The Hospital Anxiety and Depression Scale: a pilot study to examine its latent structure and the link between psychological state and symptom severity in transient ischaemic attack patients.

Transient ischaemic attack (TIA) is often associated with anxiety and depression, which may precipitate secondary stroke and interfere with treatment. The Hospital Anxiety and Depression Scale (HADS) is widely used to assess these states and to inform the management of any associated psychological problems, but there is considerable debate about what it actually measures. The HADS scores from a range of different clinical groups have been reviewed in order to assess its psychometric properties, but so far, no research has examined either its latent structure when used with TIA patients, or the association between symptom severity and the test's validity. The aims of this study, therefore, were to investigate: (a) the underlying structure of the HADS when used with TIA patients; and (b) the impact of symptom severity on the validity of the HADS. The HADS and a functional capacity measure were administered by post to a sample of 542 confirmed TIA patients. Exploratory factor analysis was conducted on the HADS scores to establish its underlying structure for this clinical group, and then, sub-sample correlations were undertaken between the anxiety/depression scores for different levels of functional capacity. Two factors emerged, with 13 of the 14 HADS items loading significantly on both, suggesting there is a common affective state underlying the standard anxiety and depression scales. Further data-exploration indicated that convergence between these affective states increased as functional capacity deteriorated. The results suggest firstly that the HADS measures general subjective distress when used with TIA patients, and secondly that the higher reported symptom severity in this clinical group may be associated with reduced affective differentiation. As the ability to retain clear affective discrimination is associated with health and well-being, this could provide a focus for post-TIA rehabilitation.

The occurrence and associated risk factors of brain metastases in well differentiated grade 1 and 2 bronchial neuroendocrine tumours: A single centre retrospective analysis of 280 patients.

Typical and atypical bronchial carcinoid account for around 2% of all neuroendocrine neoplasms of pulmonary origin. Fewer than 5% of patients with these cancers are thought to develop brain metastases, and hence routine intracranial imaging is not currently included in staging investigations. In this study, retrospective case note analysis was performed on 280 patients diagnosed with either typical carcinoid (TC) or atypical carcinoid (AC) at a large, single-site cancer centre. None of the 219 patients with TC developed brain metastases during the course of their disease, whereas seven of the 61 AC (11.5%) were found to have intracranial spread, four of which were present at the point of diagnosis. A Cox proportional hazard model showed that a Ki-67 expression ≥18%, patient age ≥65 years and disease stage at diagnosis were all independently and significantly associated with the development of brain metastases in AC. This study has found new evidence that the incidence of brain metastases in AC is significantly higher than previously thought. Of all the variables reviewed, Ki-67 expression was most strongly associated with the development of intracranial disease in AC and could be readily translated into clinical practice. Predictive factors such as age, disease stage and Ki-67 expression could be used to identify patients at particularly increased risk of brain metastases, who would benefit from early intracranial imaging. This could allow for earlier detection and treatment of metastases, with the potential to improve clinical outcomes and patient quality of life.

Non-bacterial thrombotic endocarditis in pancreatic cancer and other high-risk malignancies: the case for prophylactic treatment.

Non-bacterial thrombotic endocarditis (NBTE) typically affects patients with underlying adenocarcinoma, often of pancreatic origin. If untreated, it can lead to serious morbidity and mortality, including recurrent ischaemic stroke. NBTE is frequently missed or confused with infective endocarditis, leading to inappropriate management. We present the case of a 54-year-old male with newly diagnosed pancreatic malignancy (CA19-9 >120 000) who suffered recurrent deep-vein-thromboses and multiple ischaemic strokes despite full anticoagulation therapy. Transoesophageal echocardiography was correctly performed, but only after a second stroke was NBTE considered. We recommend early clinical suspicion and investigation for NBTE in patients with known or suspected malignancy presenting with neurological symptoms consistent with stroke. Initial calculations indicate this could also be cost-effective. Further, the patient's significantly elevated tumour-markers and NBTE-severity raise the possibility of a link; if further research established a reliable relationship, routine surveillance of high-risk malignancies could identify patients who might benefit from earlier echocardiography and anticoagulation management.

