ORIGINAL ARTICLES: Effects of digital screen property modification on symptoms of digital eye strain

BackgroundIrritable bowel syndrome (IBS) has a high worldwide prevalence and there are few effective treatment options. Patient education can influence patient behavior that subsequently may lead to changes in attitudes and skills necessary for maintenance or improvement in management of symptom severity and quality of life. However, as postdiagnostic patient education can be resource demanding, assessment of digital approaches and verification of their effectiveness is warranted.ObjectiveThis cohort study aimed to investigate the effects of a digital web-based multidisciplinary eHealth program on the domains of symptom severity (Irritable Bowel Syndrome Symptom Severity Scale [IBS-SSS]), quality of life (irritable bowel syndrome quality of life [IBS-QOL]), anxiety and depression (Hospital Anxiety and Depression Scale), and a measure of general client satisfaction (client satisfaction questionnaire), compared with an onsite multidisciplinary 2-day group-based education program (“IBS-school”), in 2 cohorts of 255 patients with IBS.MethodsPatients diagnosed with IBS, aged 15-70 years, were enrolled after referral to the Section of Gastroenterology at Haukeland University Hospital, Norway. In total, 132 patients were recruited to the eHealth program and 123 to the IBS-school group for comparison. Data were self-reported and collected digitally at enrollment and after 3 months, between 2017 and 2019. Furthermore, 71 attending the eHealth program and 49 attending the IBS-school completed the questionnaires at 3 months. Intervention response was defined as a reduction of ≥50 points on the IBS-SSS.ResultsPatients attending the eHealth program reported a significant reduction in IBS symptom severity 3 months after treatment (n=71), compared with patients attending the IBS-school (n=50). Overall, patients categorized as intervention responders in both programs showed a significant reduction in symptom severity at 3 months. Here, 41% (29/71) of patients attending the eHealth program reported a mean IBS-SSS reduction of 103 (SD 72.0) points (P<.001). In addition, these patients reported reduced anxiety (P>.001) and depression (P=.002) and enhanced quality of life (P=.03), especially the degrees of dysphoria, body image, food avoidance, health worry, interference with activity, relations, and social relations. Patients responding to the IBS-school intervention (18/50, 36%) reported a mean IBS-SSS reduction of 119 (SD 86.2) points (P<.001), and reduced depression scores (P=.046), but no difference in overall quality of life. Both groups reported the respective interventions as “good” quality health care programs, scoring them 23.5 (SD 4)—the eHealth program 23.5 (SD 4), and the IBS-school 24.2 (SD 4)—on the client satisfaction questionnaire.ConclusionsWe conclude that the digital multidisciplinary eHealth program has a significant effect on IBS symptom severity in a portion of patients; it is useful as a tool in disease self-management and does not result in worse symptom scores than an onsite multidisciplinary 2-day group-based education program after 3 months. We believe these results indicate that a digital eHealth approach is preferable to an onsite multidisciplinary 2-day group-based education program covering the same topics.

Comparison of the Impact of Out-of-plane and In-plane Injection Approaches on Injection Pain and Functionality in Patients With Carpal Tunnel Syndrome Undergoing Ultrasound-guided Injection: A Patient- and Assessor-blinded Randomized Study

Patients need information about the course of recovery after surgery for lung cancer, but knowledge about symptoms in this period is limited. The purpose of this study was to assess for changes in symptom occurrence rates and severity scores from the preoperative period to 1 month after surgery. Patients (n = 228) completed questionnaires before and at 1 month after surgery. McNemar tests were used to evaluate for changes over time in symptom occurrence rates and paired t tests for changes in symptom severity scores. General linear model was used to determine if select demographic and clinical characteristics were associated with the number of symptoms after surgery. The total number of symptoms increased significantly from the preoperative (mean, 9.4) to the postoperative (mean, 13.1) assessment. Of the 11 symptoms that occurred in 50% or more of the patients 1 month after surgery, 8 increased significantly in both occurrence and severity. Four symptoms were experienced by more than 80% of the patients 1 month after surgery: shortness of breath (85.5%), lack of energy (83.8%), pain (83.8%), and feeling drowsy (82.5%). Patients experienced a high number of symptoms after lung cancer surgery. The only characteristic that was associated with a higher number of symptoms 1 month after surgery was the number of symptoms reported preoperatively. These findings can be used to educate patients about the normal course of postoperative recovery. Clinicians need to assess for these symptoms and develop effective interventions to improve symptom management for these patients.

