Pain Distress Research Articles

Effect of a Distraction Method on Pain, Anxiety and Behavioral Distress among Children during Venipuncture

Effect of a Distraction Method on Pain, Anxiety and Behavioral Distress among Children during Venipuncture

Study on chronic pain distress and coping strategies of the elderly in nursing home

Study on chronic pain distress and coping strategies of the elderly in nursing home

Comment on: [The Relationship Between Pain Distress Severity and Fatigue Levels of Women with Breast Cancer Receiving Chemotherapy: A Descriptive Cross-sectional Study

Bu yazıda “Kemoterapi Alan Meme Kanserli Kadınların Ağrı Distresi Şiddeti ve Yorgunluk Düzeyleri Arasındaki İlişki: Tanımlayıcı Kesitsel Bir Çalışma” isimli araştırma makalesine fiziyatrist bakış açısıyla katkı sunmak ve bilgilerimi paylaşmak istiyorum.

Using Automated Machine Learning to Predict Necessary Upcoming Therapy Changes in Patients With Psoriasis Vulgaris and Psoriatic Arthritis and Uncover New Influences on Disease Progression: Retrospective Study.

Psoriasis vulgaris (PsV) and psoriatic arthritis (PsA) are complex, multifactorial diseases significantly impacting health and quality of life. Predicting treatment response and disease progression is crucial for optimizing therapeutic interventions, yet challenging. Automated machine learning (AutoML) technology shows promise for rapidly creating accurate predictive models based on patient features and treatment data. This study aims to develop highly accurate machine learning (ML) models using AutoML to address key clinical questions for PsV and PsA patients, including predicting therapy changes, identifying reasons for therapy changes, and factors influencing skin lesion progression or an abnormal Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score. Clinical study data from 309 PsV and PsA patients were extensively prepared and analyzed using AutoML to build and select the most accurate predictive models for each variable of interest. Therapy change at 24 weeks follow-up was modeled using the extreme gradient boosted trees classifier with early stopping (area under the receiver operating characteristic curve [AUC] of 0.9078 and logarithmic loss [LogLoss] of 0.3955 for the holdout partition). Key influencing factors included the initial systemic therapeutic agent, the Classification Criteria for Psoriatic Arthritis score at baseline, and changes in quality of life. An average blender incorporating three models (gradient boosted trees classifier, ExtraTrees classifier, and Eureqa generalized additive model classifier) with an AUC of 0.8750 and LogLoss of 0.4603 was used to predict therapy changes for 2 hypothetical patients, highlighting the significance of these factors. Treatments such as methotrexate or specific biologicals showed a lower propensity for change. An average blender of a random forest classifier, an extreme gradient boosted trees classifier, and a Eureqa classifier (AUC of 0.9241 and LogLoss of 0.4498) was used to estimate PASI (Psoriasis Area and Severity Index) change after 24 weeks. Primary predictors included the initial PASI score, change in pruritus levels, and change in therapy. A lower initial PASI score and consistently low pruritus were associated with better outcomes. BASDAI classification at onset was analyzed using an average blender of a Eureqa generalized additive model classifier, an extreme gradient boosted trees classifier with early stopping, and a dropout additive regression trees classifier with an AUC of 0.8274 and LogLoss of 0.5037. Influential factors included initial pain, disease activity, and Hospital Anxiety and Depression Scale scores for depression and anxiety. Increased pain, disease activity, and psychological distress generally led to higher BASDAI scores. The practical implications of these models for clinical decision-making in PsV and PsA can guide early investigation and treatment, contributing to improved patient outcomes.

