Symptom Distress Research Articles

Patient-reported sexual health outcomes of cervical cancer patients treated with definitive chemoradiation and MRI-guided brachytherapy

BackgroundSexual health is an important survivorship issue in cervical cancer. We assessed patient-reported sexual health outcomes and correlations with oncologist-assessed vaginal toxicity (VT). MethodsThis was a prospective, cross-sectional study of stage IB-IVA cervical cancer patients treated with definitive chemoradiation, who completed a socio-demographic questionnaire and the following patient-reported-outcomes (PROs): Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Menopause Rating Scale (MRS), Hospital Anxiety and Depression Scale (HADS). VT was assessed using the CTCAE v4.0. Sociodemographic, clinical data, PROs and VT were summarized using descriptive statistics; correlations were evaluated using linear regression analyses. ResultsBetween August 2018 and April 2022, 73 patients were analyzed. Median age was 49 (range 25–81), 57.5% had vaginal involvement at diagnosis and 76.9% were partnered. Sexual dysfunction (FSFI score ≤ 26), sexual distress (FSDS-R ≥ 11), severe menopausal symptoms (MRS ≥ 17), anxiety (HAD-Anxiety >7) and depression (HAS-Depression >7) were reported in 86.3%, 54.5%, 36.2%, 46.6% and 24.7%, respectively. Grade 2+ VT was reported in 27.4%. No significant associations were found between PROs and VT. On multivariable analysis, non-partnered status, use of hormone replacement therapy, and International Commission on Radiation Units and Measurements – rectovaginal dose (ICRU-RV) >65Gy were associated with worse sexual health (p < 0.005). ConclusionCervical cancer patients self-report high rates of sexual distress, dysfunction and menopause symptoms. Discordance between oncologist-assessed VT and PROs highlights the importance of evaluating the patient's experience. Proactive treatment of menopausal symptoms and attention to radiotherapy doses to the vagina should be considered.

Resting-state networks in chronic tinnitus: Increased connectivity between thalamus and visual areas

Tinnitus is thought to be associated with aberrant spontaneous activity in the central nervous system. Previous resting-state fMRI findings support this hypothesis and have shown a variety of alterations in neural activity in people with tinnitus compared to people without tinnitus. However, there is little replication of findings. Therefore, the current study aimed to extend on previous findings by investigating eight common resting-state networks (i.e. auditory, default mode, sensorimotor, visual, salience, dorsal attention, frontoparietal and language networks) using a a control group (n = 36) and a group of tinnitus patients (n = 46) matched for age, sex and years of education. Hearing profiles matched up to 2kHz and had a small but significant difference between groups in the high frequency range. Functional connectivity (FC) with dorsolateral prefrontal cortex (DLPFC) was also investigated separately for the first time, as this region is proposed to be core to tinnitus distress symptoms and most often used as a stimulation target in transcranial direct current stimulation (tDCS) research. The results showed that tinnitus patients had increased FC between bilateral thalamus and right visual association cortex compared to control participants. No differences were found with DLPFC, or with any of the resting-state networks (RSN), contrary to previous studies which have reported alterations in several RSNs.

Congenital partial diaphragmatic eventration presenting with Chilaiditi’s sign: a case report

BackgroundChilaiditi’s sign is an incidental radiographic finding, associated with intestinal disposition located between liver and right diaphragm. It is considered as an acquired rather than a congenital condition and the prevalence ranges from 1.18% to 2.4% according to recent adult retrospective studies. The aspects of this rare entity with regards to a 7-month-old male initially misdiagnosed as diaphragmatic hernia is discussed.Case presentationA 4-month-old Caucasian male was misdiagnosed with a congenital diaphragmatic hernia owing to previous hospitalization with complaints of respiratory tract infection. On admission 3 months later, he was free of any signs and symptoms of intestinal obstruction or respiratory distress. Thorax computed tomography revealed Chilaiditi’s sign. A diagnostic laparoscopy was regarded necessary to evaluate the anatomical details. The most prominent finding was the lack of muscle fibers and almost transparent appearance of the medial aspect of the partially eventrated right hemidiaphragm. Owing to delicate anatomical presentation, diaphragmatic plication was considered hazardous. The patient is doing well and under follow-up.ConclusionsIt is obvious that Chilaiditi’s sign is not always a completely incidental finding of no consequence, and may indicate an underlying congenital diaphragmatic pathology, clearly defined by laparoscopic evaluation in this case.

