Burden For Patients Research Articles

Long-Term Impact of COVID-19 on Disorders of Gut-Brain Interaction: Incidence, Symptom Burden, and Psychological Comorbidities.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has highlighted the potential exacerbation of gastrointestinal symptoms in patients with disorders of gut-brain interaction (DGBIs). However, the distinct symptom trajectories and psychological burden in patients with post-COVID-19 DGBIs compared with patients with pre-existing irritable bowel syndrome (IBS)/functional dyspepsia (FD) and non-DGBI controls remain poorly understood. To examine the long-term gastrointestinal symptom progression and psychological comorbidities in patients with post-COVID-19 DGBI, patients with pre-existing IBS/FD and non-DGBI controls. This post hoc analysis of a prospective multicenter cohort study reviewed patient charts for demographic data and medical history. Participants completed the Gastrointestinal Symptom Rating Scale at four time points: baseline, 1, 6, and 12months, and the Hospital Anxiety and Depression Scale at 6 and 12months. The cohort was divided into three groups: (1) post-COVID-19 DGBIs (2) non-DGBI, and (3) pre-existing IBS/FD, with the post-COVID-19 DGBIs group compared to the latter two control groups. Among 599 eligible patients, 27 (4.5%) were identified as post-COVID-19 DGBI. This group experienced worsening abdominal pain, hunger pain, heartburn, and acid regurgitation, unlike symptom improvement or stability in non-DGBI controls (p<0.001 for all symptoms, except hunger pain, p=0.001). While patients with pre-existing IBS/FD improved in most gastrointestinal symptoms but worsened in constipation and incomplete evacuation, patients with post-COVID-19 DGBI exhibited consistent symptom deterioration across multiple gastrointestinal domains. Anxiety and depression remained unchanged in patients with post-COVID-19 DGBI, contrasting with significant reductions in controls (non-DGBI: p=0.003 and p=0.057; pre-existing IBS/FD: p=0.019 and p=0.007, respectively). COVID-19 infection is associated with the development of newly diagnosed DGBIs and distinct symptom trajectories when compared with patients with pre-existing IBS/FD. Patients with post-COVID-19 DGBI experience progressive gastrointestinal symptom deterioration and persistent psychological distress, underscoring the need for tailored management strategies for this unique subgroup.

Provider Perceptions of Burden in Patients with Chronic Pain: Implications for Disparities in Healthcare Delivery.

Provider Perceptions of Burden in Patients with Chronic Pain: Implications for Disparities in Healthcare Delivery.

Equivalence of in-person and videoconference administration of the Physical and Neurological Examination of Subtle Signs (PANESS) timed motor section

ABSTRACT Demand for telehealth services has increased in many settings as a means of reducing patient burden and increasing access to care. It is therefore critical to understand if clinical tools validated for in-person use are feasible to administer via telehealth and, if so, how results may vary from those obtained in-person. The Revised Physical and Neurological Examination of Subtle Signs (PANESS) is a validated assessment of pediatric neuromotor functioning that is sensitive to detecting motor dysfunction in youth. The Timed Motor section of the PANESS is an ideal candidate for telehealth administration given its strong inter-rater reliability when scored via video review. Here, we preliminarily examined the feasibility of administering the Timed Motor section of PANESS via videoconferencing and its equivalence with in-person administration. We administered the Timed Motor section of the PANESS in-person and via videoconferencing in 25 typically developing youth ages 10–18 (including n = 11 who had clinically recovered from concussion). All were able to complete the assessment via videoconference. We observed moderate to excellent reliability of scores obtained in-person and via videoconference (intraclass correlations ranging from .743 to .971). Results suggest that the Timed Motor Section of the PANESS can be administered remotely in typically developing youth (including those with a history of concussion) and that the scores obtained are stable with in-person scores. Future work is needed to examine the feasibility and equivalence of telehealth-based PANESS administration in clinical settings and patient populations.

Effects of long-term oxygen therapy on acute exacerbation and hospital burden: the national DISCOVERY study

BackgroundLong-term oxygen therapy (LTOT) improves survival in patients with chronic severe resting hypoxaemia, but effects on hospitalisation are unknown. This study evaluated the potential impact of starting LTOT on acute...

