Scratching In Patients Research Articles

Defining the Digital Measurement of Scratching During Sleep or Nocturnal Scratching: Review of the Literature.

Digital sensing solutions represent a convenient, objective, relatively inexpensive method that could be leveraged for assessing symptoms of various health conditions. Recent progress in the capabilities of digital sensing products has targeted the measurement of scratching during sleep, traditionally referred to as nocturnal scratching, in patients with atopic dermatitis or other skin conditions. Many solutions measuring nocturnal scratch have been developed; however, a lack of efforts toward standardization of the measure's definition and contextualization of scratching during sleep hampers the ability to compare different technologies for this purpose. We aimed to address this gap and bring forth unified measurement definitions for nocturnal scratch. We performed a narrative literature review of definitions of scratching in patients with skin inflammation and a targeted literature review of sleep in the context of the period during which such scratching occurred. Both searches were limited to English language studies in humans. The extracted data were synthesized into themes based on study characteristics: scratch as a behavior, other characterization of the scratching movement, and measurement parameters for both scratch and sleep. We then developed ontologies for the digital measurement of sleep scratching. In all, 29 studies defined inflammation-related scratching between 1996 and 2021. When cross-referenced with the results of search terms describing the sleep period, only 2 of these scratch-related papers also described sleep-related variables. From these search results, we developed an evidence-based and patient-centric definition of nocturnal scratch: an action of rhythmic and repetitive skin contact movement performed during a delimited time period of intended and actual sleep that is not restricted to any specific time of the day or night. Based on the measurement properties identified in the searches, we developed ontologies of relevant concepts that can be used as a starting point to develop standardized outcome measures of scratching during sleep in patients with inflammatory skin conditions. This work is intended to serve as a foundation for the future development of unified and well-described digital health technologies measuring nocturnal scratching and should enable better communication and sharing of results between various stakeholders taking part in research in atopic dermatitis and other inflammatory skin conditions.

ENDOMETRIAL SCRATCHING IN PATIENTS WITH UNEXPLAINED INFERTILITY UNDERGOING INTRAUTERINE INSEMINATION: PRELIMINARY REPORT OF A RANDOMIZED CONTROLLED TRIAL

To evaluate the impact of endometrial scratching in patients with unexplained infertility undergoing ovarian stimulation and intrauterine insemination.

225 Identification of meaningful aspects of health connected to the symptom of nocturnal scratching in patients with atopic dermatitis

Substantial work is underway across both pharmaceutical companies and digital product manufacturers to apply digital technologies to better measure symptoms in acute dermatologic conditions. To date, among the more advanced and promising applications of digital clinical measures as a drug development tool is nocturnal scratch. Novel digital clinical measures could provide an additional tool in answering the need for improved, precise, long-term quantitative measures of nocturnal scratching. In this work, a consortium of industry, patient advocacy and non-profit organizations came together to develop a mixed methods study to explore patient experience with nocturnal scratch.

Objective evaluation of the ``scratch collapse test'' for the diagnosis of carpal tunnel syndrome

PurposeEvaluate the Scratch Collapse Test in an objective way, by replacing the subjective evaluation made by the physician with an objective evaluation measure, made with a digital dynamometer. MethodsObservational study carried out, in 90 patients divided into three groups of 30 patients, taking into account the electromyographic study of the median nerve in the carpal tunnel (no alteration, moderate, severe).The external rotation of the shoulder was measured in four different situations (no scratch, scratch over the carpal tunnel, scratch in the dorsum of the wrist and scratch in the shoulder). ResultsThere were no statistical differences in the result of the strength in any of the four different situations in patients without carpal tunnel of with moderate carpal tunnel syndrome. However, there were statistical differences between the basal measurement (without scratching) and the measurement after tunnel scratching in patients with severe carpal tunnel syndrome. But this statistical difference was only 0.08 kg in the average measure, and this difference is clinically undetectable and far for producing a real collapse of the external rotation of the shoulder. ConclusionThe Scratch Collapse Test is not a valid diagnostic exam for carpal tunnel syndrome if the strength is measured in an objective manner.