Sense of community, life satisfaction and psychological distress among seniors – HUNT4 study, Norway

Abstract Background Strong sense of community with one’s neighbors may benefit psychosocial well-being. Moreover, local communities with high level of belonging and social cohesion can have a positive impact on public mental health. This study aims to investigate associations between sense of community and life satisfaction - at both an individual and local community level in a Norwegian county. Methods Data from Trøndelag Health Study 4 (HUNT4: 2017-2019) on 22 939 participants were linked to geographic data of residence from Statistics Norway. The basic statistical unit in Norwegian, known as “grunnkrets,” serves to identify participants’ local communities. These units are subdivisions of municipalities, covering geographically contiguous areas that typically include a few hundred inhabitants. This population-based study enables investigation of variation in sense of community, trust, life satisfaction and psychological distress on individual and community level. Results Seniors (median age 70.3 years) with strong sense of community with their neighbors had more than three times higher odds (95%CI 3.08-3.93) of high level of life satisfaction and less than 0.3 times lower odds (95%CI 0.26-0.33) of psychological distress symptoms vs those with low sense of community, adjusted to sociodemographic variables. The average sense of community varied between local communities (N = 284). At this local geographical unit, strong sense of community was associated with high level of trust, enjoying the neighborhood and high life satisfaction. Conclusions The study can inform public health policy to consider development of social infrastructures that bolster sense of community among seniors within neighborhoods. Policy and action plans targeting to increase the overall sense of community in neighborhoods may contribute to create mental health-promoting and age-friendly local communities in Norway. Key messages • At individual level, sense of community with neighbors are associated with life satisfaction and psychological distress among Norwegian seniors. • The average sense of community varies between geographic local areas and are associated with level of trust, enjoying the neighborhood, average life satisfaction, and psychological distress.

Moderated mediation role of trust in authorities by the Kahramanmaras earthquake survivors

ABSTRACT This article examines the moderated mediation role of trust in authorities in the direct and indirect effects of earthquake exposure on psychological distress symptoms (depressive, anxiety and stress symptoms) through somatic fear (sleep loss and increased heart rates). Convenience and snowball sampling methods were used to collect survey data from 552 adult participants (221 men, 331 women) living in the earthquake zone. The independent variable is earthquake exposure, the mediating variable is somatic fear, and the moderating variable is trust in authorities (emergency plans and strategies, government policies, and media information). Factor analysis using structural equation modelling confirmed one factor for fear of earthquake and trust in authorities and three factors for symptoms of psychological distress. Regression results showed that disaster survivors had low trust in authorities in Turkiye. Mediation and moderated mediation results based on the bootstrap method showed that somatic fear mediated the effect of earthquake exposure on depressive symptoms, anxiety symptoms and stress symptoms, and trust in authorities moderated the indirect effects of earthquake exposure on stress symptoms through somatic fear. Increased trust in authorities in Turkiye would alleviate psychological distress symptoms among the Kahramanmaras earthquake survivors.

Assessing the biobehavioral effects of ultramicronized-palmitoylethanolamide monotherapy in autistic adults with different severity levels: a report of two cases

