Management Of Chronic Symptoms Research Articles

Palliative Care for Pediatric Urology

Palliative care in the field of urology has largely been limited to adult oncologic conditions. Although there is a plethora of established literature suggesting the advantageous impact of palliative care, there is limited integration of palliative care in adult urology. This underutilization is further exacerbated in pediatric urology, and palliative care in pediatric urology remains an underexplored area despite the prevalence of several life-limiting conditions in this patient population. This paper highlights the potential need for palliative care intervention in a variety of urologic conditions in the pediatric population, including congenital lower urinary tract obstruction, neurogenic bladder dysfunction, exstrophy-epispadias complex, and congenital bilateral renal agenesis. Each condition poses unique challenges that can be addressed with the inclusion of a palliative care team, including decision-making spanning prenatal-neonatal-pediatric periods, acute and chronic symptom management, family relations, body image issues, risk of recurrent hospitalizations and surgeries, and potentially fatal complications. Alongside standard urologic interventions, palliative care can serve as an additional means of addressing physical and psychosocial symptoms experienced by pediatric urology patients to enhance the quality of life of patients and their families.

Abstract 11437: False Atrial Fibrillation Alerts From Smartwatch in Relation to Perceived Physical Well-Being and Confidence in Management of Chronic Symptoms: The Pulsewatch Study

Background: Atrial fibrillation (AF) can cause strokes that may be preventable with timely detection and anticoagulation therapy. Smartwatches offer the potential for non-invasive, long-term AF monitoring, but potential implications for psychological well-being associated with these alert systems remain to be studied. We examined the psychosocial impact of false alerts for AF on patients prescribed a smartwatch post stroke. Methods: We analyzed data from the Pulsewatch study (NCT03761394), which enrolled patients ≥50 years from the UMass Memorial Health system who had a history of stroke or transient ischemic attack, CHA 2 DS 2 -VASc ≥2, and no contraindications to anticoagulation. Data from participants in the intervention group, who received a cardiac patch monitor, as well as a smartwatch and smartphone installed with Pulsewatch applications, were analyzed. At baseline and 14 days, participants completed the Health Survey SF-12 to assess perceived physical well-being, and the Symptom Management survey to assess confidence in disease self-management. We employed logistic regression to assess changes in anxiety, perceived mental and physical health, and chronic disease management self-efficacy over 14 days with exposure to false alerts. Results: Among 85 participants who received a smartwatch for AF detection (mean age 64.8±9.2 years, 41% female, 86% non-Hispanic white) 11 (13%) received a false AF alert. Receipt of false alerts was associated with significant decreases in perceived physical well-being and management of chronic symptoms (β = -9.08, p < 0.01 and β = -6.50, p = 0.03, respectively), but not significantly associated with changes in perceived mental health (β = 0.70, p = 0.78). Conclusions: Perceived physical well-being and levels of disease self-management, but not perceived mental health, decreased with exposure to false AF alarms over 14 days. Further studies are required to explore the psychological impact of smartwatch AF monitoring in patients post stroke.

Evaluation of an Electronic Consultation Service for COVID-19 Care.

COVID-19 has increased the need for innovative virtual care solutions. Electronic consultation (eConsult) services allow primary care practitioners to pose clinical questions to specialists using a secure remote application. We examined eConsult cases submitted to a COVID-19 specialist group in order to assess usage patterns, impact on response times and referrals, and the content of clinical questions being asked. This was a mixed-methods analysis of eConsult cases submitted between March and September 2020 in Ontario, Canada to 2 services. We performed a descriptive analysis of the average response time and the total time spent by the specialist for eConsults. Primary care practitioners completed a post-eConsult questionnaire that asked about the outcome of the eConsult. We performed an inductive and deductive content analysis of a subset of cases to identify common themes among the clinical questions asked. A total of 208 primary care practitioners submitted 289 eConsult cases. The median specialist response time was 0.6 days (range = 3 minutes to 15 days); the average time spent by specialists per case was 16 minutes (range = 5 to 59 minutes). In 69 cases (24%), the eConsult enabled avoidance of a face-to-face referral. Content analysis of 51 cases identified 5 major themes: precautions for high-risk and special populations, diagnostic clarification and/or need for COVID-19 testing, guidance on self-isolation and return to work, guidance on personal protective equipment, and management of chronic symptoms. This study demonstrates the considerable potential of eConsults during a pandemic as our service was quickly implemented across Ontario and resulted in primary care practitioners' rapid and low-barrier access to specialist input.