MYLK-AS1 improves fracture by targeting miR-146a-5p to regulate cell viability and apoptosis in osteoblasts

BackgroundDelayed fracture healing (DFH) is a significant burden for patients. Therefore, early diagnosis and detection are important for the treatment of DFH. The long non-coding RNA (LncRNA) MYLK-AS1 is abnormally expressed in patients with DFH and has the potential to be used as a diagnostic marker.Methods40 patients with DFH and 87 patients with normal fracture healing were included. The levels of MYLK-AS1, miR-146a-5p and several mRNA markers of osteogenic differentiation were assessed by RT-qPCR. The diagnostic value of MYLK-AS1, miR-146a-5p was assessed using ROC curves. Cell proliferation ability was assessed by CCK-8, and apoptosis rate was detected by flow cytometry. DLR, RIP and RNA pull down assays demonstrated the targeting relationship between MYLK-AS1 and miR-146a-5p.ResultsMYLK-AS1 levels were significantly lower and miR-146a-5p levels were significantly up-regulated in DFH compared to normal healing patients. MYLK-AS1 was found to target miR-146a-5p, and the levels were negatively correlated with each other. MYLK-AS1 with miR-146a-5p is of high value for the diagnosis of DFH. High expression of MYLK-AS1 could inhibit miR-146a-5p levels, support cell proliferation, reduce apoptosis, and increase the levels of osteogenesis-specific matrix proteins and osteogenesis-related regulatory factors.ConclusionMYLK-AS1 has potential as a diagnostic marker for DFH. By increasing the expression level of MYLK-AS1 in cells can reduce the level of miR-146a-5p, increase the activity of osteoblasts and reduce their apoptosis rate, thus affecting the process of fracture healing.

Perspectives on long-term medical management of urea cycle disorders: insights from a survey of UK healthcare professionals

BackgroundUrea cycle disorders (UCDs) are rare inborn errors of metabolism which impact the body’s ability to detoxify ammonia produced during protein metabolism. In the UK, there is a nationally adopted guideline for the emergency management of hyperammonaemia in UCD patients, however there is no guideline for long‑term management, and treatment decisions are left to the discretion of individual healthcare professionals (HCPs).ResultsTwenty-three HCPs, comprising 13 (57%) metabolic consultants, two (9%) specialist nurses, four (17%) pharmacists, and four (17%) dietitians, participated in interviews to document their attitudes and beliefs regarding the long‑term management of UCD patients, including their current practices, treatment goals, and clinical ambitions. The highest priority for 14/23 (61%) of HCPs was to minimise the risk of hyperammonaemia, however the ammonia level that HCPs advised they aimed for varied significantly, with some targeting above the upper limit of normal. Glycerol phenylbutyrate was the highest ranked ammonia scavenger treatment amongst HCPs for safety, tolerability, duration of scavenging action and reducing patient burden, and HCPs suggested that it would be the first-line treatment in an updated guideline. All prescribing HCPs agreed they would prefer their patients receive a licenced product rather than an unlicensed one for reasons including more reliable supply, greater insurance/legitimacy, and the reassurance of regulatory scrutiny and approval. However, analysis of NHS England’s dispensing data between July 2023 and June 2024 indicated annual spend on nitrogen scavengers of £6.7 million with unlicensed specials accounting for £3 million (45%) of the total. Differences between HCPs in the awareness of clinically relevant characteristics of ammonia scavengers, including their sodium and propylene glycol content, were observed.ConclusionsTo standardise the treatment of UCDs within and between metabolic centres in the UK, there is merit in developing a UK-specific treatment guideline.

Reducing unnecessary free thyroid hormone testing by the reinforcement of a reflexive algorithm in an outpatient environment.

Reducing unnecessary free thyroid hormone testing by the reinforcement of a reflexive algorithm in an outpatient environment.

Body Mass Index Affects Hospital-Associated Disability and Economic Burden in Elective Cardiovascular Surgery - JROAD/JROAD-DPC Database.

Both underweight and overweight are recognized as important factors influencing outcomes in patients undergoing cardiovascular surgery. This study investigated the effects of body mass index (BMI) on hospital-associated disability (HAD) and hospitalization costs in patients undergoing elective cardiovascular surgery (coronary artery bypass grafting, valve surgery, aortic surgery) by analyzing data from the Japanese Registry of All Cardiac and Vascular Diseases - Diagnosis Procedure Combination (JROAD-DPC) database. All patients in the JROAD-DPC database were categorized into 5 groups according to the World Health Organization BMI criteria for Asians. HAD was defined as a decrease of ≥5 points in the Barthel Index from admission to discharge. The primary outcome was the prevalence of HAD, and the secondary outcome was hospitalization costs. Among the 228,891 patients included in the study, the median BMI was 23.2 kg/m2. The prevalence of HAD was 8.7%, with a U-shaped relationship between BMI and HAD, indicating that both extremely low and high BMIs were associated with a higher incidence of HAD. Hospitalization costs also showed a U-shape relationship with BMI, with higher costs for patients with HAD. Low BMI in any age group was associated with HAD, and older people with a BMI considered too high also had HAD. BMI could be an important risk stratification tool for functional outcomes and economic burden in patients undergoing elective cardiovascular surgery.

