Self-rated Visual Analogue Scale Research Articles

PENGARUH MENGUNYAH PERMEN KARET RENDAH GULA TERHADAP PENINGKATAN SEKRESI SALIVA PADA PASIEN YANG MENJALANI TERAPI HEMODIALISA

Abstract Background: Chronic kidney failure is a health problem that needs special attention. The number of end-stage renal failure sufferers undergoing hemodialysis therapy increases every year. Hemodialysis therapy is an appropriate action to replace kidney function with a method of supplying fluid intake which results in most patients complaining of dry mouth (xerostomia). Objective: Fluid restriction generally causes dry mouth in hemodialysis (HD) patients. The observed effects of chewing gum on the amount of saliva, interdialytic weight gain (IDWG), and thirst levels in HD patients are inconsistent. We are considering whether gum can modulate this third parameter in patients undergoing HD. Method: This study used purposive sampling with 37 patients on HD. Thirst levels were measured using a self-rated visual analogue scale (VAS) and the summed xerostomia inventory (SXI). Results: The level of thirst after blood washing was significantly lower in the gum chewing group compared to the control group with a p value (0.000) <0.005. The amount of saliva was higher in the gum group than in the control group before dialysis, but the amount of saliva was comparable between the groups after dialysis. In addition, the amount of saliva was not associated with IDWG in patients undergoing HD before or after dialysis. Conclusion: Chewing gum can relieve thirst but does not affect the amount of saliva and IDWG in HD patients. Therefore, we suggest that chewing gum may be a useful approach to treat dry mouth and thirst in HD patients.

Chewing Gum May Alleviate Degree of Thirst in Patients on Hemodialysis.

Background and Objectives: Fluid restriction commonly causes dry mouth in patients on hemodialysis (HD). The observed effects of chewing gum on the amount of saliva, interdialytic weight gain (IDWG), and degree of thirst in patients on HD have been inconsistent. We investigated whether chewing gum can modulate these three parameters in patients on HD. Materials and Methods: We used purposive sampling to enroll 37 patients on HD who were then randomly divided into the chewing gum group (n = 19) and the control (non-chewing gum) group (n = 18). The degree of thirst was assessed using a self-rated visual analog scale (VAS) and a summated xerostomia inventory (SXI), respectively. Results: The degree of thirst after dialysis was significantly lower in the chewing gum group than in the control group. The amount of saliva was higher in the chewing gum group than in the control group before dialysis, but the saliva amount was comparable between the groups after dialysis. Furthermore, the amount of saliva was not associated with IDWG in patients on HD before or after dialysis. Conclusions: Chewing gum may alleviate the feeling of thirst but may not affect the amount of saliva and IDWG in patients on HD. Therefore, we suggest that chewing gum may be a useful approach to improve dry mouth and thirst in patients on HD.

High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort.

Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased risk for acute ischemic stroke (AIS). We aimed to estimate the prevalence of AF in a Lithuanian cohort of stroke patients, and its impact on patients regarding case fatality, functional outcome, and health-related quality of life (HRQoL) at 90 days. Materials and Methods: A single-center prospective study was carried out for four non-consecutive months between December 2018 and July 2019 in one of the two comprehensive stroke centers in Eastern Lithuania. A telephone-based follow-up was conveyed at 90 days using the modified Rankin Scale (mRS) and EuroQoL five-dimensional three-level descriptive system (EQ-5D-3L) with a self-rated visual analog scale (EQ-VAS). One-year case fatality was investigated. Results: We included 238 AIS patients with a mean age of 71.4 ± 11.9 years of whom 45.0% were female. A striking 97 (40.8%) AIS patients had a concomitant AF, in 68 (70.1%) of whom the AF was pre-existing. The AIS patients with AF were at a significantly higher risk for a large vessel occlusion (LVO; odds ratio 2.72 [95% CI 1.38–5.49], p = 0.004), and had a more severe neurological impairment at presentation (median NIHSS score (interquartile range): 9 (6–16) vs. 6 (3–9), p < 0.001). The LVO status was only detected in those who had received computed tomography angiography. Fifty-five (80.9%) patients with pre-existing AF received insufficient anticoagulation at stroke onset. All patients received a 12-lead ECG, however, in-hospital 24-h Holter monitoring was only performed in 3.4% of AIS patients without pre-existing AF. Although multivariate analyses found no statistically significant difference in one-year stroke patient survival and favorable functional status (mRS 0–2) at 90 days, when adjusted for age, gender, reperfusion treatment, baseline functional status, and baseline NIHSS, stroke patients with AF had a significantly poorer self-perceived HRQoL, indicated by a lower EQ-VAS score (regression coefficient ± standard error: β = −11.776 ± 4.850, p = 0.017). Conclusions: In our single-center prospective observational study in Lithuania, we found that 40.8% of AIS patients had a concomitant AF, were at a higher risk for an LVO, and had a significantly poorer self-perceived HRQoL at 90 days. Despite the high AF prevalence, diagnostic tools for subclinical AF were greatly underutilized.

A Chinese Medicine Formula (Bushen Huoxue Tongluo) for the Treatment of Chronic Subjective Tinnitus: A Study Protocol for a Pilot, Assessor-Blinded, Randomized Clinical Trial.

Background: Tinnitus is a common problem worldwide. There is still no effective method to cure it. Traditional Chinese medicine (TCM) may be a potentially effective treatment approach for tinnitus. However, there is still no clinical trial with scientifically rigorous methodology to evaluate the treatment effect of TCM for tinnitus. Therefore, we propose a pilot study to inform the feasibility of a future full-scale RCT to establish the efficacy of TCM formula for tinnitus. Objectives: The aim of this study is to determine the feasibility of a full-scale RCT and explore whether a TCM formula (BHT) has an additional effect on improving tinnitus when compared to informative counseling alone. Design: An assessor-blinded, randomized, controlled clinical trial is used. Participants: Twenty-four patients with chronic subjective tinnitus will be enrolled. Interventions: The patients will be allocated randomly to receive a TCM formula (BHT, Bushen Huoxue Tongluo) and informative counseling or informative counseling alone. The oral BHT herbal granules will be taken twice per day continuously for 8 weeks. Main outcome measures: The primary outcomes include recruitment rate, intervention completion rate, and data completion rate to evaluate the feasibility. The secondary outcomes include Tinnitus Handicap Inventory, tinnitus functional index, tinnitus sensation level, self-rated visual analogue scale on tinnitus loudness and annoyance, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, and adverse event. The outcome measures will be collected at baseline, end of treatment, and 4-week follow-up. Discussion: This trial is currently ongoing and is recruiting patients. The expected study results will find some preliminary evidence about the clinical effectiveness of BHT on chronic tinnitus and will also determine if it is feasible to conduct a full-scale RCT of BHT and identify the necessary changes to the protocol if possible.

Effects of acute exercise on drug craving in adults with poly-substance use disorder. A randomized controlled trial

