Memorial Symptom Research Articles

Impact of Multimorbidity on Symptom Burden and Symptom Clusters in Patients Receiving Chemotherapy.

Detailed information on patient characteristics and symptom burden associated with multimorbidity in oncology patients is extremely limited. Purposes were to determine the prevalence of low (≤ 2) and high (≥ 3) multimorbidity in a sample of oncology outpatients (n = 1343) undergoing chemotherapy and evaluate for differences between the two multimorbidity groups in demographic and clinical characteristics; the occurrence, severity, and distress of 38 symptoms; and the stability and consistency of symptom clusters. Using the Self-Administered Comorbidity Questionnaire, patients were classified into low and high multimorbidity groups. Memorial Symptom Assessment Scale was used to assess the occurrence, severity, and distress of 38 symptoms prior to the patients' second or third cycle of chemotherapy. For each multimorbidity group, symptom clusters based on occurrence rates were identified using exploratory factor analysis. Compared to the low group (61.4%), patients in the high group (38.6%) were older, had fewer years of education, were less likely to be married or partnered, less likely to be employed, and had a lower annual income. In addition, they had a higher body mass index, poorer functional status, were a longer time since their cancer diagnosis, and were more likely to have received previous cancer treatments and have metastatic disease. Patients in the low and high groups reported 12.7 (±6.7) and 15.9 (±7.5) concurrent symptoms, respectively. Eight and seven symptom clusters were identified for the low and high groups, respectively. Psychological, gastrointestinal, weight gain, hormonal, and respiratory clusters were stable across multimorbidity groups. Weight gain and respiratory clusters were consistent. Three unstable clusters were identified in the low group and two in the high group. Findings suggest that higher multimorbidity is associated with various social determinants of health and a higher symptom burden. Differences between multimorbidity groups may be related to aging, treatments, and/or comorbid conditions.

Low-level auricular vagus nerve stimulation lowers blood pressure and heart rate in paroxysmal atrial fibrillation patients: a self-controlled study

ObjectiveTo investigate the effects of low-level auricular vagus nerve stimulation (LL-aVNS) on blood pressure and heart rate in patients with paroxysmal atrial fibrillation.MethodsA total of 22 patients with paroxysmal atrial fibrillation diagnosed in Fuzhou First General Hospital Affiliated with Fujian Medical University from September 2021 to December 2022 were selected and given LL-aVNS treatment based on the original unchanged drug treatment for 4 weeks. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate maximum (HRmax), heart rate minimum (HRmin), left ventricular ejection fraction (LVEF), left atrial diameter (LAD), Atrial Fibrillation Severity Scale (AFSS) symptom subscale, and Memorial Symptom Assessment Scale-Heart Failure (MSAS-HF) before and after the treatment were observed and compared. In addition, adverse effects of the LL-aVNS procedure and 6-month follow-up were recorded.ResultsSBP, DBP, and HRmin were lower after the treatment than before the treatment (p < 0.05); AFSS symptom subscale scores and MSAS-HF scores after the treatment were lower before the treatment (p < 0.05); itching of the skin was observed in one case during the course of LL-aVNS; and two patients were hospitalized for acute exacerbation of chronic heart failure between 4 months and 6 months after the treatment.ConclusionLL-aVNS in patients with paroxysmal atrial fibrillation can assist in controlling blood pressure and heart rate, effectively relieving symptoms, and the treatment process is safe and feasible.

Symptom Documentation in Unstructured Palliative Care Notes of Children and Adolescents With Cancer.

Children and adolescents with cancer experiencing complex symptoms can benefit from subspeciality palliative care. However, standardized methods of symptom documentation by pediatric palliative care teams are lacking. Understanding current approaches to symptom documentation will inform next steps to optimize symptom support. To explore the documentation of symptom prevalence and characteristics in unstructured clinical notes by pediatric palliative care clinicians caring for children and adolescents with cancer. We reviewed unstructured clinical notes documented by the pediatric palliative care team for 115 children and adolescents with cancer. Symptom-related data were abstracted and evaluated using content analysis based on the Memorial Symptom Assessment Scale 10-18 instrument items. We also evaluated documentation of severity and distress for six commonly experienced symptoms in pediatric cancer: difficulty sleeping; feelings of sadness; lack of energy; nausea/vomiting; pain; and worry. We identified 1420 symptoms in 662 clinical notes for 106 patients. We identified a median of 5 individual symptoms (IQR = 3-8.5) per patient. Pain was the most frequently documented symptom (n = 79 patients, 74.5%). We identified at least one of the six commonly experienced symptoms in 88 patients (83%). Documentation of the associated severity and distress of these symptoms was inconsistent. Palliative care clinicians routinely documented the co-occurrence of multiple complex symptoms experienced by children and adolescents with cancer. Unstructured progress notes captured evidence of symptom impact on daily life. Clinicians may benefit from a systematic approach to document symptoms in the clinical record which supports symptom identification and communication across clinical teams.

