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1.
Int J Radiat Oncol Biol Phys ; 106(2): 300-309, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31669565

RESUMO

PURPOSE: Current incidence methods for reporting mild or moderate symptoms capture the (first) occurrence of an event and do not allow distinguishing between patients who suffer from long-lasting versus transient morbidity. This paper introduces a new methodological approach that identifies cancer survivors who have clinically relevant, long-lasting symptoms (patients with late, persistent, substantial and treatment-related symptoms, [LAPERS]). METHODS AND MATERIALS: LAPERS can be evaluated in patients with baseline information and at least 3 late follow-up assessments after treatment. LAPERS identifies individual patients with a given symptom that is substantial (above a predefined clinically relevant threshold) and must be present in at least half of the follow-ups. Baseline morbidity is accounted for by requiring the median of the late symptom score to be worse than the baseline condition. The LAPERS approach was applied to 4 relevant patient-reported genito-urinary/gastrointestinal symptoms within the prospective, longitudinal EMBRACE study (An intErnational study on MRI-guided BRachytherapy in locally Advanced CErvical cancer, www.embracestudy.dk). LAPERS was compared with crude incidence and prevalence rates. RESULTS: Within the EMBRACE cohort, 651/1044 patients (62%) had baseline and long-term follow-up available (median follow-up: 42 months). There was a considerable gap between LAPERS, crude incidence, and prevalence rates. The proportion of patients with LAPERS events was 3.8-4.8 times lower than crude incidences. The highest prevalence rates across follow-up times were 1.8-2.6 times lower than crude incidences. CONCLUSIONS: These findings indicate limitations of incidence methods for reporting substantial patient-reported symptoms because a considerable proportion of patients with symptoms do not experience them persistently over time, as they may fluctuate or get successfully treated. In contrast, the LAPERS method for longitudinal analysis identifies patients with clinically relevant, long-lasting symptoms.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Radioterapia Conformacional/efeitos adversos , Radioterapia Guiada por Imagem/efeitos adversos , Avaliação de Sintomas/métodos , Neoplasias do Colo do Útero/radioterapia , Idoso , Braquiterapia , Sobreviventes de Câncer , Diarreia/epidemiologia , Progressão da Doença , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Estudos Longitudinais , Imagem por Ressonância Magnética Intervencionista , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Qualidade de Vida , Radioterapia Guiada por Imagem/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Avaliação de Sintomas/estatística & dados numéricos , Transtornos Urinários/epidemiologia
2.
Radiol Med ; 125(2): 228-235, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31784925

RESUMO

PURPOSE: To linguistically validate the Italian translation of the Vanderbilt Head and Neck Symptom Survey (VHNSS), there is a patient-reported outcome measure to screen for symptoms in the head and neck cancer (HNC) patients population. The goal was to ensure conceptually equivalence with the original version and maintain clarity, ease of use and understanding. METHODS: We conducted a multi-step linguistic process (forward translation, backward translation and patient testing) to generate and validate an Italian translation of the VHNSS. RESULTS: Two intermediate Italian versions were created: The first Italian version was derived from a reconciliation of the three forward translations, and the second Italian version was derived from changes in the first version after the backward translation step. All investigators involved actively discussed possible solutions to produce a translated instrument that maintained a reading and comprehension level accessible by most respondents, without altering the meaning and content of the original source. During the patient testing step, only two patients reported problems with items comprehension and the rate of comprehension problems per single item was lower than expected. This phase allowed patients to give suggestion in order to make items clearer and easier to understand: 43% of patients proposed a revision of the survey during the face-to-face interview, and most of these suggestions were retained. CONCLUSIONS: A valid multi-step process leads to the creation of the final version of the VHNSS-IT, a suitable instrument to screen for symptoms in the Italian HNC patients population and an official measurement tool that can be used in cooperative research group.


Assuntos
Neoplasias de Cabeça e Pescoço/psicologia , Linguística , Medidas de Resultados Relatados pelo Paciente , Avaliação de Sintomas/métodos , Humanos , Itália , Traduções
3.
Support Care Cancer ; 28(1): 87-98, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30982093