Unraveling the Complexity of Peyronie's Disease: A Comprehensive Exploration

Peyronie's disease (PD) stands as a distinctive pathology within the realm of urology, presenting a multifaceted clinical panorama characterized by the development of fibrous plaques in the tunica albuginea of the penis. Named after the 18th-century French surgeon François Gigot de la Peyronie, this disorder engenders penile deformities, pain, and psychological distress, underscoring the need for a nuanced understanding and comprehensive management approach. This article endeavors to provide an exhaustive exploration of PD, delving into its intricate etiology, pathophysiological underpinnings, clinical manifestations, and the far-reaching implications on psychosocial well-being. The disease's genesis intertwines genetic predispositions, microtrauma during sexual activity, and inflammatory responses, culminating in dysregulated wound healing processes marked by the excessive deposition of collagen. From a clinical standpoint, PD transcends beyond its physical manifestations, adversely impacting patients' mental and emotional states. The altered penile morphology and compromised sexual function pose not only physical challenges but also unravel a complex tapestry of psychological consequences. As such, this article scrutinizes the dual facets of PD, advocating for a holistic approach that addresses both the physical and psychosocial dimensions of the disease. Diagnostic modalities, ranging from clinical evaluation to imaging techniques, form a pivotal aspect of our discourse, providing clinicians with a comprehensive armamentarium for accurate and timely diagnosis. Moreover, an exhaustive review of treatment modalities, encompassing conservative measures, pharmacotherapy, and surgical interventions, aims to distill evidence-based insights guiding therapeutic decision-making. This comprehensive analysis seeks to contribute substantively to the existing body of knowledge, fostering a deeper understanding of PD within the medical community. By amalgamating clinical insights with emerging research trends, this article endeavors to illuminate the path toward refined diagnostic strategies and novel therapeutic interventions, ultimately striving for improved patient outcomes and an elevated standard of care in the management of Peyronie's disease.

Needle-Free Jet Injector-Assisted Triamcinolone Treatment of Keloids and Hypertrophic Scars is Effective and Well Tolerated in Children.

Keloids and hypertrophic scars can cause severe pain, pruritus, and psychological distress. Conventional intralesional corticosteroid treatment with needle injections remains challenging, especially in children with needle phobia. We aimed to evaluate the effectiveness, tolerability, and patient satisfaction of intralesional treatment with triamcinolone acetonide using a needle-free electronic pneumatic jet injector in children with keloids and hypertrophic scars. A retrospective study was performed in children with keloids and hypertrophic scars who received intralesional triamcinolone acetonide treatments using an electronic pneumatic jet injector. Effectiveness was evaluated using the Patient and Observer Scar Assessment Scale and Global Aesthetic Improvement Score at follow-up versus baseline. Tolerability was assessed with reported adverse effects and injection-related pain using a visual analog scale. Satisfaction questionnaires were used to evaluate treatment-related patient satisfaction. Six female patients and five male patients aged 5-17 years, with a total of >118 keloids or hypertrophic scars were included. Electronic pneumatic jet injector treatment led to a significant reduction in the total Patient and Observer Scar Assessment Scale observer and patient scores compared with baseline, with a median reduction of 28.9% and 23.8%, respectively (p = 0.005; p = 0.009). Median visual analog scale pain scores for electronic pneumatic jet injector treatment were significantly lower compared with needle injections, 3.0 versus 7.0, respectively (p = 0.027). No severe adverse effects were reported. Overall, 6 patients were 'satisfied' and five patients were 'very satisfied' with the treatment. Electronic pneumatic jet injector-assisted intralesional triamcinolone acetonide is an effective and well-tolerated treatment for keloids and hypertrophic scars in children. It should be considered as an alternative non-traumatic delivery method, especially in children with needle phobia or severe pain during previous needle injections.

Can emotional distress induce acute low back pain? A systematic review

INTRODUCTION: Low back pain (LBP) is a leading cause of disability worldwide. A spectrum of psychological conditions such as anxiety, fear, stress and low mood are often reported to co-occur in individuals with persistent back pain and are cited as reasons for the continued experience of pain. However, any potential causal effect of emotional distress on new onset LBP is understudied. Therefore, the aim of this review is to examine the impact of emotional distress as a risk factor for new presentations of acute low back pain. METHODS: A systematic review was performed in accordance with the PRISMA guidelines. The Medline, Embase and APA databases were searched for primary research articles exploring emotional distress and low back pain. Prospective studies that investigated subjects initially free from back pain, who also undertook some form of psychometric testing at baseline, were included in the review. In total, 6 studies were identified with a broad geographical spread and diverse population cohorts including pregnant women, forestry workers, nursing students, adolescents, individuals with medical comorbidities and adult population studies. RESULTS: The results from all six studies found a significant relationship between an initial presence of emotional distress and subsequent onset of acute low back pain. CONCLUSION: This review encourages the acknowledgement of underlying emotional distress as a risk factor in acute low back pain, and to address it as part of the overall management plan.