Despite promise of its supplementation as both monotherapy and add-on treatment in autism spectrum disorder (ASD), the biobehavioral effects of Palmitoylethanolamide (PEA) in autistic adults have never been explored so far. We discussed the cases of two autistic adults with different degrees of severity (level 1 and level 2) presenting with symptoms of psychic distress, who were treated with ultramicronized-PEA (um-PEA) 600 mg/day monotherapy for a sustained period of 4 months. The level 1 autistic patient showed improved depressive symptoms and social engagement at a 12-week follow-up, in parallel to a tendency toward reduced inflammatory response and enhanced endocannabinoid (eCB) signaling, partially relapsing after um-PEA discontinuation at four months. Opposedly, the level 2 autistic patient exhibited a generally stable psychosocial functioning for the initial 12 weeks, consistent with basically unchanged immune and eCBs levels, abruptly deteriorating and leading to antipsychotic initiation afterwards. No significant side effects were reported in both cases during the observation period. The two cases suggest that um-PEA could be an effective option for the treatment of psychic distress in level 1 autistic adults, warranting further investigation of its age- and level-specificity and of the biological underpinnings of its therapeutic effect in ASD.

Symptom- and function-based trajectories of patients with dementia in hospital and community palliative care settings in the last two weeks of life: a retrospective cohort study

BackgroundThe prevalence of dementia is increasing worldwide and many people with the condition require some level of palliative care. However, the trajectories of function and symptom burden in palliative care services at the end of life remain unclear. This study aimed to describe and compare the longitudinal trajectories of function and symptom burden among patients with dementia between hospital versus palliative community care services in the last two weeks of life.MethodsA retrospective cohort study used data from the Australian Palliative Care Outcomes Collaboration. Patients with dementia who died between 1 January 2013 and 31 December 2020 from the Australian Palliative Care Outcomes Collaboration. Four validated clinical instruments were used to collect outcomes on each individual’s function and symptom distress and severity. Multilevel models were used to estimate the differences in clinical trajectories between hospital and community-based palliative care in the last two weeks of life.ResultsPatients with dementia tended to have low levels of distress for most symptoms but increasing levels of functional impairment. There were no or only marginally significant differences in the symptom trajectories between the community and hospital groups (OR ranged from 0.57 to 1.97). Although clinical trajectories of function were relatively similar between two groups, statistically higher functional indicators were observed for people when admitted to community palliative care services (OR = 0.42 and 2.27, respectively).ConclusionsOur findings suggest that community-based palliative care services can be as effective as hospital-based care for many patients with dementia nearing the end of life. With appropriate support for families, community-based care could serve as a viable alternative to hospital-based care for some patients in the final stages of dementia.

Living From Test to Test: A Concept Analysis of CA-125 Preoccupation in Ovarian Cancer Survivorship

Background: Ovarian cancer has a high risk of recurrence and is rarely curable. One method for monitoring recurrence is trending Cancer antigen 125 (CA-125) levels. However, treatment based on rising CA-125 levels is controversial, often contributing to anxiety and an excessive focus on test results, described as “CA-125 preoccupation.” Objective: To present an analysis on the concept of CA-125 preoccupation. Methods: Rodgers’ method of evolutionary concept analysis was used to evaluate the attributes, antecedents, and consequences. PubMed, Medline, PsycINFO, and CINAHL electronic databases were searched. Results: Antecedents include a diagnosis of ovarian cancer that necessitates CA-125 surveillance, awareness of CA-125 as a tumor marker, and perceived disease status. Attributes include psychosocial symptoms characterized by a fixation with CA-125 levels and symptoms of anxiety, depression, distress, and illness intrusiveness that present in a cyclical pattern. Consequences include urgency to treat rising levels and surveillance and survivorship care preferences. Conclusions: CA-125 preoccupation is characterized by psychosocial symptoms that present in a cyclical and dynamic state akin to living “test to test” or feeling suspended in a perpetual cycle of tests, driven by a desire to feel relief or prompt action. Implications for Practice: Nurses are poised to influence the patient’s experience through identification of the presence of CA-125 preoccupation and its consequences. Understanding the antecedents and attributes of CA-125 may assist with identifying women who are most at risk. What is Foundational: This research presents the first known conceptual definition of CA-125 preoccupation, which may lead to validated survey measures and improved survivorship care.