Xenon gas as a potential treatment for opioid use disorder, alcohol use disorder, and related disorders.

Xenon gas is considered to be a safe anesthetic and imaging agent. Research on its other potentially beneficial effects suggests that xenon may have broad efficacy for treating health disorders. A number of reviews on xenon applications have been published, but none have focused on substance use disorders. Accordingly, we review xenon effects and targets relevant to the treatment of substance use disorders, with a focus on opioid use disorder and alcohol use disorder. We report that xenon inhaled at subsedative concentrations inhibits conditioned memory reconsolidation and opioid withdrawal symptoms. We review work by others reporting on the antidepressant, anxiolytic, and analgesic properties of xenon, which could diminish negative affective states and pain. We discuss research supporting the possibility that xenon could prevent analgesic- or stress-induced opioid tolerance and, by so doing could reduce the risk of developing opioid use disorder. The rapid kinetics, favorable safety and side effect profiles, and multitargeting capability of xenon suggest that it could be used as an ambulatory on-demand treatment to rapidly attenuate maladaptive memory, physical and affective withdrawal symptoms, and pain drivers of substance use disorders when they occur. Xenon may also have human immunodeficiency virus and oncology applications because its effects relevant to substance use disorders could be exploited to target human immunodeficiency virus reservoirs, human immunodeficiency virus protein-induced abnormalities, and cancers. Although xenon is expensive, low concentrations exert beneficial effects, and gas separation, recovery, and recycling advancements will lower xenon costs, increasing the economic feasibility of its therapeutic use. More research is needed to better understand the remarkable repertoire of effects of xenon and its potential therapeutic applications.

Addiction Memory, Family Functioning, and Depression in Illicit Drug Users: Self-Esteem as a Mediator.

Depression is a common issue among illicit drug users. However, the interaction between addiction memory, family functioning, and depressive symptoms remains insufficiently examined. This study investigates the relationship between addiction memory, family functioning, and depressive symptoms, with self-esteem serving as a mediator. A random sample of 600 illicit drug users from Hubei, China, was evaluated using the Addiction Memory Intensity Scale (AMIS), Family APGAR Index, Patient Health Questionnaire (PHQ-9), and Rosenberg Self-Esteem Scale (RSES). A factorial algorithm was used to parcel the AMIS, PHQ-9, and RSES items, and structural equation modeling was applied to examine the mediation effect. The model fit the data well (χ2/df = 2.248, CFI = 0.956, NNFI = 0.966, RMSEA = 0.046, SRMR = 0.040), with significant path coefficients (p < 0.05). Addiction memory was positively correlated with depression (β = 0.195, p < 0.001), while family functioning negatively correlated with depression (β = -0.113, p = 0.008). Both addiction memory and family functioning indirectly influenced depression through self-esteem, with mediating effects equal to 1.154 (95% CI: 0.106 to 0.209) and -0.097 (95% CI: -0.154 to -0.047). These findings suggest that interventions targeting addiction memory and family functioning may alleviate depressive symptoms by improving self-esteem among illicit drug users.