RESUMO

PURPOSE: Dyspnea is frequently experienced in advanced cancer patients and is associated with poor prognosis and functional decline. This study used the Edmonton Symptom Assessment System (ESAS) to characterize the relationship between dyspnea and concurrent symptoms experienced by advanced cancer patients. METHODS: A prospective database was collected and analyzed to extract patient demographics and ESAS scores. Logistic regression analysis and generalized estimating equations (GEE) identified correlations of other ESAS symptoms in three categories: severity of dyspnea (none, mild, moderate, severe), moderate/severe dyspnea (ESAS ≥ 4), and presence of dyspnea (ESAS ≥ 1), at patients' first visit and over time, respectively. RESULTS: Multivariable analysis revealed drowsiness (p = 0.001), and anxiety (p = 0.01) and appetite loss (p = 0.02) were associated with increased severity of dyspnea at first visit. Over time, tiredness (p = 0.02), drowsiness (p = 0.04), nausea (p = 0.02), and anxiety (p = 0.0006) were more likely to experience increased dyspnea severity. Tiredness (p = 0.0003), depression (p = 0.03), and appetite loss (p = 0.003) were significant for moderate/severe dyspnea at first visit. Over multiple visits, tiredness (p < 0.0001), anxiety (p = 0.0008), and appetite loss (p = 0.0008) had higher probabilities of moderate/severe dyspnea. For the presence of dyspnea at the first visit, anxiety (p = 0.03) and drowsiness (p = 0.002) were significantly correlated with an increased frequency of dyspnea. Over time, anxiety (p < 0.0001) and drowsiness (p < 0.0001) remained significant with the addition of nausea (p = 0.0007). CONCLUSIONS: The highly interactive relationship between dyspnea and other common cancer symptoms necessitates the development of comprehensive symptom assessments and utilization of multimodal management approaches that consider concurrent symptoms for improved identification and treatment of dyspnea.


Assuntos
Dispneia/diagnóstico , Dispneia/etiologia , Neoplasias/complicações , Neoplasias/patologia , Avaliação de Sintomas/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Progressão da Doença , Dispneia/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/terapia , Cuidados Paliativos/métodos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Doente Terminal , Adulto Jovem
4.
Support Care Cancer ; 28(1): 163-176, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31001692

RESUMO

PURPOSE: We designed a novel, manualized intervention called Emotion And Symptom-focused Engagement (EASE) for acute leukemia (AL) and report here on a phase II randomized controlled trial (RCT) to assess its feasibility and preliminary efficacy. METHODS: Patients were recruited within 1 month of hospital admission and randomized to EASE plus usual care (UC) or UC alone. EASE includes (1) EASE-psy, a tailored psychotherapy delivered over 8 weeks, and (2) EASE-phys, weekly physical symptom screening over 8 weeks to trigger early palliative care. The primary outcome was traumatic stress symptoms; secondary outcomes included physical symptom burden and quality of life. Assessments were conducted at baseline and at 4, 8, and 12 weeks. Between-group differences were evaluated using multilevel modeling. RESULTS: Forty-two patients were randomized to EASE (n = 22) or UC (n = 20), with 76% retention at 12 weeks. Predefined feasibility outcomes were met: 86% (19/22) of EASE participants completed ≥ 50% of EASE-psy sessions (goal ≥ 64%); 100% received Edmonton Symptom Assessment System (ESAS, modified for AL) screenings, 64% (14/22) of whom completed ≥ 50% of planned screenings (goal ≥50%); and 100% with scores ≥ 4/10 on any physical ESAS-AL item had ≥ 1 meeting with the EASE-phys team (goal 100%). Significant treatment-group differences favoring EASE were observed in traumatic stress symptoms at 4 and 12 weeks, and pain intensity and interference at 12 weeks (all p < .05). CONCLUSIONS: EASE is feasible in patients newly diagnosed with AL and shows promise of effectiveness. These results warrant a larger RCT to provide evidence for its more routine use as a standard of care.


Assuntos
Leucemia/terapia , Cuidados Paliativos/métodos , Psicoterapia/métodos , Estresse Psicológico/terapia , Avaliação de Sintomas/métodos , Doença Aguda , Adulto , Idoso , Intervenção Médica Precoce/métodos , Emoções , Estudos de Viabilidade , Feminino , Hospitalização , Humanos , Leucemia/complicações , Leucemia/psicologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Estresse Psicológico/etiologia , Adulto Jovem
5.
Am Surg ; 85(11): 1265-1268, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775969

RESUMO

We investigated whether laryngoscopy should be performed before total thyroidectomy on all patients without a history of neck surgery. A total of 2523 patients who underwent total thyroidectomy between January 1, 2013, and March 18, 2018, were retrospectively examined. Preoperative vocal cord examination was performed on 2070 of these patients by the otorhinolaryngology department using indirect laryngoscopy. Patients with a history of neck or thyroid surgery were not included in the study. The patients were evaluated in terms of age, gender, symptom (hoarseness/dyspnea), comorbidity, surgical history, biopsy, nodule diameter, pathological diagnosis, and tracheal deviation. Preoperative vocal cord paralysis was detected in 0.8 per cent of the patients (17/2070). Four patients (23.5%) were male and 13 patients (76.5%) were female. The mean age was 62 (range, 25-82) years. Seven of the 17 patients (41%) were symptomatic, with complaints of dyspnea in five and hoarseness in two. The univariate analysis revealed that a nodule diameter >30 mm and the presence of dyspnea were associated with vocal cord damage. Furthermore, the multivariate analysis showed that dyspnea alone was an independent variable (P = 0.011). It is recommended that preoperative vocal cord evaluation should be performed only in patients with severe symptoms, such as dyspnea.


