Perceived Symptom Severity Research Articles

Evaluating the acceptability and efficacy of a psycho‐educational intervention for coping and symptom management by children with cancer: a randomized controlled study

To evaluate the acceptability and efficacy of a psycho-educational intervention designed to improve effective coping and reduce symptom severity in children with cancer. Cancer treatments increase survival rates and also cause physical and psychological effects on children with cancer. A psycho-educational intervention is used to assist children and adolescents with these effects and its efficacy has been described in several studies. A randomized controlled trial. Participants being treated were recruited and randomly assigned to two groups from September 2011-February 2013 in Taiwan. The intervention group received a psycho-educational intervention in addition to standard care, while the control group received only standard care. Each participant was assessed using a paediatric cancer coping scale and perceived symptom severity was evaluated at three time points (baseline, 1 month and 3 months). A repeated-measures analysis of variance was used to estimate the effects of intervention. Qualitative findings were analysed using content analysis. No significant difference in coping scores was found between groups, but the experimental group reported significantly lower scores in gastrointestinal problems and pain. Most symptoms decreased significantly over time in both groups, except for gastrointestinal problems. The scores in pain, bone marrow suppression and body image showed significant interaction effects between groups on changes over time. Qualitative results reported that participants evaluated the intervention positively, especially about receipt of psychological support and learnt coping skills. The psycho-educational intervention administered was acceptable for children with cancer and was found to reduce gastrointestinal problems and pain.

Barriers and Facilitators of Mental Health Treatment Seeking Among Active-Duty Army Personnel

The purpose of the current two-phase study was to comprehensively identify the barriers and facilitators of mental health treatment seeking among active-duty service members. For Sample 1, focus groups were conducted with a general sample (n = 78) of United States soldiers. For Sample 2, interviews were conducted with soldiers who had sought mental health treatment (n = 32). Transcripts were coded using Atlas.ti software (Berlin, Germany), and descriptive analyses identified key themes. Factors identified by this study that have been underinvestigated in previous research included medication concerns, discomfort with discussing mental health problems, beliefs promoted by military culture, positive leader behaviors, and witnessing treatment seekers’ experiences. Common barriers included career concerns, stigma, treatment concerns, leadership problems, and practical barriers. Common facilitators included social support, leadership support, and perceived symptom severity. Findings suggest that treatment-facilitating interventions should reframe treatment-inhibiting perceptions, change leader behaviors, and employ testimonials.

Uncertainty, mood states, and symptom distress in patients with primary brain tumors

Patients with primary brain tumors (PBTs) face uncertainty related to prognosis, symptoms, treatment response, and toxicity. The authors of this report examined the direct/indirect relations among patients' uncertainty, mood states, and symptoms. In total, 186 patients with PBTs were accrued at various points in the illness trajectory. Data-collection tools included an investigator-completed clinician checklist, a patient-completed demographic data sheet, the Mishel Uncertainty in Illness Scale-Brain Tumor Form (MUIS-BT), the MD Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT), and the Profile of Mood States-Short Form (POMS-SF). Structural equation modeling was used to explore correlations among variables. Participants were primarily white (80%) men (53%) with a variety of brain tumors. They ranged in age from 19 to 80 years (mean ± standard deviation, 44.2 ± 12.6 years). Lower functional status and earlier point in the illness trajectory were associated with greater uncertainty (P < .01 for both). Uncertainty (P < .05), except in the model of "confusion," and the 5 negative mood states measured by the POMS-SF were directly associated with symptom severity perceived by patients (P < .01 for all). The impact of uncertainty on perceived symptom severity also was mediated significantly by mood states. The results from the study clearly demonstrated distinct pathways for the relations between uncertainty-mood states-symptom severity for patients with PBTs. Uncertainty in patients with PBTs is higher for those who have a poor performance status and directly impacts negative mood states, which mediate patient-perceived symptom severity. This conceptual model suggests that interventions designed to reduce uncertainty or that target mood states may help lessen patients' perception of symptom severity, which, in turn, may result in better treatment outcomes and quality of life.

