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1.
Kaustav Bhowmick Biswadip Ghosh Shantasil Pain 《The Journal of emergency medicine》2019,56(5):512-518
Background
The nature and profile of different modes of poisoning vary significantly in different parts of India. The assessment of the magnitude of suicidal poisoning is an area of paramount importance not only for appropriate management but also for raising social awareness and framing government policies for the prevention of same.Objectives
We aimed to determine the pattern of poisoning, the sociodemographic profile of patients who poison themselves, and the in-hospital outcome of self-poisoned patients over a 1-year period.Methods
This was a cross-sectional observational study conducted between May 2015 and April 2016 that included 492 patients >12 years of age who were admitted to our hospital after consuming poison with the intention of deliberate self-harm. Relevant history with respect to the nature and amount of poison ingested were taken and recorded, and the patients’ sociodemographic profiles and outcome (as either discharge or death) were noted.Results
Most of the patients were 13–28 years of age (69%). Males (n = 293 [59.55%]) predominated over females and the majority were farmers (n = 193 [39.23%]). Rural cases (n = 373 [75.81%]) outnumbered urban cases. The major causes of deliberate self-harm attempts were impulsive actions (n = 442 [89.84%]). Pesticides (n = 393 [79.88%]) were the most commonly consumed poison. The overall mortality rate was 12%, with paraquat (94.74%) topping the list of fatal substances.Conclusion
Young adults and males constitute majority of the population in this study. Agricultural poisons made up the bulk of the cases, mostly taken by rural population. Paraquat, an herbicide banned in several countries, had the highest mortality rate in this study. 相似文献2.
Walter Hardesty Bhavna Singichetti Honggang Yi Julie C. Leonard Jingzhen Yang 《The Journal of emergency medicine》2019,56(5):571-579
Background
Although concussion-related emergency department (ED) visits increased after the passage of concussion laws, little is known about how the laws may disproportionately impact ED utilization and associated health care costs among children in different demographic groups.Objective
Our aim was to examine the patient and clinical characteristics of pediatric ED visits and associated health care costs for sports- and recreation-related concussions (SRRCs) before and after concussion law enactment.Methods
We retrospectively analyzed ED visits for SRRCs by children ages 5–18 years between 2006 and 2014 in the Pediatric Health Information System database (n = 123,220). ED visits were categorized as “pre-law,” “immediate post-law,” and “post-law” according to the respective state concussion law's effective date. Multinomial logistic regression models were used to assess the impact of the law on ED utilization.Results
The majority of visits were by males (n = 83,208; 67.6%), children aged 10–14 years (n = 49,863; 40.9%), and privately insured patients (n = 62,376; 50.6%). Female sex, older age, and insured by Medicaid/Medicare were characteristics associated with increased ED visits during the immediate post-law and post-law periods compared to their counterparts. A significant decrease in proportion of imaging use was observed from pre-law to post-law (adjusted odds ratio 0.49; 95% confidence interval 0.47–0.50; p < 0.0001). While annual adjusted costs per ED visits decreased, annual total adjusted costs per hospital for SRRCs increased from pre-law to post-law (p < 0.0001).Conclusions
Concussion laws might have impacted pediatric concussion-related ED utilization, with increased annual total adjusted costs. These results may have important implications for policy interventions and their effects on health care systems. 相似文献3.
4.
Purpose
Adverse health effects of smoking could be made worse by worker's tobacco use, and combining tobacco use with occupational hazards could enhance the likelihood of occupational disease and injury. This study was aimed to develop a workplace smoking cessation program based on self-determination theory (SDT) and then to examine the effectiveness of the program.Methods
A quasi-experimental design with nonequivalent control group pretest–posttest design was used. An intervention group (n = 30) received a smoking cessation program using individual counseling and tailored text messaging based on SDT during 12 weeks. Participants in the control group (n = 30) received a smoking cessation leaflet and telephonic follow-up for 3 times.Results
At 6 and 12 weeks, there were significant differences between the two groups on autonomous regulation, perceived competence, nicotine dependence, tobacco abstinence rate, and exhaled carbon monoxide concentration. At 12 weeks, the abstinence rate in the intervention group was 96.7%, whereas that in the control group was 12.9%.Conclusion
SDT-based workplace smoking cessation program using individual counseling and tailored text messaging is effective in encouraging autonomous regulation and competence for workers. 相似文献5.