ObjectivesTo examine the short-term effects of exercise on drug craving in poly-drug-dependent inpatients, duration of effects, differences between exercise types, explore the relationship between craving and mood, and possible moderators. DesignMulticenter randomized control trial (RCT) with a crossover design. Methods38 (25 completed) inpatients (37.3 ± 6.4 years; 84 % male) from three treatment centers participated in soccer, circuit training and control condition in random order for 45-min. Craving was assessed with a self-rated visual analog scale (VAS), mood with Feeling scale (FS), immediately before and after each condition and 1, 2, and 4 h post interventions. Ratings of perceived exertion (RPE) and heart rate were assessed. Intervention effects were assessed using linear mixed effects model, including moderator analyses. ResultsExercise sessions were perceived as “somewhat hard” to “hard”. Compared to control, there was an immediate reduction in craving after soccer and circuit training (β = −1.35, 95 %CI: 1.96, −0.75, p = 0.000; β = -1.44, 95 %CI: 2.06, −0.83, p = 0.000) that persisted for 4 h (β = −1.11, 95 %CI: 1.72, −0.49, p = 0.000; β = -0.85, 95 %CI: 1.49, −0.22, p = 0.008). Elevations in mood after soccer (β = 1.08, 95 %CI: 0.41, 1.76, p = 0.002) and circuit training (β = 0.99, 95 %CI: 0.32, 1.67, p = 0.004) were significantly larger than control. Depressive disorder and primary drug of use might moderate the effect. ConclusionReduced drug cravings and elevated mood following soccer and circuit training were observed in people with poly-SUDs. Single exercise sessions can be an effective strategy to alleviate craving and potentially prevent relapse and treatment drop-out.

Short-term functional outcome after fast-track primary total knee arthroplasty: analysis of 623 patients

Background and purpose — Early functional outcome after total knee arthroplasty (TKA) has been described before, but without focus on the presence of certain functional recovery patterns. We investigated patterns of functional recovery during the first 3 months after TKA and determined characteristics for non-responders in functional outcome. Patients and methods — All primary TKA in a fast-track setting with complete patient-reported outcome measures (PROMs) preoperatively, at 6 weeks, and 3 months postoperatively were included. Included PROMs were Oxford Knee Score (OKS), Knee disability and Osteoarthritis Outcome Score Physical Function Short-Form (KOOS-PS), and EuroQol 5 dimensions (EQ-5D) including the self-rated health Visual Analogue Scale (VAS). Patients with improvement on OKS less than the minimal clinically important difference (MCID) were determined as non-responders at that time point. Characteristics between groups of responders and non-responders in functional recovery were tested for differences: we defined 4 groups a priori, based on the responder status at each time point. Results — 623 patients were included. At 6 weeks OKS, KOOS-PS, and EQ-5D self-rated health VAS were statistically significant improved compared with preoperative scores. The mean improvement was clinically relevant at 6 weeks for KOOS-PS and at 3 months for OKS. Patient characteristics in non-responders were higher BMI and worse scores on EQ-5D items: mobility, self-care, usual activities, and anxiety/depression. Interpretation — Both statistically significant and clinically relevant functional improvement were found in most patients during the first 3 months after primary TKA. Presumed modifiable patient characteristics in non-responders on early functional outcome were BMI and anxiety/depression.

Yoga as a potential psychosocial tool: Results from a quasi-experimental single-arm study on victims of flood affected state of Kerala

ObjectivesMental and social health is among the notable domains affected by natural disasters, with nearly one-quarter of the people living in an area affected by natural disasters expressing the symptoms of depression, anxiety, post-traumatic stress disorder, bipolar disorder, or schizophrenia. Bringing harmony among these affected individuals is an important clinical priority. The effect of yoga, which is reported to reduce mental disorders to a great extent in many conditions, has not been studied in the setting of natural disaster recovery. MethodsThirty-two participants [Mean age 37.8(SD ± 8.9)] from a flood-affected state of India exhibiting mental and social impacts from the natural disaster were enrolled for 15 days of yoga interventions after obtaining written consent. Breathing exercises and guided relaxation techniques were provided as intervention after obtaining a self-rated visual analog scale (VAS) for fear, sadness, anxiety, and lack of sleep. ResultsAll participants completed the study. Statistically significant changes were observed (P<0.05) in all the VAS dependent scale variables such as fear, sadness, anxiety, and lack of sleep. No adverse events were reported. ConclusionFifteen days of yoga interventions in victims of the flood-affected region might offer resilience to the people affected by natural disasters. Results of this study are encouraging and yoga can be introduced for addressing mental health issues in such emergencies and can be a valuable tool. However, more studies with robust designs and focused tools to determine the effects are warranted.