Sources of meaning and hope and associated well‐being among psychotherapy clients: A practice‐based mixed method study

AbstractBackgroundDespite the recognition of meaning and hope as salient for many individuals in mental health treatment, little empirical attention has been given to patient perspectives. Research has primarily looked at the presence—or absence—of meaning and hope, and associations with symptom distress and suicidality.AimsThese constructs are multi‐faceted and influenced by social, cultural and spiritual/religious contexts. Understanding where clients draw meaning and hope from can provide valuable information to inform case formulation, treatment planning and intervention.Materials and MethodsThis mixed method practice‐based study (N = 233) in an outpatient community clinic (a) elucidated key areas that fuel clients' sense of meaning and hope and (b) explored associations with well‐being.ResultsQualitatively, we identified six domains through thematic analysis: interpersonal, action‐based, transcendent, intrapersonal, environmental/contextual and lacking/searching. A sub‐set of clients also emerged who were lacking in and/or searching for meaning or hope. Quantitatively, one‐way ANOVA results indicated that source diversity was associated with greater well‐being.DiscussionFindings illustrate that patients draw from culturally and spiritually embedded sources to construct meaning and hope in their lives, with distinctions between areas most salient for meaning, hope and both. Furthermore, having fewer sources of meaning and/or hope may represent a well‐being liability.ConclusionTherapists should pro‐actively explore and consider ways to bolster patients' sources of meaning and hope, considering evidence of implications for well‐being outcomes.

Exploring longitudinal associations between farmer wellbeing and the welfare of their livestock. The HUNT Study, Norway

The One Welfare approach acknowledges the interrelationships between human wellbeing and animal welfare. Early research has suggested associations between stockperson wellbeing and livestock welfare, however these scenarios are complex and challenging to untangle.In this study, we utilised merged data from over 700 farms to explore associations between farmer wellbeing and livestock welfare. The farms were engaged in cattle, sheep, and/or swine production in Norway between 2017 and 2020. The farmers participated in a general population-based health survey, and livestock welfare was measured using routinely collected, animal-based abattoir observations of over 480,000 animals. We determined a farm’s overall livestock welfare relative to the other farms and calculated within-farm differences in this relative welfare level over time. A subset of enterprises (n=328) with sufficient and non-ambiguous farmer wellbeing information were then used to explore differences in these within-farm differences by farmer wellbeing status. We found that poor farmer wellbeing — whether it was defined by anxiety symptoms, depression symptoms, symptoms of psychological distress, or life satisfaction — was associated with a deterioration in overall livestock welfare level (in terms of the mean of the farm’s abattoir observed welfare indicators). There was evidence that this association persisted for at least two years.Given societal concerns regarding sustainable food production, farmer wellbeing, and livestock welfare, further research is indicated to explore the complex farmer-livestock relationship within the One Welfare framework. This study suggests that using within-farm changes in relative livestock welfare derived from routinely collected information can be a useful approach.

Move, connect and go outside! A randomized controlled trial of two online interventions and analysis of helpful coping strategies in COVID-19 "homestayers".

The COVID-19 pandemic has led to a global health crisis and a significant increase in psychological distress and psychopathological symptoms. We conducted a randomized controlled trial with two online interventions derived from positive psychology (PP) and acceptance and commitment therapy (ACT) in N = 138 "homestayers" during the first lock-down period in Germany. PP exercises had a positive impact on anxiety scores, which decreased significantly during the intervention, particularly in participants without access to a garden. Direct or indirect social contact, movement/exercise, and exposure to nature were the most frequently reported helpful coping strategies. We conclude that low-threshold online interventions with a focus on positive aspects of people's lives may be helpful to support mental health during pandemic crises. From a mental health perspective, the results also reinforce the approach of countries that allow their citizens to, for example, still go for walks during periods of contact restrictions, compared to full lock-down conditions.