Objective
To determine whether prehospital point-of-care lactate (pLA) is associated with mortality, admission, and duration of hospital stay.Design
A retrospective clinical audit, where elevated lactate was defined as ≥2 mmol/L.Setting
The ambulance service and primary referral hospital in the Australian Capital Territory from 1st July 2014 to 30th June 2015.Participants
Adult patients (≥18 years) who had pLA measured and were transported to the primary referral hospital.Main outcome measures
Mortality, admission, and duration of hospital stay.Results
Two hundred fifty-three patients with a median pLA of 2.5 mmol/L (interquartile range [IQR]: 1.5–3.7) were analysed. Overall mortality was 8.3%; 68% were admitted to the hospital; 8.3% to the intensive care unit (ICU). pLA was non-significantly higher in those who died compared to survivors (3.5 [IQR: 2.75–5.85] vs 2.4 [1.5–3.6]; W = 1631.5; p = 0.053). pLA was higher for those admitted to the hospital (2.9 [1.9–3.9] vs 2.0 [1.4–3.1]; W = 5094.5, p = 0.001) and the ICU (3.2 [2.4–5.7] vs 2.4 [1.5–3.6]; W = 1578.5; p = 0.008). There was no relationship between pLA and duration of stay. Considered as a screening tool, at a cut-off of 2.5 mmol/L, pLA had a likelihood ratio+ of 1.61 for mortality and 1.44 for ICU admission; the odds ratio for mortality was 3.76 (95% confidence interval = 1.30, 13.89).Conclusions
Elevated prehospital lactate was associated with significantly increased ICU and hospital admissions. There may be value in pLA as a screening tool. 相似文献6.
Kolia Milojevic Alexandra Beltramini Mohsen Nagash Alexandre Muret Olivier Richard Yves Lambert 《The Journal of emergency medicine》2019,56(3):308-318
Background
Recent-onset atrial fibrillation (RAF) is the most frequent supraventricular dysrhythmia in emergency medicine. Severely compromised patients require acute treatment with injectable drugsObjective
The main purpose of this external validity study was to compare the short-term efficacy of esmolol with that of amiodarone to treat severe RAF in an emergency setting.Methods
This retrospective survey was conducted in mobile intensive care units by analyzing patient records between 2002 and 2013. We included RAF with (one or more) severity factors including: clinical shock, angina pectoris, ST shift, and very rapid ventricular rate. A blind matching procedure was used to constitute esmolol group (n = 100) and amiodarone group (n = 200), with similar profiles for age, gender, initial blood pressure, heart rate, severity factors, and treatment delay. The main outcome measure was the percentage of patients with a ventricular rate control defined as heart frequency ≤ 100 beats/min. More stringent (rhythm control) and more humble indicators (20% heart rate reduction) were analyzed at from 10 to 120 min after treatment initiation.Results
Patient characteristics were comparable for both groups: age 66 ± 16 years, male 71%, treatment delay < 1 h 36%, 1–2 h 29%, > 2 h 35%, chest pain 61%, ST shift 62%, ventricular rate 154 ± 26 beats/min, and blood pressure 126/73 mm Hg. The superiority of esmolol was significant at 40 min (64% rate control with esmolol vs. 25% with amiodarone) and for all indicators from 10 to 120 min after treatment onset.Conclusion
In “real life emergency medicine,” esmolol is better than amiodarone in the treatment of RAF. 相似文献7.