Effect of pharmacological pupil changes on intraocular lens power calculation: a systematic review and Meta-analysis.

To investigate the effect of pharmacological pupil alterations on intraocular lens (IOL) power calculations. A systematic review and Meta-analysis of studies published before December 2023 in the PubMed, Embase, and Cochrane library databases on the accuracy of pharmacological pupil changes on IOL power calculation was performed. The primary outcome was the results of IOL power calculations before and after the use of medications. Subgroup analyses were performed based on participants' basic characteristics, such as age, axial length (AL), and whether miosis or mydriasis were used as classification criteria for further analyses. Each eligible study was evaluated for potential risk of bias by the AHRQ assessment scale. The study was registered on PROSPERO (CRD 42024497535). A total of 3062 eyes from 21 studies were eligible. There was no significant difference in the IOL power calculation before and after pharmacological pupil changes using any of the Hoffer Q (WMD=0.055, 95%CI=-0.046-0.156; P=0.29), SRK/T (WMD=0.003, 95%CI=-0.073-0.080; P=0.93), Haigis (WMD=-0.030, 95%CI=-0.176-0.116; P=0.69), Holladay 2 (WMD=-0.042, 95%CI=-0.366-0.282; P=0.80), and Barrett Universal II (WMD=0.033, 95%CI=-0.061-0.127; P=0.49) formulas. On the measurement of parameters related to IOL power calculation, for either miosis or mydriasis AL (P=0.98 and 0.29, respectively), lens thickness (P=0.96 and 0.13, respectively), and mean keratometry (P=0.90 and 0.86, respectively) did not present significant differences, while anterior chamber depth (P=0.07 and <0.01, respectively) and white-to-white distance (P=0.01 and 0.04, respectively) changed significantly between the two measurements prior and posterior. At the same time, despite there being some participants with the difference between the before and after calculations greater than 0.5 diopter, there was no significant difference in the incidence rate between these formulas. There is no significant effect of pharmacological pupil changes on the IOL power calculation. It will considerably reduce the visit time burden for patients who require cataract surgery.

Femtosecond Laser Liquid Optics Interface as Low Vision Optical Resource

Purpose To assess the efficacy of a low-cost optical magnifier created from the repurposed femtosecond laser interface used in cataract surgery to reduce healthcare waste and financial burden for low-vision patients. Methods This prospective study included 16 Brazilian patients from the Low Vision Department of the Irmandade da Santa Casa de Misericórdia de São Paulo. Participants had visual acuity between +0.5 and +1.3 logMAR and visual field constrictions under 20°. The Catalys® femtosecond laser interface lens, usually discarded after surgery, was sterilized and attached to a recyclable support to create a magnifying device. Patients were trained to use it for 30 days. Visual function was assessed with the NEI VFQ-25, and reading performance was measured using the MNREAD-P test. Results Thirteen patients (81.25%) completed the study. The use of the optical device led to significant improvements in all MNREAD-P parameters. Reading acuity improved from 0.74 ± 0.19 logMAR (20/110 Snellen) to 0.41 ± 0.22 logMAR (20/50 Snellen) (p < 0.001). Critical print size decreased from 0.85 ± 0.19 logMAR (20/140 Snellen) to 0.56 ± 0.24 logMAR (20/70 Snellen) (p < 0.001). Maximum reading speed increased from 41.4 ± 18.0 words per minute (wpm) to 56.2 ± 25.2 wpm (p < 0.001). NEI VFQ-25 scores improved from 32.7 ± 13.8 to 46.9 ± 15.0 (p < 0.001), with increases observed in all subcategories, particularly in “Reactions to Vision Problems.” Conclusion Repurposing the femtosecond laser interface lens as a low-cost magnifier showed promising improvements in reading and visual function for low-vision patients while addressing healthcare waste. Further studies with larger samples are recommended to validate and expand this sustainable approach in visual rehabilitation.

