Extent Of Symptoms Research Articles

Techniques to improve and confirm pulmonary vein isolation.

Atrial fibrillation is the most common acquired arrhythmia and is increasing in frequency as the population ages. Treatment for atrial fibrillation ranges from minimal intervention to complex catheter ablations. The strategy used to treat atrial fibrillation largely rests on the extent of symptoms in an individual patient. This review will focus on ablation for atrial fibrillation and efforts to improve the success of the procedure.

5. Neurophysiological assessment of spasticity in multiple sclerosis

Objective Spasticity is a frequent and often disabling feature of multiple sclerosis (MS). Up to 80–85% of MS cases suffer from different levels of spasticity. Appropriate management of spasticity is therefore an important part of the patient’s care. Muscle hypertonia is generally easy to recognize clinically, quantifying it is quite a complex matter. Correlation between the clinical and neurophysiological measures makes it especially difficult. The aim of the study is to review the main methods of evaluating spasticity published in the scientific literature with stress on our own experience. Methods In this session we will present neurophysiological tests used in assessment of spasticity with a special stress on the comparison of commonly used Modified Ashworth Scales scores (MAS), H-reflex testing, cutaneous and cortical silent periods, and brainstem reflexes. The main treatment options of pharmacological and non-pharmacological approaches will be discussed. Results Oral antispastic medication, therapeutic exercise and physical modalities are commonly used. From a pharmacological perspective of spasticity treatment, it is strongly recommended to use local chemodenervation with botulinum toxin for intramuscular administration under the EMG guidance. A modern approach to treat generalised spasticity is a continuous intrathecal baclofen (ITB) administration directly into the cerebrospinal fluid under neurophysiological monitoring. Conclusion Adequate evaluation and management of spasticity requires multidisciplinary approach and the setting of realistic goals that need to be achieved on an individual level, with regard to every single patient’s needs. Different options for spasticity management are available, however, choice of treatment hinges on a combination of the extent of symptoms, patient preference, and availability of services. Supported by Research Project of Charles University PRVOUK P34, Czech Republic.

Dimensions of a Woman's Experience of Inevitable Miscarriage

Poster Presentation Objective To explore a woman's experience of early pregnancy loss when she is diagnosed with an inevitable miscarriage through understanding her description of symptoms and treatment decisions. Design This qualitative study consisted of transcribed data from a recorded telephone interview lasting from 30 to 45 minutes. Researchers used a semistructured interview guide. Setting Nurses recruited the participants from an obstetrics/gynecology outpatient clinic at a Midwestern medical center. Sample A purposive sample of women who experienced a miscarriage at or before 14 weeks of pregnancy, needed to make a treatment decision (medical, surgical, expectant management), were at least 18 years old, and spoke English were recruited. Methods Dimensional analysis, a method generic to grounded theory but appropriate for existing data, was used to analyze transcripts. Women were asked, “Tell me about your miscarriage” with follow‐up questions such as, “How did you decide what to do next?” or “What went into knowing what to do next?” Using line‐by‐line analysis, the research team identified dimensions and related conditions. Results Participants ranged in age from 23 to 40 years, with a mean age of 31. All were married. Fifteen women decided on surgical intervention, one chose medical, and seven chose expectant management. The women described two central dimensions: being sure they were miscarrying and being sure they chose the right treatment option. Making decisions about treatment were compelling due to potential for pregnancy viability. Conditions for being sure included relationship with their health care provider (physician or nurse midwife), severity or extent of symptoms (bleeding and cramping, absence or change in pregnancy symptoms), medical technology, personal intuition, and input and advice from others (e.g., friend who had miscarried). Conclusion/Implications for Nursing Practice Women wanted to know what to watch for (e.g., how to determine how much bleeding is too much) when they learned their miscarriage was inevitable. They were also traumatized by miscarrying in the toilet and either retrieving or flushing the products of conception. Findings support the critical role of nurses in health care of women with early pregnancy loss. Understanding symptoms, helping women know what to expect, the importance of confirmed nonviability of pregnancy, and the need for support from the woman's health care team are key to evidence‐ and relationship‐based nursing care.