Amyloid‐related imaging abnormalities in a woman with apolipoprotein E ε4 homozygotes treated with lecanemab for Alzheimer's disease

AbstractBackgroundLecanemab (Leqembi®) is an anti‐amyloid monoclonal antibody used for the treatment of Alzheimer's disease (AD). However, side effects may occur with lecanemab, including amyloid‐related imaging abnormalities (ARIA), especially in patients with apolipoprotein E ε4 (APOE4) homozygous.Case PresentationA 69‐year‐old woman had a 2‐year history of worsening memory symptoms and was diagnosed with mild cognitive impairment due to AD. Because she carries two copies of the E4 allele of APOE, her doctor did not recommend lecanemab treatment. However, she strongly desired lecanemab treatment and received four infusions of lecanemab. She had no symptoms or neurological abnormalities, but a head MRI before the fifth infusion showed moderate radiographic ARIA; therefore, she was admitted and treated with steroids. One month later, a head MRI showed the ARIA had disappeared.ConclusionThe indications of lecanemab treatment for patients with APOE4 homozygous must be carefully considered due to the higher risk of ARIA.

Psychological distress in biliary tract malignancy patients: influencing factors and development of a predictive nomogram model.

This study aims to investigate the psychological distress and its influencing factors in patients with biliary tract malignant tumors, alongside the development of a predictive model. A total of 219 patients diagnosed with biliary tract malignant tumors who were admitted to the Department of Liver Surgery at Fudan University Shanghai Cancer Center from July 2021 to May 2023, were selected using a convenience sampling method. Research tools involve psychological distress management screening tools, a demographic questionnaire, self-rating anxiety and depression scales, and the Chinese version of the Memorial Symptom Assessment Scale. Bootstrap method was utilized for repeated sampling to identify relevant factors influencing psychological distress in biliary tract cancer patients. The R software was employed to create a nomogram model, and the model's accuracy and predictive performance were assessed using the receiver operating characteristic curve (ROC) and the Hosmer-Lemeshow test. The average score of psychological distress among the 219 patients was (3.91 ± 2.44), with a psychological distress detection rate of 54.8%. Regression model results indicated that factors such as the presence of distant metastasis, comorbidity with other major diseases, poor sleep quality, anxiety, and severity of anxiety and depression were the primary influencers of psychological distress. The detection rate of psychological distress in patients with biliary tract malignant tumors is notably high. The predictive model constructed in this study exhibits good predictive efficacy and clinical value, providing valuable reference for healthcare professionals in developing targeted intervention strategies.

Symptom prevalence in patients with advanced heart failure and its association with quality of life and activities of daily living.

Quality of life (QOL) and functional status are two key outcomes for patients with advanced heart failure (HF). We examined the association of eleven symptoms with QOL and functional status impairment in patients with advanced HF. This was a retrospective analysis of baseline data from a multi-center, cluster-randomized controlled trial (NCT01459744) which enrolled patients with an implanted cardioverter-defibrillator and advanced HF at high-risk for mortality. Study instruments included the Condensed Memorial Symptom Assessment Scale, the Kansas City Cardiomyopathy Questionnaire QOL subscale, and the number of activities of daily living (ADL) patients had difficulties with. The study included 413 subjects. In generalized linear models which were adjusted for baseline characteristics, the total number of symptoms was significantly associated with worse QOL, as was the presence of each individual symptom, except constipation. Lack of energy demonstrated the strongest negative association with QOL. Similarly, the total number of symptoms was associated with a higher number of ADL difficulties (i.e., worse functional status). The presence of pain, lack of energy and drowsiness was individually associated with more ADL difficulties. Among patients with advanced HF, a higher number of symptoms and specific individual symptoms were associated with worse QOL and functional status.

Management of inoperable malignant bowel obstruction using the 4-step BOUNCED diet.

Malignant bowel obstruction (MBO) presents with multiple symptoms. The 4-step BOUNCED diet educates patients to self-manage oral intake according to symptoms. It includes clear fluids, thin liquids, purée and soft, sloppy foods, which are low in fibre. This mixed methods single-arm feasibility study aimed to establish if the diet could reduce MBO symptoms in patients with inoperable colorectal and gynaecological malignancies. The secondary objectives were to investigate if it was easily followed, improved quality of life (QOL) and reduced hospital admissions. Patients able to tolerate an oral diet with one or more symptoms (pain, bloating, early satiety, nausea and vomiting) were eligible. Following informed consent, an oncology dietitian took a diet history and determined which step of the diet they needed to follow using a detailed patient information leaflet. Patients remained on the trial for 28 days. Symptom and QOL data were collected on Days 1 and 28 using the Memorial Symptom Assessment Scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) questionnaires. Thirty patients (24 female, 6 male) aged 18-85 years consented from March 2021 to November 2022. Twenty-six participants completed the trial and 25 found the diet very easy or easy to understand. There was a significant reduction in pain from 96% on Day 1 to 63% on Day 28 (p = 0.004). The mean increase of EORTC global health status/QOL was 23.5 points, 95% CI (12.4-32.5) (p ≤ 0.001). There was a significant difference between number of admissions (p = 0.018) and bed days (p = 0.004) in the 28 days prior to consent compared to the trial period. A modified consistency low-fibre diet is easily followed, may reduce symptoms of MBO, admissions to hospital and improve QOL.