Assuntos
Laringoscopia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Paralisia das Pregas Vocais/diagnóstico , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Dispneia/etiologia , Feminino , Rouquidão/etiologia , Humanos , Laringoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Fatores Sexuais , Avaliação de Sintomas/métodos , Câncer Papilífero da Tireoide/diagnóstico , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/cirurgia , Paralisia das Pregas Vocais/complicações
6.
Medicine (Baltimore) ; 98(42): e17530, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626114

RESUMO

Serious bacterial infection (SBI) is a major cause of morbidity and mortality in children. Distinguishing SBI from self-limiting viral infections is a very important task in the emergency department (ED), especially in the children with fever without source (FWS). The aim of this study was to analyze whether parents' statements about clinical manifestations, which were categorized according to grades, are related to the actual diagnosis of SBI in children with FWS.Retrospective analysis was conducted using prospectively acquired cohort data for all febrile children in the pediatric ED of Seoul National University Hospital from August 2016 to August 2017. The association of clinical manifestations and SBI was the main outcome of this study. The SBIs included diagnoses such as bacteremia, bacterial meningitis, urinary tract infection, and pneumonia. Clinical manifestations including activity, urination, and feeding were categorized into 3 or 4 grades according to the parents' statements. The linear-by-linear association test was used to examine linear associations between the severity of clinical manifestations and SBI. Receiver operating characteristic curves for clinical manifestations were constructed for patients with SBI. Area under the curve (AUC) statistics and 95% confidence intervals (CIs) were obtained to evaluate the predictive performance of clinical manifestations.There was no linear association between SBI and non-SBI when compared by severity of the clinical manifestations, such as duration of fever (P = .299), activity (P = .781), feeding (P = .161), and urination (P = .834). The AUC was 0.54 (95% CI 0.41-0.67) for duration of fever, 0.52 for activity (95% CI 0.40-0.64), 0.42 for feeding (95% CI 0.32-0.53), and 0.51 for urination (95% CI 0.39-0.62).There was no evidence that the test performance of the clinical manifestations is valid for predicting SBIs, even considering the severity of manifestations. For optimal evaluation of the children with FWS, more comprehensive approach including laboratory tests, are needed.


Assuntos
Infecções Bacterianas/diagnóstico , Febre de Causa Desconhecida/diagnóstico , Pais , Avaliação de Sintomas/estatística & dados numéricos , Pré-Escolar , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Lineares , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Seul , Avaliação de Sintomas/métodos
7.
Urology ; 134: 97-102, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31499079

RESUMO

OBJECTIVE: To determine whether women overactive bladder symptoms would report more frequent unhealthy toileting behaviors. METHODS: A community-based sample of adult women was electronically recruited to complete the Toileting Behavior Scale and the International Consultation on Incontinence Questionnaire - Overactive Bladder module, as well as clinical and demographic questionnaires. The associations between overactive bladder and toileting behavior subscales were assessed as continuous variables using Spearman's rank correlation and as dichotomous variables with multivariable logistic regression. RESULTS: Of the 6562 adult women included in the analytic sample, 1059 (16.1%) were classified as having overactive bladder. Of the toileting behavior subscales, convenience voiding had the highest, positive association with overactive bladder score (r = 0.301, P < .0001). On multivariable logistic regression, women with overactive bladder (OAB) were more likely to report behaviors of convenience voiding (odds ratio [OR] 1.13, confidence intervals [CI] 1.11-1.15), delayed voiding (OR 1.05, CI 1.02-1.08), straining to void (OR 1.05, CI 1.03-1.07), and position preference (OR 1.13, CI 1.08-1.18). CONCLUSION: OAB symptoms were associated with specific toileting behaviors of convenience voiding, delayed voiding, straining to void, and position preference. Further investigation is needed to determine if toileting behaviors are a risk factor for OAB or a compensatory adaptation to mitigate symptoms.


Assuntos
Sintomas Comportamentais/diagnóstico , Qualidade de Vida , Autocuidado , Bexiga Urinária Hiperativa , Incontinência Urinária de Urgência , Micção , Adulto , Aparelho Sanitário , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Autocuidado/métodos , Autocuidado/psicologia , Inquéritos e Questionários , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos , Estados Unidos , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/epidemiologia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/psicologia , Incontinência Urinária de Urgência/etiologia , Incontinência Urinária de Urgência/psicologia
8.
Res Dev Disabil ; 94: 103464, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31479914