Integrative surgical oncology: A model of acute integrative oncology.

Integrative oncology has emerged as a recognized medical subspecialty because of growing interest in the use of integrative medicine in modern cancer care on behalf of both patients and providers. Acutherapy and mind-body techniques, such as meditation and yoga, have been shown to aid in symptom control and improve quality of life in oncologic patient populations, and the Society of Integrative Oncology and American Society of Clinical Oncology have recently endorsed a set of guidelines for the implementation of these techniques specifically in patients with breast cancer. Although the current guidelines focus largely on the management of chronic symptoms, there exists evidence to support the use of these techniques in acute symptom management as well. With surgical resection representing the backbone of many cancer treatment regimens, symptoms that arise during the perioperative period are prime examples of the acute symptomatology common among patients with cancer. Here, the authors provide a detailed literature review of the current evidence supporting the use of integrative techniques during the perioperative period and demonstrate their applicability for acute symptom management within oncologic and surgical populations. In doing so, the authors introduce a new paradigm of surgical practice they call integrative surgical oncology and integrative surgery.

Research in adolescent healthcare: The value of qualitative methods

BackgroundThe vast majority of publications about adolescent healthcare use a quantitative methodology that often involves long and expensive research protocols with results that do not always provide answers adequate to the complexity of the questions being asked. The qualitative method is sometimes a more effective alternative for exploring some of these. This method can be defined from its objective, which is to generate theoretical hypotheses, its mandatory consideration of the researcher's subjectivity, and the importance it ascribes to the context of the participants’ experience. Among the many techniques of qualitative research, the use of phenomenological methods, in particular, interpretative phenomenological analysis (IPA), is highly developed in medical research. ObjectivesTo define the qualitative method and describe the principal stages of a phenomenological qualitative study. ResultsThe three stages of a qualitative study are data collection (population and sampling, data collection methods), data analysis, and writing up the results. Purposive sampling makes it possible to include participants who can describe in detail, and as experts, their experience during semi-structured interviews. The analysis takes place in two stages, the first very descriptive, the second more interpretative. The results are written-up in a narrative form, including both direct quotations from the interviews and the researchers’ interpretation. DiscussionThe issues of health promotion and healthcare associated with the management of chronic symptoms or diseases in adolescents involve an extremely rich and complex context. Qualitative methods make it possible to approach these questions and to understand them better by generating hypotheses from a rigorous scientific procedure appropriate to the context and objectives. In addition to being used on their own, they can be used on an exploratory basis early in a quantitative study to help define it better, for explanatory purposes, to help understand complex quantitative results, or combined with a quantitative study. The qualitative and quantitative results will then be integrated.

Palliative care in patients with chronic nononcological diseases

The prevalence of chronic diseases has been increasing globally and in the region of the Americas. The World Health Organization states that the population older than 60 years has doubled in the last 30 years, and the cost of these diseases to health systems is of immense significance. Neurologic diseases, such as dementia and cerebrovascular disease, as well as chronic obstructive pulmonary disease, significantly deteriorate the quality of life of patients owing to an increase in symptoms that are often not treated. The management of chronic symptoms, which is the basis of palliative care, becomes a major approach to the patient, his or her family, and the system. This article seeks to show the importance of joint work between physicians and palliative care specialists to define the most appropriate management for these patients and optimize quality of life.