PPS Scores Research Articles

Comparison of preemptive etoricoxib and dexamethasone in third molar surgery - a randomized controlled clinical trial of patient-reported and clinical outcomes.

To compare preemptive single-dose etoricoxib and dexamethasone on postoperative patient satisfaction (pPS) and clinical parameters following the impacted mandibular third molar (IMTM) extraction. A parallel-group, triple-blinded, controlled clinical study included a total of 90 patients (n = 30), randomized to receive: etoricoxib 90mg, dexamethasone 4mg, or no premedication (control group) 1h before surgery. Paracetamol 500mg was prescribed as rescue medication (RM). Check-ups were scheduled at 24h, 48h, and day 7 post-surgery. At each time point, pPS was assessed using the 5-point Likert scale. RM parameters, swelling, trismus, and the occurrence of adverse events were also recorded, and patients were instructed to rate the perceived pain on Visual Analogue Scale. In all the follow-up periods, data indicated significantly higher pPS scores in the preemptive medication groups when compared to the control group (p < 0.05). Both regimens delayed the first RM intake when compared to controls. In the etoricoxib group, a significantly lower total RM consumption was observed (p < 0.05). Dexamethasone significantly decreased swelling at each check-up and increased mouth opening at day 7 after the surgery (p < 0.05). Preemptive etoricoxib and dexamethasone elevate pPS after IMTM surgery. Etoricoxib improves RM parameters, while dexamethasone ameliorates the patient's postoperative functional ability. Preemptive etoricoxib and dexamethasone use may decrease patients' discomfort following the impacted mandibular third molar extraction. ClinicalTrials.gov Identifier: NCT05791721. Date of Registration: 28/03/2023 (retrospectively registered).

Hematologic Malignancies Patients Face High Symptom Burden and Are Lately Referred to Palliative Consultation: Analysis of a Single Center Experience.

Although hematologic neoplasms have been on the vanguard of cancer therapies that led to notable advances in therapeutic efficacy, many patients face significant symptom burden, which make them eligible for early palliative care (PC) integration. However, previous reports demonstrated that hematological malignancies receive more aggressive care at the end-of-life and are less likely to receive care from specialist palliative services compared to solid tumors. Our aim was to characterize symptom burden, performance status and clinical characteristics of a cohort of hematologic malignancies patients referred toPCoutpatient consultation, according to their diagnosis. Fifty-nine hematological malignancies patients referred toPCconsultation between January 2018 and September 2021 were included. Clinical and laboratory data were evaluated retrospectively by medical charts analysis. Patients exhibited high ESAS and reduced PPS scores at the time ofPCreferral. Acute leukemia and multiple myeloma patients had the highest symptom burden scores; in spite of this, median time from the firstPCconsultation until death was only 3 and 4 months, respectively. In conclusion, we identified that hematologic neoplasms patients are highly symptomatic and are frequently referred toPCin end stages of their disease.

GEBELERDE KOVİD SALGINI SIRASINDA STRES, UYKU, FİZİKSEL AKTİVİTE VE AĞRI DÜZEYİ: TANIMLAYICI ÇALIŞMA

COVID-19 pandemic may lead to changes in stress, sleep, physical activity (PA), and pain intensity related to the pregnancy. The study aimed to investigate the perceived stress, quality of sleep, PA, and pain intensity of pregnant women who were advised to stay at home as much as they could to provide isolation during the pandemic. The study included 149 pregnant women between April and May 2020. Demographics were recorded; Perceived-Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire-Short Form (IPAQ-SF), and Numerical Pain Rating Scale (NPRS) were performed. According to social isolation duration, 79.2% of the participants were in social isolation for more than 21 days. Self-reported anxiety level was severe for 65.8% of participants. The mean PPS score (±SD) was 26.98±8.26, PSQI score was 6.14±2.87, IPAQ-SF score was 466.1±1421.28, and NPRS score was 4.42±2.65. When the participants were classified and compared according to the trimester, no statistical significance was found in PPS, PSQI, IPAQ-SF, and NPRS scores (p&gt; 0.05). The correlation was low between PPS-PSQI scores (r=0.291, p0.001); NPRS and PSQI scores (r=0.198, p=0.016). As a conclusion, pregnant women reported moderate stress level, poor sleep quality, very low PA level, and moderate pain intensity in the pandemic.