Jordan R. Atkins J. Frank Titch William P. Norcross Julie A. Thompson Virginia C. Muckler 《Nursing for Women's Health》2019,23(2):105-113
Objective
To decrease hospital expenses by administering oral acetaminophen rather than intravenous (IV) acetaminophen to women who undergo laparoscopic hysterectomy.Design
A quality improvement project using a between-groups, pre-/postimplementation design for women undergoing total laparoscopic hysterectomy. Retrospective chart review was used to compare data of women who received intraoperative IV acetaminophen before implementation versus women who received oral acetaminophen after implementation. Pain scores and opioid consumption in morphine equivalents were recorded at four time points.Setting/Local Problem
A 369-bed hospital in the southeastern United States, where, in 2016, nearly $260,000 was spent on perioperative IV acetaminophen for all operating room cases.Participants
Women between the ages of 18 and 55 years scheduled to have total laparoscopic hysterectomy were included. Excluded were women with a history of chronic pain, opioid use, or liver pathology; women with a contraindication to nonsteroidal anti-inflammatory drugs; and women whose procedures were converted from laparoscopic to open.Intervention/Measurements
Women were instructed to take oral acetaminophen the day before surgery in divided doses, with 1 g every 6 hours, for a total dose of 3 g. On the day of surgery, women received the final 1-g dose of oral acetaminophen.Results
There were no significant differences between groups for pain scores or total opioids received before implementation (mean = 3.28, standard deviation = 2.05) compared with after implementation (mean = 3.65, standard deviation = 1.63; t [18] = –.043, p = .674). The preimplementation cost per individual was $30.03 for 1 g of IV acetaminophen, and the postimplementation cost was $0.36 for 2 500-mg oral acetaminophen tablets, a 98.8% relative cost decrease per woman.Conclusion
Replacing IV acetaminophen with preemptive oral acetaminophen has the potential to save money without compromising care. 相似文献8.
9.
Purpose
This study aimed to examine the association among sexual double standard, dating violence recognition, and sexual assertiveness among Korean university students.Methods
Using a cross-sectional survey study in January 2018, Korean university students (N = 322, years; 54.3% female) completed structured questionnaires with the double standard scale, dating violence recognition index, and sexual assertiveness index. The relationship among the variables was analyzed with Pearson's correlations and multiple regression analyses.Results
There were significant correlations among sexual double standard, dating violence recognition, and sexual assertiveness. Sexual double standard (β = .12, p = .043) was determined to influence dating violence recognition. In addition, gender (β = .63, p < .001) and sexual double standard (β = .11, p = .015) were determined to influence dating violence recognition; the explanatory power was 43%.Conclusion
These findings will serve as a basis for the development of education programs that help university students to establish appropriate sexual values and enjoy a healthy sex life. 相似文献10.
Anneke Rebel Vince Marzano Margot Green Karlee Johnston Jiali Wang Teresa Neeman Imogen Mitchell Bernie Bissett 《Australian critical care》2019,32(2):139-146
Background
Mobilisation of intensive care unit (ICU) patients reduces ICU-acquired weakness and is associated with better functional outcomes. However, the prevalence of mobilisation of ICU patients remains low. A known barrier to mobilisation is haemodynamic instability, frequently with patients requiring vasoactive therapy. There is a lack of published data to guide clinicians about the safety and feasibility of mobilising patients receiving vasoactive therapy.Objectives
To describe our mobilisation practice in ICU patients receiving vasoactive therapy and identify factors associated with mobilisation and adverse events.Methods
Retrospective cohort study of patients undergoing vasoactive therapy in a 31-bed tertiary ICU (October–December, 2016). Details of vasoactive drug dosage, mobilisation, and adverse events were extracted from databases, including mobilisation intensity (ICU Mobility Scale [IMS]). Two generalised linear mixed models were used: first, to describe factors associated with mobilisation and second, to describe factors associated with adverse events during mobilisation, adjusting for age, gender, and acute physiology and chronic health evaluation II score as co-variates.Results
In 119 patients undergoing vasoactive therapy on 371 cumulative vasoactive days, 195 mobilisation episodes occurred (37.5% of vasoactive days). Low (76.8%) and moderate (13.7%) dose vasoactive therapies were associated with a higher probability of mobilisation relative to high (9.4%) dose therapy (odds ratio = 5.50, 95% confidence interval = 2.23–13.59 and odds ratio = 2.50, 95% confidence interval = 0.95–6.59, respectively). For patients who mobilised on vasoactive therapy (n = 72), maximum mobilisation intensity was low (IMS = 1–2) in 31%, moderate (IMS = 3–5) in 51%, and high (IMS = 6–10) in 18% of vasoactive days. While no serious adverse events occurred, there were 14 occurrences of reversible hypotension requiring transient escalation of vasoactive therapy (7.3%), associated with lower mean arterial pressure (p = 0.001).Conclusion
In our ICU, patients mobilised on approximately one-third of vasoactive days. Clinicians should anticipate a higher risk of hypotension during mobilisation in patients receiving vasoactive therapy, which may require transient escalation of vasoactive therapy. 相似文献11.