Effect of endometrial injection scratching in cycles of treatment by assisted reproductive technology methods

Objective: optimization of pregravid (pre-pregnancy) preparation in patients with tubal-peritoneal infertility factor and marked delay in endometrial development after unsuccessful assisted reproductive technology (ART) treatment by the use of endometrium injection scratching technology with autoplasma.Material and methods. Study included 40 cases of unsuccessful treatment attempts for tubal-peritoneal factor infertility with severe delay of endometrial development and 10 patients with tubal-peritoneal factor infertility with normal endometrium with one or more unsuccessful ART attempts on history and the existence of cryopreserved embryos of satisfactory quality from previous cycles of assisted reproductive technology. The average age was 39.5 ± 3.1 years. Patients were divided into groups: I – 21 patients who underwent endometrial injection scratching and hormonе replacement therapy (HRT) with a standard (4/6 mg) dose of estradiol; II – 19 patients who were prescribed HRT with a standard (4/6 mg) dose of estradiol; control – 10 patients with normal endometrium who underwent cryo-ET with standard (4/6 mg) dose of estradiol.Clinical results were evaluated and compared in terms of pregnancy rate per embryo transfer and pregnancy loss rate in the first trimester. The correspondence of the morphofunctional structure of the endometrium was evaluated by ultrasound, cytologically, Doppler measurements, histologically, immunohistochemically and via selective electron microscopy. Endometrium was 8.9 ± 1.1 mm during the period of progesterone prescription in the cryoembryo transfer cycle. All participants were transferred day 5 embryos. Results. In the cryo-ET program autoplasma injection scratching in patients with marked delay of endometrial development after the first seven days of monotherapy with a starting dose of estradiol was accompanied by a significant improvement in clinical outcomes in terms of pregnancy rate (25%) and definite decrease of early reproductive losses (25%).Conclusions. After pre-pregnancy preparation according to our method, it is quite sufficient to perform HRT with a standard dose of estradiol (4/6 mg/day) before starting progesterone irrespective of the endometrial development degree. Meanwhile, injection scratching is advisable to be prescribed in cases of marked delay in the endometrium development and it should be combined with physiotherapy methods.

Timing of endometrial scratching for women undergoing ICSI: A randomized clinical trial

Aim: To determine the optimum time for endometrial scratching in patients with unexplained primary infertility undergoing ICSI-ET cycles after one or more implantation failure. Methods: A randomized clinical trial wasconducted at fertility care unit, Mansoura University Hospital and 2 private fertility centers, Egypt, fromNovember 2016 tillJune 2018. Eligible participants [142] had unexplained primary infertility, were prepared and sched- uled to obligate for ICSIcycles. Patients were randomly allocated into two equal groups using computer-generated tables and sealed opaque envelopes. Endometrial scratching was done either just af- ter oocyte retrieval in (group 1) or mid-luteal in the cycle before induction (group 2). Patients, investigators, and data analysts were not masked to group assignment. The primary outcome measure was implantation rate while the clinical pregnancy rate was settled as the secondary outcome measure. Results: one hundred forty two clients were included (71 in each group). Baseline characteristics did not differ between both groups as regard the age, BMI, duration of infertility and basic laboratory inves- tigations (p>0.05). The mean estimated day of triggering (14.2 ± 2.1 in G1 vs 13.6 ± 2.2 in G2) together with the mean follicular size (19.3 ± 0.8 in G1 vs 18.5 ± 1.8 in G2) showed also no statistical significance (p values 0.690 and 0.751 respectively). Again, the mean estimated number of ova retrieved (7.4+ 2.1 in G1 vs 7.1+ 1.3 in G2) and zy- gote transferred (2 in each group) presented no significant differences together with the chemical pregnancy rates (54 in G1 vs 52 in G2, p>0.05). On the other hand, IR and CPR are found significantly high- er in group 1 compared to group 2, (IR 53.5% vs, 40.8%; whilst CPR 49.3% vs 35.2%, p<0.05). Conclusion: retrieval day endometrial scratching seemed to improve clinical pregnancy and implantation rates than does mid-luteal endo- metrial scratching in patients with unexplained infertility