Assessment of Plasma C-Reactive Protein as a Biomarker of Posttraumatic Stress Disorder Risk

Posttraumatic stress disorder (PTSD) has been associated in cross-sectional studies with peripheral inflammation. It is not known whether this observed association is the result of PTSD predisposing to inflammation (as sometimes postulated) or to inflammation predisposing to PTSD. To determine whether plasma concentration of the inflammatory marker C-reactive protein (CRP) helps predict PTSD symptoms. The Marine Resiliency Study, a prospective study of approximately 2600 war zone-deployed Marines, evaluated PTSD symptoms and various physiological and psychological parameters before deployment and at approximately 3 and 6 months following a 7-month deployment. Participants were recruited from 4 all-male infantry battalions imminently deploying to a war zone. Participation was requested of 2978 individuals; 2610 people (87.6%) consented and 2555 (85.8%) were included in the present analysis. Postdeployment data on combat-related trauma were included for 2208 participants (86.4% of the 2555 included) and on PTSD symptoms at 3 and 6 months after deployment for 1861 (72.8%) and 1617 (63.3%) participants, respectively. Severity of PTSD symptoms 3 months after deployment assessed by the Clinician-Administered PTSD Scale (CAPS). We determined the effects of baseline plasma CRP concentration on postdeployment CAPS using zero-inflated negative binomial regression (ZINBR), a procedure designed for distributions, such as CAPS in this study, that have an excess of zeroes in addition to being positively skewed. Adjusting for the baseline CAPS score, trauma exposure, and other relevant covariates, we found baseline plasma CRP concentration to be a highly significant overall predictor of postdeployment CAPS scores (P = .002): each 10-fold increment in CRP concentration was associated with an odds ratio of nonzero outcome (presence vs absence of any PTSD symptoms) of 1.51 (95% CI, 1.15-1.97; P = .003) and a fold increase in outcome with a nonzero value (extent of symptoms when present) of 1.06 (95% CI, 0.99-1.14; P = .09). AND RELEVANCE A marker of peripheral inflammation, plasma CRP may be prospectively associated with PTSD symptom emergence, suggesting that inflammation may predispose to PTSD.

23Na-magnetic resonance imaging of the human lumbar vertebral discs: in vivo measurements at 3.0 T in healthy volunteers and patients with low back pain

Background context1H magnetic resonance imaging (MRI) of the spine can rule out common causes of low back pain (LBP), such as disc protrusions or nerve root compression; however, no significant causal relation exists between morphology and the extent of symptoms. Functional MRI techniques, such as 23Na, may provide additional information, allowing indirect assessment of vertebral glycosaminoglycan concentrations, decreases in which are associated with early degenerative changes. PurposeTo evaluate 23Na-MRI of asymptomatic healthy volunteers and symptomatic patients with LPB and correlate the results to the Pfirrmann classification of MRI disc morphology. Study designRetrospective cohort study at an academic medical center. Patient sampleTwo groups were studied: (1) 55 healthy volunteers (31 men, 24 women; mean age 28.8 years) and (2) 12 patients (6 men, 6 women; mean age: 35.3 years) with a recent history of LBP. MethodsLumbar spines of the aforementioned groups were examined on a 3.0 T MRI scanner with morphological 1H and 23Na imaging. Intervertebral disc (IVD) 23Na at each level was normalized (23Nanorm). Distribution and differences between mean 23Nanorm corresponding to each Pfirrmann classification were evaluated in the two study groups (analysis of variance). Linear correlations between 23Nanorm, body mass index (BMI), and age were assessed (Pearson correlation coefficient). Gender-dependent differences were evaluated (paired t test). Outcome measuresPhysiological measure: IVD 23Nanorm as determined by 23Na-MRI. ResultsA normal distribution of 23Nanorm was confirmed for both groups (p=.072 and p=.073, respectively). The mean Pfirrmann score statistically significantly differed between them (p<.0001). 23Nanorm was statistically significantly reduced in degenerated IVDs (Pfirrmann scores 4+5) (p<.0001). No statistically significant differences were seen for the mean 23Nanorm of IVDs with the same Pfirrmann score in healthy volunteers and patients (.469<p<.967). Age (0.007<R2<0.202) and BMI (0.074<R2<0.288) showed either weak or no correlation to 23Nanorm. Mean 23Nanorm was significantly (p=.0002) greater in women relative to men. ConclusionsThe results underline the feasibility and robustness of 23Na-MRI of human IVDs and affirm, in a large cohort, decreases in 23Na IVD content seen with disc degeneration.

