Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study

BACKGROUND

Reducing symptom burden is paramount at the end-of-life, but typically considered secondary to risk factor control in chronic disease, such as diabetes. Little is known about the symptom burden experienced by adults with type 2 diabetes and the need for symptom palliation.

OBJECTIVE

To examine pain and non-pain symptoms of adults with type 2 diabetes over the disease course ?C at varying time points before death and by age.

DESIGN

Survey follow-up study.

PARTICIPANTS

13,171 adults with type 2 diabetes, aged 30?C75?years, from Kaiser Permanente, Northern California, who answered a baseline symptom survey in 2005?C2006.

MAIN MEASURES

Pain and non-pain symptoms were identified by self-report and medical record data. Survival status from baseline was categorized into ??6, >6?C24, or alive >24?months.

KEY RESULTS

Mean age was 60?years; 48?% were women, and 43?% were non-white. Acute pain was prevalent (41.8?%) and 39.7?% reported chronic pain, 24.6?% fatigue, 23.7?% neuropathy, 23.5?% depression, 24.2?% insomnia, and 15.6?% physical/emotional disability. Symptom burden was prevalent in all survival status categories, but was more prevalent among those with shorter survival, p?<?.001. Adults ??60?years who were alive >24?months reported more physical symptoms such as acute pain and dyspnea, whereas participants <60?years reported more psychosocial symptoms, such as depressed mood and insomnia. Adjustment for duration of diabetes and comorbidity reduced the association between age and pain, but did not otherwise change our results.

CONCLUSIONS

In a diverse cohort of adults with type 2 diabetes, pain and non-pain symptoms were common among all patients, not only among those near the end of life. However, symptoms were more prevalent among patients with shorter survival. Older adults reported more physical symptoms, whereas younger adults reported more psychosocial symptoms. Diabetes care management should include not only good cardiometabolic control, but also symptom palliation across the disease course.     

The Relationship Between Time Spent Communicating and Communication Outcomes on a Hospital Medicine Service

BACKGROUND  

Quality care depends on effective communication between caregivers, but it is unknown whether time spent communicating is associated with communication outcomes.     

Changes of smooth muscle contractile filaments in small bowel atresia

AIM: To investigate morphological changes of intestinal smooth muscle contractile fibres in small bowel atresia patients.METHODS: Resected small bowel specimens from small bowel atresia patients (n = 12) were divided into three sections (proximal, atretic and distal). Standard histology hematoxylin-eosin staining and enzyme immunohistochemistry was performed to visualize smooth muscle contractile markers α-smooth muscle actin (SMA) and desmin using conventional paraffin sections of the proximal and distal bowel. Small bowel from age-matched patients (n = 2) undergoing Meckel’s diverticulum resection served as controls.RESULTS: The smooth muscle coat in the proximal bowel of small bowel atresia patients was thickened compared with control tissue, but the distal bowel was unchanged. Expression of smooth muscle contractile fibres SMA and desmin within the proximal bowel was slightly reduced compared with the distal bowel and control tissue. There were no major differences in the architecture of the smooth muscle within the proximal bowel and the distal bowel. The proximal and distal bowel in small bowel atresia patients revealed only minimal differences regarding smooth muscle morphology and the presence of smooth muscle contractile filament markers.CONCLUSION: Changes in smooth muscle contractile filaments do not appear to play a major role in postoperative motility disorders in small bowel atresia.     

A template free protocol for fabrication of a Ni(ii)-loaded magnetically separable nanoreactor scaffold for confined synthesis of unsymmetrical diaryl sulfides in water

In the present report, an environmentally benign magnetically recoverable nickel(ii)-based nanoreactor as a heterogeneous catalyst has been developed via a template free approach. The catalytic performance of the synthesized catalyst is assessed in the confined oxidative coupling of arenethiols with arylhydrazines to form unsymmetrical diaryl sulfides under aerobic conditions. The salient features of our protocol include oxidant- and ligand-free conditions, use of water as a green solvent, room temperature and formation of nitrogen and water as the only by-products. Moreover, a broad range of functional groups are tolerated well and provide the corresponding diaryl sulfides in moderate to good yields. Moreover, the heterogeneous nature of the catalyst permits facile magnetic recovery and reusability for up to seven runs, making the present protocol highly desirable from industrial and environmental standpoints.

An environmentally benign nickel(ii)-based magnetic nanoreactor has been developed for oxidative coupling of arenethiols with arylhydrazines to form unsymmetrical diaryl sulfides in water at room temperature.     

Mental and Physical Health Consequences of the September 11, 2001 (9/11) Attacks in Primary Care: A Longitudinal Study

The magnitude of the September 11, 2001 (9/11) attacks was without precedent in the United States, but long‐term longitudinal research on its health consequences for primary care patients is limited. We assessed the prevalence and exposure‐related determinants of mental disorders, functioning, general medical conditions, and service utilization, 1 and 4 years after the 9/11 attacks, in an urban primary care cohort (N = 444) in Manhattan. Although the prevalence of posttraumatic stress disorder (PTSD) and levels of functional impairment declined over time, a substantial increase in suicidal ideation and missed work was observed. Most medical outcomes and service utilization indicators demonstrated a short‐term increase after the 9/11 attacks (mean change of +20.3%), followed by a minor decrease in the subsequent year (mean change of ?3.2%). Loss of a close person was associated with the highest risk for poor mental health and functional status over time. These findings highlight the importance of longitudinal assessments of mental, functional, and medical outcomes in urban populations exposed to mass trauma and terrorism.     

Continuous assessment of undergraduate students at a dental college in India

The purpose of this retrospective study was to evaluate the quantitative assessment of a structured essay and standardized oral examination and its correlation to the final-year graduating exam in the Department of Pediatric Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, India. The records of 531 students from 2005 to 2009 were collected. Students were categorized based on their "completion" and "grading" in a structured essay and standardized oral examination, which is a continuous assessment of dental students in the college. The grades obtained by continuous assessment were compared to students' final-year examination scores. The assessment showed that students who completed all tasks and had desirable performance in their written assessment and standardized oral examination also scored better on their final examination. Therefore, the continuous assessment by written assessment and standardized oral examination had a direct relationship to students' performance on the final examination and is useful for evaluation.     

Oropharyngeal dysphagia may occur in late-onset Pompe disease,implicating bulbar muscle involvement

Late-onset Pompe disease (presenting after 12 months of age) often presents with limb-girdle and respiratory weakness, but oropharyngeal dysphagia has not been reported previously. A retrospective review of all late-onset Pompe disease patients evaluated in the neuromuscular clinic at Duke University Medical Center from 1999–2010 was performed. Twelve patients were identified and 3 had symptoms of oropharyngeal dysphagia. The medical record was reviewed, including the results of electromyography, videofluroscopic swallow examinations, and motor speech examination including instrumental assessment of lingual force with the Iowa Oral Performance Instrument. Oropharyngeal dysphagia was mild in two cases and severe in one. One of the two patients with mild severity demonstrated oral stage swallow signs; in the other, residual material was observed in the area of the cervical esophagus. In the patient with severe oropharyngeal dysphagia, both the oral and pharyngeal stages of swallowing were affected with penetration and aspiration documented. The degree of swallowing impairment appeared to correlate with overall physical strength and function. Oropharyngeal dysphagia may occur in patients with late-onset Pompe disease, implicating bulbar muscle involvement. Screening for symptoms of dysphagia may help reduce morbidity and mortality, while improving understanding of the late-onset Pompe disease phenotype. Further studies, including examination of the relationship between lingual weakness and oropharyngeal dysphagia, are warranted.