Impact of Symptoms on Quality of Life in Patients with Chronic Wounds.

To analyze the occurrence of symptoms and quality of life (QoL) among patients with chronic wounds and the impact of chronic wounds on QoL. Researchers evaluated 200 patients with chronic wounds using a general information questionnaire, a modified version of the Memorial Symptom Assessment Scale, and the Chinese version of the Cardiff Wound Impact Questionnaire. They performed correlation and linear regression analyses to explore the impact of symptoms on QoL. Mean symptoms scores were all moderately severe and ranged as follows: 0 to 7.06 ± 3.85 for mean total symptom, 0 to 2.69 ± 1.33 for mean frequency, 0 to 2.27 ± 1.02 for mean severity, and 0 to 2.29 ± 1.29 for mean distress. Scores on the three dimensions of QoL (daily life, social life, and well-being) were 51.61 ± 14.73, 48.63 ± 17.20, and 47.45 ± 8.65, respectively. Patients' symptoms on each subscale were negatively correlated with the dimensions of QoL (r = -0.383 to -0.559, P < .01). Multiple linear regression analyses showed that 9 symptoms collectively explained 66.1% of the total variance of daily life (P < .01); 7 symptoms explained 59.0% of the total variance of social life (P < .01); and 10 symptoms explained 59.6% of the total variance of well-being (P < .01). Patients with chronic wounds had high levels of psychological symptoms and moderate QoL, scoring lowest on well-being. Sleep disruption, limitations in activity, and scarring were the main symptoms affecting their QoL. Nurses should prioritize managing these symptoms to improve patients' QoL.

Validation of the Integrated Palliative Care Outcome Scale (IPOS) in adults with cystic fibrosis.

A primary palliative care model for cystic fibrosis (CF) recommends using the Integrated Palliative Care Outcome Scale (IPOS) for screening. Validation of the IPOS is needed. This secondary analysis utilized baseline data from a multisite trial of the palliative care model, Improving Life with CF. Adults with CF completed the IPOS, the Memorial Symptom Assessment Scale-CF (MSAS-CF), the CF Questionnaire-Revised (CFQ-R), the Patient Health Questionnaire (PHQ-8), the Generalized Anxiety Disorder (GAD-7), and the Perceived Stress Scale (PSS). IPOS structure was assessed using Cronbach α coefficients and a factor analysis. Construct validity was evaluated through bivariate relationships between IPOS scores and other questionnaire scores, and linear regressions assessing the extent to which the IPOS explains variance in quality-of-life domains. The sample comprised 256 adults with complete IPOS data. α coefficients were .86 for the IPOS total score, .81 for the Physical Symptoms subscale, .79 for the Emotional Symptoms subscale, and .63 for the Communication/Practical Issues subscale. A two-component factor structure best aligned with the current subscales. IPOS scores were significantly associated with other measures; associations with MSAS-CF and CFQ-R subscales differentiated the IPOS Physical and Emotional subscales. The IPOS total score provided unique information about the variance in the CFQ-R Physical Functioning and Respiratory Symptoms domain scores. In adults with CF, the IPOS has acceptable internal consistency and there is evidence of construct validity. These findings support adoption of the IPOS in the primary palliative care model for CF.