RESUMO

BACKGROUND: Many children with autism spectrum disorder (ASD) experience comorbid symptoms of attention-deficit/hyperactivity disorder (ADHD). Additionally, children with ASD and ADHD often have sleep disturbances and deficits in executive functioning (EF). In typical development, sleep disturbances are causally linked to EF deficits and exacerbate ADHD-like symptoms. AIM: The aim of this study was to determine whether caregiver-report sleep and EF difficulties predict ADHD symptoms in children with ASD. METHODS: Caregiver-report of child sleep, EF, and ADHD symptom severity was collected for 101 children with ASD, 7-11 years of age. Hierarchical linear regressions tested the independent and interactive effects of sleep and EF in predicting ADHD symptoms. RESULTS: Children with ASD were more likely to have symptoms of ADHD if they experienced both sleep and EF difficulties. Children with difficulties in working memory were particularly at risk for clinically significant symptoms of ADHD. Notably, however, sleep did not mediate or moderate the relation between working memory and ADHD symptoms in this sample, suggesting that these variables act through independent mechanisms to increase vulnerability for comorbidity. CONCLUSIONS: These results have clinical significance as sleep and EF deficits may identify an ASD subgroup that is at increased risk for a comorbid ADHD diagnosis.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Espectro Autista , Função Executiva , Transtornos da Memória , Transtornos do Sono-Vigília , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , Sintomas Comportamentais/diagnóstico , Sintomas Comportamentais/psicologia , Cuidadores , Criança , Comorbidade , Feminino , Humanos , Masculino , Transtornos da Memória/diagnóstico , Transtornos da Memória/etiologia , Transtornos da Memória/psicologia , Testes de Memória e Aprendizagem , Memória de Curto Prazo , Fatores de Risco , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/psicologia , Avaliação de Sintomas/métodos
9.
Urology ; 134: 72-78, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31487513

RESUMO

OBJECTIVE: To assess the symptoms associated with long-term Double-J ureteral stenting including the influence of biofilms on ureteral stents. METHODS: Patients with long-term (>8 weeks) uni- or bilateral ureteral stents completed the Ureteral Stent Symptoms Questionnaire (USSQ) at the day of stent exchange. Repeated assessment of patients was possible to allow for analysis of intraindividual changes. Assessment of biofilm mass on the stents was performed according to a validated method, its correlation with the USSQ total score was defined as primary outcome. Secondary outcomes included further analyses of stent-associated symptoms and their temporal course. RESULTS: A total of 87 stent indwelling periods in 35 patients were investigated. Median USSQ total score did not differ significantly between unilateral and bilateral stenting (42 vs 39 points; P = .17). An increasing total stent treatment time up to study inclusion did not correlate with the USSQ total score, but was significantly correlated with less urinary symptoms and a better quality of life. USSQ total score and subscores within individual patients did not significantly increase or decrease over the sequence of stent indwelling periods. Higher total biofilm masses were not associated with higher USSQ total scores or subscores. CONCLUSION: Long-term Double-J stenting provides a valuable treatment option, if stent-associated symptoms are low during the initial indwelling period. Thus, symptoms remain stable over the long-term course and the majority of patients are satisfied with the treatment. Furthermore, biofilm formation on ureteral stents does not seem to be the relevant driver of symptoms.


Assuntos
Bactérias , Biofilmes , Efeitos Adversos de Longa Duração , Implantação de Prótese , Infecções Relacionadas à Prótese , Qualidade de Vida , Stents , Obstrução Ureteral/cirurgia , Idoso , Bactérias/classificação , Bactérias/isolamento & purificação , Correlação de Dados , Remoção de Dispositivo/métodos , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/microbiologia , Efeitos Adversos de Longa Duração/psicologia , Masculino , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/psicologia , Stents/efeitos adversos , Stents/microbiologia , Inquéritos e Questionários , Suíça , Avaliação de Sintomas/métodos
10.
Rev. clín. esp. (Ed. impr.) ; 219(6): 303-309, ago.-sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186571

RESUMO

Introducción y objetivos: La gestión clínica aplicada a pacientes terminales debería considerar diferentes aspectos, particularmente la valoración funcional que correlaciona bien con pronóstico a corto plazo. La estimación pronóstica podría mejorar si se incluyera la presencia de síntomas fuertemente asociados a peor evolución. El objetivo principal del estudio fue evaluar si el pronóstico según Palliative Performance Scale (PPS) mejoraba con la presencia/ausencia de los síntomas dolor-disnea-delirium. Secundariamente estimar la satisfacción de los cuidadores con el traslado a Unidades de Cuidados Paliativos de Media Estancia (UCPME), preparadas para estancias medias deseables en torno al mes. Pacientes y método: Estudio prospectivo, observacional, multicéntrico (autonómico). Se analizó supervivencia en UCPME según PPS dicotomizado en>o≤20%. Se estimaron sus funciones de supervivencia mediante método Kaplan-Meier y se compararon según riesgo proporcional de Cox (HR). La satisfacción de los cuidadores se estudió mediante cuestionario anónimo autocumplimentado tipo Likert. Resultados: Incluimos 130 pacientes. Los subgrupos PPS ≤ 20% y PPS>20% tuvieron una mediana de supervivencia de 6[3-13] y 21[11-42] días respectivamente, con HR no ajustado 3,1 veces mayor de fallecer en PPS≤20%. El HR no se modificó ajustando para los síntomas. El 83% de cuidadores encontró el traslado beneficioso y el 40% apreciaron mejores cuidados sanitarios. Conclusiones: En pacientes trasladados desde hospitales generales a UCPME puntuaciones PPS<20% se asocian a supervivencia menor de una semana con HR 3 veces superior de fallecer que pacientes PPS>20%, sin que el análisis ajustado por presencia de dolor-disnea-delirium aporte mayor precisión pronóstica. Los cuidadores encontraron beneficio fundamentalmente en comodidad de instalaciones y distancia