Systematic Review of the Effect of Psychedelic-Assisted Therapy on Attitudes Toward Death, Life, and Spirituality on Symptoms of Distress, Depression, and/or Anxiety in Patients with Life-Threatening Illness

Systematic Review of the Effect of Psychedelic-Assisted Therapy on Attitudes Toward Death, Life, and Spirituality on Symptoms of Distress, Depression, and/or Anxiety in Patients with Life-Threatening Illness

Don’t forget to mind the mind: a prospective cohort study over 12 months on mental health symptoms in active professional male footballers

AimsWe examined the prevalence and incidence of mental health symptoms (MHS) in active professional male footballers over a 12-month period and investigated if MHS was associated with severe injuries or surgeries.Participants and methodsFootball Players Worldwide (FIFPRO) affiliated national unions invited active professional male football players to participate in the study. MHS was operationalised in symptoms of anxiety, disordered eating, depression, distress, sleep disturbance, alcohol misuse and drug misuse, all being assessed with validated questionnaires.ResultsOf the 101 participants enrolled, the prevalence of distress was 53% and MHS was between 6% for drug misuse and 48% for alcohol misuse. The incidence of distress was 29% and MHS ranged from 1% for anxiety to 11% for sleep disturbance. At baseline, players suffering from injury/surgery were more likely to report depression (OR 1.35; 95%CI 1.10–1.70) and disordered eating (OR 1.22; 95%CI 1.02–1.47). At follow-up, players who suffered injury or surgery were inclined to report distress (OR 2.15; 95%CI 1.26–4.31) and drug misuse (OR 2.05; 95%CI 1.01–4.04).ConclusionThere seems to be a greater prevalence of MHS in active professional male footballers than in the global population and other sports. After severe injury/surgery, the risk of developing MHS is increased, confirming that healthcare professionals should be aware of the mental health of injured players.

Quality of Life Effects of Renal Artery Stenting Versus Medical Therapy for Atherosclerotic Renal-Artery Stenosis: Results from the Randomized CORAL Trial.

Renal-artery stenosis can be associated with difficult to control hypertension, although renal-artery stenting has not been shown to improve clinical outcomes. Alternative antihypertensive medications could potentially result in quality of life benefits with renal-artery stenting. We performed a pre-specified quality of life sub-study of the CORAL trial-multicenter, randomized, open-label trial of renal-artery stenting versus medical therapy in patients with atherosclerotic renal-artery stenosis. Longitudinal growth curve models were used to compare the Physical Symptoms Distress Index (PSDI), SF-36, and EQ-5D scores over time between treatment groups. We also sought to validate the approach of assessing quality of life in hypertension studies. Among 906 patients (mean age 69.2±9.1years, 49.7% men), symptom frequency and distress due to side effects from antihypertensive medications changed minimally over time, with no significant differences between treatment groups. There were also no clinically significant differences between treatment groups for the SF-36 and its subscales or the EQ-5D. In internal validation of the quality of life measures, the PSDI correlated well with number/type of antihypertensive medications, and generic health status measures correlated with late clinical events. In a large, multicenter, randomized clinical trial, we found no significant benefit of routine renal-artery stenting over medical management for the treatment of atherosclerotic renal-artery stenosis in terms of disease-specific or generic quality of life measures. As these quality of life measures are important to patients and are associated with medication compliance, future studies of antihypertensive treatments should consider including these quality of life measures as secondary outcomes. Trial registration: ClinicalTrials.gov: NCT00081731.

A cross-sectional observational study of suicidal behavior among people in prison at Lajpore Central district jail, India

ABSTRACT Suicidal ideation assessment can help reduce the suicide rate among people in prison. Studies for the assessment of suicidal ideation and risk factors for suicide among inmates have been done in Western countries, but in India, data is lacking regarding the assessment of suicidal ideation among the people in prison. 1. To assess the prevalence of suicidal ideationin people in prison. 2. To identify aggravating factors for suicidal behavior. It was a cross Sectional Observational Study at a district jail, Lajpore, Surat, Gujarat. After permission from the jail authority, people in prison with or without conviction, who were willing to give consent for participation, were enrolled in the study. Semi-structured questionnaires are used to assess socio-demographic profiles. Modified Suicide Ideation scale (MSSI) and General Health Questionnaire (GHQ) and PatientHealth Questionnaire (PHQ) scales were used as materials to assess suicidal ideation and psychiatric comorbidity. Frequency analysis and Pearson correlation among various factors with the use of appropriate statistical methods. Descriptive and qualitative analysis of data was done on 140 incarcerated persons in prison. Analysis showed that 10 (7.1%) people in prison had moderate suicidal ideation in the last 48 hours while 58 (41.4%) people in prison had suicidal ideation at any point in their life. The prevalence of depressive symptoms was high among people in prison. 57.9% had minimal depressive symptoms, while 9.3% had moderate to severe symptoms. Non-convicted inmates from urban areas were having significantly more psychological distress and depressive symptoms than other inmates. Advanced ageof the inmates, negative impact of imprisonment on life, depressive symptoms, and psychosocial distress emerged as risk factors correlated with suicidal ideation. During suicide risk assessment, inmate’s age, the impact of imprisonment, psychosocial distress, and depressive symptoms should be considered as risk factors among people in prison.

