Physical Well-being Of Patients Research Articles

Comparison of the effectiveness of oral morphine versus oral tramadol on early pain control in opioid-naive patients with moderate cancer pain.

11581 Background: Adequate pain control, an essential part of cancer care remains a challenge in resource limited countries like Nepal. Early use of morphine for Moderate Cancer Pain (MCP) and not sequential World Health Organization (WHO) analgesic ladder seems reasonable in the setting of limited access to health care. The purpose of this study was to compare efficacy of oral Morphine (MOR) with oral Tramadol (TRM) in control of pain as well as physical wellbeing in patients (pts) with MCP using Edmonton Symptom Assessment Scale (ESAS). Methods: An IRB approved randomized phase II trial was performed in opioid-naive pts with MCP as defined by pain score in Numerical rating score (NRS)of 4-6.Patients were randomized to receive MOR syrup 5 mg 4 hourly or TRM 50 mg four times a day. Titration of dose was done in both groups for 3 days as per standard recommendation for MOR or till maximum recommended daily dose for TRM. MOR was changed to prolonged release form at Day 4.The primary endpoint was number of early responders, defined as pts with at least 20% reduction in pain intensity on NRS on Day 3. Secondary outcome was number of patients with highly meaningful pain reduction, defined as decrease in pain intensity on NRS by ≥ 5 and improvement in physical well-being with ESAS at Day 7. Results: 68 pts consented and were randomized, 34 in each arm. The primary endpoint occurred in 94.1% pts in MOR and 55.9% in TRM (p <0.001). Number of patients with highly meaningful pain reduction was significantly higher in MOR than in TRM (76.5% vs. 32.35%; p<0.001). Improvement in general physical wellbeing as assessed by ESAS was better in morphine group. No difference in adverse effects was noted between the treatment arms. Conclusions: In this study Morphine was superior to Tramadol in the control of pain with statistically significant difference in the primary and secondary endpoints. So, early use of morphine skipping the WHO sequential analgesic ladder for moderate cancer pain seems a higher value option in resource scarce country with limited access to healthcare.

Food allergy test in chronic urticaria adult patients: A cross sectional study

Food allergy test in chronic urticaria adult patients: A cross sectional study - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.027, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol

Psychological Treatment for Major Depressive Disorder: Effectiveness of Cognitive Behavioural Therapy

Major depression, as a recurring and disabling disorder, can have a negative effect on the psychological and physical well-being of patients. Various psychological and medical interventions are generally used for patients with major depressive disorders. Patients suffering from major depressive disorders (MDD) may be subjected to medication only or medication may be used concurrently with psychological interventions. Psychological interventions like cognitive behavioural therapy (CBT) uses behavioural and cognitive principles to treat patients suffering from MDD, by helping them to identify, understand and analyse how the interaction of their thoughts, moods and behaviours triggers and aggravates depression. CBT has been beneficial in treating patients suffering from comorbidity of MDD with other disorders. While there is empirical and theoretical evidence supporting the use of CBT under various treatment settings and patient characteristics, research findings indicate varying rates of adequacy of the treatment. Further investigation of potential prescriptive risk factors associated with MDD in different contexts can help to predict more unbiased and consistent responses to different CBT techniques. This will make a valuable contribution to improving the use of CBT techniques for patients with different depressive characteristics and across different treatment settings and modes of delivery.

Effects of health-related quality of life on health service utilisation in patients with colorectal neoplasms.