Background and objectives: Clinical management for terminal patients should consider various aspects, particularly the patient's functional assessment, which correlates well with the short-term prognosis. The prognosis could improve if the presence of symptoms strongly associated with a poorer progression were included. The study's main objective was to assess whether the prognosis according to the Palliative Performance Scale (PPS) improved with the presence/absence of pain-dyspnoea-delirium symptoms. The secondary objective was to determine caregiver satisfaction with the transfer to medium-stay palliative care units (MSPCUs), which are prepared for medium stays of approximately one month. Patients and method: We conducted a prospective, observational, multicentre (regional) study that analysed survival in MSPCUs according to the PPS dichotomized to>20% and≤20%. We estimated the mean survival functions using the Kaplan-Meier method and compared them according to the Cox proportional hazards ratios (HR). Caregiver satisfaction was studied using an anonymous self-administered Likert questionnaire. Results: The study included 130 patients. The PPS≤20% and PPS>20% subgroups had a median survival of 6 (3-13) days and 21 (11-42) days, respectively, with an unadjusted mortality HR 3.1-fold greater in the PPS≤20% subgroup. The HR did not change when adjusted for the symptoms. Eighty-three percent of the caregivers found the transfer beneficial, and 40% observed better patient care. Conclusions: For patients transferred from general hospitals to MSPCUs, PPS scores≤20% were associated with survival shorter than one week, with a 3-fold higher mortality HR than patients with PPS scores>20%, without the analysis adjusted for the presence of pain-dyspnoea-delirium providing greater prognostic accuracy. The caregivers found benefits mainly in the convenience of the facilities and distance


Assuntos
Humanos , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Avaliação de Sintomas/métodos , Estado Terminal/classificação , Neoplasias/complicações , Transferência de Pacientes/estatística & dados numéricos , Prognóstico , Tempo de Internação/estatística & dados numéricos , Doente Terminal/estatística & dados numéricos , Estudos Prospectivos , Modelos de Riscos Proporcionais , Cuidadores/psicologia , Taxa de Sobrevida
12.
Int J Chron Obstruct Pulmon Dis ; 14: 1633-1638, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413558

RESUMO

Objective: To investigate the prevalence and predictors of COPD in a large cohort of symptomatic smokers and ex-smokers in a primary care setting. Methods: General practitioners (n=390) consecutively recruited individuals ≥35 years, with current or previous tobacco exposure, at least one respiratory symptom, and no previous diagnosis of obstructive airways disease; and obtained data on tobacco exposure, body mass index (BMI), and dyspnea (Medical Research Council dyspnea scale). All individuals with airflow obstruction, ie, FEV1/FVC <0.70 at initial lung function test, had diagnostic spirometry, including bronchodilator reversibility test. COPD was defined as respiratory symptom(s), tobacco exposure, and nonreversible airflow limitation. Results: Of the 6,710 at-risk individuals screened with spirometry (52% male sex, mean age 58 years [SD 10.9]), 1,185 were diagnosed with COPD (17.7%). Apart from age and pack-years, multivariate logistics regression analysis, adjusted for FEV1, revealed that BMI <25 kg/m2 (OR 4.2, 95% CI 3.0-5.9, p<0.001), BMI 35+ kg/m2 (OR 1.6, 95% CI 1.2-2.3), self-reported dyspnea (OR 1.2, 95% CI 1.1-14, p=0.04), wheeze (OR 1.3, 95% CI 1.1-1.6, p=0.001), phlegm (OR 1.4, 95% CI 1.1-1.6, p<0.001), and MRC ≥3 (OR 1.6, 95% CI 1.2-2.0, p=0.001) were associated with a significantly higher likelihood of being diagnosed with COPD. No association was found between sex, cough, and recurrent respiratory tract infections and a diagnosis of COPD. Conclusion: The prevalence of COPD is high among smokers and ex-smokers with one or more respiratory symptoms seen in primary care, and the presence of wheeze, phlegm and dyspnea, together with both low BMI and obesity identify a subgroup with an even higher likelihood of COPD.