The effect of motivational interviewing on patients with early post-stroke depression: a quasi-experimental study

BackgroundPost-stroke depression (PSD) constitutes an important complication of stroke, affecting approximately one-third of stroke patients. PSD decreases rehabilitation motivation, delays function recovery, and increases the family and social burden of stroke patients. Motivational interviewing (MI) may be an effective and practical intervention strategy, but its effectiveness in improving PSD remains uncertain.MethodsA parallel two-group quasi-experimental study was conducted. Patients with early PSD were recruited from the neurology department of a hospital in southeast China and were allocated to the control group and intervention group by wards. Patients in the intervention group received one session of face-to-face motivational interviewing and three sessions of telephone motivational interviewing, while patients in the control group received routine nursing and follow-up of the neurology department. Outcomes including depression, sleep quality, and quality of life were evaluated at baseline (T0), after intervention immediately (T1) and three months after intervention (T2). Descriptive statistics, t-test, Mann-Whitney U test, Wilcoxon signed rank sum test and generalized estimating equation were used to analyze data.ResultsThere were no significant differences in patients’ sociodemographic and clinical information between the intervention and control groups at baseline. The scores for depression were statistically different between the two groups (Z=-5.757, p < 0.001) at T1 and T2 (t=-7.964, p < 0.001). The scores for sleep quality were statistically different between the two groups at T1 (Z=-2.840, p = 0.005). The result of the generalized estimating equation modeling analyses indicated that interaction effects were statistically significant in depression and sleep quality scores. The intervention group showed a significantly higher rate of decrease in the depression score from T0 to T1 (95% CI: -11.227 to -7.748, p < 0.001) and T0 to T2 (95% CI: -11.683, -6.170, p < 0.001), compared with the control group; the intervention group had a greater reduction in the sleep score from T0 to T1 (95% CI: -2.502 to -0.962, p < 0.001), compared with the control group.ConclusionsMI could effectively improve depression and sleep quality in patients with early PSD. However, MI failed to improve quality of life in patients with early PSD. These findings provide a foundation for future large-scale randomized controlled trials to further evaluate the efficacy of MI in patients with early PSD.Trial registrationRetrospectively Registered, Chinese Clinical Trial Registry (http://www.chictr.org.cn|| ChiCTR2200064386|| Registration Date: 2022/10/06).

Generalized Pustular Psoriasis (GPP) Control is Limited on Traditional Small-molecule Therapy as Measured by the GPP Physician Global Assessment (GPPGA) and Dermatology Life Quality Index (DLQI): Baseline Data from the EFFISAYIL® 2 Trial

Introduction: GPP is a chronic inflammatory, potentially life-threatening skin disease. Most patients experience chronic skin symptoms between flares leading to significant patient burden. Spesolimab, an anti-interleukin-36 receptor monoclonal antibody, is approved to treat GPP in adults and pediatric patients aged ≥12 years and weighing ≥40 kg. EFFISAYIL® 2 (NCT04399837) evaluated the efficacy and safety of subcutaneous (SC) spesolimab in GPP. Most patients entering the trial were receiving a traditional small-molecule therapy prior to randomization and all had a baseline GPPGA1 total score of 0 or 1. Here, we report the GPPGA total score and DLQI score at baseline stratified by small-molecule medication received prior to randomization in EFFISAYIL® 2. Methods: Patients were stratified by baseline medication use, including medications received by ≥5 patients or no medication. GPPGA was assessed as the proportion of patients with a score of 1. For DLQI, mean and standard deviation (SD) were calculated. Results: Despite treatment with traditional small-molecule therapies before entering EFFISAYIL® 2, most patients in each baseline medication group did not have clear skin (GPPGA total score=1) and all groups reported poor quality of life (mean DLQI&gt;5). These observations were consistent with findings among patients who did not receive small-molecule therapy before randomization. The respective proportion of patients with a GPPGA total score of 1 by each medication group was: 95.6% (n=43) for acitretin, 84% (n=21) for cyclosporine, 66.7% (n=10) for methotrexate, and 80% (n=4) for any 2 small molecules (i.e., acitretin, methotrexate, cyclosporine), compared with 87.1% (n=27) for those not receiving prior small-molecule therapy. The mean (SD) DLQI scores at baseline were: 8.3 (5.6) for acitretin (n=45), 7.7 (7.4) for cyclosporine (n=25); 9.9 (7.4) for methotrexate (n=15), and 5.4 (7.2) for 2 small molecules (n=5); compared with 8.1 (6.1) for no therapy. Conclusion: Despite being treated with traditional small-molecule therapy before randomization, many patients entering EFFISAYIL® 2 still demonstrated incomplete skin clearance, as shown by GPPGA total score and DLQI scores, reflecting a moderate effect on a patient’s life. These findings suggest that approved, targeted therapy should be considered to reduce the clinical burden of GPP.