This study was to assess the impact of HRQOL on health service utilisation using four different count data models. The HRQOL was measured using the Short-Form Six-Dimension instrument and the functional assessment of cancer therapy-colorectal whereas health service utilisation was measured by the number of monthly clinical consultations and the number of monthly hospitalisation. Different count data models (Poisson's regression, negative binomial regression, zero-inflated Poisson's regression and zero-inflated negative binomial regression) were used to assess the association between HRQOL and health service utilisation. A performance comparison was made between the models. Goodness-of-fit statistics (the Pearson's chi-squared test statistic, the Akaike and Bayesian information criteria) were used to determine the best-fitting model. The negative binomial model performed the best in assessing the association between HRQOL measures and health service utilisation in patients with colorectal neoplasm and thus recommended. Physical well-being of patients was negatively and significantly associated with the monthly rate of health service utilisation after controlling for patient demographics. Both physical and function well-beings of patients were negatively and significantly associated with the number of monthly hospitalisations. If the data for the condition-specific FACT-C are not available, SF-6D showed a very strong negative relationship with health service utilisation. Such models can be used to guide the allocation of clinical resources and funding for the care of colorectal cancer patients.

Examining Factors Related to Health-Related Quality of Life in People With Parkinson's Disease.

Parkinson's disease (PD) results in a range of dysfunctions and disabilities as it progresses to later stages. All these not only affect a patient's physical well-being but also emotional, social, and spiritual well-being. To tailor interventions that can address these concerns, this study aimed to examine the impacts of PD on their health-related quality of life (HRQOL). A cross-sectional study with 123 PD patients. Measures included the following: Hospital Anxiety and Depression Scale, Unified PD Rating Scale-Motor Examination, Hoehn and Yahr Stage, PD Questionnaire-8. Associating factors of HRQOL was examined using stepwise linear regression. Psychological distress and functional impairment are significantly associated with the HRQOL of the PD population. Psychological distress is associated most to the variance of HRQOL (42.4%). Considering that PD is chronic, rehabilitation programs should be applied to address not just functional but also psychosocial needs of PD patients. Early recognition and management of psychological distress in PD patients is indispensable to promote their HRQOL.

Effectiveness of health checks to improve the physical health of people with severe mental illness in secondary care: A single blind cluster randomised controlled trial

IntroductionAnnual monitoring of physical health of people with severe mental illness (SMI) in primary or secondary care is recommended in England.ObjectiveThe SMI Health Improvement Profile (HIP) was developed to target physical well-being in SMI through the role of the mental health nurse.AimThe primary aim was to investigate if health checks performed by community mental health nurses (CMHNs) trained to use the HIP improved the physical well-being of patients with SMI at 12 months.MethodsA single blind, parallel group randomised controlled trial of training to use the HIP (clustered at the level of the nurse). Physical well-being was measured in study patients using the physical component score of the SF36v2 at baseline and at 12 months.ResultsSixty CMHNs (working with 173 patients) were assigned to the HIP programme (training to use the HIP) or treatment as usual. The HIP was completed with 38 (42%) patients at baseline and 22 (24%) at follow-up in the HIP programme group. No effect of the HIP programme on physical health-related quality of life of study patients was identified, a finding supported by per protocol analyses.ConclusionsThis study found no evidence that CMHN delivered health checks following training to use the HIP are effective at improving the physical well-being of SMI patients at one year. More attention to methods that aim to enable the delivery, receipt and enactment of evidence-based interventions to improve physical health outcomes in this population is urgently required.ISRCTN: 41137900.Disclosure of interestThe authors have not supplied their declaration of competing interest.

PERCEPÇÕES DE PACIENTES E PROFISSIONAIS DE SAÚDE SOBRE AS VISITAS MUSICAIS DO PROGRAMA DE EXTENSÃO “BOA NOITE, BOM DIA HUAP"

“Good night, good morning HUAP” is an outreach project developed by Fluminense Federal University which pays visits at university hospital wards in order to improve the quality of the hospitalization period through music. The study carried out a qualitative research, through 28 interviews with patients and 10 interviews with health care professionals, subjected to content analysis. It assessed the contribution of the visits to the emotional and to the physical well-being of patients. The patients and professionals perceived that the visits contributed to distract patients, to improve their mood and sleep quality, to relieve pain and discomfort and to reduce anxiety. The health care professionals reported that the visits had beneficial effects on themselves, such as relaxation and joy in a routine of heavy work. Besides, they notice positive changes in the wards during and after the visits.