To compare the rate of reintervention and midterm changes in symptom severity (SS) and Total health-related quality of life (HRQoL) scores after uterine artery embolization (UAE) and magnetic resonance-guided high-intensity focused ultrasound (MR-g HIFU) for symptomatic uterine fibroids. Eighty women (median age 38.3 years), equally eligible for MR-g HIFU and UAE who underwent one of both treatments between 2002 and 2009 at our institution, were included. The primary end point of the study was defined as the rate of reintervention after both therapies. The secondary outcome was defined as changes in SS and Total HRQoL scores after treatment. SS and Total HRQoL scores before treatment and at midterm follow-up (median 13.3 months) were assessed by the uterine fibroid symptom and quality-of-life questionnaire (UFS-QoL) and compared. The rate of reintervention was significantly lower after UAE than after MR-g HIFU (p = 0.002). After both treatments, SS and Total HRQoL scores improved significantly from baseline to follow-up (UAE: p < 0.001, p < 0.001; MR-g HIFU: p = 0.002, p < 0.001). Total HRQoL scores were significantly higher after UAE than after MR-g HIFU (p = 0.032). Changes in the SS scores did not differ significantly for both treatments (p = 0.061). UAE and MR-g HIFU significantly improved the health-related quality of life of women with symptomatic uterine fibroids. After UAE, the change in Total HRQoL score improvement was significantly better, and a significantly lower rate of reintervention was observed.

Symptom Management for Cancer Patients: A Trial Comparing Two Multimodal Interventions

A Randomized Clinical Trial of Caregiver-Delivered Reflexology for Symptom Management During Breast Cancer Treatment

Few pharmacotherapies have demonstrated sufficient efficacy in the treatment of posttraumatic stress disorder (PTSD), a chronic and disabling condition. To test the efficacy and safety of a single intravenous subanesthetic dose of ketamine for the treatment of PTSD and associated depressive symptoms in patients with chronic PTSD. Proof-of-concept, randomized, double-blind, crossover trial comparing ketamine with an active placebo control, midazolam, conducted at a single site (Icahn School of Medicine at Mount Sinai, New York, New York). Forty-one patients with chronic PTSD related to a range of trauma exposures were recruited via advertisements. Intravenous infusion of ketamine hydrochloride (0.5 mg/kg) and midazolam (0.045 mg/kg). The primary outcome measure was change in PTSD symptom severity, measured using the Impact of Event Scale-Revised. Secondary outcome measures included the Montgomery-Asberg Depression Rating Scale, the Clinical Global Impression-Severity and -Improvement scales, and adverse effect measures, including the Clinician-Administered Dissociative States Scale, the Brief Psychiatric Rating Scale, and the Young Mania Rating Scale. Ketamine infusion was associated with significant and rapid reduction in PTSD symptom severity, compared with midazolam, when assessed 24 hours after infusion (mean difference in Impact of Event Scale-Revised score, 12.7 [95% CI, 2.5-22.8]; P = .02). Greater reduction of PTSD symptoms following treatment with ketamine was evident in both crossover and first-period analyses, and remained significant after adjusting for baseline and 24-hour depressive symptom severity. Ketamine was also associated with reduction in comorbid depressive symptoms and with improvement in overall clinical presentation. Ketamine was generally well tolerated without clinically significant persistent dissociative symptoms. This study provides the first evidence for rapid reduction in symptom severity following ketamine infusion in patients with chronic PTSD. If replicated, these findings may lead to novel approaches to the pharmacologic treatment of patients with this disabling condition. clinicaltrials.gov Identifier: NCT00749203.

Transcranial magnetic stimulation as a treatment for functional (psychogenic) upper limb weakness

A dietitian-first gastroenterology clinic results in improved symptoms and quality of life in patients referred to a tertiary gastroenterology service

Objective The present network meta-analysis (NMA) was conducted to compare and generate evidence for the most efficacious treatment among available pharmacological interventions for treatment-resistant schizophrenia (TRS). Methods Reviewers extracted data from 47 studies screened from PubMed/MEDLINE, Embase, Cochrane databases and clinical trial registries fulfilling the eligibility criteria. Random effects Bayesian NMA was done with non-informative priors. Network geometry was visualized, and node splitting was done for the closed triangles. Standardized mean difference and 95% credible interval(95%CrI) were reported for the reduction in symptom severity scores. The probability of each intervention for each rank was plotted. Meta-regression was done for the duration of the therapy. Results Augmentation of antipsychotics with escitalopram (SMD: −1.7[95%CrI: −2.8, −0.70]), glycine (SMD: −1.2 [95%CrI: −2.2, −0.28]) and Yokukansan (SMD: −1.3 [95%CrI: −2.4, −0.24]) shows a statistically significant reduction in symptom severity when compared to clozapine. As per surface under cumulative ranking curve analysis, escitalopram in combination with antipsychotics appeared to be the best intervention with moderate certainty of evidence. There was no significant effect of the duration of therapy on the treatment effects. Conclusion Escitalopram augmentation of antipsychotics appears to be the most efficacious treatment with moderate certainty of evidence among the available pharmacological interventions. PROSPERO Registration CRD42022380292