Sa1338 Do Co-Morbid Mental Disorders Impact Differently on Perceived Symptom Severity in Patients With Gastrointestinal Diseases? A Comparison of Functional Dyspepsia and Intestinal Graft-Versus-Host Disease

Sa1338 Do Co-Morbid Mental Disorders Impact Differently on Perceived Symptom Severity in Patients With Gastrointestinal Diseases? A Comparison of Functional Dyspepsia and Intestinal Graft-Versus-Host Disease

Using One's Head to Treat Menopausal Symptoms

Using One's Head to Treat Menopausal Symptoms

Therapeutic implications of adding the psychotropic drug escitalopram in the treatment of patients suffering from moderate–severe psoriasis and psychiatric comorbidity: a retrospective study

It is known that stress and/or psychiatric diseases can play an important role in determining psoriasis, including the well-known negative somato-psychiatric rebound that comes with the disease. Samples of 38 subjects suffering from both moderate-severe psoriasis treated with anti-TNFα, and depressive and/or anxious mood disorders were studied. Part of them were additionally treated with escitalopram, whereas the other group only consulted to a dermatological and psychiatric follow-up. The aim of this study was to determine if an improvement in the dermatological manifestation as well as an improvement in the anxious-depressive disorder can be observed. The study revealed that patients treated with escitalopram had a reduction of psycho-diagnostic test scores that measure depression and anxiety levels as well as the values of pruritus. Our study suggests that psychological interventions and antidepressant medications may improve perceived symptom severity, quality of life and major compliance to the treatment in selected patients (suffering from psoriasis and mood disturbance), without a clinician necessarily being able to see an impact on psoriasis severity.

How Long Are Patients Willing to Wait in the Emergency Department Before Leaving Without Being Seen

Introduction:Our goal was to evaluate patients’ threshold for waiting in an emergency department (ED) waiting room before leaving without being seen (LWBS). We analyzed whether willingness to wait was influenced by perceived illness severity, age, race, triage acuity level, or insurance status.Methods:We conducted this survey-based study from March to July 2010 at an urban academic medical center. After triage, patients were given a multiple-choice questionnaire, designed to ascertain how long they would wait for medical care. We collected data including age, gender, race, insurance status, and triage acuity level. We looked at the association between willingness to wait and these variables, using stratified analysis and logistic regression.Results:Of the 375 patients who were approached, 340 (91%) participated. One hundred seventy-one (51%) were willing to wait up to 2 hours before leaving, 58 (17%) would wait 2 to 8 hours, and 110 (32%) would wait indefinitely. No association was found between willingness to wait and race, gender, insurance status, or perceived symptom severity. Patients willing to wait >2 hours tended to be older than 25, have higher acuity, and prefer the study site ED.Conclusion:Many patients have a defined, limited period that they are willing to wait for emergency care. In our study, 50% of patients were willing to wait up to 2 hours before leaving the ED without being seen. This result suggests that efforts to reduce the percentage of patients who LWBS must factor in time limits.

Impact of pandemic A/H1N1/2009 influenza on children and their families: Comparison with seasonal A/H1N1 and A/H3N2 influenza viruses

To make a direct comparison between the total burden of pandemic influenza and that of other seasonal influenza A viral subtypes in otherwise healthy children. The total clinical and socioeconomic burden of pandemic A/H1N1/2009 influenza was compared with that of seasonal influenza A viral subtypes in 389 otherwise healthy children with A/H1N1/2009, 126 with seasonal A/H1N1 and 486 with seasonal A/H3N2 infection referred to the Emergency Room and hospitalised in the in-patient units of a large, university-based paediatric hospital. Influenza diagnosis was confirmed by real-time polymerase chain reaction. Regardless of age or gender, the variables significantly associated with pandemic A/H1N1/2009 and seasonal A/H3N2 infection were a diagnosis of lower respiratory tract infection upon clinical presentation, the need for hospitalisation, hospitalisation for ≥7 days, school absences of ≥7 days, the need for aerosol therapy, the household development of a disease similar to that of the infected child, and the need for additional household medical visits and antibiotic prescriptions (p<0.001). A longer period of hospitalisation and lost school days seemed to be associated with pandemic A/H1N1/2009 infection (p<0.01). Perceived symptom severity and the risk of serious outcomes are similar in children with influenza due to pandemic A/H1N1/2009 or seasonal A/H3N2 influenza, but both of these viruses seem to have a greater clinical and socioeconomic impact than seasonal A/H1N1 virus, regardless of the patients' age or gender.

Validated Instruments in the Evaluation and Treatment Outcomes of Stress Urinary Incontinence in Women

Urinary incontinence is a highly prevalent condition. Although there are commonly used tools for the evaluation of urinary incontinence and measurement of treatment outcomes, there is no universally accepted standard. However, there are several validated instruments currently available and in use for assessment of patient-reported outcomes. Such an emphasis on patient-reported outcomes is key because there can be discrepancies between a physician's and a patient's perception of symptom severity and outcome.