Patients Are Socially Excluded When Their Pain Has No Medical Explanation.

This study investigated whether observers socially exclude patients who experience pain that is not medically explained by means of an experimental design. Fifty-nine participants (individuals from the general population) viewed videos of 4 patients, each accompanied by a vignette describing the presence or absence of a medical explanation for their pain. Participants estimated patient's pain, and rated the sympathy felt for and the inclination to help the patient. To measure social exclusion, participants indicated their willingness to interact with the patients in several situations (Social Distance Scale). Furthermore, the participants were invited to select 2 of the 4 patients as confederates to play a game against another duo. When no medical explanation for the pain was provided, participants attributed less pain, reported feeling less sympathy, and were less inclined to help the patients with daily activities. Of particular importance to this study, participants were less willing to interact with patients with medically unexplained pain and selected less often patients with 'medically unexplained' pain than patients with 'medically explained' pain as confederates in the social game. These results are indicative of social exclusion of patients with pain for which there is no clear medical explanation. Observers socially exclude patients with pain for which there is no clear medical explanation. These findings have important clinical implications. In particular, social exclusion might have detrimental effects on the mental and physical well-being of patients with pain.

Outpatient brain tumor craniotomy under general anesthesia.

OBJECTIVE Outpatient craniotomy has many advantages to the psychological and physical well-being of patients, as well as benefits to the health care system. Its efficacy and safety have been well demonstrated, but barriers to its widespread adoption remain. Among the challenges is a perception that its application is limited to cases performed under conscious sedation, which is not always feasible given certain patient or surgeon factors. The object of this study was to characterize the rate of patient discharge from the day surgery unit (DSU) following craniotomy for tumor resection in a patient under general anesthesia. The authors identify postoperative complications and discuss appropriate patient selection for day surgery craniotomy. METHODS Patients undergoing elective craniotomy for supratentorial tumors between January 2010 and June 2014 were prospectively considered for outpatient management. Authors of the present study performed a retrospective chart review of these patients, analyzing cases by intention to treat. RESULTS Of 318 craniotomies undertaken in the study period, 141 were performed with the patient under general anesthesia. The day surgery protocol was initiated in 44 cases and completed in 38 (86%). Five patients required admission from the DSU, and 1 was discharged but admitted within the 1st postoperative day. In-hospital medical complications were fewer in the outpatient group, and no patients experienced an adverse outcome due to early discharge. CONCLUSIONS Close clinical and imaging surveillance in the early postoperative period allows for safe discharge of patients following craniotomy for tumor resection performed under general anesthesia. Therefore, general anesthesia does not preclude the application of outpatient craniotomy.

Effect of cardiac rehabilitation following coronary bypass surgery or other coronary interventions

Cardiac rehabilitation is a well-established treatment for patients with coronary artery disease but limited information is available for Icelandic patients. The aim of this study was to investigate whether Phase II cardiac rehabilitation at the HL rehabilitation center was improving physical health and quality of life of patients. Patients that had undergone coronary artery intervention were invited to participate. There were 64 participants (of 65 invited) that started in the study and 48 that finished. On average participants attended 2.1 sessions pr. week, for 8.4 weeks. Measurements performed: endurance (W/kg), blood pressure and pulse responses from an exercise test and body mass index (kg/m2). To measure health related quality of life the SF-36v2 questionnaire was used. Endurance improved by 14.4% (p<0,001) and a 6.1% increase was seen in peak pulse (p=0.001). The group was divided by age (32-64 years and 65-86 years) and both age groups improved their endurance number similarly (14.6% and 14.1%) but only the older age group improved peak pulse significantly or 7.2% (p=0.007). When the group was divided according to number of training sessions per week there was a 10.1% increase in endurance in the group that had fewer sessions but it was 19.8% in those that attended more sessions (p<0.001). Participants assessed that their physical health, measured with a questionnaire, had improved at the end of training (p=0.003). When the group was divided into two groups according to how they measured their physical health at the beginning of the study there was a significant increase of 15.1% in physical health in those that estimated worse quality of life at the beginning of the study, but the other group had an increase of 1.2%. Cardiac rehabilitation improves endurance and physical wellbeing in patients. Training magnitude is essential for improvement.

