Comprehensive Assessment Of Symptoms Research Articles

Chinese expert consensus on diagnosis and treatment of infection after fracture fixation

Currently, accurate diagnosis and successful treatment of infection after fracture fixation (IAFF) still impose great challenges. According to the onset of infection symptoms after implantation, IAFF is classified as early infection (<2 weeks), delayed infection (2∼10 weeks) and late infection (>10 weeks). Confirmation of IAFF should be supported by histopathological tests of intraoperative specimens which confirm infection, cultures from at least two suspected infection sites which reveal the same pathogen, a definite sinus or fistula which connects directly the bone or the implant, and purulent drainage from the wound or presence of pus during surgery. Diagnosis of IAFF is built on comprehensive assessment of medical history, clinical signs and symptoms of the patient, and imaging and laboratory tests. The gold standard of diagnosis is histopathological tests. Treatment of IAFF consists of radical debridement, adequate irrigation, implant handling, systematic and local antibiotics, reconstruction of osseous and/or soft tissue defects, and functional rehabilitation of an affected limb. Early accurate diagnosis and appropriate treatment of IAFF play a key role in increasing the cure rate, reducing infection recurrence and disability risk, restoring limb function and improving quality of life of the patient.

Persistent Heart Failure Symptoms at Hospital Discharge Predicts 30-Day Clinical Events

Introduction The relationship between heart failure (HF) symptoms at discharge and 30-day clinical events is unknown. Persistent symptoms at discharge are common and approximately 25% of patients are readmitted within 30 days. Variability in assessment of HF symptoms at discharge may affect capacity to predict readmission risk. Objective To describe symptom burden and symptom profiles of HF patients at hospital discharge. A secondary aim was to examine the relationship between symptom burden at hospital discharge and 30-day clinical event rate. Methods An exploratory descriptive design was used. HF patients (n=129) preparing for hospital discharge were enrolled 24-48 hours pre-hospital discharge. The Heart Failure Somatic Perception Scale (HFSPS) assesses 18 physical signs and symptoms of HF on a range of 0 (I did not have this symptom) to 5 (extremely bothersome). The Patient Health Questionnaire-9 (PHQ-9) was used to measure depressive symptoms. Self-Assessed Health (SAH) and comorbid illnesses were documented. Participants were called 30 days post-discharge to assess clinical event rates. HFSPS scores were divided into tertiles (0-10; 11-19; 20 and higher) to explore symptom burden in a subgroup analysis. Results were analyzed using descriptive statistics, chi-square and logistic regression. Results The sample (n=129) was predominantly Caucasian (87.6%), male (63%), elderly (M=73.6, SD=12.6) and symptomatic (94.6%) at discharge. HFSPS scores ranged 0 to 53, M=15.8 (SD 10.6). Hypertension, hyperlipidemia and diabetes were the most common comorbid illnesses. The most bothersome symptoms at discharge were fatigue (71%), nocturia (66%), need to rest more than usual (61%), and inability to do usual activities due to shortness of breath (61%). Thirty-day readmission rate was 28.7% overall with significant differences between HFSPS groups (43.2% and 40.5% of readmissions occurred in second and third tertiles respectively χ2 (2, N = 129) = 7.85, p=0.02). HFSPS and SAH were significant predictors of readmission with increased likelihood of readmission by OR 3.9 (p=0.02) and OR 2.97 (p=0.02) respectively. PHQ9 scores were not significant predictors of readmission in this sample. Conclusions The majority of patients in this sample had persistent and bothersome symptoms at hospital discharge that predicted likelihood of 30-day readmission. Comprehensive symptom assessment of HF patients at time of discharge is important and may guide care to decrease 30-day clinical events.

A New Brief Clinical Assessment of Lower Urinary Tract Symptoms for Women and Men: LURN SI-10.