Bumps on the Neck and Groin of a 2-Year-Old Male

Patient: 2-year-old white male. Chief Complaint: Bumps on neck and groin. History of Present Illness: A 2-year-old boy arrived at the emergency department with a 1- to 2-week history of bumps on his neck and groin. He had been referred to the emergency department by his primary care physician (PCP) when the results of an in-office fingerstick blood test revealed a high white blood cell (WBC) count and a low platelet count. The parents of the patient say that he had had bilateral knee pain a few days previously, which had resolved spontaneously, and had had a cough for the past week. The parents mentioned that when their son had started coughing one week prior, they had contacted the PCP and had mentioned the bumps on his neck and his cough. The physician diagnosed the boy as having lymphadenopathy attributed to a viral illness. Medical and Family History: As of this writing, the patient’s immunizations are up to date. He experiences seasonal allergies, with symptoms that include itchy eyes and runny nose. His recurrent ear infections have been resolved by pressure-equalization tubes and adenoidectomy. The patient’s maternal grandmother and maternal uncle have long QT syndrome. His paternal great-grandfather has a low platelet count (specificity not given). The patient lives with his parents; as of this writing, his mother is currently at 31 weeks’ gestation, originally with triplets but currently with twins (one fetus recently died in utero). Physical Examination: During examination to determine the extent of symptoms, abnormalities were found in the respiratory, lymphatic, and musculoskeletal systems. The patient was observed to cough and have leg and knee pain; he also had swollen lymph glands. Laboratory Findings: Table 1, Table 2; Figure 1 ; Image 1, Image 2, Image 3 Additional Diagnostic Tests: Results of flow …

SP0032 Mucopolysaccharidoses - what should the rheumatologist know?

Mucopolysaccharidosis (MPS) are lysosomal disorders belonging to the inborn errors of metabolism. MPS are caused by a deficiency in one of the enzymes responsible for the degradation of glycosaminoglycans (GAGs),...

Multi‐symptom asthma as an indication of disease severity in epidemiology

Epidemiological questionnaires have failed to identify individuals with severe asthma. The extent of symptoms of asthma can, however, easily be established in epidemiological studies by identification of multiple symptoms. We hypothesized that reporting of multiple symptoms of asthma reflects uncontrolled disease and can be a sign of more severe asthma. The aims of the current study were, therefore, to determine the prevalence and determinants of multi-symptom asthma. In this paper we report our definition of multi-symptom asthma and its clinical characteristics. A postal questionnaire was mailed to 30,000 randomly selected subjects aged 16–75 yrs. A subgroup underwent detailed clinical examinations including lung function test, exhaled NO, methacholine test in addition to a detailed clinical history by using structured interview. Multi-symptom asthma was defined as questionnaire reported physician-diagnosed asthma, use of asthma medication, recurrent wheeze, attacks of shortness of breath, and at least one additional respiratory symptom. The overall prevalence of physician-diagnosed asthma was 8.3%, while of multi-symptom asthma the prevalence was 2.0% (women 2.4%, men 1.5%, p < 0.001). Multi-symptom asthma versus other asthma was associated with lower FEV1 (88.8% pred vs. 98.8% pred), higher FeNO (29.3 ppb vs. 23.2 ppb), a greater proportion having PD20 < 1.96 mg methacholine chloride (82.9% vs. 58.7%), all statistically highly significant. The same pattern was found for asthma exacerbations, emergency department visits and hospitalizations. All respiratory symptoms were more common in multi-symptom asthma compared with other asthma, and that was true also for symptoms of bronchitis, rhinitis and rhino-sinusitis. In contrast, allergic rhinitis and allergic sensitization were not more common in multi-symptoms asthma than in other asthma. Multi-symptom asthma cannot be used for defining severe asthma. We conclude, however, that multi-symptom asthma, as we defined the condition, is related to signs of more severe disease and could be used as an epidemiological marker of asthma severity.