A treatment algorithm to identify therapeutic approaches for leg ulcers in patients with sickle cell disease.

Sickle cell leg ulcers (SCLUs) are a common complication of sickle cell disease (SCD). Patients who develop ulcers appear to have a more severe haemolysis-associated vasculopathy than individuals who do not develop them, and manifest other complications such as priapism and pulmonary hypertension. SCLUs are slow to heal and often recur, affecting both the emotional and physical well-being of patients. Here we summarise what is known about the pathophysiology of SCLUs, describe available treatment options and propose a treatment algorithm.

Persistence of psychological distress and correlated factors among patients with head and neck cancer.

Many patients with head and neck cancer (HNC) suffer from psychological distress associated with dysfunction and/or disfigurement. Our aim was to evaluate the ratio of patients with persistence of psychological distress during hospitalization and identify the predictors of persistence or change in psychological distress among HNC patients. We conducted a single-center longitudinal study with self-completed questionnaires. We evaluated psychological distress (the Hospital Anxiety and Depression Scale; HADS) and functional level (the Functional Assessment of Cancer Therapy-Head and Neck Scale; FACT-H&N) among patients during hospitalization at the Medical Hospital of Tokyo Medical and Dental University. Of 160 patients, 117 (73.1%) completed the questionnaire at both admission and discharge. Some 42 (52.5%) patients reported persistent psychological distress. The physical well-being of patients with continued distress was significantly lower than that of other patients (21.7 ± 4.7, 19.4 ± 6.1, 19.5 ± 5.4; p < 0.01), and the emotional well-being of patients with continued distress was significantly lower than that in patients with no distress and reduced distress (22.3 ± 3.5, 20.5 ± 2.5; p < 0.01). Significant of results: Impaired physical and emotional function appears to be associated with persistent psychological distress among HNC patients. Psychological interventions focused on relaxation, cognition, or behavior may be efficacious in preventing such persistent distress.

Nurse led Patient Education Programme for patients undergoing a lung resection for primary lung cancer.

There has been an increase in the number of patients undergoing lung resection for primary or suspected primary lung cancer in the UK due to improved staging techniques, dedicated thoracic surgeons and other initiatives such as preoperative pulmonary rehabilitation. This has had an impact on local healthcare resources requiring new ways of delivering thoracic surgical services. When considering service changes, patient reported outcomes are pivotal in terms of ensuring that the experience of care is enhanced and may include elements such as involving patients in their care, reducing the length of inpatient stay and reducing postoperative complications. The implementation of a thoracic surgical Patient Education Programme (PEP) has the potential to address these measures and improve the psychological and physical wellbeing of patients who require a lung resection. It may also assist in their care as an inpatient and to enhance recovery after surgery both in the short and long term.

Listening to people to cure people: the LpCp - tool, an instrument to evaluate hospital humanization.

