground and aimsA sizable body of research has elucidated the significant role of psychological reactions to trauma on pain coping and outcomes. In order to best inform intervention development and clinical care for patients with both trauma and pain at the tertiary care level, greater clarity is needed regarding the magnitude of these effects and the specific pathways through which they may or may not function at the time of first presentation to such a treatment setting. To achieve this, the current study examined the cross-sectional relationships between traumatic etiology of pain, psychological distress (anger, depressive symptoms, and PTSD symptoms), and pain outcomes (pain catastrophizing, physical function, disability status).MethodsUsing a structural path modeling approach, analyses were conducted using a large sample of individuals with chronic pain (n = 637) seeking new medical evaluation at a tertiary pain management center, using the Collaborative Health Outcomes Information Registry (CHOIR). We hypothesized that the relationships between traumatic etiology of pain and poorer pain outcomes would be mediated by higher levels of psychological distress.ResultsOur analyses revealed modest relationships between self-reported traumatic etiology of pain and pain catastrophizing, physical function, and disability status. In comparison, there were stronger relationships between indices of psychological distress and pain catastrophizing, but a weaker pattern of associations between psychological distress and physical function and disability measures.ConclusionsTo the relatively small extent that self-reported traumatic etiology of pain correlates with pain-related outcomes, these relationships appear to be due primarily to the presence of psychiatric symptoms and manifest most notably in the context of psychological responses to pain (i.e. catastrophizing about pain).ImplicationsFindings from this study highlight the need for early intervention for patients with traumatic onset of pain and for clinicians at tertiary pain centers to include more detailed assessments of psychological distress and trauma as a component of comprehensive chronic pain treatment.