Lower urinary tract symptoms are common in men and women. Members of the LURN (Lower Urinary Tract Dysfunction Research Network) sought to create a brief, clinically relevant tool to improve existing measurements of lower urinary tract symptoms in men and women. Using a modified Delphi methodology during an expert consensus meeting we reduced the LURN CASUS (Comprehensive Assessment of Self-Reported Urinary Symptoms) questionnaire to a brief set of clinically relevant items measuring lower urinary tract symptoms. The sum score of these items was evaluated by comparing it to the AUA SI (American Urological Association Symptom Index), the UDI-6 (Urinary Distress Inventory Short Form) in women only and the CASUS lower urinary tract symptoms screening questions using the Pearson correlation, regression analysis and ROC curves. The LURN SI-10 (10-Item LURN Symptom Index) assesses urinary frequency, nocturia, urgency, incontinence, bladder pain, voiding and post-micturition symptoms (score range 0 to 38). The correlation between LURN SI-10 and AUA SI scores was 0.77 in men and 0.70 in women. The UDI-6 and the LURN SI-10 correlated highly in women (r=0.76). The LURN SI-10 showed good accuracy to predict moderate and severe lower urinary tract symptoms as defined by the AUA SI (ROC AUC range 0.82-0.90). Similar accuracy was shown in predicting different levels of symptom status using the UDI-6 (AUC range 0.84-0.86). The LURN SI-10 correlates well with the AUA SI and the UDI-6. It includes items related to a broader spectrum of lower urinary tract symptoms, particularly incontinence, bladder pain and post-micturition symptoms, and it applies to men and women.

Which symptoms and problems do advanced cancer patients admitted to specialized palliative care report in addition to those included in the EORTC QLQ-C15-PAL? A register-based national study.

Patients in palliative care are willing to answer short questionnaires, like the EORTC QLQ-C15-PAL; however, patients may suffer from other symptoms and problems (S/Ps) not covered by such questionnaires. Therefore, to identify which other S/Ps patients experience, in addition to those already included in the EORTC QLQ-C15-PAL, we developed a brief instrument to supplement this questionnaire named WISP (Write In three Symptoms/Problems), permitting patients to report 1-3 additional S/Ps and their severity. We aim to investigate the nature, prevalence, and severity of S/Ps reported on WISP. A register-based study with data obtained from the Danish Palliative Care Database. This study included adults with advanced cancer admitted to specialized palliative care in Denmark, who reported S/Ps on WISP. S/Ps were categorized qualitatively, and their prevalence and severity were calculated. Of the 5447 patients who completed the EORTC QLQ-C15-PAL, 1788 (32.8%) reported at least one symptom/problem using WISP. In total, 2796S/Ps were reported; 24.8% were already covered by EORTC QLQ-C15-PAL; 63.6% were new, 10.1% were diagnoses and 1.6% could not be coded. S/Ps already covered and new were grouped into 61 categories. The most prevalent S/Ps reported were (in decreasing order) pain, edema, dizziness, impaired physical or emotional function, cough, and sweats. Overall, 85% of the S/Ps were rated as moderate to severe. The WISP instrument strongly improves the recognition of S/Ps by combining standardization with individualization. We recommend its use for comprehensive symptom assessment alongside the EORTC QLQ-C15-PAL, and potentially also alongside the EORTC QLQ-C30.

The Comprehensive Assessment of Self-Reported Urinary Symptoms: A New Tool for Research on Subtypes of Patients with Lower Urinary Tract Symptoms.

To improve the potential for finding clinically important subtypes of patients with lower urinary tract symptoms we developed the CASUS (Comprehensive Assessment of Self-reported Urinary Symptoms). We used it to present data on the experiences of lower urinary tract symptoms in treatment seeking women and men from a prospective observational cohort. We created an initial list of lower urinary tract symptoms that were confirmed in 22 qualitative interviews with providers, and 88 qualitative interviews with care seeking and noncare seeking women and men with lower urinary tract symptoms. Items from extant measures were adopted and revised, and new items were developed. All items were evaluated for understanding in 64 cognitive interviews. Items were administered to a prospective cohort of female and male patients with lower urinary tract symptoms who were seeking care. Analyses were done to describe item response distributions and correlations among item responses separately for women and men. A total of 444 males and 372 females provided responses to the CASUS. Several sets of items showed different relationships for women compared to men. In particular the associations between sensation related items and incontinence related items were generally positive among females but often negative among males. After using an intensive development process the CASUS addresses a wide range of lower urinary tract symptoms. It should help identify clinically important subtypes of patients. Further, item collection can provide the foundation for shorter measures for use in the clinic and as trial end points.