In the healthcare environment, nowadays, only a few among the available evaluation systems pay enough attention to certain social sustainability aspects. Among these, humanization plays a key role in an environment, like hospitals, where the mental and physical well-being of patients and healthcare operators is crucial. Our research project, known as 'SustHealth', is focused on the deficiencies of the evaluation methodology and aims at developing an assessment system related to a questionnaire-based investigation capable of revealing the most influential conditions and dynamics in people's hospital experience, while also recommending areas in hospitals where efforts can be made to sustain improvement strategies. The humanization of healthcare structures began with a significant investigation to assess all the major evaluation tools in both hospitals - to better understand the physical and emotional interactions in the structure-user ratio - and other areas. This helped understand the strengths and criticalities of the systems that were examined. This first step also allowed to shed light on the most important aspects to keep in mind when developing an evaluation system. During the operational steps an all-new LpCp - tool (Listening to people to Cure people) was created, which includes a questionnaire-based investigation and processing software, and its application for beta-testing in a 600-bed hospital in Milan. The LpCp - tool proved to be effective and capable of finding the deficiencies and potential in the examined hospital. Considering different themes through alternative viewpoints (staff, patients/visitors, technicians, etc.), the tool has allowed underlining different perceptions of the same place and also provided sound information to guide healthcare management in taking informed decisions about specific problems or users. Former interesting results show an inadequate appraisal about e.g. on-site facilities or recreational activities and a lack of perception on existing services by users (e.g. translation, P.R.). The LpCp - tool was presented to other healthcare centres in Milan for wider-scale testing. Therefore, the LpCp - tool will hopefully increase healthcare companies' responsiveness towards improving comfort and humanization levels in hospitals. Sometimes all that is needed are small and inexpensive actions that often improve a hospital user's experience, and often important services are not used due to a lack of communication and information.

Admission to the Intensive Care Unit and Well-being in Patients With Advanced Chronic Illness

To describe the association of intensive care with trajectories of functional, emotional, social, and physical well-being in patients with 3 common advanced illnesses. Cross-sectional cohort study of 42 patients admitted to the intensive care unit selected from 210 patients with stage IV breast, prostate, or colon cancer or stage IIIb or IV lung cancer; New York Heart Association class III or IV congestive heart failure; and chronic obstructive pulmonary disease with hypercapnea (Pco2 > 46 mm Hg). Scores on subscales of the Functional Assessment of Chronic Illness Therapy-General survey were measured monthly for 6 months before and after admission to the intensive care unit and were analyzed by using the unit admission date as a point of discontinuous change to illustrate trajectories before and after the admission. Overall, trajectories of well-being declined sharply after admission to the intensive care unit. Declines in physical, functional, and emotional well-being were statistically significant. During the 6 months after admission, physical, functional, and emotional well-being scores trended back up to baseline while social well-being scores continued to decline. Well-being trajectories declined sharply after admission to the intensive care unit, with recovery in the subsequent 6 months, and may be characterized by common patterns. These results help to better describe intensive care as a marker for advancing illness in patients with advanced chronic illness.

Oncologic Emergencies

Oncologic Emergencies

The Impact of Coping Strategies on Mental and Physical Well-Being in Patients with Rheumatoid Arthritis

To investigate the relation of coping strategies to coping effectiveness, helplessness, and mental as well as physical well-being as indicators of quality of life. Cross-sectional international study. Coping strategies were assessed by a validated 18-item questionnaire, while coping effectiveness and helplessness were measured by numerical rating scales. The predictability of both and quality of life (SF-36) was evaluated by multiple linear regression including demographic and disease-related factors. Four hundred thirty-four rheumatoid arthritis (RA) patients (77% female; mean age 55.96 ± 13.34 years) were included. Distancing was the coping strategy used most frequently in RA patients (mean ± SD 1.89 ± 0.78 on a scale ranging from 0 to 3). Female RA patients used coping strategies significantly more often than males, whereas age and duration of disease did not seem to influence the use of coping strategies. Cognitive reframing and active problem-solving contributed to coping effectiveness while emotional expression was related to helplessness. Coping effectiveness was positively related to general health perception, suggesting certain coping strategies to be effective in influencing the quality of life of RA patients. Coping strategies used in RA are dependent on gender, but not on age. The use of problem-focused coping strategies may allow for an improved coping effectiveness in patients with RA, while also influencing mental and physical well-being as indicators of quality of life. Coping should therefore be considered as an important factor in determining the overall health state of patients with RA.