Specific symptom change associated with ecological momentary assessments of intrusive trauma memories

As the global prevalence of exposure to traumatic events rises, there is a growing need for accessible and scalable treatments for trauma-related disorders like posttraumatic stress disorder (PTSD). Intrusive reexperiencing symptoms, such as trauma-related intrusive memories (TR-IMs), are central to PTSD and a target of gold-standard treatments that are effective but resource-intensive. This study examined whether completing a brief ecological momentary assessment (EMA) protocol assessing the occurrence and phenomenology of TR-IMs was associated with decreases in intrusion symptom severity. Trauma-exposed adults (N = 139) experiencing at least 2 TR-IMs per week related to a DSM-5 criterion A traumatic event completed a 2-week EMA protocol. During this period, they reported on 18 sensory-perceptual and affective qualities of their TR-IMs three times per day and on posttraumatic stress symptom severity at day’s end. Longitudinal symptom measurements were entered into linear mixed-effects models to test the effect of Time on symptom severity. Over the 2-week protocol, intrusion symptom severity decreased, while other symptom cluster scores did not change. Within the intrusion symptoms, this effect was specific to TR-IMs and emotional reactivity to trauma reminders, and was not moderated by survey completion rate, total PTSD symptom severity, ongoing treatment, or time since trauma. This study was quasi-experimental and lacked a control group, therefore no definitive conclusions about clinical utility can be made. Nonetheless, these findings provide preliminary proof-of-principle and warrant future clinical trials assessing the clinical efficacy of EMAs of intrusive trauma memories as a scalable treatment option targeting intrusive memory symptoms.

The Effect of Heart Failure Symptom Clusters on Quality of Life: The Moderating Effect of Self-Care Behaviours.

Although heart failure (HF) symptoms affect patients' quality of life (QoL), improving patients' QoL requires certain self-care behaviours. However, the specific role of self-care behaviours in the relationship between HF symptoms and QoL has not been clarified. To evaluate the status of symptom clusters, self-care behaviours and QoL in HF patients, and to analyse and test the moderating effect of self-care behaviours between symptom clusters and QoL. This study is a cross-sectional study. A total of 320 HF patients who treated in thethree hospitals in Chengdu, China, from December 2022 to July 2023 were selected as the research subjects. The patients were evaluated using The General Information Questionnaire, Memorial Symptom Assessment Scale Heart Failure, Self-Care of Heart Failure Index and Minnesota Living with Heart Failure Questionnaire. The statistical analysis methods were exploratory factor analysis, Pearson correlation analysis, hierarchical regression analysis and simple slope analysis. There were five symptom clusters in HF patients: emotional symptom cluster (sadness, anxiety, irritability, feeling nervous), digestive symptom cluster (lack of appetite, dry mouth, weight loss, nausea, abdominal distension), ischemic symptom cluster (dizziness, chest pain, palpitations, fatigue), dyspnoea symptom cluster (difficulty breathing when lying flat, waking up breathless at night, sleep difficulty) and congestion symptom cluster (cough, shortness of breath, oedema). There was a significant correlation between HF symptom group, self-care behaviours and QoL (p < 0.05). Both self-care maintenance (β = -0.262, p < 0.001) and self-care management (β = -0.258, p < 0.001) had a moderating effect between symptom clusters and QoL. There are a variety of symptom clusters in HF patients. Improving the self-care behaviours ability of HF patients is conducive to reducing the impact of HF symptom clusters on QoL. The study used the STROBE checklist for reporting. Medical staff should focus on the impact of HF symptom clusters and self-care behaviours on QoL, and formulate corresponding interventions for HF symptom clusters and self-care behaviours to improve the QoL of patients. The head nurse of the cardiovascular department actively assisted us in collecting questionnaires from HF patients, and all HF patients surveyed participated in this study seriously.

Symptom clusters and symptom network analysis during immunotherapy in lung cancer patients.

This study analyzes symptoms in lung cancer patients undergoing immunotherapy to identify core symptom clusters through network analysis and lay a foundation for effective symptom management programs. The sample comprised 240 lung cancer patients receiving immunotherapy. Participants were assessed using the Memorial Symptom Assessment Scale. Exploratory factor analysis was used to extract symptom clusters, and network analysis using JASP 0.17.3 was performed to explore the centrality indices and density of the symptom network. Five symptom clusters were identified, i.e., emotion-related, lung cancer-related, physical, skin, and neural symptom clusters, with a cumulative variance contribution rate of 55.819%. Network analysis revealed that sadness was the most intense symptom (rs = 2.189), dizziness was the most central symptom (rc = 1.388), and fatigue was the most significant bridging symptom (rb = 2.575). This study identified five symptom clusters and a symptom network among lung cancer patients during immunotherapy. The network analysis's centrality indices and network density results can assist healthcare professionals in devising more precise symptom management strategies.