638-P: Differences in Perceived Stress between Genders among People with Diabetes during COVID Lockdown in Argentina

Many studies suggest that there is a difference in perceived stress (PS) among genders in general population. Gender differences in patients with diabetes are uncertain. Descriptions of gender differences in PS during Covid lockdown in people with diabetes are lacking. Objectives: To assess the differences regarding perceived stress and anxiety between genders among persons with diabetes during COVID-pandemic lockdown. Secondary: To describe the association between PS with metabolic control and other co-variables. Methods: Multicenter, cross-sectional observational study of data collection through an online survey. Adults with T1D and T2D in 37 Argentine Diabetes Centers were included, from April to May, 2020. Degree of stress was evaluated by the Perceived Stress Scale (PSS) , and anxiety by the Beck Anxiety Inventory (BAI) . Results: 2273 patients were included. 1194 (52.5%) were female. Age in woman 48.6 years and 52.1 in men. The proportion of patients with T2D was higher in male (58.6% vs. 48.9%) . Diabetes duration was around 14 years, similar in both genders. A1c levels were higher in female patients (7.7% vs. 7.5%, p &amp;lt; 0.05) . BAI and PPS scales resulted significantly correlated (r=0.58; p &amp;lt;0.001) . In the univariate analysis BAI and PPS scores were significantly higher in women with both T1D and T2D vs. men (BAI 8.9 vs. 6.6, p&amp;lt;0.001, PSS 14.3 vs. 11.8, p&amp;lt;0.001) . Using a logistic model as a discriminant function, female gender was significantly associated with BAI and PPS scores after adjustment for type of diabetes, age, A1c, educational level, living alone condition and the presence of comorbidities or complications (p&amp;lt;0.001) . Using multiple linear regression, BAI and PSS scores were significantly associated with female gender, after adjustment by the same covariates (BAI p&amp;lt;0.00 and PSS p&amp;lt;0.0013) . Conclusion: In the study sample, female gender was associated with higher scores of anxiety and PS, in a context of isolation due to COVID pandemic in Argentina. Disclosure M.L.Pomares: None. Study group covid-grad, argentine diabetes society: n/a. C.Gomez martin: None. S.Apoloni: None. C.M.Muratore: None. P.J.Avila: None. M.A.Forlino: Speaker's Bureau; Novo Nordisk. F.Rivera: None. L.Castagnino: None. B.Piedimonte: None.

Factors predicting the risk of loss of decisional capacity for medical assistance in dying: a retrospective database review.

Bill C-14, the legislation that legalized medical assistance in dying (MAiD) in Canada in 2016, outlines eligibility criteria and includes both a mandated 10-day reflection period and a requirement that the patient have capacity to consent at the time MAiD is provided. We examined clinical factors associated with shortened reflection periods or loss of capacity before provision of MAiD. This retrospective database review involved patients who requested MAiD at a tertiary care hospital in Toronto, Canada, between June 2016 and April 2019. We used logistic regression analyses to examine the association between the combined outcome of unanticipated loss of decisional capacity, shortening of the reflection period or death and the clinical risk factors of interest (age, sex, location of MAiD request [inpatient v. outpatient], score on palliative performance scale [PPS] and diagnosis [cancer v. noncancer]). We generated receiver operating characteristic curves to identify the PPS score (encompassing 5 functional domains: ambulation, activity level, self-care, intake and level of consciousness) that best predicted loss of capacity, shortening of the reflection period or death. In total, 155 patients requested assessment for MAiD, and 136 of these were included in the statistical analyses. For 68 patients, the reflection period was not shortened; the other 68 patients lost capacity, died or required shortening of the reflection period. In contrast to the results for age, sex, location of request and diagnosis, the PPS score was associated with loss of capacity or shortening of the reflection period (odds ratio 4.63, 95% confidence interval 2.87-8.23, per 10-point decrease in PPS score). PPS scores less than or equal to 40% balanced sensitivity, specificity and negative predictive value while emphasizing sensitivity to prevent false negative errors. The PPS score at the time of MAiD request was strongly associated with loss of capacity or shortening of the reflection period, with lower scores incrementally increasing the risk of these outcomes. For patients with a PPS score of 40% or below, close monitoring is warranted, potentially with plans made to allow rapid provision of MAiD should their clinical condition deteriorate.