Cardiopulmonary exercise capacity markers and their link to symptom burden in patients at risk for heart failure with non-reduced ejection fraction

The American Heart Association (AHA) guidelines assess heart failure (HF) via comorbidities, laboratory markers, and echocardiography, while the New York Heart Association (NYHA) classification evaluates functional capacity. The primary objective of this study was to investigate the correlation between objectified HF-related symptoms and cardiac and muscular exercise capacity in Stage B HF patients with non-reduced ejection fraction. As secondary endpoints, we stratified this analysis for subgroups of NYHA classes to evaluate the primary endpoint for different levels of impairment and for sex to address for differences between men and women. Sixty-two Stage B HF patients with non-reduced EF were screened from an HF-risk cohort. Assessments included medical history, HF-related symptoms (Kansas City Cardiomyopathy Questionnaire, KCCQ), physical examination, laboratory tests, echocardiography, and cardiopulmonary exercise testing (CPET) with cardiac output monitoring. Correlations were analyzed between KCCQ score and exercise capacity markers: maximal oxygen uptake (VO2max), arterio-venous oxygen difference (avDO2), cardiac power output (CPO), mean arterial pressure (MAP), and respiratory efficiency (Ve/VO2). Subgroup analyses were performed by sex and NYHA class determined by VO2max or KCCQ functional scores. Our HF patient cohort showed reduced KCCQ scores (78.3) and VO₂max (22.9 ml/kg/min), and a progressed reduction in avDO₂. In the total cohort, KCCQ scores showed moderate correlations with Ve/VO₂ (r = -0.39) and MAP (r = 0.27). NYHA stratification by VO₂max revealed differences in avDO₂ and cardiac output but not KCCQ scores, while KCCQ-functional stratification only showed differences in Ve/VO₂. Sex-specific analysis showed KCCQ scores correlated with CPO in men (r = 0.65) and Ve/VO2 in women (r = -0.68). Our identified Stage B HFpEF cohort showed already alterations in total, cardiac and muscular exercise limitation. The HF symptom severity was weakly associated to the higher blood pressure and ventilatory inefficiency and, but moderately to strongly correlated CPO in men and Ve/VO2 in women in sex-specific analyses.

Effect of travel distance on utilization of ancillary services among patients with pancreatic ductal adenocarcinoma: A single institution study.

Fragmentation of care among patients with pancreatic cancer between specialized tertiary centers and community centers may be associated with increased patient burden and poorer outcomes. However, the impact of distance from a tertiary center on utilization of key ancillary services such as dietician consultation, and palliative or pain medicine consultation is unclear. We sought to examine how this travel distance influences the utilization of key ancillary services. This retrospective cohort study included 200 consecutive patients who were seen for a diagnosis of pancreatic ductal adenocarcinoma (PDAC) in 2021. Patients were grouped by travel distance: < 12.5, 12.5-49, and > 50 miles. Demographics, disease staging, and use of key ancillary services such as, dietician consultation, palliative, and pain medicine consultation were compared. Multiple logistic regression assessed associations between travel distance and ancillary service utilization. Of the 200 patients, 14.5% traveled < 12.5 miles, 39.5% traveled 12.5-49 miles, and 46% traveled over 50 miles to our institution. Patients living over 50 miles away were significantly more likely to receive chemotherapy and radiation locally (81.8% vs 44.4%, p < 0.001). Importantly, they were less likely to utilize key ancillary services, including registered dietician consultation (Odds Ratio (OR) 0.34, p = 0.03), pancreatic enzyme prescriptions (OR 0.35, p = 0.03), pain medicine consultation (OR 0.20, p < 0.01), and palliative care consultation (OR 0.24, p < 0.01) compared to those living closer. Patients living over 50 miles from our institution were significantly less likely to receive key supportive services. Despite similar clinical characteristics, these disparities show how initiatives are necessary to guarantee equitable access to comprehensive cancer care, regardless of geographic location.