Aasha I. Hoogland Hailey W. Bulls Brian D. Gonzalez Brent J. Small Lianqi Liu Joseph Pidala Heather S.L. Jim Asmita Mishra 《Journal of pain and symptom management》2019,57(5):952-960.e1
Context
Quality of life (QoL) is increasingly recognized as an important outcome of cancer treatment. Previous studies have examined clinical predictors of QoL, but with the increasing prevalence of wearable sensors that monitor sleep and activity patterns, further investigation into whether these behaviors are predictive of post-treatment QoL is now feasible. Among patients receiving aggressive cancer treatment such as hematopoietic cell transplantation (HCT), analysis of circadian rhythms (24-hour patterns of sleep and activity) via wearable sensors is limited.Objective
To evaluate the relationship between overall QoL and circadian rhythms in patients receiving allogeneic HCT.Methods
Patients wore an ActiGraph GT3X (Pensacola, FL) activity monitor for at least 72 hours before the initiation of conditioning chemotherapy and transplantation and completed a QoL (Functional Assessment of Cancer Therapy-General [FACT-G]) assessment. QoL assessments were also completed 1, 3, and 6 months after HCT.Results
Patients (n = 45, M age = 55) were mostly male (66%) with a total FACT-G score of 80.96 (SD = 16.05) before HCT. Mixed models revealed robust cross-sectional associations between overall QoL and multiple circadian rhythmicity parameters, including durations of high physical activity, overall circadian rhythmicity, and earlier starts of daily activity (P's < .01). Recovery of QoL after transplant was predicted by longer pre-transplant durations of high physical activity (P = .04) and earlier evening retirement (P = .04).Conclusion
Our findings suggest that wearable sensor information is a promising method of predicting recovery of QoL after HCT. Additional studies are needed to confirm these findings in a larger sample. 相似文献12.
Maureen E. Lyon Leah Squires Lawrence J. D&#x;Angelo Debra Benator Rachel K. Scott Isabella H. Greenberg Patricia Tanjutco Melissa M. Turner Tara E. Weixel Yao I. Cheng Jichuan Wang 《Journal of pain and symptom management》2019,57(3):607-616
Context
No prospective studies address disease-specific advance care planning (ACP) for adults living with HIV/AIDS.Objective
To examine the efficacy of FAmily-CEntered (FACE) ACP in increasing ACP and advance directive documentation in the medical record.Methods
Longitudinal, two-arm, randomized controlled trial with intent-to-treat design recruited from five hospital-based outpatient HIV clinics in Washington, DC. Adults living with HIV and their surrogate decision-makers (N = 233 dyads) were randomized to either an intensive facilitated two-session FACE ACP (Next Steps: Respecting Choices goals of care conversation and Five Wishes advance directive) or healthy living control (conversations about developmental/relationship history and nutrition).Results
Patients (n = 223) mean age: 51 years, 56% male, 86% African-American. One hundred ninety-nine dyads participated in the intervention. At baseline, only 13% of patients had an advance directive. Three months after intervention, this increased to 59% for the FACE ACP group versus 17% in the control group (P < 0.0001). Controlling for race, the odds of having an advance directive in the medical record in the FACE ACP group was approximately seven times greater than controls (adjusted odds ratio = 6.58, 95% CI: 3.21–13.51, P < 0.0001). Among African-Americans randomized to FACE, 58% had completed/documented advance directives versus 20% of controls (P < 0.0001).Conclusions
The FACE ACP intervention significantly improved ACP completion and advance directive documentation in the medical record among both African-American and non-African-American adults living with HIV in Washington, DC, providing health equity in ACP, which can inform best practices. 相似文献13.