The desire for death in Portuguese home-care palliative patients: Retrospective analysis of the prevalence and associated factors.

Desire for death (DfD) is a complex and multifactorial dimension of end-of-life experience. We aimed to evaluate the prevalence of DfD and its associations, arising within the setting of a tertiary home-based palliative care (PC) unit. Retrospective analysis of all DfD entries registered in our anonymized database from October 2018 to April 2020. Of the 163 patients anonymously registered in our database, 122 met entry criteria; 52% were male, the average age was 69 years old; 85% had malignancies, with a mean performance status (PPS) of 56%. The prevalence of DfD was 20%. No statistical differences were observed between patients with and without DfD regarding sex, age, marital status, religion, social support, prior PC or psychological follow-up, type of diagnosis, presence of advanced directives/living will, time since diagnosis and PC team's follow-up time. Statistically significant associations were found between higher PPS scores and DfD (OR = 0.96; 95% confidence interval (CI) [0.93-0.99]); Edmonton Symptom Assessment Scale scores for drowsiness (OR = 4.05; 95% CI [1.42-11.57]), shortness of breath (OR = 3.35; 95% CI [1.09-10.31]), well-being (OR = 7.64; 95% CI [1.63-35.81]). DfD was associated with being depressed (OR = 19.24; 95% CI [3.09-+inf]); feeling anxious (OR = 11.11; 95% CI [2.51-49.29]); HADS anxiety subscale ≥11 (OR = 25.0; 95% CI [2.10-298.29]); will-to-live (OR = 39.53; 95% CI [4.85-321.96]). Patients feeling a burden were more likely to desire death (OR = 14.67; 95% CI [1.85-116.17]), as well as those who were not adapted to the disease (OR = 4.08; 95% CI [1.30-12.84]). In multivariate regression analyses predicting DfD, three independent factors emerged: higher PPS scores were associated with no DfD (aOR = 0.95; 95% CI [0.91-0.99]), while the sense of being a burden (aOR = 12.82; 95% CI [1.31-125.16]) and worse well-being (aOR = 7.72; 95% CI [1.26-47.38]) predicted DfD. Prevalence of DfD was 20% and consistent with previous Portuguese evidence on DfD in PC inpatients. Both physical and psychosocial factors contribute to a stronger DfD.

Association of sleep quality during pregnancy with stress and depression: a prospective birth cohort study in China

BackgroundThe sleep quality of pregnant women in the third trimester is related to mental health. However, there is still a lack of large-scale cohort research exploring this relationship in the second trimester. Thus, we assessed the associations of sleep quality during the second trimester with antenatal stress and antenatal and postnatal depression.MethodsWe examined 1152 pregnant women from a prospective cohort study in China to assess the associations of sleep quality in the second trimester with antenatal stress, antenatal depression, and postnatal depression. We used linear regression models and logistic regression models to examine the associations of sleep quality (Pittsburgh Sleep Quality Index [PSQI]) during pregnancy with perinatal stress (Pregnancy Pressure Scale [PPS]) and depression (Edinburgh Postnatal Depression Scale [EPDS]) status. We further assessed the relationship in groups divided according to maternal age.ResultsPSQI scores were positively associated with antenatal PPS scores (β: 1.52, 95% confidence interval [CI]: 1.28, 1.76), antenatal EPDS scores (β: 0.68, 95% CI: 0.58, 0.78), and postpartum EPDS scores (β: 0.51, 95% CI: 0.38, 0.64). Poor sleep quality (PSQI scores ≥5) was associated with antenatal stress status (odds ratio [OR]: 2.60, 95% CI: 1.79, 3.77), antenatal depression status (OR: 3.42, 95% CI: 2.48, 4.72), and postpartum depression status (OR: 2.40, 95% CI: 1.58, 3.64) after adjusting maternal age, BMI, gestational age, smoking, educational level, annual household income and social support. The association of poor sleep quality (PSQI scores ≥5) in the second trimester with postnatal depression status was significant among women more than or equal to 30 years old (OR: 4.12, 95% CI: 2.18, 7.78) but not among women less than 30 years old after adjusting covariates above.ConclusionPoor sleep quality in the second trimester among Chinese pregnant women is associated with stress and depression symptoms. Strategies to boost sleep quality should be considered during prenatal health care to improve women’s mental health status.