The Impact of Sense of Coherence (SOC) on Perceived Symptom Severity in IBS Patients at Baseline and Three-Years Follow up

The Impact of Sense of Coherence (SOC) on Perceived Symptom Severity in IBS Patients at Baseline and Three-Years Follow up

Patients with crohn's disease report high levels of fatigue during a symptomatic disease flare

IntroductionThe symptom of fatigue can have a major impact on quality of life and is often overlooked by physicians. Previous research has indicated a significant link between fatigue and a...

Rural and urban Vietnamese mothers utilization of healthcare resources for children under 6 years with pneumonia and associated symptoms

Worldwide, pneumonia causes 14% of deaths among children and infants (ages 4 weeks to 5 years). UNICEF and WHO have established treatment guidelines to reduce risk of death from pneumonia including caregiver symptom recognition, appropriate care, and use of antibiotics. In June 2008, cross-sectional survey data were collected in Khanh Hoa Province Viet Nam with 329 mothers of children under 6 years. In relation to pneumonia and associated symptoms (fever >38 °C, strong cough, "fast or difficult" breathing), data were collected on perceptions of symptom severity and child vulnerability, reported healthcare utilization including use of antibiotics, sources of health information, and barriers to care. Pearson's chi square, independent t tests, and multinomial analysis were conducted to assess different patterns of reported healthcare utilization in relation to residency (rural/urban), mother's education, and household income. Outcomes include rural and urban residency-based patterns related to perceptions of child's vulnerability and symptom severity, health facility utilization and barriers to care, and reported use of antibiotics during previous episodes of pneumonia. Implications include the need to target different healthcare facilities in urban and rural Viet Nam in relation to education about symptoms of childhood pneumonia and associated treatments.

Impact of symptom burden on health related quality of life of cancer survivors in a Danish cancer rehabilitation program: A longitudinal study

Introduction. Little research has been conducted on the effect of self-reported rating of symptom severity on quality of life (QoL) among cancer survivors. The aim of the study was to examine the prevalence of symptoms and whether information about self-reported symptom severity adds value to QoL measurements. Material and methods. A questionnaire including the EORTC QLQ-C30 and an empirically derived symptom check-list was completed by 2 486 cancer survivors participating in a rehabilitation program at baseline and at 1, 6 and 12 months’ follow-up. We used multivariate linear regression models to evaluate the association between QoL and the dichotomous variables for perceived symptom severity (high vs. low) and cancer stage (high vs. low), with adjustment for age, gender, education and time since diagnosis. Results. Of the 2 379 participants who reported having one or more symptoms, 1 479 (62%) considered the reported symptom to be severe. This subgroup had significantly poorer QoL at baseline for all sites, ranging from −15.9 to −10.2, compared to those who did not regard their symptom as severe. Significantly lower baseline levels on all functional subscales were seen for all sites in association with high perceived symptom severity (range from −9.9 to −3.0 (physical functioning), from −21.1 to −13.0 (social functioning), from −18.8 to −8.5 (emotional functioning), and from −18.4 to −9.6 (cognitive functioning). The impairment of physical, social, emotional, and cognitive functioning persisted through 12 months for participants with cancer of the breast, lung and those with lymphomas, although not all reached significance. Discussion. Cancer survivors, irrespective of cancer site, experience a high burden of symptoms. Thorough monitoring and assessment of symptoms and careful scrutiny of cancer survivors’ perceptions of how symptoms affect their lives is critical for clinical identification of patients who might benefit from enhanced medical attention and may be an important supplement to QoL measures.

Sleep and Fatigue Symptoms in Children and Adolescents With CKD: A Cross-sectional Analysis From the Chronic Kidney Disease in Children (CKiD) Study

Although symptoms of sleepiness and fatigue are common in adults with chronic kidney disease (CKD), little is known about the prevalence of these symptoms in children with CKD. Cross-sectional analysis within a cohort study. We describe the frequency and severity of sleep problems and fatigue and assess the extent of their association with measured glomerular filtration rate (mGFR) and health-related quality of life (HRQOL) in 301 participants of the Chronic Kidney Disease in Children cohort. Sleep and fatigue-related items from the Pediatric Quality of Life Inventory 4.0 Generic Scales and the CKD-related Symptoms List were used. Median mGFR was 42.0 mL/min/1.73 m(2) (25th-75th percentiles, 31.2-53.2), and median age was 13.9 years (25th-75th percentiles, 10.8-16.2). Children with mGFR of 40-<50, 30-<40, or <30 mL/min/1.73 m(2) had 2.07 (95% CI, 1.05-4.09), 2.35 (95% CI, 1.17-4.72), and 2.59 (95% CI, 1.15-5.85) higher odds of having more severe parent reports of low energy than children with mGFR > or = 50 mL/min/1.73 m(2). Compared with participants with mGFR > or = 50 mL/min/1.73 m(2), those with mGFR < 30 mL/min/1.73 m(2) had 3.92 (95% CI, 1.37-11.17) higher odds of reporting more severe weakness, and those with mGFR of 40-<50 mL/min/1.73 m(2) had 2.95 (95% CI, 1.26-6.88) higher odds of falling asleep during the day. Low energy, trouble sleeping, and weakness were associated with lower HRQOL scores. Symptoms of sleep and fatigue represent the child's or parent's perception of symptom severity, whereas individual items can lead to imprecise measurements of sleep and fatigue. Lower mGFR was associated with increased weakness, low energy, and daytime sleepiness. Furthermore, a strong association between trouble sleeping, low energy, and weakness with decreases in overall HRQOL was observed. Detection and treatment of poor sleep and fatigue may improve the development and HRQOL of children and adolescents with CKD.