Toshihiko Okumura Jun-ichi Kawada Masaharu Tanaka Kotaro Narita Tomonori Ishiguro Yuji Hirayama Sho Narahara Genki Tsuji Yuichiro Sugiyama Michio Suzuki Takeshi Tsuji Shin Hoshino Masahiro Nakatochi Hideki Muramatsu Hiroyuki Kidokoro Yoshiyuki Takahashi Yoshiaki Sato 《Journal of infection and chemotherapy》2019,25(5):346-350
Background
Mycoplasma pneumoniae pneumonia (MPP) is generally a self-limiting disease, but it may become refractory. It is thought that refractory MPP is linked to the excessive immunologic responses of the host. Consequently, the use of adjunctive systemic corticosteroids may have beneficial effects. In this study, we compared the effects of high- and low-dose corticosteroid therapy in a pediatric population with refractory MPP.Methods
We retrospectively collected data from 91 pediatric MPP patients treated with adjunctive systemic corticosteroids between April 2014 and October 2016. The patients were divided into the following two groups: high-dose corticosteroid group (2 mg/kg/day or more of prednisolone equivalents; n = 38) and low-dose corticosteroid group (<2 mg/kg/day; n = 53). Additionally, we compared the number of febrile days post-corticosteroid administration. We used 25 paired patients in a propensity score matching analysis to correct for confounding factors both by age and by days (from onset till corticosteroid therapy initiation).Results
We observed that in the high-dose corticosteroid group defervescence following corticosteroid therapy initiation was achieved significantly earlier and length of hospitalization was significantly shorter (0.8 ± 1.0 vs. 1.5 ± 1.4 days and 8.2 ± 2.4 vs. 10.7 ± 2.7 days, respectively). In the propensity score matching, we observed that significant differences in the length of fever following corticosteroid therapy initiation and hospitalization were still present. Further, neither of the groups developed corticosteroid-related adverse events.Conclusion
Our results suggest that patients with refractory MPP treated with high-dose corticosteroid could achieve defervescence earlier and have a shorter hospitalization. 相似文献14.
Intranasal Sufentanil Versus Intravenous Morphine for Acute Pain in the Emergency Department: A Randomized Pilot Trial 总被引：1，自引：0，他引：1
Billy Sin Iain Jeffrey Zachary Halpern Adebanke Adebayo Tom Wing Amy S. Lee Josel Ruiz Kevin Persaud Lilia Davenport Sylvie de Souza Mollie Williams 《The Journal of emergency medicine》2019,56(3):301-307
Background
Patients in the United States frequently seek medical attention in the emergency department (ED) to address their pain. The intranasal (i.n.) route provides a safe, effective, and painless alternative method of drug administration. Sufentanil is an inexpensive synthetic opioid with a high therapeutic index and rapid onset of action, making it an attractive agent for management of acute pain in the ED.Objective
The objective of our study was to evaluate the safety and efficacy of i.n. sufentanil as the primary analgesic for acute pain in the ED.Methods
This was a single-center, prospective, randomized, double-blind, double-dummy, controlled trial that evaluated the use of i.n. sufentanil 0.7 μg/kg via mucosal atomizer device vs. intravenous morphine 0.1 mg/kg in adult patients who presented to the ED with acute pain. The primary outcome was patient's pain score at 10 min after administration of intervention. Secondary outcomes were adverse events, the need for rescue analgesia, and patient satisfaction after treatment.Results
Thirty patients were enrolled in each group. There was no significant difference in pain scores at 10 min after administration of intervention (sufentanil: 2.0, interquartile range = 2.0–3.3 vs. morphine: 3.0, interquartile range = 2.0–5.3, p = 0.198). No serious adverse events were reported. Rescue analgesia was not requested in either group. No significant difference in median satisfaction scores was found.Conclusion
The use of i.n. sufentanil at 0.7 μg/kg/dose resulted in rapid and safe analgesia with comparable efficacy to i.v. morphine for up to 30 min in patients who presented with acute pain in the ED. 相似文献15.