The relation of body mass index and total symptom burden in female oncologic patients

Objectives: Examine the relationship between obesity and symptom burden (SB) among female oncologic patients evaluated in cancer rehabilitation (CR) clinics. Secondary aims included evaluation of the relationship between obesity and SB among race, types of cancer, comorbid conditions and differences in symptom severity on the Edmonton Symptom Assessment Scale (ESAS) questionnaire across body mass index. Background: Obesity is a risk factor for some types of breast and gynecologic cancers. Studies have shown an increased risk for pain persistence and higher symptom severity experienced by obese female patients who undergo oncologic treatments. The severity of symptom burden (SB), however, has not been studied in obese oncologic patients in the rehabilitation medicine setting. Methods: Retrospective chart review study in CR clinics, single institution. All the medical records of female patients (n = 61) who completed ESAS on initial evaluation in CR clinics were evaluated, from August 2020 to January 2022. Results: Obese female patients reported increased SB based on the ESAS questionnaire, specifically three symptom domains: pain, drowsiness, and spiritual distress. Conclusions: Nutrition counseling and lifestyle modifications in CR clinics may positively impact SB.

A Working Definition of Acute Chest Syndrome without the Requirement of Chest X-Rays

Introduction:Sickle Cell Disease (SCD) is a rare genetic disease in high-income countries where most of the cited literature used to guide clinical management emanate from. One of the most serious and potentially fatal complications of SCD is acute chest syndrome (ACS) which requires immediate medical attention. Approximately 50% of individuals with SCD will eventually develop ACS ( Blood 84, 643-649 (1994)). Despite the high frequency of ACS and its associated risk of death, no consensus diagnosis has been established that applies to children and adults living in low-middle income countries, where 95% of the children born with SCD are found. To create a uniform definition of ACS in both low, middle, and high-income countries, we propose using a new ACS definition that does not require a chest X-ray. Additionally, the new ACS definition should have a quantifiable and reproducible physical examination and clinical findings to allow for the reproducibility of the definition in all settings. This definition was developed over several years at Korle Bu Teaching Hospital, Accra Ghana, in pregnant women with SCD. Before we started the multidisciplinary team care in pregnant women with SCD, ACS was the most common cause of maternal death. Subsequently, based on the new ACS definition that did not require a chest X-ray, we developed strategies to prevent, aid early diagnosis, and treat ACS resulting in an 89% relative risk reduction of death. We refer to this new definition as the Korle Bu Teaching Hospital (KBTH)-ACS definition. In this study, we compare the ACS definition in the top 20 cited ACS articles as of July 2023 with our proposed KBTH-ACS definition. Methods:Using Google Scholar, we identified the top 20 cited articles with ACS in children or adults with SCD as primary or secondary outcomes. Each article was reviewed for the presence of the following criteria: chest x-ray, vitals, hemoglobin oxygen saturation, and lung physical exam findings. We compared the definition of ACS in the top 20 cited ACS articles to the KBTH-ACS definition that included the following features: “abnormal findings on lung auscultation and the presence of at least 2 of the following criteria: 1) temperature ≥ 38.0°C, 2) increased respiratory rate greater than the 90th percentile for age, positive chest pain or pulmonary auscultatory findings, 3) hemoglobin oxygen saturation decrease by ≥3% from a documented steady-state value on room air, and 4) a new radiodensity on chest roentgenogram. A diagnosis of pneumonia was considered an ACS episode.”. Results:The 20 most cited ACS articles required radiographical criteria to diagnose ACS. Fourteen of twenty articles included fever in their ACS definition. However, only 4 articles specified any temperature and all specified ≥ 38.5 ºC. A total of 17 articles mentioned the presence of lung or respiratory findings, but only 12 articles specifically identified the pulmonary findings. Among the 12 articles that specified lung findings, 5 included increased respiratory rate (tachypnea) without a specific definition, 2 included abnormal auscultatory findings, and 3 included hypoxemia/hypoxia in their definition. However. One study defined hypoxemia/hypoxia as “transcutaneous oxygen saturation <85% despite supplemental oxygen.”. Another article included “SpO2 of ≥ 3% compared to baseline steady-state values.”. In addition, among the twelve studies that specified respiratory findings, the following were present or absent features: chest pain (n=12), wheezing (n=3), coughing(n=3), and respiratory distress without a formal definition (n=3). No article included pneumonia in the ACS definition nor defined a threshold for tachypnea that was age-adjusted. None of the articles would allow for a direct comparison with the KBTH-ACS definition. Conclusion: All the 20 most cited ACS articles required a chest X-ray with various clinical and physical examination findings. Many of the ACS definitions in these studies were based on clinical impressions that were not quantifiable or reproducible. We propose using the KBTH-ACS definition in future ACS studies to improve generalizability, reproducibility, and genotype and phenotype studies designed to elucidate the genetic variation of lung disease in children and adults with SCD.