Impact of Nusinersen on the Health-Related Quality of Life and Caregiver Burden in Patients with Spinal Muscular Atrophy with Symptom Onset before the Age of 6 Months

Impact of Nusinersen on the Health-Related Quality of Life and Caregiver Burden in Patients with Spinal Muscular Atrophy with Symptom Onset before the Age of 6 Months

Comparison of outcomes after spinal column shortening for secondary tethered cord syndrome in pediatric versus adult patients: the University of Oklahoma experience.

Spinal column shortening (SCS) is an emerging alternative to traditional untethering in cases of secondary tethered cord syndrome. It was originally described and applied in adult patients with spinal dysraphism. In the more recent past, SCS has been used in pediatric patients. A comparison between pediatric and adult patients undergoing SCS has not been performed previously. A retrospective analysis was conducted on 19 patients (11 children, 8 adults) who underwent SCS procedures from November 30, 2020, to July 21, 2024, at the University of Oklahoma. Outcomes were assessed based on changes in pain, overall symptom burden, subjective bowel/bladder symptoms, and objective testing of urodynamic function. The median follow-up period was 30 months (range 10-41 months). Most vertebral column resections were performed at the T12 level (79%), with T10-L2 being the most common fusion level (68%). There were no significant preoperative differences in clinical features between children and adults. Both children and adults experienced significant reductions in pain (p = 0.002 and p = 0.018, respectively) and overall symptom burden (p < 0.001 and p = 0.003, respectively). Complete symptom resolution was achieved in 63% of children and 25% of adults. Improvements in objective urodynamic function were observed but were not statistically significant in either group (p = 0.082 for children, p = 0.351 for adults). However, only children reported significant improvement in bowel/bladder function (p < 0.01). The difference in surgical metrics or postoperative clinical features was not significant between children and adults. SCS procedures appear to be effective in reducing pain and overall symptom burden in both pediatric and adult patients with complex tethered cord syndrome. SCS seems to improve bowel/bladder symptoms in children specifically. Further research with larger cohorts and longer follow-up periods is warranted to confirm these findings and assess long-term outcomes.

Headache relief following endoscopic drainage of Rathke’s cleft cyst

PurposeHeadache is the most common presenting complaint in patients with Rathke’s cleft cysts (RCC). The study aimed to assess the headache burden in patients undergoing endoscopic endonasal drainage of RCC.MethodsIn this longitudinal cohort study, a prospectively collected database of patients undergoing endoscopic endonasal drainage of RCC between 2017 and 2024 was analysed. The Headache Impact Test (HIT-6) and Anterior Skull Base questionnaire (ABSQ) were collected pre-operatively and at 3 weeks, 6 weeks, 3, 6 and 12 months from July 2020.Results64 RCC patients were identified, 24 of whom had HIT-6 scores collected pre-operatively and at least one post-operative time point. 67% had a headache pre-operatively (HIT-6 > 36). Overall, HIT-6 score reduced by 5 points at 6 months (95% CI -0.3, -9.0, p = 0.04) compared to pre-operatively, adjusted for age. In patients with headache pre-operatively, HIT-6 reduced on average by 7 and 6 points respectively at 6 and 12 months (p < 0.05). No association was found with sex, pre-operative pituitary dysfunction, cyst location, size, MRI signal, histopathological characteristics or reoperation. Overall QOL decreased within the first 6 weeks postoperatively, but returned to baseline thereafter. A higher HIT-6 score was associated with worse ABSQ at 12 months (p = 0.01).ConclusionIn the largest prospective study using a validated headache metric, endoscopic endonasal drainage of RCC may improve headache at 6 and 12 months post-operatively, providing long lasting relief. Surgery causes a transient worsening of QOL that resolves after 6 weeks. Headache burden directly correlated with QOL.