Assuntos
Dispneia , Atenção Primária à Saúde , Doença Pulmonar Obstrutiva Crônica , Sons Respiratórios , Fumantes/estatística & dados numéricos , Espirometria , Adulto , Índice de Massa Corporal , Dinamarca/epidemiologia , Dispneia/diagnóstico , Dispneia/etiologia , Diagnóstico Precoce , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Sons Respiratórios/diagnóstico , Sons Respiratórios/etiologia , Fatores de Risco , Fumar/epidemiologia , Espirometria/métodos , Espirometria/estatística & dados numéricos , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
13.
Eur J Oncol Nurs ; 42: 14-20, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446259

RESUMO

PURPOSE: Symptoms experienced by breast cancer patients often cluster together in groups known as "symptom clusters". The aim was to determine the symptom clusters in women with non-metastatic breast cancer treated by radiation therapy (RT). METHODS: Edmonton Symptom Assessment Scale (ESAS) scores were taken from breast cancer patients receiving RT before, at completion of RT, and after RT. Exploratory factor analysis (EFA), principal component analysis (PCA), and hierarchical cluster analysis (HCA) were used to identify symptom clusters among the nine ESAS items at all three time points. RESULTS: This study included 1224 patients. The PCA and EFA identified the same two symptom clusters before the start of RT: 1) pain, tiredness, nausea, drowsiness, appetite, and dyspnea; 2) depression, anxiety, and wellbeing. The HCA further split the symptoms into three clusters. Wellbeing, depression, and anxiety consistently clustered together. Among the ESAS scores collected at the end of and after RT, each statistical method identified different symptom clusters. For the symptom clusters experienced at the end of RT, the following symptoms were always in the same cluster: wellbeing, depression, and anxiety; nausea and appetite; drowsiness and dyspnea. Following RT, depression and anxiety consistently clustered together, with nausea and appetite in a second cluster. CONCLUSION: Among the symptom clusters derived before, at the end of RT, and after RT, the following symptoms consistently presented together: depression and anxiety, nausea and appetite, pain and tiredness, and drowsiness, dyspnea, and tiredness. Understanding symptom clusters in this population can improve management of symptoms.


Assuntos
Neoplasias da Mama/complicações , Neoplasias da Mama/radioterapia , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Neoplasias da Mama/psicologia , Dor do Câncer/diagnóstico , Dor do Câncer/epidemiologia , Análise por Conglomerados , Depressão/diagnóstico , Depressão/epidemiologia , Dispneia/diagnóstico , Dispneia/epidemiologia , Análise Fatorial , Fadiga/diagnóstico , Fadiga/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Náusea/diagnóstico , Náusea/epidemiologia , Análise de Componente Principal , Avaliação de Sintomas/métodos
14.
Acta Neurol Scand ; 140(6): 375-389, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31433855

RESUMO

Mild cognitive impairment (MCI) is common in Parkinson's disease (PD), affecting almost all patients with PD at some time. It has been shown that patients with PD, who express subjective cognitive complaints, are at a higher risk of eventually developing PD-MCI. This is corroborated by the Movement Disorders Society's (MDS) diagnostic criteria from 2012 for PD-MCI, from which it follows that a subjective cognitive complaint must be present in addition to objective cognitive impairment for a patient with PD to receive a diagnosis of PD-MCI. Nevertheless, there is currently no standardized measurement available for assessing subjective cognitive complaints. Therefore, this review aims to generate an overview of how subjective cognitive complaints are commonly operationalized in the empirical literature as well as whether they are found to be associated with the level of cognitive impairment. The findings revealed that a broad range of measures has been used to obtain subjective cognitive complaints and that there is little consistency between different studies with regard to how they have obtained these complaints, from whom they had obtained them, how many they have obtained, which types of complaints they have obtained and whether they were associated with cognitive impairment. Given the fact that the presence of subjective cognitive complaints is a requirement for setting a diagnosis, there is a need for more methodological consensus with regard to the measurement hereof.


Assuntos
Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Doença de Parkinson/complicações , Doença de Parkinson/psicologia , Avaliação de Sintomas/normas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/normas , Avaliação de Sintomas/métodos
15.
Nord J Psychiatry ; 73(7): 425-432, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31407936

RESUMO

Objective: The Brief Negative Symptom Scale (BNSS) is an instrument for evaluating negative symptoms (NS) in schizophrenia based on the 2005 consensus statement by the National Institute of Mental Health. This study examines the validity and reliability of the Danish version of BNSS. Materials and methods: Acutely and chronically affected patients with schizophrenia or schizoaffective disorder were assessed with BNSS along with other psychopathological scales and clinical measures. Convergent and discriminant validity of BNSS was evaluated by its relationships with these assessments. Inter-rater agreement was estimated by the intraclass correlation coefficient (ICC). Results: Forty-nine subjects were included; the mean age was 33.1 (±10.8) years and 32 (65%) were males. BNSS correlated strongly with traditional assessment tools for NS and poorly with measures of depressive and extrapyramidal symptoms, except for Parkinsonism. Moreover, BNSS correlated well with the assessment of positive symptoms. The ICC of BNSS was 0.95 (n = 19, 95% CI: 0.88-0.98). Conclusions: Overall, BNSS holds appropriate psychometric properties in terms of reliability and validity. However, discriminant validity was compromised by correlations with positive symptoms and Parkinsonism. The former originates presumably from NS secondary to positive symptoms since the sample included acutely psychotic patients, and the latter from overlapping rating criteria regarding facial expressivity impairment.