OGBN P25 A systematic review and clinical evaluation of Morphine Versus pethidine as a good drug choice to control for biliary colic before and after cholecystectomy

Abstract Background The most commonly recommended pharmaceuticals for biliary and pancreatic pain are arguably morphine and pethidine, both of which can elicit varying effects at the gallbladder, common bile duct, and sphincter of Oddi levels. Morphine stimulates Oddi's sphincter motility, causing upper abdominal pain and biliary distress symptoms in certain patients. Pethidine is thought to have less consequences on the sphincter of Oddi than morphine. This analysis aims to evaluate the comparative outcomes and effect of morphine versus pethidine on the sphincter of Oddi and biliary colic control. Methods A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library and Science Direct. Comparative studies comparing effect of morphine versus pethidine on sphincter of Oddi pressure were included. Revman 5.4 (Cochrane, London, United Kingdom) was used for the data analysis. Results The results show four studies were eligible to be included in this review with a total number of 151 patients divided between morphine group (n=111) and pethidine group (n=40). Two prospective studies and two clinical trials were included in this review. The rate of sphincter of Oddi pressure was significantly higher in morphine group compared to pethidine group: odds ratio (OR)=1.39, and (OR) =7.82, p=0.005, respectively. Conclusions The analysis shows significant difference in sphincter of Oddi pressure when morphine used as analgesic drug to control the biliary colic compared to pethidine which seems to provide low pressure at the level of sphincter of Oddi and good control of biliary colic than morphine, however more studies and clinical trials are needed.

“It’s all connected:” A mixed methods study of insomnia, stigma, and discrimination among individuals on medication for opioid use disorder

ObjectivesInsomnia is one of the most common sleep disorders among those with opioid use disorder (OUD), including those on medication for OUD. There is a dearth of literature exploring the role of social stressors on sleep outcomes among this group. The purpose of this study was to explore the association between OUD-related stigma and intersectional discrimination with insomnia among individuals on medication for OUD. MethodsParticipants were recruited from treatment clinics in the Northeast United States. Using a convergent mixed-methods research design, we explored associations with stigma (The Brief Opioid Stigma Scale), intersectional discrimination (Intersectional Discrimination Index), and insomnia (Insomnia Severity Index) through quantitative survey data and qualitative data from interviews for participant experiences. Data from the quantitative (n = 120) and qualitative (n = 25) components of the study were integrated for interpretation. ResultsQuantitative analysis indicated weak to moderate positive correlations between intersectional discrimination, and exploratory variables including pain, perceived stress, and psychological distress with insomnia severity. The qualitative analysis generated 4 main themes, which highlighted negative emotions and ruminations as factors that participants connected experiences with stigma and discrimination to poor sleep outcomes. Integration of data identified concordant and discordant findings. ConclusionsStigma, discrimination, physical symptoms, and psychological distress appear to contribute to poor sleep outcomes among those with OUD. Future research should target maladaptive outcomes of rumination and negative emotions to improve sleep outcomes among those with OUD.