BackgroundRecent studies have linked inflammation, obesity, and lipid dysregulation with cognitive impairment, a core feature of schizophrenia. Elevated C-reactive protein concentration has been shown to be a reliable biomarker for inflammatory states. We conducted an exploratory analysis to investigate the potential influence of inflammation, obesity and lipid metabolism on changes in symptom severity and cognitive performance in patients with schizophrenia treated with lurasidone.MethodsPatients with acute exacerbation of schizophrenia were treated with one of two fixed doses of lurasidone (80 or 160 mg/day), placebo, or 600 mg/day quetiapine XR in a 6-week double-blind study. A wide-range CRP (wr-CRP) assay (equivalent to high sensitivity CRP assay) was used to assess levels of inflammation. CRP was evaluated as a logarithm transformed (log) continuous variable and as a categorical variable divided into low (≤ 2 mg/L), medium (> 2 mg/L and ≤ 5 mg/L) and high (> 5 mg/L) subgroups. Cognitive function was assessed with the CogState computerized cognitive battery at baseline and week 6 endpoint. Nonparametric bootstrap resampling method was applied to estimate the main and interactive effects of CRP on ranked cognitive scores.ResultsElevated level of wr-CRP (log) was associated with cognitive impairment at study baseline (P < 0.05), with significantly lower cognitive performance in the subgroup with high wr-CRP (> 5 mg/L) compared to those with low wr- CRP (< 2 mg/L) at study baseline (P < 0.05). Higher level of CRP (log) was also associated with significantly greater symptom severity as assessed by PANSS score, as well as higher BMI/body weight, and lower levels of high-density lipoprotein (HDL) and high hemoglobin A1c (HbA1c) at study baseline (P < 0.05). No significant associations were found for wr-CRP (log) with low-density lipoprotein (LDL) and total cholesterol at study baseline. High wr-CRP level (> 5 mg/L) at study baseline predicted less improvement of cognitive composite score at week 6 endpoint for all treatment groups, compared to those with low to medium wr-CRP levels (< 5 mg/L).The joint effect of wr-CRP (log) and HDL or HOMA-IR on moderating procognitive effects of lurasidone was significant (P<0.05), with greater lurasidone (vs. placebo) effect size in patients with either low wr-CRP and high HDL concentration or lower levels of both wr-CRP and HOMA-IR.Lurasidone treatment was associated with significant reduction in symptom severity as assessed by PANSS, CGI-S, and MADRS change scores from baseline to week 6, independent of wr-CRP, HDL and HOMA-IR levels at study baseline. Lurasidone had no significant effect on change in wr-CRP level from baseline to week 6 endpoint.DiscussionOur findings from this exploratory analysis of a placebo-controlled trial in patients with schizophrenia suggest that the joint effects of low wr-CRP level combined with either high HDL or low HOMA-IR can predict cognitive improvement in patients treated with lurasidone (vs. placebo). These findings suggest that inflammation and its interactive effects with insulin resistance and lipid parameters in patients with schizophrenia might impact cognition and response to treatment with antipsychotics.

Patients with chronic schizophrenia often display enlarged striatal volumes, and antipsychotic drugs may contribute via the dopamine D2/3 receptor (D2/3R) blockade. Separating the effects of disease from medication is challenging due to the lack of a proper placebo-group. To address this, we conducted a longitudinal study of antipsychotic-naïve, first-episode schizophrenia patients to test the hypothesis that selective blockade of D2/3R would induce a dose-dependent striatal volume increase. Twenty-one patients underwent structural magnetic resonance imaging (sMRI), single-photon emission computed tomography (SPECT), and symptom severity ratings before and after six weeks of amisulpride treatment. Twenty-three matched healthy controls underwent sMRI and baseline SPECT. Data were analyzed using repeated measures and multiple regression analyses. Correlations between symptom severity decrease, volume changes, dose and receptor occupancy were explored. Striatal volumes did not differ between patients and controls at baseline or follow-up, but a significant group-by-time interaction was found (p = 0.01). This interaction was explained by a significant striatal volume increase of 2.1% in patients (Cohens d = 0.45). Striatal increase was predicted by amisulpride dose, but not by either D2/3R occupancy or baseline symptom severity. A significant reduction in symptom severity was observed at a mean dose of 233.3 (SD = 109.9) mg, corresponding to D2/3R occupancy of 44.65%. Reduction in positive symptoms correlated significantly with striatal volume increase, driven by reductions in hallucinations. Our data demonstrate a clear link between antipsychotic treatment and striatal volume increase in antipsychotic-naïve schizophrenia patients. Moreover, the treatment-induced striatal volume increase appears clinically relevant by correlating to reductions in core symptoms of schizophrenia.