0979 INFANT FEEDING AND NOCTURNAL SLEEP

Breast milk has many advantages, but many caregivers believe that due to the easily digestible nature of breast milk, infants feeding with breast milk would have more nocturnal awakenings. As a result, formula is often given in an attempt to consolidate infant sleep. However, few studies have examined infant feeding and sleep using objective instruments. The purpose of this study was to examine the association between infant feeding and nocturnal sleep patterns. This study included 78 healthy 6-month-old infants. Mothers provided information about demographic background, infant feeding patterns, and completed the Extended version of the Brief Infant Sleep Questionnaire and Perceived Stress Scale (PSS). Infant sleep was measured by both actigraphy and sleep diary for 7 consecutive days. Infants were categorized into three different feeding types: infants feeding with exclusive breast milk (n=26, 33.3%), with mixed of breast milk and formula (n=18, 23.1%), or with exclusive formula (n=34, 43.6%). Infants were also categorized into two different feeding practice groups: infants who were breastfed (n=29, 37.2%) and those who were exclusively bottle-fed (n=49, 62.8%). Actigraphy derived sleep parameters, including actual sleep at night, wake after sleep onset, and fragmentation index, did not differ significantly among infants with different feeding types and practices. Infants who were breastfed had significantly more nocturnal awakenings by maternal report than those who were bottle-fed (1.97 ± 1.45 vs. 1.31 ± 1.28, p=0.04). Breastfeeding mothers’ PPS scores were significantly higher than mothers who bottle-fed their infants (18.93 ± 6.39 vs. 14.8 ± 6.06, p=0.004). Objective actigraphic sleep estimates are not compromised in infants who are breastfed or fed with breast milk. Mothers who are concerned that breastfeeding would disrupt infant sleep should be encouraged to continue breastfeeding and providing breast milk. More support should also be given to breastfeeding mothers to reduce their breastfeeding-related stress. This research was funded by National Health Research Institute (NHRI-EX105-10229PC).

Can Hospices Predict Which Patients Are Likely to Live More than Six Months? (FR421-B)

1.Discuss factors among dementia and debility patients more likely to lead to long survival in hospice patients.2.Discuss 6-month survival statistics among patients with cancer based upon admission performance status. Some studies have analyzed characteristics associated with long stays in subgroups of hospice admissions but there have been no studies that have determined predictors of long stays in the overall hospice population. To determine whether it is possible to predict, at the time of hospice enrollment, patients with a high likelihood of surviving more than 6 months. Data were extracted from the electronic records of participating CHOICE network hospices for patients admitted between January 2008 and May 2012. A multivariable regression model was used to identify independent predictors of better 6-month survival. Among the 117,188 patients whose status (living vs. dead) at 6 months was known, 15,129 (11%) were still alive at 6 months. A strong predictor of increased 6-month mortality was admission from a hospital (OR=1.42, 95% CI=1.36, 1.48, P=<.001). Debility (OR=-1.29, 95% CI=-1.34, -1.23, P=<.001) and dementia patients (OR=-1.42, 95% CI=-1.48, 1.36, P=<.001) were less likely to die within 6 months. The greatest odds of 6-month mortality was for patients admitted with PPS scores of 30 (OR=-1.83, 95% CI=-1.92, -1.74, P=<.001). Even for patients in the best prognostic group (patients admitted with dementia and PPS 60% or greater), however, odds of surviving 6 months was only 48%. Although there are several variables that could be used to identify those patients who are more likely than others to survive for 6 months, even those patients with the best prognosis still meet Medicare's prognostic criteria for eligibility.