The impact of Aspergillus fumigatus viability and sensitization to its allergens on the murine allergic asthma phenotype.

Aspergillus fumigatus is a ubiquitously present respiratory pathogen. The outcome of a pulmonary disease may vary significantly with fungal viability and host immune status. Our objective in this study was (1) to assess the ability of inhaled irradiation-killed or live A. fumigatus spores to induce allergic pulmonary disease and (2) to assess the extent to which inhaled dead or live A. fumigatus spores influence pulmonary symptoms in a previously established allergic state. Our newly developed fungal delivery apparatus allowed us to recapitulate human exposure through repeated inhalation of dry fungal spores in an animal model. We found that live A. fumigatus spore inhalation led to a significantly increased humoral response, pulmonary inflammation, and airway remodeling in naïve mice and is more likely to induce allergic asthma symptoms than the dead spores. In contrast, in allergic mice, inhalation of dead and live conidia recruited neutrophils and induced goblet cell metaplasia. This data suggests that asthma symptoms might be exacerbated by the inhalation of live or dead spores in individuals with established allergy to fungal antigens, although the extent of symptoms was less with dead spores. These results are likely to be important while considering fungal exposure assessment methods and for making informed therapeutic decisions for mold-associated diseases.

Congenital Sucrase‐Isomaltase Deficiency

Congenital Sucrase‐Isomaltase Deficiency

Ethmoid Sinus Osteoma Associated With Blow-Out Fracture

Osteoma is a benign tumor that is composed of compact or cancellous bone. It is the most common benign neoplasm of the paranasal sinus, and ethmoid sinuses are the second most common sites of paranasal sinus osteoma. The symptoms of ethmoid sinus osteoma can give rise to various kinds and extent of symptoms. In symptomatic cases, surgical management is necessary, but appropriate surgical approach to the ethmoid sinus is not clearly established. We describe 2 male patients with a diagnosis of blow-out fractures after trauma; ethmoid sinus osteoma on preoperative computed tomography scans was coincidentally found, and the surgical correction was done simultaneously. The purpose of this article was to present the successful surgical removal of ethmoid osteoma through lamina papyracea and transcaruncular approach, resulting in both successful surgical correction and good cosmetic outcome.

DEBRA International: International cooperation to improve healthcare access for patients with epidermolysis bullosa.