Comparison of Clinical Pregnancy Rates and Implantation Rates in Hysteroscopic Lateral Metroplasty versus Endometrial Scratching in Patients of Repeated Implantation Failures

ABSTRACT Introduction Implantation is one of the rate-limiting steps of success rates in patients undergoing in vitro fertilization. Repeated implantation failure is defined as failure of good-quality embryos to successfully implant in uterine cavity in repeated IVF treatment cycle. The cause of such implantation failures may be maternal or embryonal. Endometrial scratching and lateral metroplasty are found to increase successful implantation rates in various studies. There is hardly any study in the literature comparing the success rates of endometrial scratching and hysteroscopic lateral metroplasty. Keeping in mind this fact, we conducted this comparative study to compare the successful pregnancy rates and clinical pregnancy rates in patients who had undergone endometrial scratching and hysteroscopic lateral metroplasty for repeated implantation failures. Materials and methods A total of 60 patients having primary or secondary infertility and had history of repeated implantation failure were included in this study on the basis of a predefined inclusion and exclusion criteria. The patients were divided into two groups on the basis of treatment they received. In group A, 30 patients underwent endometrial scratching, and in group B, 30 patients underwent hysteroscopic lateral metroplasty. The successful pregnancy rates and clinical pregnancy rates in both the groups were compared. SPSS 22.0 was used for statistical analysis, and P value less than 0.05 was taken as statistically significant. Results Out of 60 patients, 50 (87.5%) patients belonged to primary infertility, whereas 10 (12.5%) patients were found to have secondary infertility. The mean age of patients in group A was 34.12 ± 3.12, whereas the mean age in group B was 35.42 ± 4.46 years. The mean duration of infertility in patients of group A and group B was found to be 7.43 ± 2.50 and 6.93 ± 2.54 years, respectively. The mean number of antral follicle count in group A was 9.52 ± 1.82, whereas in group B, it was 10.42 ± 1.52. In group A, 12 (40%) patients were confirmed to be having successful pregnancy on the basis of β-hCG levels on D14, whereas 17 (56.67%) patients in group B were found to have successful pregnancy on the basis of β-hCG. Fetal cardiac activity was present in 13 (43.33%) patients and 18 (60%) patients in group A and group B, respectively (p = 0.301). The difference was not found to be statistically significant (p = 0.30). Conclusion Endometrial scratching and hysteroscopic lateral metroplasty both are effective management strategies in patients having history of repeated implantation failure. Though lateral metroplasty appears to be a better choice, the difference was statistically insignificant (p &gt; 0.05). How to cite this article Kale A, Kale A. Comparison of Clinical Pregnancy Rates and Implantation Rates in Hysteroscopic Lateral Metroplasty versus Endometrial Scratching in Patients of Repeated Implantation Failures. J South Asian Feder Obst Gynae 2020;12(6):348–352.

Endometrial scratching prior to IVF; does it help and for whom? A systematic review and meta-analysis.