Patterns of Functional Decline in Hospice: What Can Patients and Families Expect? (SA528-B)

1.Anticipate likely trajectories of decline for hospice patients based on patient characteristics.2.Anticipate levels of functional status on the last day of life based on patient characteristics. Although a decline in functional status is expected during hospice enrollment, it is not known whether decline happens more quickly for some groups of patients than for others. To describe the trajectory of patients’ functional decline after they are referred to hospice. Prospective electronic health record-based study of patients in three hospice programs in the Southeast, Northeast, and Midwest US. A total of 10,344 patients were admitted between October 1, 2010 and May 31, 2011, for whom 53,286 PPS scores were recorded. After adjusting for the baseline PPS score, patients’ scores declined an average of 3.45 points/week (95% confidence interval: 2.98-3.94). Three distinct trajectories of decline were identified. The most rapid decline was observed for patients with cancer (adjusted decline of 7.84 points/week; 95% CI 7.14-8.47) and stroke (6.37; 5.74-7.63). A significantly slower decline was observed in patients with pulmonary disease (4.55; 3.71-5.39) and cardiac disease (3.85; 3.22-4.48). The slowest decline was seen in patients with debility (1.47; 0.35-2.59) and dementia (1.33; 0.28-2.38). Of the 8,669 patients who died, 1,959 (22.6%) had a PPS score recorded in the last day of life. In an inverse probability-weighted sample of these patients, 35.9% had PPS scores of at least 40, indicating some oral intake, variable mental status, limited self-care, and an ability to get out of bed for at least part of the day. Although functional status generally declines among hospice patients, this decline is heterogeneous and some patients retain some physical and cognitive function on up until the last day of life.

Differential Frequency Effects of Strong Nonpainful Transcutaneous Electrical Nerve Stimulation on Experimentally Induced Ischemic Pain in Healthy Human Participants

Electrophysiological studies show frequency-dependent effects of transcutaneous electrical nerve stimulation (TENS) in animal models of hyperalgesia. Evidence of frequency-dependent effects of TENS in humans is conflicting. To assess the effects of low-frequency and high-frequency TENS at a strong nonpainful intensity on experimentally induced ischemic pain. Submaximal effort tourniquet tests were carried out on 48 healthy human participants before (baseline) and during TENS at 3 pulsed currents per second (pps), 80 pps, and no current (placebo). TENS was switched on for 20 minutes and a submaximal effort tourniquet test was carried out during the final 5 minutes of the intervention. There was a 30-minute washout, with TENS switched off, between the interventions. Repeated measure analysis of variance detected significant effects for pain intensity [100 mm Visual Analog Scale (VAS)] for condition (P<0.001), time (P<0.001), and time×condition (P=0.039). When compared with pre-TENS lower VAS scores were detected for placebo TENS (P=0.026) and 80 pps (P<0.001), but not for 3 pps (P=0.19). There were lower VAS scores for 80 pps than placebo (mean difference, 13.29 mm; 95% CI, 9.71, 16.87; P<0.001) and 3 pps (mean difference, 19.88 mm; 95% CI, 17.20-22.55; P<0.001), yet 3 pps scores were higher than placebo (mean difference, 6.58 mm; 95% CI 3.45, 9.72; P<0.001). There were significantly lower scores for sensory dimensions of the short-form McGill Pain Questionnaire for both 3 pps and 80 pps when compared with the placebo (P<0.001; P=0.005, respectively), but no significant differences between TENS at 80 and 3 pps (P=1.0). There were no significant effects detected for condition (P=0.217) or for condition×sequence interaction (P=0.800) for affective dimensions. Strong nonpainful TENS delivered at 80 pps reduced experimentally induced ischemic pain when compared with TENS delivered at 3 pps.

Quality of Life in Patients Treated with Palliative Radiotherapy for Advanced Lung Cancer and Lung Metastases.