Epidermolysis bullosa (EB) is a group of genetic conditions causing blistering to the skin and body linings which vary in the extent of symptoms but are always painful and disabling and often life threatening. In its most severe form it is fatal in infancy. Currently there is no cure or effective treatment but good management greatly improves quality of life and current research offers good prospects for therapy development. DEBRA International is the international organisation coordinating the activities of national EB patient support groups, currently working in over 40 countries, with a strong presence in Europe, North and South America and Australasia and a growing membership in Asia, the Middle East and North Africa. The objectives, both internationally and nationally, are to bring about lasting and effective treatments for all forms of EB as quickly as possible and to provide services to help currently affected individuals and families. DEBRA International recognises that these aims can only be met in partnership with clinicians, researchers, industry, other research funders and governments. Amongst our current priority areas of work are: Funding and facilitating research to develop innovative treatments including gene, cell, protein and small molecule therapies; a number of which are in early stage human clinical trials or where such trials are on the horizon. Normally two calls for research grant applications are made each year and, unusually, there is a single system of international peer review used by all of the DEBRAs funding significant amounts of research. On average, we invest around €3 million each year into new research. An invitation-only research planning conference is held every three years, involving the leading research teams worldwide together with expert patients and industry, to identify opportunities and barriers facing therapy development. Identifying potential partners and advisers in industry and venture capital, recognising that expertise in bringing products to market is essential in translating the significant scientific advances being made into available treatments in the clinic. The generation of best practice clinical guidelines by groups of specialist clinicians in various areas of importance to people with EB. The guideline on dental care is about to be published and guidelines on cancer management, pain management, nutrition, physical therapies and wound care are in preparation. Creating stronger clinical networks of specialist EB centres worldwide to promote sharing of expertise and to facilitate clinical trials. The inaugural meeting of this formal network, EB-CLINET, will be held in Salzburg on 5–7 October 2012. The establishment of clinical training opportunities for professionals interested in starting, or improving, a specialist EB clinical service in their own countries including, it is hoped, an online, modular course and mentoring. This programme will be launched at EBCLINET. The creation of an international patient-reported database to understand better the natural history of different forms of EB and the costs of living with the condition. This registry, EBCare, is internet based, www.EBCare.org, and we welcome the help of health professionals in encouraging patients to register. It is currently published in English with Spanish and other languages to follow shortly. DEBRA International welcomes contact and partnership with researchers, health care professionals, industry and anyone interested in our work. For more information, visit www.debra-international.org.

Management of Chondral Injuries Associated With Patellar Instability

The treatment of cartilage injuries secondary to patellar instability is multifactorial. These factors include the time frame of patellar instability, the pathoanatomic factors, the extent of symptoms, and the size and location of the cartilage injury. The chondral or osteochondral injury which occurs with acute patellar instability is managed with either reduction and internal fixation or removal. The treatment of the patellar instability component is controversial in the acute setting, especially when there is no need for an osteochondral surgery. In such cases, patellar dislocations are treated nonoperatively. However, if the patient is indicated for surgery for treatment of osteochondral fracture and intra-operatively the medial patellofemoral ligament (MPFL) remains pathologically lax and presents with a discrete MPFL injury site, there is the option of acute repair. Chondral injury associated with recurrent patellar instability may be subdivided into 2 overlapping groups: (1) chondral damage resulting from the instability episodes (distal medial region of the patellar and/or lateral proximal region of the lateral femoral condyle) and (2) chondrosis secondary to the chronic lateral tracking of the patella (chronic patellar subluxation) from patholaxity of the MPFL (lateral chondrosis to patella and trochlea in addition to the injuries sustained from the actual instability episodes). The treatment is based on the patient's chief complaints and the unique underlying pathoanatomy. Many of these patients will have one or more predisposing factors, such as patella alta, trochlear dysplasia, patholaxity of the MPFL and an excessively lateral position of the tibial tuberosity. Therefore, the key to managing this patient population is to address each patient's specific pathoanatomy, which by definition will include addressing the MPFL patholaxity. The goals are to stabilize the patella, normalize patellofemoral contact area and/or forces, and then restore the articular cartilage based on relevant symptoms. As of this writing, treatment options in the United States include debridement, marrow stimulation, osteochondral auto and allograft, autologous chondrocyte implantation, and the use of particulate articular cartilage.