Assuntos
Escalas de Graduação Psiquiátrica/normas , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Avaliação de Sintomas/normas , Adulto , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Avaliação de Sintomas/métodos , Adulto Jovem
16.
Neonatal Netw ; 38(2): 63-68, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470368

RESUMO

Numerous chromosome abnormalities are seen in NICUs around the world. With increased access to health care, in some cases, parents and practitioners are aware of an abnormality prior to birth, and a plan of care can be made. However, in many situations there is no prenatal diagnosis and these discoveries and diagnoses are made during the neonate's NICU stay. Providers in the NICU setting need to have a vast understanding of chromosome abnormalities, as they may be the first to guide parents through the maze of decisions that will follow. This case study analyzes a very rare deletion on chromosome 1q43q44. The 1q43q44 deletion is located at the subtelomeric region, the region farthest from the centromere, on the long arm of chromosome 1. This case study describes Baby D, who presented with multiple anomalies and was subsequently diagnosed with 1q43q44 deletion.


Assuntos
Anormalidades Múltiplas , Deleção Cromossômica , Testes Genéticos/métodos , Deficiência Intelectual , Enfermagem Neonatal/métodos , Triagem Neonatal/métodos , Pais , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/fisiopatologia , Adulto , Assistência ao Convalescente/métodos , Cromossomos Humanos Par 1 , Feminino , Humanos , Recém-Nascido , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/fisiopatologia , Unidades de Terapia Intensiva Neonatal , Trabalho de Parto Induzido/métodos , Exame Neurológico/métodos , Pais/educação , Pais/psicologia , Gravidez , Apoio Social , Avaliação de Sintomas/métodos
17.
Acta Oncol ; 58(9): 1307-1314, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31284797

RESUMO

Background: Patients with pancreatic and periampullary cancer have poor prognoses, experience multiple symptoms following surgery and sometimes lack knowledge of self-care activities. Consequently, it is vital to develop systems that support self-management, improvement of health-related quality of life and reduction of symptoms. Therefore, the aim was to evaluate the impact on health-related quality of life and self-care activity when using the Interaktor app following pancreaticoduodenectomy due to cancer. Material and Methods: Patients in the intervention group used Interaktor up to six months after surgery. They reported symptoms daily at home and received support for self-management by continuous access to written self-care advice and to their healthcare professionals. Descriptive data from the app were collected. Health-related quality of life and self-care activity were collected before surgery, and six weeks and six months after surgery. Comparisons between the intervention group (n = 26) and a historical control group (n = 33) were made. Decline/dropout rate was 37% in the intervention group and 10% in the control group. Results: Six weeks after surgery the intervention group rated significantly higher emotional functioning and less nausea/vomiting, pain, appetite loss, constipation, pancreatic pain, flatulence and worry about low weight. Twenty-five subscales/items showed non-statistical differences. Six months after surgery the intervention group rated significantly fewer hepatic symptoms, less worry about low weight, and higher self-care activity level. Thirty subscales/items showed non-statistical differences. The first four weeks, patients reported symptoms in a median 95% of the intended days, and for the rest of the period in median 83%. Conclusion: The use of an app for management of patient-reported outcomes reduces symptom burdens six weeks after pancreaticoduodenectomy due to cancer. Interaktor is well accepted for patients choosing to participate and appears to facilitate supportive care needs and timely symptom management for this patient group. Future studies should also include cost-benefits and objective measures.


Assuntos
Ampola Hepatopancreática , Neoplasias do Ducto Colédoco/cirurgia , Aplicativos Móveis , Neoplasias Pancreáticas/cirurgia , Qualidade de Vida , Autocuidado/métodos , Avaliação de Sintomas/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreaticoduodenectomia , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Padrão de Cuidado , Fatores de Tempo
18.
Eur Arch Otorhinolaryngol ; 276(10): 2827-2833, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31325032

RESUMO

PURPOSE: The effects of nasal obstruction in patients with chronic rhinosinusitis (CRS) are associated with depressed mood. We sought to validate this finding by determining whether improvement in nasal obstruction would translate to improvement in depressed mood. METHODS: This was a prospective observational study of 150 patients undergoing medical management for CRS. Data were collected at two timepoints: enrollment and a subsequent follow-up visit 3-12 months later. Impact of nasal obstruction was measured using the Nasal Obstruction Symptom Evaluation (NOSE) instrument and depressed mood was measured using the 2-item Patient Health Questionnaire (PHQ-2). Sinonasal symptoms associated with CRS were also measured using the 22-item Sinonasal Outcome Test (SNOT-22). Clinical and demographic characteristics were collected. The relationship between changes in PHQ-2 and NOSE scores was determined with correlation and linear regression. RESULTS: Change in PHQ-2 score was significantly correlated with change in NOSE score (ρ = 0.30, p < 0.001). After controlling for covariates, change in PHQ-2 score was associated with change in NOSE score (adjusted linear regression coefficient [ß] = 0.014, 95% CI 0.006-0.022, p = 0.001). We confirmed these relationships, finding that change in PHQ-2 was associated (adjusted ß = 0.037, 95% CI 0.013-0.061, p = 0.003) with change in the nasal subdomain score of the SNOT-22. Improvement in NOSE score by greater than 22 points was predictive of improvement in PHQ-2 score with sensitivity 54.5% and 83.8% specificity (p < 0.001). CONCLUSION: These results provide evidence that improvements in nasal manifestations/symptoms of CRS translate to significant improvements in mood.