Rosemary Frey Deborah Balmer Jackie Robinson Merryn Gott Michal Boyd 《Journal of pain and symptom management》2019,57(3):545-555.e1
Context
In most resource-rich countries, a large and growing proportion of older adults with complex needs will die while in a residential aged care (RAC) facility.Objectives
This study describes the impact of facility size (small/large), ownership model (profit/nonprofit) and provider (independent/chain) on resident comfort, and symptom management as reported by RAC staff.Methods
This retrospective “after-death” study collected decedent resident data from a subsample of 51 hospital-level RAC facilities in New Zealand. Symptom Management at the End-of-Life in Dementia and Comfort Assessment in Dying at End of life with Dementia (SM-EOLD and CAD-EOLD, respectively) scales were used by RAC staff who were closely associated with 217 deceased residents. Data collection occurred from January 2016 to February 2017.Results
Results indicated that residents of large, nonprofit facilities experienced greater comfort at the end of life (CAD-EOLD) as indicated by a higher mean score of 37.21 (SD = 4.85, 95% CI = 34.4, 40.0) than residents of small for-profit facilities who recorded a lower mean score of 31.56 (SD = 6.20, 95% CI = 29.6, 33.4). There was also evidence of better symptom management for residents of chain facilities, with a higher mean score for symptom management (SM-EOLD total score) recorded for residents of chain facilities (mean = 28.07, SD = 7.64, 95% CI = 26.47, 29.66) than the mean score for independent facilities (mean = 23.93, SD = 8.72, 95% CI = 21.65, 26.20).Conclusion
Findings suggest that there are differences in the quality of end-of-life care given in RAC based on size, ownership model, and chain affiliation. 相似文献16.
Margot L. Schwartz Julie C. Lima Melissa A. Clark Susan C. Miller 《Journal of pain and symptom management》2019,57(3):525-534
Context
The nursing home (NH) culture change (CC) movement, which emphasizes person-centered care, is particularly relevant to meeting the unique needs of residents near the end of life.Objectives
We aimed to evaluate the NH-reported adoption of person-centered end-of-life culture change (EOL-CC) practices and identify NH characteristics associated with greater adoption.Methods
We used NH and state policy data for 1358 NHs completing a nationally representative 2016/17 NH Culture Change Survey. An 18-point EOL-CC score was created by summarizing responses from six survey items related to practices for residents who were dying/had died. NHs were divided into quartiles reflecting their EOL-CC score, and multivariable ordered logistic regression was used to identify NH characteristics associated with having higher (quartile) scores.Results
The mean EOL-CC score was 13.7 (SD = 3.0). Correlates of higher scores differed from those previously found for non-EOL-CC practices. Higher NH leadership scores and nonprofit status were consistently associated with higher EOL-CC scores. For example, a three-point leadership score increase was associated with higher odds of an NH performing in the top EOL-CC quartile (odds ratio [OR] = 2.0, 95% CI: 1.82–2.30), whereas for-profit status was associated with lower odds (OR = 0.7, 95% CI: 0.49–0.90). The availability of palliative care consults was associated with a greater likelihood of EOL-CC scores above the median (OR = 1.5, 95% CI: 1.10–1.93), but not in the top or bottom quartile.Conclusion
NH-reported adoption of EOL-CC practices varies, and the presence of palliative care consults in NHs explains only some of this variation. Findings support the importance of evaluating EOL-CC practices separately from other culture change practices. 相似文献17.
Laura C. Prater Thomas Wickizer Seuli Bose-Brill 《Journal of pain and symptom management》2019,57(4):731-737
Context
Opportunities for patients to receive unnecessary, costly, and potentially harmful care near the end of life abound. Advance care planning (ACP) can help to make this vulnerable period better for patients, caregivers, and providers.Objective
The objective of this study was to determine whether older age predicted the presence of certain forms of retrievable ACP documentation in the electronic health record (EHR) in a large sample of hospice-referred patients.Methods
This was a retrospective analysis of medical-record data on 3595 patients referred to hospice between January 1, 2013 and December 31, 2015. EHR documentation of an ACP note in the problem list, presence of a scanned advance directive, and the presence of a verified do-not-resuscitate order were the outcome measures. Logistic regression was used to assess the effect of age, education, race, gender, cancer diagnosis, dementia diagnosis, palliative encounter, and death on the outcome variables.Results
Our results suggest that when we control for prognosis, patients over age 70 years may experience gaps in ACP communication. We found that as patients age, the odds of having documentation of a conversation (odds ratio [OR] = 0.56; P < 0.001) or scanned advance directive decreased (OR = 0.63; P < 0.001), while the odds of having a verified do-not-resuscitate order increased (OR = 1.42; P < 0.001).Conclusion
The results of this study may imply some degree of unilateral and physician-driven decision making for end-of-life care among older adults. Collaborative efforts between an interdisciplinary medical team should focus on developing policies to address this potential disparity between younger and older adults at the end of life. 相似文献18.