Gastroparesis is a chronic gastric motility disorder in which the pathophysiology mimics a postvagotomy state. Pyloroplasty is beginning to emerge as a successful drainage procedure for refractory gastroparesis. Here we report our experience using pyloroplasty in the surgical management of diabetic and nondiabetic gastroparesis. A retrospective study was performed of 46 patients undergoing pyloroplasty for refractory gastroparesis from January 2010 through December 2013. Gastric emptying scintigraphy and the Gastroparesis Cardinal Symptom Index were assessed pre- and postoperatively. Laparoscopic pyloroplasty was performed in 42 patients, open pyloroplasty in three, and one patient was converted from laparoscopic to open pyloroplasty. Studies were repeated during the six to 12 month postoperative interval. The postoperative gastric emptying scintigraphy improved in 90 per cent of patients and normalized in 60 per cent. Postoperative T½ was significantly reduced (P = 0.001) as was four-hour retention (P < 0.001). The Gastroparesis Cardinal Symptom Index showed statistically significant reduction in symptom severity for all nine categories (P < 0.0005) as well as total symptom score (P < 0.005). No patients developed dumping syndrome. Pyloroplasty is a highly effective therapy for refractory gastroparesis, offering significant reduction in symptom severity, improvement in quality of life, and acceleration of gastric emptying.

Neurocognitive impairment due to Alzheimer's disease (previously termed Alzheimer's dementia) (AD) is the most common form of cognitive impairment worldwide. Given the anticipated increase in the population aged 65 and over, the prevalence of persons with AD is expected to increase exponentially during the next 30 years. Noncognitive neuropsychiatric symptoms (NPS) commonly occur in AD and are associated with adverse outcomes for patients and their caregivers. This review summarizes randomized, controlled trials (RCTs) published between 2004 and 2014 with a primary outcome measure of change in symptom severity for NPS in AD. Of the 388 articles initially identified through a literature search, 33 trials met inclusion criteria. Fifteen of these studies had agitation/aggression as a targeted symptom. Twenty-eight evaluated pharmacologic treatments, including psychotropics, cognitive enhancers, stimulants, and nutraceuticals. Nonpharmacologic interventions included bright light, music, exercise, and cognitive-stimulation therapies. Among the pharmacologic interventions, modest efficacy was reported with aripiprazole, citalopram, trazodone, methylphenidate, and scheduled analgesics. Significant reduction in symptom severity was reported with nearly all the nonpharmacologic interventions. Variations in methodology such as inclusion criteria, study setting, and outcome measures limit the generalizability of these results. Barriers to the implementation of nonpharmacologic interventions in clinical settings include resource and training limitations. Electroconvulsive therapy and dronabinol are promising as emerging treatment strategies. Randomized clinical trials are needed in order to validate the utility of electroconvulsive therapy and dronabinol, including where and with whom these interventions will prove most valuable.

BackgroundCarpal tunnel syndrome (CTS) is a prevalent entrapment neuropathy resulting in hand pain, numbness and/or weakness, which significantly impairs hand function in daily activities. Repetitive peripheral magnetic stimulation (rPMS) is a potential therapeutic option for focal peripheral nerve disease and may be beneficial for CTS treatment. We aimed to compare the effects of rPMS and conventional therapy in the management of CTS.MethodsA blinded assessor randomly assigned 24 participants with electrodiagnostically-confirmed mild or moderate CTS to either rPMS or conventional therapy. Both groups were briefed on disease progression and tendon-gliding exercises. In the intervention group, the rPMS protocol, five sessions of rPMS—with a frequency of 10 Hz, 10 pulses/train, and 100 trains/session—were performed over a period of 2 weeks, with three sessions in the first week and two sessions in the second week. At baseline and the end of the second week, the Boston Carpal Tunnel Questionnaire, pinch strength, and electrodiagnostic results were evaluated.ResultsThe rPMS group demonstrated significantly greater within-group improvement in symptom severity scores (2.3 vs. 1.6, p = 0.009) and pinch strength (10.6 lbs vs. 13.8 lbs, p < 0.001). Regarding electrodiagnostic parameters, sensory nerve action potential (SNAP) amplitude was significantly increased (8.7 µV vs. 14.3 µV, p = 0.002) within the group treated with rPMS. With conventional therapy, there were no statistically significant within-group differences. Multiple linear regression models showed that there were no significant differences in other outcomes in between-group comparisons.ConclusionsFive sessions of rPMS resulted in significant reduction in symptom severity, improvement in pinch strength and increase in SNAP amplitude. Future research should investigate the clinical utility of rPMS using a larger sample and longer treatment and follow-up durations.