Preliminary outcomes from the MMX mesalamine patient experience program in patients with ulcerative colitis

The MMX mesalamine patient experience program was designed to evaluate the efficacy of MMX mesalamine treatment in patients who were beginning a new course of therapy for ulcerative colitis (UC). This program was launched in October 2007. Patients who were beginning a new course of treatment on or after this date were invited to participate. Surveys were completed via the internet or an automated telephone system, and questions examined perceived symptom severity, self-assessed disruption to daily activities, prior UC medication and treatment satisfaction, at baseline and at approximately 30 and 60 days post-baseline. Additional disease education and related questions was included in the survey and further questions included examined patients' understanding of their disease and its management. Reponses from patients who completed the baseline and 60-day surveys are included in this analysis. In total, 319 patients were enrolled into the program, of whom 110 had completed the 60-day post baseline questionnaire at the time of reporting. Almost 75% of patients had previously received UC medication (most had received a mesalamine formulation [other than MMX mesalamine]). Patients' self-reported adherence to MMX mesalamine was 88%, and higher satisfaction was reported for MMX mesalamine than with other formulations, giving an average satisfaction score of over 7 out of 9. Indeed, after 60 days' treatment, patients reported a 36-57% reduction in symptom severity, with an approximately 46% reduction in the disruption to their daily activities. Overall, 81% of patients indicated that they would continue taking MMX mesalamine, with 78% stating that they would recommend it. The majority of patients (67%) felt that the patient experience program enhanced communication with their physician, with 80% stating that they would participate in similar programs in the future. The results of this patient experience program indicate that treatment of UC with MMX mesalamine could reduce symptom severity and disruption to daily activities. In general, patients preferred this formulation over previous treatments that they had received, and most would continue using MMX mesalamine. Positive perception of their medication regimen may benefit patient adherence with MMX mesalamine therapy. This research was funded by Shire Pharmaceuticals Inc., Wayne, Pennsylvania, USA.

MMX® Mesalamine Treatment for Ulcerative Colitis: Preliminary Outcomes from a Patient Experience Program

Purpose: In this program, we evaluated the impact of MMX mesalamine (LIALDA®; Shire Pharmaceuticals Inc., USA; MMX; Cosmo Technologies Limited, Wicklow, Ireland) treatment in patients who were commencing a new course of therapy for ulcerative colitis (UC). Methods: Patients initiating MMX mesalamine therapy were invited to participate in the LIALDA patient experience program (launched in October 2007). Patients were surveyed using a secure website or automated telephone system, where they completed a questionnaire on perceived symptom severity, self-assessed disruption to daily activities, prior UC medication and treatment satisfaction, at baseline and at approximately 30 and 60 days post-baseline. Patients were also questioned on their understanding of UC and its management, and received further UC education. Reponses from those patients who completed the baseline and 60-day surveys are included in this analysis. Results: Overall, 319 patients were enrolled and 110 had completed the 60-day post-baseline questionnaire at the time of reporting. After 60 days' treatment, patients reported a reduction in UC symptom severity of 36-57%, and a reduction of approximately 46% in disruption to daily activities. Almost 75% of patients had previously received UC medication (the majority of whom received another mesalamine formulation). Patient-reported adherence to MMX mesalamine was 88%, and patients were more satisfied with MMX mesalamine than with other formulations, giving an average satisfaction score of >7 out of 9. Indeed, 81% of patients stated that they would continue taking MMX mesalamine, and 78% would recommend it. Overall, most patients (67%) believed that communication with their physicians was enhanced by this program, and the majority (80%) indicated that they would volunteer for similar patient experience programs. Conclusion: Patients reported that MMX mesalamine treatment reduced UC symptom severity and disruption to daily activities. This formulation was generally preferred compared with patients' previous treatments, and most patients would continue using MMX mesalamine. Positive patient perception of their medication regimen may enhance treatment adherence with MMX mesalamine therapy. This research was funded by Shire Pharmaceuticals Inc., Wayne, Pennsylvania, USA. Disclosure: Dr T Hamilton - Employee, Shire Pharmaceuticals Inc Dr M Sumner - Employee, Shire Pharmaceuticals Inc Dr D Solomon - Employee, Shire Pharmaceuticals Inc Dr D Kerney - Employee, InfoMedics Inc. Funded by Shire Pharmaceuticals Inc.