High-density lipoprotein over midlife and future cognition in women: The SWAN HDL ancillary study.

Limited data provides evidence-based insights on the association between comprehensive metrics of high-density lipoproteins (HDL) and cognitive performance, especially in midlife women for whom benefit might be the greatest. To assess the associations of serum HDL metrics including HDL lipid content [HDL cholesterol, phospholipid (HDL-PL), triglyceride], proteins/subclasses [apolipoprotein A-1 (apoA-1); small, medium, large, total HDL particle (HDL-P); and HDL size], and cholesterol efflux capacity with cognitive performance in midlife women. This prospective cohort study was conducted among 503 midlife women (1234 observations) from the Study of Women's Health Across the Nation HDL ancillary study. Joint models were applied to examine associations of HDL metrics assessed at midlife (50.2 ±2.9 years, baseline of the current study) and their changes over midlife (6.1 ±3.9 years of duration) with subsequent cognitive performance [working memory (Digit Span Backward Test), processing speed (Symbol Digit Modalities Test), and episodic memory immediate and delayed recall (East Boston memory test)] assessed repeatedly (maximum 5 times) 1.5 ±1 years later over 7.72 ± 4.10 years of follow up. Higher total HDL-P and smaller HDL size at midlife were associated with a better subsequent immediate recall, delayed recall and/or processing speed. Greater increase in HDL-PL, apoA-1, medium HDL-P, and total HDL-P and less increase in HDL size over midlife were associated with a better subsequent immediate and/or delayed recall. Enhancing specific serum HDL metrics during midlife could be promising in cognitive restoration, particularly memory, the initial and predominant symptom of Alzheimer's disease.

Symptom Network Analysis and Unsupervised Clustering of Oncology Patients Identifies Drivers of Symptom Burden and Patient Subgroups With Distinct Symptom Patterns.

Interindividual variability in oncology patients' symptom experiences poses significant challenges in prioritizing symptoms for targeted intervention(s). In this study, computational approaches were used to unbiasedly characterize the heterogeneity of the symptom experience of oncology patients to elucidate symptom patterns and drivers of symptom burden. Severity ratings for 32 symptoms on the Memorial Symptom Assessment Scale from 3088 oncology patients were analyzed. Gaussian Graphical Model symptom networks were constructed for the entire cohort and patient subgroups identified through unsupervised clustering of symptom co-severity patterns. Network characteristics were analyzed and compared using permutation-based statistical tests. Differences in demographic and clinical characteristics between subgroups were assessed using multinomial logistic regression. Network analysis of the entire cohort revealed three symptom clusters: constitutional, gastrointestinal-epithelial, and psychological. Lack of energy was identified as central to the network which suggests that it plays a pivotal role in patients' overall symptom experience. Unsupervised clustering of patients based on shared symptom co-severity patterns identified six patient subgroups with distinct symptom patterns and demographic and clinical characteristics. The centrality of individual symptoms across the subgroup networks differed which suggests that different symptoms need to be prioritized for treatment within each subgroup. Age, treatment status, and performance status were the strongest determinants of subgroup membership. Computational approaches that combine unbiased stratification of patients and in-depth modeling of symptom relationships can capture the heterogeneity in patients' symptom experiences. When validated, the core symptoms for each of the subgroups and the associated clinical determinants may inform precision-based symptom management.

Predictors of Concordance between Patient-Reported and Provider-Documented Symptoms in the Context of Cancer and Multimorbidity.