Symptom Burden and Palliative Care Needs Among High-Risk Veterans With Multimorbidity

ContextPalliative care research has focused on patients with disease-specific conditions. However, older patients with multimorbidity may have unmet palliative care needs. ObjectivesWe assessed symptom burden and quality of life among veterans with multimorbidity and sought to determine if their bothersome symptoms were addressed and treated in the primary care setting. We sought to identify specific diagnoses that may account for greater symptom burden. We hypothesized that patients with a higher number of diagnoses would experience greater symptom burden and poorer quality of life. MethodsWe identified veterans at high risk of hospitalization or death using a validated prognostic model. We administered cross-sectional surveys via telephone, The Memorial Symptom Assessment Scale—Short Form and Veterans RAND 12, to randomly selected patients in primary care in the VA Health Care System from May to December 2015. We assessed if their most bothersome symptom was addressed and treated during their most recent visit. Regression models identified specific diagnoses accounting for greater symptom burden and patient predictors of high symptom burden and poor quality of life. ResultsPatients (n = 503) reported (10.6 ± 5.5) active symptoms and poor physical quality of life. Patients reported pain and dyspnea as their most bothersome symptoms (n = 145 [29%] and n = 57 [11%], respectively). Most patients acknowledged their clinicians assessed (n = 348 [74%]) and treated (n = 330 [70%]) their most bothersome symptom. Physical symptoms (78%, P < 0.0001) were more likely to be addressed than psychological symptoms (55%, P < 0.001). Patients diagnosed with obesity or depression experienced greater physical symptom burden. Younger patients reported greater symptom severity than older patients (P < 0.01). Younger patients and those with greater multimorbidities reported lower self-perceived quality of health than older patients and those with fewer multimorbidities (P = 0.01 and P < 0.01, respectively). ConclusionOutpatients with multimorbidity have high symptom burden, unaddressed symptoms, poor quality of life, and unmet palliative care needs. Our findings support standardization of comprehensive symptom assessment and management in primary care for veterans with multimorbidities, which may ameliorate symptoms and improve quality of life.

Patient Reported Review of Symptoms in Survivorship Clinic

Allogeneic hematopoietic cell transplant (HCT) is a potentially curative treatment for many hematologic malignancies. Survivors of HCT have a variety of side effects from chemotherapy, graft-versus-host disease, as well as late effects including cardiovascular disease, diabetes and osteoporosis. Patient report of symptoms has been demonstrated to be a more accurate measure of health status, and can enhance patient-physician communication. Within our survivorship program, we collect a comprehensive assessment of core symptoms at day 100 and 1 year. These patient reported symptoms presents an opportunity to screen and detect potential complications early. All allogeneic HCT recipients are seen within our survivorship program and asked to complete a systematic and comprehensive screening questionnaire to evaluate a variety of symptoms related to skin, eyes, mouth, gastrointestinal tract, cardio/pulmonary, musculoskeletal, sexual functioning, work, substance use, exercise, cognition and performance status at day 100 and 1-year post HCT. From 2016-2018 161 patients had an allogeneic HCT and 42 patients completed survivorship appointments at day 100 and 1-year.We performed a review of patient assessments of their symptoms. Patients reported more symptoms at 1 year compared to day 100 (Figure). The most common symptoms reported were involving the musculoskeletal system (N=35 at both day 100 and 1-year) and cognitive functioning (N= 29 at day 100 and N=24 at 1 year). Musculoskeletal complaints included tremors and leg weakness, more common at day 100; and numbness, joint stiffness, decreased range of motion and joint pain more commonly at 1-year. Difficulties with memory and having to cut back on activities due to fatigue were prevalent day 100 and 1-year after HCT. Many symptoms reported were related to acute and chronic GVHD (17 developed acute GvHD by day 100 and 21 had chronic GVHD at 1 –year). In summary, this review demonstrates a continued high burden of symptoms in transplant survivors even at 1 year—with persistent or even new symptoms occurring. This emphasizes the need for continued follow up of late-effects and importance of patient self-report. Through our survivorship program, we hope to continue to capture patient-reported outcomes to better measure health status and late effects.

ПЕРВИЧНЫЙ ОСТЕОАРТРИТ КОЛЕННЫХ СУСТАВОВ: СОВРЕМЕННЫЕ ПОДХОДЫ К РАННЕЙ ДИАГНОСТИКЕ И ОЦЕНКЕ КОМОРБИДНОГО ФОНА

Objective: To study and evaluation of modern approaches to early diagnosis of primary knee osteoarthritis (PKOA), analysis of the frequency of comorbid diseases. Methods: The study included 98 patients with PKOA. In order to early diagnose the disease and determining prevalence and spectrum of the comorbid pathology, all patients were submitted to a comprehensive clinical laboratory and instrumental survey. Results: The most informative symptoms in the early diagnosis of PKOA were typical pain syndrome, sluggish synovitis and specific changes from the soft peri- and intraarticular tissues and bone structures of the knee joint, detected by MRI and arthrosonography (ASG). Comorbid diseases had 80.6% of the patients examined. Most commonly identified: cardiovascular pathology (CVP, 73.4%), metabolic syndrome (MS, 66.3%), gastrointestinal pathology (19.4%), type 2 diabetes mellitus (16.6%) and respiratory system diseases (12.2%). The majority of patients (66.2%) with developed of PKOA (of II and III stages) had two or more comorbid diseases. Conclusion: Early diagnosis of PKOA implies a comprehensive assessment of both subjective and objective symptoms of lesion, as well as MRI and ASG data. The most common and prognostically unfavorable comorbid diseases in patients with PKOA are CVP and MS, which have close associative relationship with the pathogenetic aspects of PKOA. Keywords: Primary osteoarthritis , early diagnosis, comorbidity, metabolic syndrome, cardiovascular pathology.

Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: systematic review of psychometric properties

BackgroundOutcome after nerve repair of the hand needs standardized psychometrically robust measures. We aimed to systematically review the psychometric properties of available functional, motor, and sensory assessment instruments after nerve repair.MethodsThis systematic review of health measurement instruments searched databases from 1966 to 2017. Pairs of raters conducted data extraction and quality assessment using a structured tool for clinical measurement studies. Kappa correlation was used to define the agreement prior to consensus for individual items, and intraclass correlation coefficient (ICC) was used to assess reliability between raters. A narrative synthesis described quality and content of the evidence.ResultsSixteen studies were included for final critical appraisal scores. Kappa ranged from 0.31 to 0.82 and ICC was 0.81. Motor domain had manual muscle testing with Kappa from 0.72 to 0.93 and a dynamometer ICC reliability between 0.92 and 0.98. Sensory domain had touch threshold Semmes-Weinstein monofilaments (SWM) as the most responsive measure while two-point discrimination (2PD) was the least responsive (effect size 1.2 and 0.1). A stereognosis test, Shape and Texture Identification (STI), had Kappa test-retest reliability of 0.79 and inter-rater reliability of 0.61, with excellent sensibility and specificity. Manual tactile test had moderate to mild correlation with 2PD and SWM. Function domain presented Rosén-Lundborg score with Spearman correlations of 0.83 for total score. Patient-reported outcomes measurements had ICC of 0.85 and internal consistency from 0.88 to 0.96 with Patient-Rated Wrist and Hand Evaluation with higher score for reliability and Spearman correlation between 0.38 and 0.89 for validity.ConclusionsFew studies included nerve repair in their sample for the psychometric analysis of outcome measures, so moderate evidence could be confirmed. Manual muscle test and Rotterdam Intrinsic Hand Myometer dynamometer had excellent reliability but insufficient data on validity or responsiveness. Touch threshold testing was more responsive than 2PD test. The locognosia test and STI had limited but positive supporting data related to validity. Rosén-Lundborg score had emerging evidence of reliability and validity as a comprehensive outcome following nerve repair. Few questionnaires were considered reliable and valid to assess cold intolerance. There is no patient-reported outcome measurement following nerve repair that provides comprehensive assessment of symptoms and function by patient perspective.

Personalized Goal for Dyspnea and Clinical Response in Advanced Cancer Patients

BackgroundThe clinical response after comprehensive symptom management is difficult to determine in terms of a clinically important difference. Moreover, therapies should try to reach the threshold perceived by the individual patient for the determination of a favorable response to a treatment. MeasuresThe Edmonton Symptom Assessment Score (ESAS) was measured at admission (T0), and seven days after starting palliative care (T7). Patient Global Impression and Goal Response after one week of palliative care and its relation with the Personalized Dyspnea Goal were measured at T7. InterventionPatients admitted to palliative care units underwent a comprehensive symptom assessment by a specialist palliative care team. At T0, patients were asked about their Personalized Dyspnea Intensity Goal on ESAS. One week later (T7), after a comprehensive palliative care treatment, Personalized Dyspnea Intensity Goals were measured again. Patients were considered to have achieved a Patient Dyspnea Goal Response if dyspnea intensity (measured at T7) was equal or less than their expected Personalized Dyspnea Intensity Goal. At the same interval (T7), Patient Global Impression (improvement or deterioration) was measured. Outcomes279 patients were analyzed in this study. The mean Personalized Dyspnea Intensity Goal at T0 and T7 were 0.97 (SD 1.3), and 0.71 (SD 2.1), respectively. 263 patients (94.2%) indicated a Personalized Dyspnea Intensity Goal of ≤3 as a target at T0. Patients perceived a bit better, a better improvement, and a much better improvement with a mean decrease in dyspnea intensity of -2.1, -3.5, and -4.3 points on the dyspnea intensity scale, respectively. In 60 patients (21.5%), dyspnea intensity did not change, and in 4.7%, dyspnea intensity worsened. Patients perceived a Minimal Clinically Important Difference (little worse) with a mean increase in dyspnea intensity of 0.10, and they perceived a worse with a mean increase of 1.7 points. Higher dyspnea intensity at T0 and lower dyspnea intensity at T7 were independently related to Patient Global Impression. At T7, 93 (33.3%) patients achieved their Personalized Goal Response, based on Personalized Dyspnea Intensity. Patient Dyspnea Goal Response was associated with Memorial Delirium Assessment Scale score and Personalized Dyspnea Intensity Goal at T0, and inversely associated with dyspnea intensity at T0 and T7, and lower Karnofsky level. For Patient Dyspnea Goal Response, no significant differences among categories of dyspnea intensity were found (P>0.05). ConclusionPatient Dyspnea Goal Response and Patient Global Impression seem to be relevant for evaluating the effects of a comprehensive management of symptoms, including dyspnea, assisting decision making process. Some factors may be implicated in determining the individual target and clinical response. A personalized symptom goal may translate in terms of therapeutic intervention, according to the achievement of the patients' expectations. High values of dyspnea intensity, a lower Karnofsky level, as well as high level of Dyspnea Intensity Goal (that is less patients' expectations) favor the achievement of the target.