Assuntos
Depressão , Obstrução Nasal , Rinite , Sinusite , Doença Crônica , Depressão/etiologia , Depressão/fisiopatologia , Depressão/prevenção & controle , Feminino , Humanos , Masculino , Conduta do Tratamento Medicamentoso , Pessoa de Meia-Idade , Obstrução Nasal/tratamento farmacológico , Obstrução Nasal/etiologia , Obstrução Nasal/psicologia , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Rinite/complicações , Rinite/fisiopatologia , Sinusite/complicações , Sinusite/fisiopatologia , Avaliação de Sintomas/métodos , Estados Unidos
19.
Indian Pediatr ; 56(7): 556-559, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31333208

RESUMO

OBJECTIVE: To study the histopathological characteristics and mutation spectrum of patients presenting with the Duchenne muscular dystrophy (DMD) phenotype. METHODS: This was a descriptive study conducted over a period of 8 years. Multiplex ligation-dependent probe amplification (MLPA) was done in patients presenting with the DMD phenotype. If MLPA was negative, patients were offered muscle biopsy for histopathological studies and/or next generation sequencing (NGS) based multigene panel testing for muscular dystrophies. RESULTS: Of the 510 patients included, mutation in the DMD gene was detected by MLPA in 372 (72.9%), of whom 342 (67.1%) had exonic deletions and 30 (5.9%) had exonic duplications. Exons 45-55 were most commonly involved in large deletions and exons 1-10 were the commonest exons involved in duplications. In the MLPA-negative cohort, 27 proceeded for muscle biopsy. NGS was done in 14 patients, 10 of whom had pathogenic mutations in the DMD gene, 3 were non dystrophinopathies and no pathogenic variant could be identified in one patient. CONCLUSIONS: For patients presenting with the DMD phenotype, MLPA of the DMD gene has a high diagnostic rate of about 73%, and non-dystrophinopathies may constitute a small but significant proportion.


Assuntos
Biópsia/métodos , Distrofina/genética , Testes Genéticos , Distrofia Muscular de Duchenne , Adolescente , Idade de Início , Criança , Pré-Escolar , Testes Genéticos/métodos , Testes Genéticos/estatística & dados numéricos , Humanos , Imuno-Histoquímica , Índia/epidemiologia , Masculino , Anamnese/métodos , Transtornos das Habilidades Motoras/diagnóstico , Transtornos das Habilidades Motoras/epidemiologia , Reação em Cadeia da Polimerase Multiplex/métodos , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/epidemiologia , Distrofia Muscular de Duchenne/genética , Distrofia Muscular de Duchenne/fisiopatologia , Mutação , Avaliação de Sintomas/métodos , Centros de Atenção Terciária/estatística & dados numéricos
20.
Int J Eat Disord ; 52(8): 871-884, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31228298

RESUMO

OBJECTIVE: The network theory of psychopathology has been described as an "innovative framework" that may "transform" clinical psychological science. Several network studies have identified central eating disorder (ED) symptoms, yet studies have been comprised primarily of women. Using two large samples, we constructed ED symptom networks among men to identify central symptoms. METHOD: Participants were recruited from three universities and using Amazon's Mechanical Turk. Participants completed the Eating Disorder Examination-Questionnaire (EDE-Q), Male Body Attitudes Scale, and Drive for Muscularity Scale. ED symptom networks were jointly estimated among men with (n = 248) and without core ED symptoms (n = 902). Core ED symptoms were defined by (a) scoring above a suggested male EDE-Q clinical cutoff and (b) reporting symptoms consistent with probable ED diagnoses. Expected influence and predictability (proportion of each node's variance explained by other nodes in the network) were calculated for each node. RESULTS: Shape overvaluation, desiring weight loss, fear of losing control over eating, feeling guilty for missing weight training, and using supplements had the greatest expected influence and predictability. Network structures did not significantly differ between participants with versus without core ED symptoms. DISCUSSION: The centricity of body dissatisfaction items in the networks supports some components of cognitive behavioral theories of EDs. However, the findings also suggest the importance of muscularity- and leanness-oriented concerns, which have been traditionally neglected from leading ED theories that tend to focus on thinness pursuits as a main driver of body dissatisfaction.


Assuntos
Imagem Corporal/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Avaliação de Sintomas/métodos , Adulto , Atitude , Medo , Humanos , Hiperfagia/psicologia , Masculino , Escalas de Graduação Psiquiátrica , Psicopatologia , Estudantes/psicologia , Magreza/psicologia , Adulto Jovem
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