Mental distress and associated factors among undergraduate students: evidence from a cross-sectional study at the University of Dodoma, Tanzania

Mental distress is a common health problem facing university students worldwide. It manifests with varying levels of depression, anxiety, and somatic symptoms such as headache, backache, sleeping problems, and fatigue. University students are a high-risk group for mental distress than the general population. This study aimed to assess knowledge, the prevalence of mental distress, and its associated factors among undergraduate students. A cross-sectional study was conducted among undergraduate students at the University of Dodoma in Tanzania. Data were collected using pre-tested and self-administered questionnaires. Bivariate and multivariable logistic regression models were used to identify factors associated with mental distress. A total of 224 undergraduate students gave a complete response, of which the majority were aware of the common symptoms of mental distress. Self-reported mental distress experience was reported among 116/224 (51.8%) students. Multivariable logistic analysis showed that only alcohol consumption (aPR = 1.61, 95% CI 1.22–2.11, p = 0.001) was independently associated with mental distress among students. The findings of this study revealed that undergraduate students had adequate knowledge of the symptoms of mental distress. Our results show that the prevalence of self-reported mental distress was moderately high among undergraduate students. Furthermore, the study indicates a significant association between alcohol consumption and self-reported mental distress among these students. These results suggest that interventions aimed at reducing alcohol consumption may be beneficial in mitigating mental health issues among undergraduate students in Tanzania.

Beliefs about voices and correlates in long-stay patients with persistent auditory hallucinations, diagnosed with schizophrenia

ABSTRACT Background High worldwide estimates of depression and suicidality in patients diagnosed with schizophrenia highlight the importance of understanding their associated factors for designing targeted interventions that can both improve distress symptoms and reduce suicide risk in this vulnerable population. In this regard, our study aims to assess the link between beliefs about voices, self-esteem, depression and suicidality in a sample of Lebanese long-stay patients with auditory hallucinations. Methods This study followed a cross-sectional design. Data has been gathered at the psychiatric hospital of the Cross, Lebanon, during the month of April 2022. Patients diagnosed with schizophrenia, aged >18 years, hospitalized for >1 year, clinically stable, and experiencing persistent auditory verbal hallucinations were included. Results Sixty-one patients were experiencing auditory hallucinations and were therefore enrolled in the study. Their mean age was 56.05 ± 12.25 years (27.9% females); 42.6% of patients had suicidal ideation, 48.9% had depression. Multivariable analyses models showed that, after adjusting for confounders, higher omnipotence (Beta = .49) and emotional resistance (Beta = .92) remained strongly linked with more depression; while only higher depression (aOR = 1.17) remained significantly linked with increased likelihood of having suicidal ideation. Discussion Pending future longitudinal research, findings suggest that mental health professionals should not only assess the presence of auditory hallucinations but also pay attention to the patient’s beliefs about their voices, as they may be determinant in the development of depression. Therapeutic approaches targeting resistant and malevolent beliefs about voices may be highly beneficial as adjuvant to existing pharmacological and psychological interventions.

Predicting change in relationship distress and depressive symptoms among couples in Taiwan: The role of attachment, emotional expressivity, and gender roles in Emotionally Focused Therapy.