The effectiveness of Melissa officinalis L. essential oil inhalation on anxiety and symptom burden of hemodialysis patients: a randomized trial study

BackgroundHemodialysis patients suffer from physical and mental symptoms for which aromatherapy might be useful. This study aimed to determine the effectiveness of Melissa officinalis L. (Lemon Balm) essential oil inhalation on anxiety and the burden of symptoms in hemodialysis patients.MethodsThis study is a randomized clinical trial with a pretest-posttest design. Sixty-eight hemodialysis patients were randomly divided into intervention (who underwent Melissa officinalis L. inhalation aromatherapy 3 times a week for one month) and control (who inhaled refined sweet almond oil) groups. The intervention in both groups was conducted during the hemodialysis session. The data were collected using the state-trait anxiety inventory and Dialysis Symptom Index. Data were analyzed through SPSS-25, using Mann-Whitney, Wilcoxon, t-tests and MANOVA.ResultsBefore the intervention, both groups were similar in terms of anxiety and symptoms burden (P > 0.05). However, after the intervention, a significant difference was found between the groups in terms of state and trait anxiety, and severity of constipation, nausea, vomit, diarrhea, swelling in legs, muscle cramps and shortness, worry, nervousness and anxiety, and trouble staying asleep. Moreover, after the intervention, a significant difference was observed between the groups regarding the prevalence of symptoms burden such as feeling anxious and having a dry mouth (P < 0.05).ConclusionMelissa officinalis L. essential oil inhalation aromatherapy reduced the symptoms burden and anxiety in hemodialysis patients. Given the effectiveness of aromatherapy in hemodialysis patients, it is suggested that healthcare workers should use this complementary and integrative health to reduce the anxiety and symptoms burden in hemodialysis patients.Trial registration RCT registryIranian Registry of Clinical Trials (IRCT) number: IRCT20191021045178N3; Registration date 27/04/2021.

The analysis of prognostic value of liver metastatic burden for non-functional pancreatic neuroendocrine tumors with synchronous liver metastasis after curative surgery: a retrospective study in a single center

Background: Pancreatic neuroendocrine tumors (pNETs) with synchronous liver metastasis (NELM) are associated with poor prognosis. Radical surgery is the only curative treatment option for these patients. However, the prognostic indicators for NELM patients who underwent radical surgery remain unclear. This study aimed to evaluate the prognostic value of liver metastasis burden (LMB) and other general clinicopathological indicators in patients who underwent radical resection. Methods: A retrospective analysis was conducted on a cohort of 36 patients who underwent surgery between January 2016 and December 2023. The LMB indicator was defined as the ratio of metastatic volume to liver volume (RML). The optimal cut-off value of RML was identified via X-tile software, dividing population into high and low groups. Results: Kaplan-Meier (KM) curves for progression-free survival (PFS) revealed a significant difference between high and low groups of RML (p = 0.0041), but there were no statistical differences in overall survival (OS) between the two groups (p = 0.3092). Cox regression univariable analysis indicated that only high RML was associated with poor PFS (Hazard ratio = 4.42, 95% confidence interval: 1.48 – 13.22, p = 0.008). However, it was not significantly associated with OS (p = 0.331). High RML emerged as an independent risk factor for PFS in these patients (Hazard ratio = 4.73, 95% confidence interval: 1.59 – 14.03, p = 0.005). In the high RML group, patients receiving preoperative chemotherapy or chemotherapy plus somatostatin analogues (SSA), had lower recurrence rates compared to those without chemotherapy or without chemotherapy plus SSA, respectively. No such benefit was observed in the low RML group. Conclusion: RML may serve as an effective prognostic indicator of PFS for patients with NELM who undergo curative surgery. For these patients with high liver metastatic burden, preoperative treatment regimens containing chemotherapy should be recommended.

The effect of attribute framing on beliefs and attitudes toward branded and generic medications.

Generic medications are developed to match brand-name medications in terms of active ingredients, quality, safety, and strength. Because generic medications cost less than their brand-name counterparts, they present an opportunity to reduce financial burden for patients and social institutions. Studies show, however, that patients often possess negative beliefs and evaluations of generic medications, thereby undermining use and effectiveness. In two pre-registered online experiments with community adults (Total N = 750), we tested the effect of attribute framing on attitudes, attitude certainty, and effectiveness beliefs regarding generic and brand-name medications. In both experiments, framing (positive vs. negative) and brand status (generic vs. brand name) of an allergy medication were manipulated in a 2 × 2 between-participant design. The results of both experiments produced strong effects of the framing and brand status manipulations. Specifically, allergy medicines were rated more favorably with a positive frame as compared to a negative frame. Also, branded allergy medicines were rated more positively than generic allergy medicines. In contrast with the pre-registered hypotheses, the two manipulated variables did not reliably interact to predict outcomes. These results held constant across multiple sets of stimuli and dependent measures. The findings support the position that positive framing can be employed to improve positive evaluations and effectiveness beliefs for both over-the-counter generic and branded medications.