Der ältere Asthmapatient

Elderly patients with asthma are a specific group with particular needs. These must be addressed in order to provide appropriate asthma care. Asthma causes higher morbidity and mortality rates among the elderly patients. Older patients often fail or have problems with compliance and self-management due to age-specific factors. Older patients with asthma are often misdiagnosed, due to an impaired patient perception of symptom severity, different opinions of what kind of asthma-control is possible, or not sufficient communication skills. Often the quality of life is impaired by asthma. Improvement in self management skills in a special way may enhance the health status of elderly patients with asthma.

Avoidant Safety Behaviors and Catastrophizing: Shared cognitive-behavioral processes and consequences in co-morbid pain and sleep disorders

Research and theory suggest that the symptom pair of chronic pain and insomnia may be maintained by shared cognitive-behavioral processes and consequences. This investigation describes the psychometric properties of an instrument designed to assess the way people think about symptoms of pain and poor sleep. A pool of 12 items was generated from existing and validated measures. Exploratory factor analysis (EFA) was conducted on item responses from a community sample of respondents who reported having had a problem with pain or sleep (n = 1702) during the three months previous to the survey. Multinomial regression analyses (MRA) were used to describe derived subscale responses for distinct groups reporting different degrees of perceived symptom severity and overlap. EFA suggested the existence of three distinct dimensions: safety behaviors of behavioral orientation, safety behaviors of cognitive orientation, and catastrophizing. MRA analyses indicated that catastrophizing appears to be a shared psychological process and that both types of safety behaviors may be enhanced in co-morbid problems with persistent pain and insomnia. Cognitions pertaining to avoidant safety behaviors and catastrophizing are associated with symptom severity and overlap in co-morbid pain and sleep disorders. More research is needed to explore the importance of shared psychological processes and consequences when studying and treating ill health.

Healthcare professional versus patient goal setting in intermittent allergic rhinitis

Objective To examine the impact of healthcare professional versus patient goal setting for the self-management of intermittent allergic rhinitis (AR) on symptom severity and quality of life. Methods This was a 6 week, parallel group study. Group A participants, with pharmacist facilitation, nominated personally relevant goals and strategies relating to their AR. Group B participants had their goals and strategies set by the pharmacist. The main outcome measures used included perceived symptom severity and quality of life. In addition, goals and strategies data from participants of both groups were collected and analysed. Results Both groups demonstrated significant improvements in symptom severity and quality of life scores however Group B symptom severity scores improved more. Group B set a greater number of goals and strategies which were better structured and more task specific. Conclusion This is the first study to investigate the impact of goal setting on patient behaviour in a chronic yet episodic illness. Our results suggest that self-management goals set by the healthcare professional which are clinically indicated but tailored to the patient's nominated symptoms yields better outcomes than goals nominated by the patient. Practice implications A brief, structured intervention, tailored to patient symptoms, can enhance self-management of intermittent allergic rhinitis.

VARIANT-SPECIFIC ANTIBODIES TO MEROZOITE SURFACE PROTEIN 2 AND CLINICAL EXPRESSION OF PLASMODIUM FALCIPARUM MALARIA IN RURAL AMAZONIANS

Naturally acquired antibodies to five variants of the merozoite surface protein 2 (MSP-2), a target of clinical immunity to Plasmodium falciparum malaria, were measured in a cohort of rural Amazonians. Local MSP-2 variants comprised both highly divergent families of alleles (FC27 and 3D7). Total IgG antibodies to two FC27-type antigens were found in 22-28% of subjects at baseline, with substantial cross-reactivity between variants and stable concentrations and specificities over time. The IgG antibodies to three 3D7-type antigens were less prevalent (6-7%), less cross-reactive, and short-lived; subsequent exposure to 3D7-type parasites rarely elicited homologous response. The clinical spectrum of 109 incident P. falciparum infections in our cohort ranged between asymptomatic infection and fully symptomatic but uncomplicated disease. Parasitemia at the time of diagnosis, rather than cumulative malaria exposure or acquired immunity (presence of variant-specific antibodies matching the MSP-2 type in infecting parasites), was a major predictor of perceived symptom severity.