STUDY QUESTIONWhat is the effect of endometrial scratching in patients with or without prior failed ART cycles on live birth (LBR) and clinical pregnancy rates (CPR)?SUMMARY ANSWERIt remains unclear if endometrial scratching improves the chance of pregnancy and, if so, for whom.WHAT IS KNOWN ALREADYEndometrial scratching is hypothesized to improve embryo implantation in ART. Multiple studies have been published, but it remains unclear if endometrial scratching actually improves pregnancy rates and, if so, for which patients.STUDY DESIGN, SIZE, DURATIONFor this review, a systematic search for published articles on endometrial scratching and ART was performed on 12 February 2018, in Pubmed, Embase and the Cochrane Library.PARTICIPANTS/MATERIALS, SETTING, METHODSRandomized controlled trials (RCTs) that evaluated endometrial scratching in the cycle prior to the stimulation cycle and reported CPR or LBR were included. RCTs investigating the effect of scratching during the stimulation cycle, or prior to cryo-thaw cycles were excluded. Studies were assessed using the Cochrane Risk of Bias tool. The effect of scratching was assessed for three different patient groups: patients with no prior IVF/ICSI treatment (Group 0), patients with one failed full IVF/ICSI cycle, including cryo-thaw cycles (Group 1) and patients with two or more failed full IVF/ICSI cycles (Group 2). A meta-analysis was performed when statistical heterogeneity was low; otherwise, a descriptive analysis was performed.MAIN RESULTS AND THE ROLE OF CHANCEFourteen RCTs involving 2537 participants were included. Most RCTs contained a high or unclear risk of bias on one or more items. Substantial clinical and statistical heterogeneity was present; therefore meta-analysis for LBR and CPR could only be performed on Group 1. For this group, no differences between scratch and control were found for both LBR (risk ratio (RR) 1.01 [95%CI 0.68–1.51]) and CPR (RR 1.04 [95%CI 0.74–1.45]). For Groups 0 and 2, pooled analysis could not be performed, and for both groups the results of the individual RCTs were negative, neutral and positive. Miscarriage and multiple pregnancy rates were evaluated for the three groups (0, 1 and 2) together. Both outcomes were not significantly different between scratch and control (miscarriage rate RR 0.82 [95%CI 0.57–1.17] and multiple pregnancy rate RR 1.06 [95%CI 0.84–1.35]). Subgroup analysis, excluding trials with a risk of unintentional endometrial injury in the control group, was performed for Group 0 and 2 for LBR and CPR, and for the overall groups for miscarriage rate and multiple pregnancy rate. This reduced the heterogeneity and allowed for pooled analysis in these subgroups. Results of pooled analysis for the subgroups of Group 0 and 2 showed no significant difference for LBR, but CPR was significantly improved after endometrial scratching (Group 0 RR 1.28 [95%CI 1.02–1.62] and Group 2 RR 2.03 [95%CI 1.20–3.43]). Subgroup analysis of the overall groups showed no significant difference for miscarriage and multiple pregnancy rate.LIMITATIONS REASONS FOR CAUTIONThe main limitations were that many RCTs had a high or unclear risk of bias on one or several items, clinical heterogeneity was still present despite categorizing into three populations, and that not all RCTs could be included in the analyses because separate data for our three groups could not be provided.WIDER IMPLICATIONS OF THE FINDINGSIt remains unclear if endometrial scratching improves the chance of pregnancy for women undergoing ART and, if so, for whom. This means endometrial scratching should not be offered in daily practice until results from large and well-designed RCTs and an individual patient data analysis become available.STUDY FUNDING/COMPETING INTERESTSNo specific funding was sought for the study. The Department of Reproductive Medicine and Gynaecology funds of the University Medical Center of Utrecht were used to support the authors throughout the study period and preparation of the manuscript. None of the authors has a conflict of interest to declare.REGISTRATION NUMBERNot applicable.

Impact of acute stress on itch sensation and scratching behaviour in patients with atopic dermatitis and healthy controls.

Patients with atopic dermatitis (AD) often report that stress aggravates their itch. However, no study has investigated if and how acute stress influences itch sensation and scratching behaviour in these patients. We evaluated the impact of acute stress on experimentally induced cowhage itch perception and scratching behaviour in 16 healthy subjects and 15 patients with AD. The Trier Social Stress Test (TSST) was used to induce acute stress. The itch sensation, provoked by applying cowhage to the forearms, and off-site scratching behaviour (not directed at the cowhage application site) were compared before and after performing the TSST or the control condition (watching a video of landscape scenes). In patients with AD, stress induced by TSST caused a significant reduction of cowhage-evoked itch but significantly increased off-site scratching behaviour. Such changes in itch perception and scratching behaviour were not observed in healthy controls. In addition, a significant positive correlation was noted between stress induced by TSST and clinical severity of eczema. We speculate that psychological stress increases spontaneous scratching in patients with AD, which may enhance the vicious cycle of itching and scratching, resulting in aggravation of the skin eczema. These results provide new insights on the mechanism of acute stress-related exacerbation of itch in patients with AD.