Efficacy of Hypnosis-Based Treatment in Amyotrophic Lateral Sclerosis: A Pilot Study

Background: Amyotrophic lateral sclerosis (ALS) and its devastating neurodegenerative consequences have an inevitably psychological impact on patients and their caregivers: however, although it would be strongly needed, there is a lack of research on the efficacy of psychological intervention. Our aim was to investigate the effect of hypnosis-based intervention on psychological and perceived physical wellbeing in patients and the indirect effect on caregivers. Methods: We recruited eight ALS volunteers patients as a pilot sample for an hypnosis intervention and self-hypnosis training protocol lasting 1 month. Anxiety and depression level was measured in patients and caregivers at pre and post treatment phase. Quality of life and perceived physical symptoms changes were also investigated in patients. Results: One month pre-post treatment improvement in depression, anxiety, and quality of life was clearly clinically observed and confirmed by psychometric analyses on questionnaire data. Moreover, decreases in physical symptoms such as pain, sleep disorders, emotional lability, and fasciculations were reported by our patients. Improvements in caregiver psychological wellbeing, likely as a consequence of patients psychological and perceived physical symptomatology improvement, were also observed. Conclusion: To the best of our knowledge, even if at a preliminary level, this is the first report on efficacy psychological intervention protocol on ALS patients. The findings provide initial support for using hypnosis and self-hypnosis training to manage some ALS physical consequences and mainly to cope its dramatic psychological implications for patients and, indirectly, for their caregivers.

Quality of life and mental health in caregivers of outpatients with advanced cancer

This study evaluates the quality of life (QOL) and mental health (MH) of caregivers of patients with advanced cancer who are receiving ambulatory oncology care and associations with patient, caregiver and care-related characteristics. Patients with advanced gastrointestinal, genitourinary, breast, lung or gynaecologic cancer, and their caregivers, were recruited from 24 medical oncology clinics for a cluster-randomized trial of early palliative care. Caregivers completed the Caregiver QOL--Cancer scale and the Medical Outcomes Study Short Form, version 2, and a questionnaire including care-related factors such as hours/day providing care and change in work situation. Patients completed a demographic questionnaire and measures of their QOL and symptom severity. Associations of these factors with caregiver QOL and MH were examined using linear regression analyses. Of the 191 caregivers, 84% were spouses/partners, 90% cohabited with the patient, half were working and 25% had a change in work situation since the patient's diagnosis. On multiple regression analysis, better caregiver QOL was associated with better caregiver MH and patient physical well-being and with not providing care for other dependents. Worse caregiver MH was associated with female caregiver sex, worse patient emotional well-being, more hours spent caregiving and change in the caregiver's work situation. Caregivers of ambulatory patients with advanced cancer may have compromised QOL and MH associated with worse patient physical and emotional well-being and with simultaneously caring for others and working outside the home. Early palliative care interventions directed at patient symptoms and caregiver support may improve QOL in this population.

Impact of androgen deprivation on physical well‐being in patients with prostate cancer

As androgen deprivation therapy (ADT) becomes a standard of treatment for men with recurrent or metastatic prostate cancer, evaluation of adverse effects associated with this treatment is needed. In this study, the authors evaluated the effect of ADT administered as monotherapy and in combination with local treatment on physical well-being in a longitudinal sample of men with prostate cancer. Exposure to ADT was defined by 3 groups: local (local treatment only), combination (local treatment with adjuvant and/or neoadjuvant ADT), and primary ADT. Associations between exposure to ADT and physical well-being measured by self-reported health-related quality of life outcomes over time were evaluated by repeated measures analysis using mixed modeling. Estimates adjusted for various clinical and demographic variables are reported. A total of 2922 men, who completed both pretreatment and follow-up health-related quality of life assessment, were identified from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) registry. During 24 months of follow-up, exposure to ADT was associated with worse physical well-being compared with local treatment at all time points (P < .001). Being exposed to ADT as primary therapy was associated with more severe declines compared with combination therapy. The potential consequence of decline in physical well-being in patients exposed to ADT has to be included in treatment decision making.