Diagnostic and Predictive Value of Brachial–Ankle Pulse Wave Velocity and Pulse Pressure Index for Coronary Heart Disease in Elderly Patients With Hypertension

Abstract OBJECTIVE To explore the diagnostic and predictive value of pulse pressure index (PPI) and brachial–ankle pulse wave velocity (baPWV) for coronary heart disease (CHD) in elderly patients with hypertension. METHODS A total of 307 elderly patients who had chest pain or chest distress and coronary angiography were enrolled. According to the Gensini score, patients with CHD (n = 260) were divided into low-risk group (<20 points, n = 96), moderate-risk group (20–40 points, n = 80), and high-risk group (>40 points, n = 84). baPWV was measured using an ankle–brachial index and pulse wave measuring device. Multivariate logistic regression analysis was used to analyze the risk factors of CHD. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of baPWV and PPI for CHD. RESULTS PPI and baPWV of elderly hypertensive patients with CHD at low, moderate, and high risk were higher than those without CHD [PPI: 0.43 ± 0.04, 0.45 ± 0.04, 0.45 ± 0.05 vs. 0.41 ± 0.05, F = 31.768, P < 0.001; baWV: 1,671 (1,587–1,755), 1,717 (1,597–1,843), 1,780 (1,661–1,960) vs. 1,570 (1,477–1,699) cm/s, X2 = 60.918, P < 0.001]. With the increase in CHD severity, the PPI and baPWV were significantly increased (P < 0.05). Spearman/Pearson correlation analysis showed that the Gensini score was positively correlated with baPWV and PPI, respectively (both P < 0.001). Multivariate logistic regression analysis showed that baPWV, PPI, and systolic blood pressure were the influencing factors of CHD in hypertensive patients. The areas under the ROC curve (95% CI) of baPWV, PPI, and their combination for diagnosing CHD were 0.792 (0.723–0.861), 0.708 (0.625–0.792), and 0.837 (0.779–0.895), respectively, and was significantly different between baPWV or PPI alone and the combination of the 2 (Z = −2.178, P = 0.029; Z = −3.330, P = 0.001). CONCLUSIONS Elevations of baPWV and PPI are positively correlated with the severity of CHD. Both baPWV and PPI have a diagnostic and predictive value for CHD in elderly hypertensive patients, and the combination of baPWV and PPI is more accurate.

Impact of central sensitization on pain, disability and psychological distress in patients with knee osteoarthritis and chronic low back pain

BackgroundCentral sensitization (CS) is becoming increasingly recognized as a significant factor in many chronic pain conditions, including knee osteoarthritis (KOA) and chronic low back pain (CLBP). Yet it presently remains unclear how strong is the involvement of CS in KOA and CLBP and which factors are involved in CS in these two chronic disabling diseases.MethodsThis is a cross-sectional study in which included a total of 178 patients with KOA and 118 patients with CLBP. Inclusion criteria for eligible participants for the KOA group were a confirmed diagnosis of KOA according to the American College of Rheumatology criteria, and for the CLBP group a chronic low back pain for more than 3 months. Subjects were excluded if they presented with a diagnosed psychiatric disorder or if they lacked the capacity to provide informed consent, understand study questionnaires or perform physical performance tests. In each group, were assessed; CS-related symptoms using the Central Sentization Inventory (CSI); demographic and clinical characteristics such as disease duration, pain intensity on a visual analog scale, self-reported function using the Lequesne index for KOA patients and the Oswestry Disability index for CLBP patients, and physical performance with the 6 minutes’ walk test; as well as psychosocial risk factors using the Patient Health Questionnaire for depression (PHQ-9), the Generalized Anxiety Disorder (GAD-7) and the Pain Catastrophizing Scale (PCS).ResultsCSI scores significantly correlated with pain intensity and disability in KOA and CLBP patients, and were highly correlated with self-reported symptoms of depression, anxiety and pain catastrophizing. Depression significantly predicted the CSI score in both groups.ConclusionThese findings provide further evidence for the impact of CS on pain, function and physical performance in KOA and CLBP patients. Psychosocial symptoms such as pain catastrophizing, anxiety and depression should also be considered as they are also associated with CS.

A human mesenchymal spheroid prototype to replace moderate severity animal procedures in leukaemia drug testing.