PIN129 - ADAPTING INFLUENZA PATIENT-REPORTED OUTCOMES (PRO) MEASURES TO MONITOR RESPIRATORY SYNCYTIAL VIRUS (RSV) SYMPTOM SEVERITY IN ADULTS: QUALITATIVE EVIDENCE OF KEY CONCEPTS AND CONTENT VALIDITY

Influenza virus and Respiratory Syncytial Virus (RSV) cause acute respiratory tract infections that present with similar symptoms. Although no PRO measures have been developed to monitor the severity of RSV symptoms in adults, influenza symptom PRO measures may be useful for RSV severity assessment. This study was conducted to evaluate the content validity of RSV adaptations of the FLU-PRO™ and Flu-iiQ™ (RI-PRO™ and R-iiQ™, respectively) for research in inpatients and outpatients with RSV infection. Combined concept elicitation and cognitive debriefing interviews were conducted with 28 US-English-speaking adults recently diagnosed with RSV (n=18) or influenza (n=10). Atlas.Ti was used for thematic analysis of verbatim transcripts. Similar symptoms were reported for RSV and influenza: ‘cough’, ‘wheezing’ and ‘fever’ were discussed by >75% of RSV and influenza patients. Some RSV patients (17%) also noted ‘rapid heartbeat’, ‘dry nose’, and ‘dry eyes.’ RSV patients understood both measures and confirmed both PROs assessed most ‘core’ RSV symptoms. The RI-PRO™ assessed more symptoms patients reported including ‘body/systemic’, ‘nasal’, ‘eye’ and ‘pain’ than the R-iiQ™, but not ‘wheezing.’ The R-iiQ™ symptom assessment was less comprehensive and some impact items were not relevant for inpatients. When symptoms were most severe, most RSV patients stated it would have been difficult for them to complete either measure. Robustly measuring RSV severity in adults is challenging. Content validity of RI-PRO™ and R-iiQ™ was supported, but neither measure provided the ideal assessment of symptoms for use in both inpatient/outpatient settings. Regulatory and best-practice guidelines highlight the need for a comprehensive symptom assessment to support content validity must be balanced with patient burden (e.g., brief symptom diaries) to monitor symptom severity daily or more often for severely ill hospitalized patients. This study identified symptoms most important to patients to include in a symptom diary for RSV inpatients and outpatients.

The Importance of Adolescent Self-Report in Autism Spectrum Disorder: Integration of Questionnaire and Autonomic Measures.