Mood Disorders

Affective disorders are among the most common disorders in psychiatry. They are generally classified according to the persistence and extent of symptoms and by the polarity of these symptoms. The two poles of the affective spectrum are mania and depression. Bipolar disorder is characterized by the presence of the mania or hypomania and often depression. Unipolar depression is defined by depression in the absence of a lifetime history of mania or hypomania. These differences are not merely categorical but have important implications for the prognosis and treatment of these conditions. Bipolar disorder, for example, is better treated using mood-stabilizing medication, whereas unipolar depression responds optimally to antidepressant medications. In addition, prognostically, unipolar depression may sometimes be limited to one episode in a lifetime, whereas bipolar disorder is typically a lifelong condition. The course of both conditions, however, is often chronic, and frequently patients can present with unipolar depression only to later develop manic symptoms. A thorough understanding of both conditions is therefore required to treat patients presenting with affective symptomatology. This chapter discusses the epidemiology, etiology and genetics, pathogenesis, diagnosis, and treatment of unipolar depression and bipolar disorder. Figures illustrate gray matter differences with lithium use and the bipolar spectrum. Tables list the pharmacokinetics of commonly used antidepressants and medications commonly used in the treatment of bipolar disorder. This review contains 2 figures, 2 tables, and 135 references.

Danos de Rhopalosiphum padi (L.) (Hemiptera: Aphididae) no trigo em função da duração e da densidade de infestação

Aphids are considered relevant pests on wheat either by direct damage through sap sucking or by indirect damage vectoring BYDV (Barley yellow dwarf virus). Rhopalosiphum padi L. has been observed infesting wheat fields with an increasing frequency. The knowledge and the available technology, besides being more related to other aphids species already recognized as pests, they are insufficient to control the specific problem of R. padi. Thus, this work evaluated the effects of feeding duration and infestation densities of R. padi on seedlings of wheat cv. Embrapa 16. Grain yield, yield components and the extent of symptoms were recorded. The experiment was carried out in the field under a completely randomized split-plot experimental design with four replications. The main plot was feeding duration (two and seven days) and the sub-plots were infestation densities (zero, two and 10 aphids per plant). Independent on feeding duration, 10 aphids per plant resulted in significant yield losses, reduction of number of heads and tillers per plant. Canopy dry matter was also reduced. Infestations of two and 10 aphids per plant resulted in continuous yellowing of wheat plants from tillering to the end of flowering stage. When aphids fed for seven days on wheat, more yellowing symptoms were observed at the flower stage in comparison with two days feeding.

Physical complaints and subjective stress in working relatives

This study was undertaken to determine the extent of physical complaints in relation to the degree of subjective burden sustained by those who care for ill relatives at home. The sampled group consisted of 114 carers (98 women, 16 men), average age 58 +/- 13 years, looking after relatives with various illnesses and various levels of care requirements. Extensive caring was needed by 48%. The complaints were documented on the Giessen Symptoms Form and the stress on the Domestic Care Scale. The extent of the symptoms compared with the general population was expressed by percentage ranking: PR > 50 (above-average extent of symptoms) and PR < or = 50 (average or below-average extent of symptoms). This sample revealed above-average extent of symptoms both for the overall stress (PR > 50: 70%; PR < or = 50: 30%, P < 0.001) as for limb aches (79 vs 21%, P < 0.001), tendency to exhaustion (74 vs 26%, P < 0.001), stomach complaints (65 vs 35%, P < 0.01) and cardiac symptoms (62 vs 38%, P < 0.02). The extent of symptoms was significantly related to the degree of stress. With less stress the relationship was similar to that in the general population (48 vs 52%), while moderate stress (71 vs 29%, P < 0.001) and especially marked stress (94 vs 6%, P < 0.001) caused a marked increase in symptoms.

The difficult patient in gastroenterology: chronic pelvic pain, adhesions, and sub occlusive episodes