Patient derived xenograft (PDX) models are regarded as gold standard preclinical models in leukaemia research, especially in testing new drug combinations where typically 45-50 mice are used per assay. 9000 animal experiments are performed annually in the UK in leukaemia research with these expensive procedures being classed as moderate severity, meaning they cause significant pain, suffering and visible distress to animal's state. Furthermore, not all clinical leukaemia samples engraft and when they do data turnaround time can be between 6-12 months. Heavy dependence on animal models is because clinical leukaemia samples do not proliferate in vitro. Alternative cell line models though popular for drug testing are not biomimetic - they are not dependent on the microenvironment for survival, growth and treatment response and being derived from relapse samples they do not capture the molecular complexity observed at disease presentation. Here we have developed an in vitro platform to rapidly establish co-cultures of patient-derived leukaemia cells with 3D bone marrow mesenchyme spheroids, BM-MSC-spheroids. We optimise protocols for developing MSC-spheroid leukaemia co-culture using clinical samples and deliver drug response data within a week. Using three patient samples representing distinct cytogenetics we show that patient-derived-leukaemia cells show enhanced proliferation when co-cultured with MSC-spheroids. In addition, MSC-spheroids provided improved protection against treatment. This makes our spheroids suitable to model treatment resistance - a major hurdle in current day cancer management Given this 3Rs approach is 12 months faster (in delivering clinical data), is a human cell-based biomimetic model and uses 45-50 fewer animals/drug-response assay the anticipated target end-users would include academia and pharmaceutical industry. This animal replacement prototype would facilitate clinically translatable research to be performed with greater ethical, social and financial sustainability.

Comparative study of topical 5-aminolevulinic acid photodynamic therapy and surgery for the treatment of vulvar squamous intraepithelial lesion

BackgroundVulvar squamous intraepithelial lesion (SIL) is a precursor lesion of vulvar squamous cell carcinoma. The current clinical treatments for vulvar SIL cause damage to the vulvar structure, chronic pain and psychological distress. Topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a novel, non-invasive therapy for intraepithelial lesions. The objective of this study was to compare the clinical efficacy and safety of ALA-PDT with local surgical resection for vulvar SIL. MethodsA total of 56 patients with vulvar SIL were enrolled in this retrospective study. Among them, 16 patients received local resection and 40 patients received ALA-PDT. HPV genotyping and ThinPrep cytologic test (TCT) were used to evaluate treatment efficacy. In addition, colposcopy-directed biopsy was performed in all patients at 3-month follow-up and in patients with positive high-risk human papillomavirus (HR-HPV) and/or abnormal TCT results during the follow-up. ResultsAt 3-month follow-up and in HSIL group the complete remission (CR) rate of the ALA-PDT group and surgery group was 90.6% (29/32) and 87.5% (14/16) (P = 1.000), respectively. The HPV clearance rate of the ALA-PDT group and surgery group was 45.2% (14/31) and 43.8% (7/16) (P = 0.927), respectively. The average numbers of ALA-PDT treatments were 5.34 for HSIL patients and 4.88 for LSIL patients, respectively. The CR rate of HSIL patients and LSIL patients was 90.6% (29/32) and 75.0% (6/8) (P = 0.550), respectively. The HPV clearance rate of HSIL patients and LSIL patients was 45.2% (14/31) and 37.5% (3/8) (P = 1.000), respectively. The ALA-PDT group showed similar clinical efficacy and milder adverse effects compared with the surgical group. ConclusionALA-PDT showed similar clinical efficacy as surgery in the treatment of vulvar SIL, but with milder adverse effects and maintaining the integrity of the vulvar structure.