Agreeableness as Predictor of Induced Scratching in Patients with Atopic Dermatitis: A Replication Study.

In patients with atopic dermatitis agreeableness and public self-consciousness have previously been shown to be significant predictors of induced scratching, while depression was significantly related to induced itch. This study aimed to replicate these findings. Itch and scratching were induced by videos of crawling insects or skin diseases. Induced itch was measured using a visual analogue scale. Scratching behavior was evaluated by two raters. Psychological variables were assessed using validated questionnaires. Induced scratching could be predicted significantly by agreeableness (corrected R2 = 15.5% or 38 % after exclusion of one outlier): Patients scoring low on agreeableness showed a higher increase in scratch movements than patients scoring high on this scale. No associations between induced scratching/itch and public self-consciousness/depression were found. One clinical implication that arises from this study could be to offer patients scoring low on agreeableness certain psychological interventions.

Role of personality and expectations for itch and scratching induced by audiovisual itch stimuli.

Itch is an unpleasant, bodily sensation, which--similar to pain--evokes behavioral reactions. As a response to itch, people start scratching. There are different ways to provoke itch and subsequent scratching in experimental settings. A non-invasive method to induce itch and scratching is the presentation of itch-related (audio-) visual stimulus material, like slide-supported lectures on skin diseases or crawling insects. Also, watching videos showing other people scratching provokes itch and the desire to scratch. In this review, we focus on psychological factors, which were shown to be associated with itch and scratching provoked by (audio-) visual itch stimuli. First, we summarize the findings on the relationship between personality characteristics and (audio-) visually induced itch. Agreeableness and self-consciousness were shown to be associated with induced itch and scratching in patients with chronic skin diseases, while neuroticism was linked to induced itch in healthy subjects. Second, we present results of a recent study, in which we altered the expectations towards audio-visually induced itch and scratching by changing the information given on upcoming itch stimuli. It was shown that subjects being informed about itch stimuli in a neutral way displayed a shorter scratch duration in itch inducing situations than subjects having catastrophizing expectations. Also, the increase in scratch duration and in the number of scratch movements induced by audiovisual itch stimuli was higher when the patients were not informed about itch induction. Thus, in itch patients neither catastrophizing nor trivializing symptoms seems to be helpful.

Does endometrial injury enhances implantation in recurrent in-vitro fertilization failures? A prospective randomized control study from tertiary care center.

BACKGROUND:Though Assisted Reproductive Techniques have overcome many fertility disorders, implantation is still considered, the rate-limiting step for the success of IVF.AIM:The aim of this study was to evaluate the role of endometrial scratching in improving the implantation rate in patients undergoing IVF-ET cycles.DESIGN:Prospective randomized control trial.METHODS:Sixty infertile women with a history of >1 previous failed IVF-ET cycles were randomizedinto two groups of 30 each. The patients in group 1 underwent endometrial scratching once between days 14-21 of menstrual cycle in the cycle prior to embryo transfer (ET), while in group 2scratching were not done. Implantation rate, ongoing pregnancy rate, abortion rate and live birth rate were comparedbetween both groups.STATISTICAL ANALYSIS:Mean values were compared between two groups using Student's’t’ independent test. Frequency distributions of categorical variables were compared using Chi-Square/Fisher's exact test as appropriate.RESULTS:Implantation rate in group 1 was 19.4% whereas in group 2 it was 8.1%. Difference between two groups was statistically significant (P =0.028). The live birth rate was higher in the group 2 compared to group 1, however this difference was not statistically significant (3.3% vs 10%, P =0.612). No significant difference was observed between the two groups regarding the ongoing pregnancy rate (16.7% vs 0.0%; P =0.052), abortion rate (10.0% vs 3.3%, P =0.612) and miscarriage rate (6.7% vs 3.3%, P =0.99).CONCLUSIONS:Implantation rate increases significantly after endometrial scratching in patients with previous failed IVF-ET.