Chronic pelvic pain (CPP) with or without adhesions and symptoms of intestinal occlusion is a complex but relatively common complaint. The etiology and pathophysiology of CPP and adhesions are unclear, as is their possible relation. However, it is evident that continuous abdominal pain leads to evident suffering and disability. Unfortunately, there is little proof or evidence of success for many of the currently used diagnostic and therapeutic interventions. Laparoscopy is neither the ultimate evaluation nor the panacea for CPP or intra abdominal adhesions. An integral approach to CPP has shown beneficial results. In this multidisciplinary approach dealing with the pain is far more important than finding an organic cause and cure for the pain. Equal and simultaneous attention is paid to psychosocial, sexual and somatic aspects. The treatment of adhesions depends on the extent of symptoms and complaints. Because of the questionable relation between adhesions and pain, and the probability of reformation and de novo adhesion formation after surgery, adhesiolysis should be avoided. Even for patients with signs and symptoms of small bowel obstruction a conservative treatment is often justified. These patients require careful evaluation and management. Frequent reassessment is important to rule out impending strangulation, complete obstruction or perforation. Water soluble contrast can be useful to justify prolongation of conservative treatment and by that postpone unnecessary surgery. Most adhesive small bowel obstructions resolve following conservative treatment. The unsolved questions about etiology, diagnosis, treatment and prevention, and the great individual and community burden of CPP and adhesions clearly show that further research is needed.

Factors influencing mother–child reports of depressive symptoms and agreement among clinically referred depressedyoungsters in Hungary

BackgroundPsychiatric assessments of children typically involve two informants, the child and the parent. Understanding discordance in their reports has been of interest to clinicians and researchers. We examine differences between mothers' and children's report of children's depressive symptom severity, and factors that may influence their reports and level of agreement. We hypothesized that agreement between mother and child would improve if (1) the mother is depressed, due to improved recall of mood congruent symptoms, (2) the child is older, due to better social-cognitive and communication skills, and (3) the child is a female. MethodsSubjects were 354 children (158 girls; mean age 11.69 years, SD: 2.05 years) with Major Depressive Disorder. Depressive symptoms were evaluated by a semi-structured interview separately with the mother and the child. Agreement on symptom severity was based on concordance of the presence and extent of symptoms. ResultsMaternal reports were significantly higher than their son's but not daughters'. Girls, particularly with increasing age, reported higher levels of symptoms; however mothers' reports were not affected by child sex or age. Maternal depression predicted more severe symptom reports for both children and mothers. Agreement between the mother and the child increased as children got older. LimitationsThe same clinician interviewed the mother and the child, which might inflate rates of agreement. However, this method mirrors clinical evaluation. ConclusionDuring a clinical interview one must consider the age and sex of the child and the depressive state of the mother in assimilating information about the child.

Significant impact of cutaneous T‐cell lymphoma on patients' quality of life

Cutaneous T-cell lymphoma (CTCL) can have a profound impact on a patient's health-related quality of life; however, little is known about its actual impact. The authors evaluated patients' perspectives on the impact of CTCL on physical functioning, lifestyle, emotional well being, and satisfaction with treatment. A 4-page, self-administered questionnaire was mailed and made available online in March 2005 to the entire United States membership of the Mycosis Fungoides Foundation (n = 930 members). Outcome measures were patients' perspectives on the psychosocial impact of CTCL and the management of their disease. The response rate was 68%, and 93.6% of respondents were white. The majority of respondents had mycosis fungoides (89%). Respondents were bothered by skin redness (94%) and by the extent of symptoms that affected their choice of clothing (63%). For most patients, the disease had a functional impact, rendering them tired or affecting their sleep. Health distress was reported by almost all respondents, with 94% reporting that they worried about the seriousness of their disease and 80% worrying about dying from the disease. Sixty-two percent of respondents reported that their disease made them feel unattractive, 85% reported that their treatment made their disease seem more manageable, but 61% reported that they felt burdened financially by their disease. The high response rate and patients' responses to the survey provided compelling evidence that patients believed CTCL had a profound and severe impact on their functioning, emotional, and social well being. A striking health distress was prevalent in almost all respondents. Although the majority of patients reported that treatments made their disease more manageable, a significant proportion reported that they felt burdened financially by their disease.

Effectiveness of Two Methods of Obtaining Feedback on Mental Health Services Provided to Anonymous Recipients

Effectiveness of Two Methods of Obtaining Feedback on Mental Health Services Provided to Anonymous Recipients