Influence of health literacy on health-related quality of life after total hip arthroplasty

IntroductionPersonal knowledge about the own disease, a key component of health literacy (HL), may have a considerable impact on treatment outcomes. The purpose of this study was to investigate whether the patients’ knowledge about the surgical procedure, risks, and aftercare, as well as the satisfaction with the preoperative level of information, has an influence on the health-related quality of life (HRQoL) after primary total hip arthroplasty (THA).Materials and methodsA total of 176 patients (68.3 ± 10.3 years, 60.8% female) were evaluated. HRQoL was assessed prior to surgery as well as one and twelve months after THA using the 12-item Short Form Questionnaire. Following standardized surgical informed consent, HL was assessed preoperatively using a self-constructed quiz score, while information satisfaction was measured with a single-item rating scale. Sociodemographic and clinical characteristics, including pain (VAS), functionality (WOMAC), and psychological distress (PHQ-4), were also assessed at baseline. Multiple linear regression analyses were performed to examine whether HL, satisfaction with information, age, social class, WOMAC, VAS, and PHQ-4 predict HRQoL at one and twelve months post-surgery.ResultsThe average HL quiz score was 23 ± 5.1 out of a possible 33 points. Social class index significantly influenced HL (p < 0.001). A weak correlation between HL and age (r = 0.23, p = 0.01) and no correlation between HL and psychological distress (p = 0.868) were observed. One month after THA, physical HRQoL was significantly predicted by the WOMAC index (p = 0.031) and subjective satisfaction with information (p = 0.022), but not by HL. After twelve months, only the WOMAC was a significant predictor (p < 0.001) of physical HRQoL.ConclusionAlthough subjective satisfaction with the patient’s preoperative level of information had a significant effect on the physical HRQoL at one month after THA, the influence of osteoarthritis severity outweighed this effect after twelve months. HL had no direct influence on HRQoL. These results suggest that patient satisfaction, rather than knowledge, predicts HRQoL.

Post-traumatic growth in cancer survivors: What is its extent and what are important determinants?

Background/ObjectiveThe aim was to investigate the extent and longitudinal determinants of post-traumatic growth (PTG) in cancer survivors. MethodsA sample of 1316 cancer survivors with various cancer types was examined using the EORTC QLQ-FA12 to assess fatigue, the EORTC QLQ-C30 pain items to assess pain and the Patient Health Questionnaire (PHQ-4) to assess emotional distress two years after diagnosis (t0). Additionally, patients rated how well they felt informed about fatigue at t0. PTG was assessed with the 21-item PTG-Inventory four years after diagnosis (t1) comprising the five subdimensions appreciation of life, relation to others, personal strengths, new possibilities and spiritual change. ResultsRegarding the extent of PTG, most positive developments were experienced in the PTG subdimension appreciation of life whereas the subdimension spiritual change was the least pronounced domain. Fatigue, pain and emotional distress were longitudinal but non-linear predictors of long-term PTG. Additionally, poor informedness about fatigue was associated with less PTG. ConclusionsPTG can be perceived even years after a traumatic cancer event and is longitudinally associated with common cancer side effects like fatigue, emotional distress and pain. Further research into the role of individuals' informedness contributing to PTG is needed.

Maternal Outcome in Patients with Abruptio Placenta: A Comprehensive Analysis in A Tertiary Care Hospital

Background: Abruptio placenta is a critical obstetric condition characterized by the premature detachment of the placenta from the uterine wall, leading to significant maternal and fetal risks. Despite its rarity, the condition demands prompt diagnosis and intervention due to the high morbidity and mortality associated with it. Prior research has established a link between maternal hypertension and increased risk of severe complications such as hemorrhagic shock, disseminated intravascular coagulation (DIC), and organ failure. Objective: This study aimed to analyze the maternal outcomes of patients with Abruptio placenta in a tertiary care setting, with a specific focus on the association between hypertension and maternal complications. Methods: A prospective cohort study was conducted over a three-month period at the Obstetrics and Gynecology Department of Khyber Teaching Hospital, Peshawar. A sample size of 100 patients was determined based on the anticipated frequency of cases. Inclusion criteria were patients diagnosed with Abruptio placenta during antenatal care or at admission for delivery. Comprehensive data on demographics, medical history, clinical presentation, and management strategies were collected using standardized forms. Ethical approval was obtained from the institutional review board, and informed consent was secured from all participants. The statistical analysis was performed using SPSS version 25, with a significance level set at p &lt; 0.05. Results: The study included 105 patients with a mean age of 28.6 years; 64.8% were multiparous, and 40.0% had hypertension. Clinical presentation included vaginal bleeding (92.4%), abdominal pain (83.8%), and fetal distress (72.4%). The majority (59.0%) were diagnosed during antenatal care, while 41.0% were diagnosed at admission. Emergency Cesarean section was performed in 93.3% of cases. Blood transfusions were required for 23.8% of patients, and 28.6% presented with a low amniotic fluid index. The mean gestational age at delivery was 34.2 weeks. The analysis revealed a significant association between hypertension and the incidence of haemorrhagic shock (12 cases with hypertension, 2 without), DIC (5 cases with hypertension, 2 without), and organ failure (3 cases with hypertension, 1 without). Conclusion: The study affirms the heightened risk of severe maternal complications associated with hypertension in patients with Abruptio placenta. The high rate of emergency Cesarean sections and blood transfusions underscores the urgency and complexity of managing this condition. These findings highlight the necessity for vigilant antenatal monitoring and rapid intervention strategies in tertiary care settings.