BackgroundThe purpose of this study was to investigate quality of life (QOL) in patients receiving palliative radiotherapy (RT) for advanced lung cancer/lung metastases using the EORTC QLQ-LC13 and the EORTC QLQ-C15-PAL questionnaires.MethodsPatients who received palliative RT for lung metastases or advanced lung cancer between November 2007 and October 2010 completed the EORTC QLQ-LC13 and the QLQ-C15-PAL at baseline prior to RT, 1, 2, 4, 8 and 12 weeks post-treatment. The Wilcoxon Signed Rank test was used to compare QOL scores between baseline and each follow-up period.ResultsThirty-one patients with advanced lung disease were included in this study; 61% of participants were male and 39% were female. The median age was 69 years (range 38 - 85), and median KPS and PPS scores at baseline were both 70 (range 30 - 90). All patients received radiotherapy to the lung. None of the QLQ-LC13 scores significantly improved or deteriorated at any follow-up. Of the QLQ-C15-PAL scales, fatigue, pain, insomnia and physical functioning significantly improved at their respective follow-ups.ConclusionsThis was the first study to use the EORTC QLQ-LC13 in conjunction with the EORTC QLQ-C15-PAL questionnaires. Future studies should continue to incorporate quality of life assessment tools specific to disease characteristics in advanced cancer patients.

Association of Obstructive Sleep Apnea and Auditory Dysfunctions in Older Subjects

Determine the association between obstructive sleep apnea (OSA) and auditory dysfunction in older subjects. Cross-sectional study. Hospital volunteer helpers undergoing questionnaire, morphometry measurement, auditory examinations, and polysomnography between 2008 and 2009. In total, 224 subjects older than 50 years were randomly sampled for above evaluation and testing. The effects of OSA on the peripheral auditory function, represented by averaged pure-tone threshold of low frequencies (PTA-low) and high frequencies (PTA-high), and central auditory function, shown by pitch pattern sequence (PPS scores), were analyzed. The mean ± SD age was 61.2 ± 6.7 years. OSA was confirmed in 6 of 98 women (6.1%) and 28 of 126 men (22.2%). After adjusting for age, gender, and other variables, OSA did not show a significant positive association with PTA-low or PTA-high for all subjects. Conversely, there was a significant negative association between OSA and PPS scores for all subjects, even after adjusting for age, gender, and other variables. When OSA and central obesity together were taken into account in the multivariate linear regression analysis, OSA still showed significant association with PPS score for all subjects. OSA is independently associated with poorer central auditory function in older subjects.

Relationship of Physical Activity, Peception of General Health, and Perceived Stress in College Freshmen

College students are an understudied population who possess unique health challenges. The level of physical activity (PA), perceived stress, and the interaction between these two variables may play a role in overall general health of this population. PURPOSE: Examine the relationship between self-reported general health, perceived stress, and physical activity. METHODS: Subjects were 41 male and 39 female first year students enrolled in a large Mid-western university residing in the same residence quadrangle. Subjects were administered a quality of life (QOL, SF-36) and a 14-tem Perceived Stress Scale (PSS) questionnaire with scores ranging from 0 - 56. Accelerometers were worn for a period of 7 days to quantify activity related energy expenditure (AEE). Perceived general health was reported as excellent, very good, good, fair, or poor as outlined in the QOL questionnaire. The five highest days of AEE were averaged. An ANOVA was utilized to determine if significant differences between the mean values of perceived stress and PA existed within general health categories (GHC). RESULTS: Mean AEE (kcal·day−1) was 963.4 ± 313.4, 658.7 ± 270.8, 632 ± 184.8, and 547.8 ± 263.5 for the excellent, very good, good, and fair GHC, respectfully. Mean PPS scores were 15.6 ± 5.4, 18.7 ± 6.2, 22.5 ± 6.8, and 20.8 ± 7.5 for each of the GHC. Significant sex differences (p < 0.001) existed for both PA (males, 763.4 ± 246.5; females 561.3 ± 230.4) and PSS (males, 17.4 ± 6.1 vs. 22.1 ± 6.9). A significant main effect of general health (p < 0.001) was found for both AEE and PSS indicating that means were dependent upon health category. Post-hoc tests revealed that the AEE of those in the excellent GHC was significantly higher than all of the other categories and PSS of those who reported excellent health was significantly lower than the very good category. CONCLUSION: High levels of AEE are associated with low stress and better perceived health in first year college students. This relationship may be dependent upon sex as female students were found to be less active, more stressed, and reported poorer health than their male counterparts. Future research should focus on tracking GH, AEE, and PS over time and examining interventions in an effort to improve/maintain AEE and decrease stress throughout the college experience and into adulthood. Funded by IU Residential Programs and Services

Need satisfaction and Edwards PPS scores in married couples.

Need satisfaction and Edwards PPS scores in married couples.