This pilot study examined predictors of change in relationship distress and depressive symptoms over the course of Emotionally Focused Therapy (EFT) in a one-arm, pragmatic clinical trial of 17 couples in Taiwan. Results revealed that masculine ideology, feminine ideology, traditionalism, and emotional expressivity at intake predicted change in relationship distress. Specifically, women's high traditional gender roles and traditionalism and both partners' high emotional expressivity at intake were associated with decreases in relationship distress over time. In addition, attachment and emotional expressivity predicted change in depressive symptoms. Specifically, high attachment avoidance, high attachment anxiety, and high emotional expressivity at intake were associated with decreases in depressive symptoms over time. While more research is needed, these findings offer preliminary support for the types of partners who may experience more improvement after receiving EFT in Taiwan.

Feasibility of Implementing Dementia Collaborative Coaching into Routine Care in Nursing Homes

ABSTRACT Objectives The study evaluated the feasibility of implementing Dementia Collaborative Coaching (DCC) into the routine workflow of speech-language pathologists (SLPs) working in nursing homes (NHs). DCC is an intervention delivered by SLPs to train nursing assistants (CNAs) in communication strategies to support people living with dementia (PLWD). Methods We assessed the feasibility of identifying eligible PLWD; estimated intervention fidelity; evaluated suitability of outcome measures; and determined the preliminary impact on behavioral and psychological symptoms of distress (BPSD) among PLWD. SLPs completed a semi-structured interview to collect further acceptability data. Results Four SLPs in four NHs completed DCC with 10 CNAs and 15 eligible PLWD that they appropriately identified from their caseloads. SLPs conducted 90 DCC sessions with 64% fidelity and billed Medicare for all sessions. The outcome measure of Minimum Data Set item E0200B: Rejection of Care did not vary enough to be useful, but positive changes were noted on the Cohen-Mansfield Agitation Inventory, t(14) = 10.51, p < .001, Cohen’s d = 2.76. Interviews further indicated feasibility. Conclusions It is feasible to implement DCC into the workflow of SLPs in NHs. Clinical Implications Given the feasibility and preliminary positive impacts, SLPs could consider implementing DCC in routine care.

Expert opinion on characteristics of vulval LS: initial identification of important clinical features through an international electronic-Delphi consensus study.

Lichen sclerosus (LS) is a chronic inflammatory condition mainly affecting genital skin. It causes distressing symptoms that impact daily quality of life as well as progressive anatomical changes and potential risk of cancer. Vulval LS is often misdiagnosed and treatment delayed. If non-experts are supported to identify clinical features of LS, they may diagnose the condition sooner and commence timely treatment or refer to specialist services for assessment and confirmatory biopsy. To reach international expert consensus on clinical diagnostic features for vulval LS. Between March and May 2023, a four-stage electronic-Delphi consensus exercise was conducted. In the first three rounds, participants were asked to rate the importance of a list of clinical features. Responses from round one were summarised and presented in rounds two and three, along with additional features suggested by participants. Any items which met the definition of consensus as 'very important/critical', or 'not important' were not voted upon again in subsequent rounds. In round four, items which met agreement for 'important but not critical' were ranked in order of their importance. Consensus was defined a priori, and all rounds were conducted anonymously. A total of 47 participants from 14 countries completed round one with 42 (89%) retained by round 3 when consensus was determined. Round four was completed by 36 (77%) participants. Participants completing all four rounds predominantly included healthcare professionals (78%, n=28) and patient support group representatives (19%, n=7). In round one, 21 diagnostic features were voted upon. Participants suggested an additional 10 features which were subsequently added to the round two survey. After three rounds, consensus was achieved for five diagnostic features: whiteness, itch, changes in anatomy, burying of the clitoral area, and improvement in response to topical steroids. There were also 12 features voted as 'important but not critical' and participants subsequently ranked them in the 4th round. Experts have agreed on five critical diagnostic features for vulval LS in adults and an additional 12 features that may also be important. Future research should assess these clinical features for diagnostic validity through a multicentre diagnostic test accuracy study.