Self-reported symptoms experienced by intensive care unit patients: a prospective observational multicenter study

PurposeThe purpose of this study is to describe the prevalence, intensity and distress of five symptoms in intensive care unit (ICU) patients and to investigate possible predictive factors associated with symptom intensity.MethodsThis is a prospective cohort study of ICU patients. A symptom questionnaire (i.e., Patient Symptom Survey) was used to describe the prevalence, intensity and distress of pain, thirst, anxiousness, tiredness, and shortness of breath over seven ICU days. Associations between symptom intensity and possible predictive factors were assessed using the general estimating equation (GEE) model.ResultsOut of 603 eligible patients, 353 (Sample 2) were included in the present study. On the first ICU day, 195 patients (Sample 1) reported thirst as the most prevalent symptom (66%), with the highest mean intensity score (6.13, 95% confidence interval (CI) [5.7–6.56]). Thirst was the most prevalent (64%) and most intense (mean score 6.05, 95%CI [5.81–6.3]) symptom during seven days in the ICU. Anxiousness was the most distressful (mean score 5.24, 95%CI [4.32–6.15]) symptom on the first day and during seven days (mean score 5.46, 95%CI [4.95–5.98]). During seven days, analgesic administration and sepsis diagnosis were associated with increased thirst intensity. Older age and being mechanically ventilated were associated with decreased pain intensity, and analgesic administration was associated with increased pain intensity. Family visits and female gender were associated with increased intensity of anxiousness and shortness of breath, respectively.ConclusionsSelf-reporting ICU patients experienced a high and consistent symptom burden across seven days. Certain variables were associated with the degree of symptom intensity, but further research is required to better understand these associations.

Mental and Physical Health-Related Cannabis Motives Mediate the Relationship between Childhood Trauma and Problematic Cannabis Use over Time among Emerging Adult Cannabis Users

Background While growing evidence has identified mental and physical health-related cannabis use motives as significant mechanisms between childhood trauma and problematic cannabis use (PCU) for emerging adults (EA), there is a need to understand the longitudinal stability of these pathways and how they impact PCU as cannabis users age into later adulthood. Methods The current study extends an analysis examining the impact of childhood trauma (e.g., emotional abuse, sexual abuse) on multiple indicators of PCU through a range of cannabis use motives. 339 medical cannabis patient and non-patient EA users from the Los Angeles area were sampled at baseline (mean age = 21.23; SD = 2.48). The present analysis used four waves of follow-up data collected from 2016 to 2018 (W3, W4) and 2019-2020 (W5, W6). Results Use of cannabis to cope with nausea, sleep, pain, and emotional distress mediated the relationships between some types of childhood abuse and PCU at W4, though most associations attenuated by later adulthood (W6). Specifically, greater emotional distress and nausea motives were associated with greater PCU in models of emotional abuse and neglect and sexual abuse, with emotional distress continuing to mediate at W6. Conversely, sleep and pain motives were associated with lower PCU in models for emotional neglect. Conclusions Mental and physical health-related motives reflect potential intervenable factors that predict PCU in emerging adulthood among EA cannabis users with histories of childhood trauma. Results highlight the importance of and value for assessing a wide range of motives and PCU outcomes to target and address areas for intervention.