Corrigendum to "Subjective Experiences of Speech and Language Therapy in Patients with Parkinson's Disease: A Pilot Study".

[This corrects the article DOI: 10.1155/2015/839895.].

Subjective Experiences of Speech and Language Therapy in Patients with Parkinson's Disease: A Pilot Study.

Purpose. Parkinson's disease can produce a range of speech-language pathologies, which may require intervention. While evaluations of speech-language therapy have been undertaken, no work has been undertaken to capture patients' experiences of therapy. This was the aim of the present study. Methods. Semistructured interviews, using themes derived from the literature, were conducted with nine Parkinson's disease patients, all of whom had undergone speech-language therapy. Participants' responses were analysed in accordance with Thematic Network Analysis. Results. Four themes emerged: emotional reactions (frustration, embarrassment, lack of confidence, disappointment, and anxiety); physical impact (fatigue, breathing and swallowing, and word production); practical aspects (cost of treatment, waiting times, and the actual clinical experience); and expectations about treatment (met versus unmet). Conclusions. While many benefits of speech-language therapy were reported, several negative issues emerged which could impact adversely on rehabilitation. Parkinson's disease is associated with a range of psychological and physical sequelae, such as fatigue and depression; recognising any individual experiences which could exacerbate the existing condition and incorporating these into treatment planning may improve rehabilitation outcomes.

Corrigendum: Stepping to phase-perturbed metronome cues: multisensory advantage in movement synchrony but not correction.

[This corrects the article on p. 724 in vol. 8, PMID: 25309397.].

Subjective experiences of transient ischaemic attack: a repertory grid approach.

PURPOSE: Research on the psychosocial reactions to stroke has been used to inform rehabilitation programmes. Yet much less research has been conducted into experiences of, and reactions to, transient ischaemic attack (TIA), despite its link with secondary stroke. This study aimed to investigate the subjective psychological experiences of TIA. METHOD: Repertory grid technique was used because of its capacity to make individual implicit experiences explicit. Using the standard repertory grid protocol, 12 post-TIA patients were asked to consider how five everyday activities had been affected by TIA. Each participant generated six constructs or personal perspectives, which were analysed using proprietary (RepGrid IV) software. RESULTS: Despite the individualised nature of the responses, six themes emerged from the constructs. These included deep-seated anxiety about future uncertainties/disruption to normality, loss of confidence, frustration, TIA as a wake-up call, a sense of loss and sadness, and embarrassment. IMPLICATIONS FOR REHABILITATION: Research has shown that the patient's subjective experience and perspective are important to the rehabilitation process post-stroke. Relatively little research has been conducted into the subjective experiences of TIA patients. This study has revealed a range of subjective reactions to TIA, which could be used to inform individualised post-TIA management, adaptation and rehabilitation.

A Q-Methodology Study of Patients' Subjective Experiences of TIA.

Background. An expanding body of research has focused on a range of consequences of TIA. However, no work has been conducted on the patient's subjective experience of TIA. Aim. To capture patients' first-hand experiences of TIA. Method. Using Q-methodology which employs both qualitative and quantitative approaches, 39 statements relating to the clinical, physical, affective, and psychological impact of TIA were distilled from the literature and from patient narratives. Consistent with conventional Q-methodology, a purposive sample of twentythree post-TIA patients sorted these statements into a normally-distributed 39-cell grid, according to the extent to which each represented their experience of TIA. Results. Casewise factoranalysis was conducted on the sorted statements. Eight factors emerged which were labelled: lack of knowledge/awareness of TIA; life impact; anxiety; interpersonal impact; depression; physical consequences; cognitive avoidance/denial; constructive optimism. Conclusions. Five of the eight factors confirmed existing research on the impact of TIA, but three new issues emerged: deep-seated anxiety, denial and constructive optimism. The emerging perspectives highlight areas to target in the management of TIA and could inform health education messages, patient information, individualised caremanagement, and enhancement of coping strategies. With development, the findings could be used as a basis for psychometric risk assessment of TIA patients.