Anxiety and sensory symptoms are highly prevalent and meaningful in the daily lives of individuals with autism spectrum disorder (ASD). Despite the importance of carefully measuring, researching, and treating these symptoms, current methods in ASD seldom include self-report. This study investigated the consistency of adolescent and parent reports of anxiety and auditory sensitivity in individuals with ASD, and examined their validity via comparisons with sympathetic arousal at baseline and in response to an auditory challenge. Fifty adolescent-parent dyads (n = 26 ASD, n = 24 typically developing; 12-16years old; IQ>80) completed parallel versions of both anxiety and auditory hypersensitivity scales, which were compared to heart rate collected at rest and during an aversive noise task. Adolescents with ASD exhibited greater anxiety and auditory hypersensitivity than their peers, based on both self and parent report. Across groups, self-report was higher than parent report. In individuals with ASD, a significant relationship was found between self-reported anxiety and autonomic arousal at rest, and between self-reported auditory sensitivity and autonomic reactivity during the noise task. These relationships were not significant for parent-report. These findings extend past work by demonstrating greater self-reported (than parent-reported) anxiety and sensory symptoms. Furthermore, the presence of significant correlations between self-reported symptoms and sympathetic arousal supports the validity of self-report in adolescents with ASD with average or above average cognitive abilities. This indicates that adolescents with ASD have a unique perspective on their internal experience, which can complement parent reports and provide a more comprehensive assessment of symptoms in research and clinical settings.

PIN59 - Cognitive Debriefing Interviews to Explore the Content Validity of the Chronic Liver Disease Questionnaire (CLDQ) and Eq-5D-5L in Patients with Chronic Hepatitis B

This study aimed to evaluate the content validity of the Chronic Liver Disease Questionnaire (CLDQ) and EQ-5D-5L in a chronic hepatitis B (CHB) patient population. Patients receiving treatment for CHB in the United Kingdom were asked to complete the measures using a ‘think aloud’ cognitive debriefing technique, sharing their thoughts on each question and response option. Framework analysis of interview transcripts using ATLAS.ti v7.5. explored conceptual relevance, understanding of item wording, and suitability of response scale/options and recall period. To identify missing concepts, CLDQ content was compared with a CHB conceptual model developed from qualitative literature and multinational concept elicitation interviews with 84 patients with CHB. Twenty-three patients completed the CLDQ (74% male; aged 18-55; 39% Asian, 35% Black, 22% White, 4% other ethnicity). Patients generally found the CLDQ response options and recall period appropriate. Patients collectively endorsed each CLDQ item as relevant, with fatigue, pain, and emotional wellbeing (e.g., worry) the most common concerns. Some concepts (e.g., shortness of breath) were less common amongst the sample. Some terminology (e.g., ‘abdominal’) was difficult for patients to understand. Comparison with the CHB conceptual model highlighted that the CLDQ does not assess several important concepts for patients with CHB related to emotional and psychological wellbeing, lifestyle limitations, and impact on relationships. Patients understood the EQ-5D-5L but many did not find items assessing mobility and self-care relevant. The CLDQ provides comprehensive assessment of fatigue and pain-related symptoms experienced by patients with CHB, and of some aspects of emotional wellbeing. The CLDQ does not assess stigmatization and impact on self-esteem which are important concepts for many patients with CHB. Revised wording is recommended to ensure the CLDQ is easy for CHB patients to understand. EQ-5D-5L items assessing self-care and mobility may be less relevant for CHB patients.

Feasibility and Acceptability of a Best Supportive Care Checklist among Clinicians.

Best supportive care (BSC) is often not standardized across sites, consistent with best evidence, or sufficiently described. We developed a consensus-based checklist to document BSC delivery, including symptom management, decision making, and care planning. We hypothesized that BSC can be feasibly documented with this checklist consistent with consolidated standards of reporting trials. To determine feasibility/acceptability of a BSC checklist among clinicians. To test feasibility of a BSC checklist in standard care, we enrolled a sample of clinicians treating patients with advanced cancer at four centers. Clinicians were asked to complete the checklist at eligible patient encounters. We surveyed enrollees regarding checklist use generating descriptive statistics and frequencies. We surveyed 15 clinicians and 9 advanced practice providers. Mean age was 41 (SD = 7.9). Mean years since fellowship for physicians was 7.2 (SD = 4.5). Represented specialties are medical oncology (n = 8), gynecologic oncology (n = 4), palliative care (n = 2), and other (n = 1). For "overall impact on your delivery of supportive/palliative care," 40% noted improved impact with using BSC. For "overall impact on your documentation of supportive/palliative care," 46% noted improvement. Impact on "frequency of comprehensive symptom assessment" was noted to be "increased" by 33% of providers. None noted decreased frequency or worsening impact on any measure with use of BSC. Regarding feasibility of integrating the checklist into workflow, 73% agreed/strongly agreed that checklists could be easily integrated, 73% saw value in integration, and 80% found it easy to use. Clinicians viewed the BSC checklist favorably illustrating proof of concept, minor workflow impact, and potential of benefit to patients.