The integration of patient-reported outcomes (PROs) into clinical care, particularly in the context of cancer and multimorbidity, is crucial. While PROs have the potential to enhance patient-centered care and improve health outcomes through improved symptom assessment, they are not always adequately documented by the health care team. This study aimed to explore the concordance between patient-reported symptom occurrence and symptoms documented in electronic health records (EHRs) in people undergoing treatment for cancer in the context of multimorbidity. We analyzed concordance between patient-reported symptom occurrence of 13 symptoms from the Memorial Symptom Assessment Scale and provider-documented symptoms extracted using NimbleMiner, a machine learning tool, from EHRs for 99 patients with various cancer diagnoses. Logistic regression guided with the Akaike Information Criterion was used to identify significant predictors of symptom concordance. Our findings revealed discrepancies in patient and provider reports, with itching showing the highest concordance (66%) and swelling showing the lowest concordance (40%). There was no statistically significant association between multimorbidity and high concordance, while lower concordance was observed for women, patients with advanced cancer stages, individuals with lower education levels, those who had partners, and patients undergoing highly emetogenic chemotherapy. These results highlight the challenges in achieving accurate and complete symptom documentation in EHRs and the necessity for targeted interventions to improve the precision of clinical documentation. By addressing these gaps, health care providers can better understand and manage patient symptoms, ultimately contributing to more personalized and effective cancer care.

Withania somnifera (Ashwagandha) Improves Spatial Memory, Anxiety and Depressive-like Behavior in the 5xFAD Mouse Model of Alzheimer's Disease.

Withania somnifera (WS), also known as ashwagandha, is a popular botanical supplement used to treat various conditions including memory loss, anxiety and depression. Previous studies from our group showed an aqueous extract of WS root (WSAq) enhances cognition and alleviates markers for depression in Drosophila. Here, we sought to confirm these effects in the 5xFAD mouse model of β-amyloid (Aβ) accumulation. Six- to seven-month-old male and female 5xFAD mice were treated with WSAq in their drinking water at 0 mg/mL, 0.5 mg/mL or 2.5 mg/mL for four weeks. In the fourth week of treatment, spatial memory, anxiety and depressive-like symptoms were evaluated. At the conclusion of behavioral testing, brain tissue was harvested, immunohistochemistry was performed, and the cortical expression of antioxidant response genes was evaluated. Both concentrations of WSAq improved spatial memory and reduced depressive and anxiety-related behavior. These improvements were accompanied by a reduction in Aβ plaque burden in the hippocampus and cortex and an attenuation of activation of microglia and astrocytes. Antioxidant response genes were upregulated in the cortex of WSAq-treated mice. Oral WSAq treatment could be beneficial as a therapeutic option in AD for improving disease pathology and behavioral symptoms. Future studies focused on dose optimization of WSAq administration and further assessment of the mechanisms by which WSAq elicits its beneficial effects will help inform the clinical potential of this promising botanical therapy.

High-Frequency rTMS Broadly Ameliorates Working Memory and Cognitive Symptoms in Stroke Patients: A Randomized Controlled Trial

Objective To explore the efficacy and tolerability of high-frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke working memory (WM) impairment and its changes in brain function. Methods In the present randomized, double-blinded, sham-controlled design, 10 Hz rTMS was administered to the left dorsolateral prefrontal cortex (DLPFC) of patients with post-stroke WM impairment for 14 days. Measures included WM (primary outcome), comprehensive neuropsychological tests, and the functional near-infrared spectroscopy test. Patients were assessed at baseline, after the intervention (week 2), and 4 weeks after treatment cessation (week 6). Results Of 123 stroke patients, 82 finished the trial. The rTMS group showed more WM improvement at week 2 (t = 5.55, P < .001) and week 6 (t = 2.11, P = .045) than the sham group. Most of the neuropsychological test scores were markedly improved in the rTMS group. In particular, the rTMS group exhibited significantly higher oxygenated hemoglobin content and significantly stronger functional connectivity in the left DLPFC, right pre-motor cortex (PMC), and right superior parietal lobule (SPL) at weeks 2 and 6. Dropout rates were equal (18% [9/50 cases] in each group), and headaches were the most common side effect (rTMS: 36% [18/50 cases]; sham: 30% [15/50 cases]). Conclusions High-frequency rTMS was effective in improving post-stroke WM impairment, with good tolerability, and the efficacy lasted up to 4 weeks, which may be due to the activation of the left DLPFC, right PMC, and right SPL brain regions and their synergistic enhancement of neural remodeling.

Symptom burden among men treated for castration-resistant prostate cancer: a longitudinal study

ObjectivesDespite rapid expansion of treatments for metastatic castration-resistant prostate cancer (mCRPC) and the importance of symptom management for enhancing quality of life, few studies have focused on men’s experiences of...