What is stable pain control? A prospective longitudinal study to assess the clinical value of a personalized pain goal.

BACKGROUND: A universal consensus regarding standardized pain outcomes does not exist. The personalized pain goal has been suggested as a clinically relevant outcome measure. AIM: To assess the feasibility of obtaining a personalized pain goal and to compare a clinically based personalized pain goal definition versus a research-based study definition for stable pain. DESIGN: Prospective longitudinal descriptive study. MEASURES: The attending physician completed routine assessments, including a personalized pain goal and the Edmonton Classification System for Cancer Pain, and followed patients daily until stable pain control, death, or discharge. Stable pain for cognitively intact patients was defined as pain intensity less than or equal to desired pain intensity goal (personalized pain goal definition) or pain intensity ⩽3 (Edmonton Classification System for Cancer Pain study definition) for three consecutive days with <3 breakthroughs per day. SETTING/PARTICIPANTS: A total of 300 consecutive advanced cancer patients were recruited from two acute care hospitals and a tertiary palliative care unit. RESULTS: In all, 231/300 patients (77%) had a pain syndrome; 169/231 (73%) provided a personalized pain goal, with 113/169 (67%) reporting a personalized pain goal ⩽3 (median = 3, range = 0-10). Using the personalized pain goal definition as the gold standard, sensitivity and specificity of the Edmonton Classification System for Cancer Pain definition were 71.3% and 98.5%, respectively. For mild (0-3), moderate (4-6), and severe (7-10) pain, the highest sensitivity was for moderate pain (90.5%), with high specificity across all three categories (95%-100%). CONCLUSION: The personalized pain goal is a feasible outcome measure for cognitively intact patients. The Edmonton Classification System for Cancer Pain definition closely resembles patient-reported personalized pain goals for stable pain and would be appropriate for research purposes. For clinical pain management, it would be important to include the personalized pain goal as standard practice.

Metabolic parameters in cord blood of newborns of women with polycystic ovary syndrome.

OBJECTIVE: To assess metabolic parameters in the cord blood of newborns of women with polycystic ovary syndrome (PCOS) and to correlate these parameters with those of mothers with PCOS during midgestation. DESIGN: Case-control study. SETTING: Unit of Endocrinology and Reproductive Medicine. PATIENT(S): Thirty newborns of mothers with PCOS (PCOSn) and 34 newborns of control mothers (Cn) were studied. INTERVENTION(S): A sample of cord blood was obtained at delivery. In all mothers, an oral glucose tolerance test (oGTT) with measurement of glucose and insulin was performed at 22-28 weeks of gestation. In cord blood and in the fasting sample of the oGTT, serum leptin, adiponectin, insulin, glucose, and lipids (triglycerides, cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) were determined. RESULT(S): PCOSn showed significantly higher leptin concentrations than Cn. Moreover, in PCOSn, leptin concentrations in cord blood were correlated with birth weight (r = 0.495) and body mass index of the mother at midpregnancy (r = 0.644). CONCLUSION(S): The metabolic parameters in the cord blood of PCOSn are similar to those observed in controls, except for leptin concentrations, which are significantly higher. The latter could be related to the fetal adiposity or the metabolic condition of the mother.

Serum adiponectin and lipid concentrations in pregnant women with polycystic ovary syndrome.

BACKGROUND: We aimed to evaluate the serum adiponectin and lipid concentrations in normal and polycystic ovary syndrome (PCOS) women during pregnancy in order to establish whether PCOS induces abnormal lipid and adiponectin levels that could constitute potential metabolic risk factors for pregnancy complications. METHODS: Women with singleton pregnancies and of similar age were included (48 pregnant PCOS and 51 normal pregnant women). During gestational weeks 10-16 and 22-28, a 2 h, 75 g oral glucose tolerance test was performed, with measurement of glucose and insulin in each sample. Adiponectin and lipid concentrations were determined in the fasting sample. RESULTS: The incidence of gestational diabetes mellitus (GDM) was significantly higher in the PCOS group (12.2%) compared with the control group (2%). In PCOS patients, triglyceride (TG) concentrations and area under the curve of glucose and insulin were higher in both study periods and adiponectin concentrations were significantly lower in the second period, compared with normal women. Moreover, adiponectin concentrations were lower in women with GDM than in those with normal glucose tolerance in the two study periods. CONCLUSION: Low adiponectin and high insulin levels are associated with GDM in pregnant PCOS patients. High TG levels seem not to be directly related to pregnancy complications in these patients.

The role of antibiotics in the management of infection-related symptoms in advanced cancer patients.

UNLABELLED: We prospectively evaluated the effect of antibiotic treatment on infection-related symptoms in patients with advanced cancer, in addition to assessing infection characteristics. METHODS: A questionnaire was completed for enrolled patients using a personal digital assistant. Pre-antibiotic and post-antibiotic treatment Edmonton Symptom Assessment Scale (ESAS) scores were evaluated. Patient and the patient's physician identified infection-related symptoms experienced by the patient, which were documented under the "other" category on the ESAS. Pre-antibiotic and post-antibiotic scores of the patient and physician for the identified infection-related symptoms were evaluated. RESULTS: Twenty-six patients on a tertiary palliative care unit with 31 episodes of infection were included for analysis. Patients' pre- and post-antibiotic ESAS scores revealed a small improvement in all variables except anxiety. Patient assessment of symptoms related to infection showed a small improvement in all symptoms, with dsyuria being statistically significant. Physician assessment revealed a slight improvement for all the symptoms, although only cough was statistically significant. A general comparative physician assessment of patient outcome following antibiotic treatment suggested symptom improvement in 48.4% of patients. However, 50% of patients died within a week of antibiotic discontinuation. CONCLUSIONS: Antibiotic treatment appears to offer a mild improvement in infection-related symptoms. Patients reported the greatest improvement in dysuria, and physicians, in cough. Despite this symptomatic improvement, one quarter of the patients died within one week of antibiotic administration. Further comparative studies to evaluate symptomatic benefit, patient burden, and cost/benefit of antibiotic therapy in the treatment of infections in advanced cancer patients are required.

Palliation of malignant bowel obstruction using a percutaneous cecostomy.

Bowel obstruction is a common complication of metastatic gastrointestinal and ovarian cancers, and can cause distressing symptoms. Along with medical options, surgical options should be considered in all patients with bowel obstruction, including percutaneous gastrostomy. We report the case of a patient with metastatic colon cancer with an obstructing recurrence at the primary site who was not eligible for major surgery or percutaneous gastrostomy and was managed with a percutaneous cecostomy for symptom control.