Prevalence and Characteristics of Urinary Incontinence in a Treatment Seeking Male Prospective Cohort: Results from the LURN Study

Male urinary incontinence is thought to be infrequent. We sought to describe the prevalence of urinary incontinence in a male treatment seeking cohort enrolled in the LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network). Study inclusion and exclusion criteria, including men with prostate cancer or neurogenic bladder, were previously reported. LURN participants prospectively completed questionnaires regarding lower urinary tract symptoms and other clinical variables. Men were grouped based on incontinence type, including 1) no urinary incontinence, 2) post-void dribbling only and 3) urinary incontinence. Comparisons were made using ANOVA and multivariable regression. Of the 477 men 24% reported no urinary incontinence, 44% reported post-void dribbling only and 32% reported urinary incontinence. African American men and those with sleep apnea were more likely to be in the urinary incontinence group than in the no urinary incontinence group (OR 3.2, p = 0.02 and OR 2.73, p = 0.003, respectively). Urinary incontinence was associated with significantly higher bother compared to men without leakage (p <0.001). Compared to men without urinary incontinence and men with only post-void dribbling those with urinary incontinence were significantly more likely to report higher scores (more severe symptoms) on the PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaires regarding bowel issues, depression and anxiety than men without urinary incontinence (p <0.01). Urinary incontinence is common among treatment seeking men. This is concerning because the guideline recommended questionnaires to assess male lower urinary tract symptoms do not query for urinary incontinence. Thus, clinicians may be missing an opportunity to intervene and improve patient care. This provides a substantial rationale for a new or updated symptom questionnaire which provides a more comprehensive symptom assessment.

Research progress of conscious pain and neurosensory abnormalities in dry eye disease

Dry eye is one of the most common ocular problems in ophthalmology clinic. With the change of social environment and people's life style, the prevalence of dry eye disease is increasing. Currently, the diagnosis criteria for dry eye is controversial, diagnosis of dry eye mainly rely on the comprehensive assessment of symptoms and the presence of associated ocular surface signs. However, previous studies have shown a poor correlation between dry eye symptoms and objective clinical signs in patients. Recent studies have found that neuropathic pain plays an important role in the occurrence of discordance between symptoms and signs in dry eye disease. The purpose of this paper is to present the conception of pain, the distribution and function of sensory nerves in ocular surface, the prevalence and mechanism of neuropathic pain and analgesic treatment in dry eye disease. (Chin J Ophthalmol, 2018, 54: 144-148).

The low FODMAP diet in the management of irritable bowel syndrome: an evidence-based review of FODMAP restriction, reintroduction and personalisation in clinical practice.

Dietary restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) is effective in the management of functional gastrointestinal symptoms that occur in irritable bowel syndrome (IBS). Numerous reviews have been published regarding the evidence for their restriction in the low FODMAP diet; however, few reviews discuss the implementation of the low FODMAP diet in practice. The aim of this review is to provide practical guidance on patient assessment and the implementation and monitoring of the low FODMAP diet. Broadly speaking, the low FODMAP diet consists of three stages: FODMAP restriction; FODMAP reintroduction; and FODMAP personalisation. These stages can be covered in at least two dietetic appointments. The first appointment focuses on confirmation of diagnosis, comprehensive symptom and dietary assessment, detailed description of FODMAPs and their association with symptom induction, followed by counselling regarding FODMAP restriction. Dietary counselling should be tailored to individual needs and appropriate resources provided. At the second appointment, symptoms and diet are re-assessed and, if restriction has successfully reduced IBS symptoms, education is provided on FODMAP reintroduction to identify foods triggering symptoms. Following this, the patient can follow FODMAP personalisation for which a less restrictive diet is consumed that excludes their personal FODMAP triggers and enables a more diverse dietary intake. This review provides evidence and practice guidance to assist in delivering high-quality clinical service in relation to the low FODMAP diet.

Characteristics of cognitive function, behavioral and psychological symptoms in patients with Alzheimer's disease versus behavioral variant frontotemporal dementia