Danielle B. Tometich Brent J. Small Judith E. Carroll Wanting Zhai George Luta Xingtao Zhou Lindsay C. Kobayashi Tim Ahles Andrew J. Saykin Jonathan D. Clapp Heather S.L. Jim Paul B. Jacobsen Arti Hurria Deena Graham Brenna C. McDonald Neelima Denduluri Martine Extermann Claudine Isaacs Jeanne S. Mandelblatt 《Journal of pain and symptom management》2019,57(3):596-606
Context
Symptoms affect quality of life (QOL), functional status, and cognitive function in cancer survivors, but older survivors are understudied.Objectives
The objectives of this study were to identify prototypical presystemic therapy psychoneurological symptom clusters among older breast cancer survivors and determine whether these symptom clusters predicted cognition and QOL over time.Methods
Women with newly diagnosed nonmetastatic breast cancer (n = 319) and matched noncancer controls (n = 347) aged 60+ years completed questionnaires and neuropsychological tests before systemic therapy and 12 and 24 months later. Latent class analysis identified clusters of survivors based on their pretherapy depression, anxiety, fatigue, sleep disturbance, and pain. Linear mixed-effects models examined changes in objective cognition, perceived cognition, and functional status (Instrumental Activities of Daily Living disability, functional well-being, and breast cancer–specific QOL) by group, controlling for covariates.Results
Nearly one-fifth of older survivors were classified as having high pretherapy symptoms (n = 51; 16%); the remainder had low symptoms (n = 268; 84%); both groups improved over time on all outcomes. However, compared to the low symptom group and controls, survivors with high symptoms had lower baseline objective cognition and lower perceived cognition at baseline and 24 months, lower functional well-being at baseline and 12 months, greater Instrumental Activities of Daily Living disability at baseline, and lower breast cancer–specific QOL at all time points (all P < 0.05).Conclusion
Nearly one-fifth of older breast cancer survivors had high psychoneurological symptoms at diagnosis, which predicted clinically meaningful decrements in perceived cognition and function in the first 24 months after diagnosis. Pretreatment psychoneurological symptom clusters could identify survivors for monitoring or intervention. 相似文献19.
Seng-Beng Tan Chong-Kin Liam Yong-Kek Pang Diana Leh-Ching Ng Tat-Seng Wong Kelvin Wei-Shen Khoo Chieh-Yin Ooi Chee-Shee Chai 《Journal of pain and symptom management》2019,57(4):802-808
Context
Dyspnea is a common and distressing symptom in respiratory diseases. Despite advances in the treatment of various lung diseases, the treatment modalities for dyspnea remain limited.Objectives
This study aims to examine the effect of 20-minute mindful breathing on the rapid reduction of dyspnea at rest in patients with lung cancer, chronic obstructive pulmonary disease, and asthma.Methods
We conducted a parallel-group, nonblinded, randomized controlled trial of standard care plus 20-minute mindful breathing vs. standard care alone for patients with moderate to severe dyspnea due to lung disease, named previously, at the respiratory unit of University Malaya Medical Centre in Malaysia, from August 1, 2017, to March 31, 2018.Results
Sixty-three participants were randomly assigned to standard care plus a 20-minute mindful breathing session (n = 32) or standard care alone (n = 31), with no difference in their demographic and clinical characteristics. There was statistically significant reduction in dyspnea in the mindful breathing group compared with the control group at minute 5 (U = 233.5, n1 = 32, n2 = 31, mean rank1 = 23.28, mean rank2 = 37.72, z = ?3.574, P < 0.001) and minute 20 (U = 232.0, n1 = 32, n2 = 31, mean rank1 = 23.00, mean rank2 = 36.77, z = ?3.285, P = 0.001).Conclusion
Our results provide evidence that a single session of 20-minute mindful breathing is effective in reducing dyspnea rapidly for patients with lung cancer, chronic obstructive pulmonary disease, and asthma. 相似文献20.
Gabrielle Alvarez Stacy J. Suskauer Beth Slomine 《Archives of physical medicine and rehabilitation》2019,100(4):687-694