Objective measurement of pruritus in dogs: a preliminary study using activity monitors

Pruritus is an important clinical sign and quality-of-life measure in canine dermatology, but can be difficult to assess objectively. Several studies in humans have used activity monitors to measure nocturnal scratching in patients with atopic dermatitis. The results correlate with observation of scratching, scoring in atopic dermatitis indices and levels of inflammatory chemokines. The aim of this study was to examine whether an activity monitor could be used to detect elevated interexercise (i.e. 'resting') activity in atopic dogs compared to healthy dogs. Five healthy dogs and six dogs with atopic dermatitis were fitted with a collar-mounted activity monitor (Actiwatch) that recorded the piezo-electric voltage generated over 15-s epochs for 7 days. Data from defined periods of exercise, playing, etc., were disregarded. Within each group, median (+/- interquartile range) epoch activity was similar during the day (atopic 21.0 [9.8-24.8]; healthy 5.1 [4.6-6.0]) and evening (atopic 19.1 [10.9-25.2]; healthy 5.8 [5.3-11.7]), and significantly lower overnight (atopic 5.8 [4.1-15.7]; healthy 2.5 [1.6-4.4]) (Mann-Whitney test; P < 0.05). The mean epoch activity, however, was significantly higher in atopic dogs compared to healthy dogs for all three time periods (P < 0.05). This study provides preliminary evidence that activity monitors could objectively assess canine pruritus in the normal home environment.

Itch and atopic dermatitis: an overview.

Itching is the hallmark of atopic dermatitis, and a vicious itch-scratch circle is easily established. Itching and scratching are important factors in the maintenance of symptoms and can have a significant impact on the sufferer's quality of life. The pathophysiology of itch in atopic dermatitis is still not understood. Unlike in urticaria, histamine is not considered to be a major pruritogen in atopic dermatitis. In fact, the peripheral pruritogens and their cellular origin(s) still remain to be identified in this disease. Various treatments are used to relieve the skin inflammation, itching, and scratching in patients with atopic dermatitis, but no specific antipruritic therapy is available. However, several nonspecific therapies can effectively break the vicious itch-scratch circle. The use of topical corticosteroids and emollients and the elimination of individual trigger factors are still first-line measures.

Management of opioid-induced pruritus: a role for 5-HT3 antagonists?

We have evaluated the efficacy of ondansetron in the prevention of opioid-induced pruritus in a prospective, randomized, double-blind, placebo-controlled study. Using a 'human model' of opioid-induced pruritus, 80 ASA I-II patients about to undergo routine surgery were given either ondansetron 4 mg i.v. or 0.9% saline i.v. (40 in each group), 30 min before alfentanil 10 mg kg-1 i.v. During the following 5 min, patients were observed for signs of perinasal scratching and at 5 min were asked about symptoms of pruritus. The study was then terminated and anaesthesia was induced. There was a significant reduction in the incidence of scratching in patients receiving ondansetron compared with placebo (42.5% vs 70%, respectively, P = 0.013). The incidence of itching in the ondansetron group was less than that in the placebo group but this was not statistically significant (30% vs 42.5%, respectively, P = 0.245). We conclude that the 5-HT3 antagonist ondansetron may have a role in the management of opioid-induced pruritus.

Effects of trimeprazine and trimipramine on nocturnal scratching in patients with atopic eczema

Effects of trimeprazine and trimipramine on nocturnal scratching in patients with atopic eczema

Effects of Trimeprazine and Trimipramine on Nocturnal Scratching in Patients With Atopic Eczema

Twelve men with severe and long-standing atopic eczema were admitted to a double-blind trial to establish the effects of trimeprazine tartrate, trimipramine maleate, and placebo on nocturnal scratching. Neither of the drugs altered the likelihood of a scratching bout beginning in wakefulness or in any stage of sleep. However, both drugs, especially trimipramine, made sleep less broken, and the reduced time spent in stage 1 of sleep accounted for a modest reduction in the overall amount of scratching during the night.