Objective: To compare the differences in cognitive function and behavioral and psychological symptoms between patients with Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD). Methods: Thirty-six AD patients and 20 bvFTD patients at mild-to-moderate stage, who were biomarker-confirmed by positron emission tomography (PET), were assessed with a neuropsychological battery and neuropsychiatry inventory (NPI). Cognitive domains, including memory, language, information processing speed and executive function, and behavioral and psychological symptoms were assessed and compared. Results: AD patients had lower scores in immediate recall, delayed recall and recognition than bvFTD patients (all P<0.05); while bvFTD patients had poorer performance in language and executive function than AD patients (all P<0.05). The NPI total score was significantly higher in patients with bvFTD compared with patients with AD (17.5±5.7 vs 9.3±3.5, P<0.05). In respect to the 12 items of NPI, the incidence of agitation and irritability was higher in AD group than in bvFTD group (72.2% vs 35.0%, 55.6% vs 20.0%, all P<0.05); while the incidence of apathy, disinhibition, euphoria, aberrant motor behavior and appetite/eating was higher in bvFTD group than in AD group (65.0% vs 33.3%, 80.0% vs 5.5%, 70.0% vs 5.6%, 40.0% vs 11.1%, 50.0% vs 5.6%, all P<0.05). Conclusion: Comprehensive neuropsychological assessment and evaluation of behavioral and psychological symptoms of patients with dementia are helpful in distinguishing AD from bvFTD.

Combined cognitive and vocational interventions after mild to moderate traumatic brain injury: study protocol for a randomized controlled trial

BackgroundA considerable proportion of patients with mild to moderate traumatic brain injury (TBI) experience long-lasting somatic, cognitive, and emotional symptoms that may hamper their capacity to return to work (RTW). Although several studies have described medical, psychological, and work-related factors that predict RTW after TBI, well-controlled intervention studies regarding RTW are scarce. Furthermore, there has traditionally been weak collaboration among health-related rehabilitation services, the labor and welfare sector, and workplaces.Methods/designThis study protocol describes an innovative randomized controlled trial in which we will explore the effect of combining manualized cognitive rehabilitation (Compensatory Cognitive Training [CCT]) and supported employment (SE) on RTW and related outcomes for patients with mild to moderate TBI in real-life competitive work settings. The study will be carried out in the southeastern region of Norway and thereby be performed within the Norwegian welfare system. Patients aged 18–60 years with mild to moderate TBI who are employed in a minimum 50% position at the time of injury and sick-listed 50% or more for postconcussive symptoms 2 months postinjury will be included in the study. A comprehensive assessment of neurocognitive function, self-reported symptoms, emotional distress, coping style, and quality of life will be performed at baseline, immediately after CCT (3 months after inclusion), following the end of SE (6 months after inclusion), and 12 months following study inclusion. The primary outcome measures are the proportion of participants who have returned to work at 12-month follow-up and length of time until RTW, in addition to work stability as well as work productivity over the first year following the intervention. Secondary outcomes include changes in self-reported symptoms, emotional and cognitive function, and quality of life. Additionally, a qualitative RTW process evaluation focused on organizational challenges at the workplace will be performed.DiscussionThe proposed study will combine cognitive and vocational rehabilitation and explore the efficacy of increased cross-sectoral collaboration between specialized health care services and the labor and welfare system. If the intervention proves effective, the project will describe the cost-effectiveness and utility of the program and thereby provide important information for policy makers. In addition, knowledge about the RTW process for persons with TBI and their workplaces will be provided.Trial registrationClinicalTrials.gov, NCT03092713. Registered on 10 March 2017.

More than constipation - bowel symptoms in Parkinson's disease and their connection to gut microbiota.

The majority of Parkinson's disease (PD) patients suffer from gastrointestinal symptoms of which constipation is considered the most prominent. Recently, in addition to constipation, a diagnosis of irritable bowel syndrome (IBS) was also found to be associated with increased PD risk. Gut microbiota alterations have been reported in IBS and recently also in PD. IBS-like bowel symptoms in PD and their possible connection to other non-motor symptoms and faecal microbiota were assessed. This case-control study compared 74 PD patients with 75 controls without any signs of parkinsonism or potential premotor symptoms. IBS-like symptoms were assessed using the Rome III questionnaire. The non-motor symptoms were assessed using the Non-Motor Symptoms Questionnaire and Non-Motor Symptom Scale. Faecal microbiota were assessed by pyrosequencing of the V1-V3 regions of the bacterial 16S ribosomal RNA gene. Symptoms that were IBS-like were significantly more prevalent in PD patients than in controls (24.3% vs. 5.3%; P=0.001). Criteria for functional constipation were met by 12.2% of PD patients and 6.7% of controls (P=0.072).PD patients with IBS-like symptoms had more non-motor symptoms and a lower faecal abundance of Prevotella bacteria than those without IBS-like symptoms. Our results indicate that PD patients may suffer from colonic dysfunction beyond pure constipation. Therefore, a more comprehensive assessment of bowel symptoms could provide valuable information. The lower abundance of Prevotella bacteria in PD patients with IBS-like symptoms suggests that the microbiota-gut-brain axis may be implicated in the gastrointestinal dysfunction of PD patients.