The Mediterranean diet increases glucagon‐like peptide 1 and oxyntomodulin compared with a vegetarian diet in patients with type 2 diabetes: A randomized controlled cross‐over trial

To compare a Mediterranean diet (MED) with a high-fibre vegetarian diet (HFV) in terms of hunger-satiety perception through post-prandial assessment of appetite-related hormones glucagon-like peptide 1 (GLP-1) and oxyntomodulin, as well as self-rated visual analogue scale (VAS) quantification, in overweight/obese subjects with type 2 diabetes (T2D). Twelve T2D subjects (Male to female ratio = 7:5), mean age 63 ± 8.5 years, were enrolled in a randomized, controlled, crossover study. Participants consumed an MED meal as well as an isocaloric meal rich in complex carbohydrate as well as an isocaloric MED meal in two different visits with a 1-week washout period between the two visits. Appetite ratings, glucose/insulin, and gastrointestinal hormone concentrations were measured at fasting and every 30' until 210' following meal consumption. GLP-1 and oxyntomodulin levels were significantly higher following MED meal compared with HFV meals (210' area under the curve, p < 0.022 and p < 0.023, respectively). Both MED and HFV meal resulted in a biphasic pattern of GLP-1 and oxyntomodulin, although MED meal was related to a delayed, significantly higher second GLP-1 peak at 150' compared with that of HFV meal (p < 0.05). MED meal was related to lower glucose profile compared with HFV meal (p < 0.039), whereas we did not observe significant changes in terms of self-reported VAS scores and insulin trend. In T2D overweight/obese subjects, an MED meal is more effective than a HFV meal in terms of post-prandial plasma glucose homoeostasis and GLP-1 and oxyntomodulin release. These changes were not confirmed by VAS appetite self-assessment over a 210' period.

Comparing the self-reported health-related quality of life (HRQoL) of artisanal and small-scale gold miners and the urban population in Zimbabwe using the EuroQol (EQ-5D-3L+C) questionnaire: a cross-sectional study

BackgroundThe role of artisanal and small-scale gold mining (ASGM) as a source of income is rapidly gaining importance in the economically difficult times in Zimbabwe. Besides limited epidemiological data, no data about the self-reported health-related quality of life (HRQoL) of artisanal and small-scale gold miners exist. The aim of the project was to access HRQoL of ASGM workers to improve the data base and compare the data to the urban Zimbabwean population.MethodsData from 83 artisanal and small-scale gold miners in Kadoma, Zimbabwe was analysed. The HRQoL was assessed using the EuroQol dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) accompanied by the cognition add-on questionnaire (EQ-5D-3L+C) and associated visual analogue scale (VAS). We described the EQ-5D dimensions and VAS values and computed health utility (HU) values using the Zimbabwean tariff. The proportions of miners reporting no problem in each EQ-5D dimension were compared with corresponding proportions reporting any problem (moderate or severe), and mean HU and VAS values were analysed across subgroups of the sample. To test differences between subgroups, Fisher’s exact test was used and between urban and mining population, Student’s t-test was used.ResultsThe reported health states of miners were homogenous, with a large amount (42%) reporting ‘full health’. Mean (SD) VAS and HU values were 81.0 (17.5) and 0.896 (0.13), respectively. Subgroup analysis showed that miners with a lower education reported significantly more problems in the dimension of daily activities and miners with mercury contact had more problems in the dimensions of pain/discomfort and cognition. Comparison between mining and urban population showed that in the oldest age group, self-rated VAS values of miners were significantly higher than of their urban counterparts.ConclusionsThere were no significant differences in the HRQoL of mining and urban populations. However, the reason might be adverse health effects faced by the urban population that do not apply to rural mining areas. A higher education level of miners can improve the HRQoL, which is especially impaired by problems in the cognition dimension.

226-OR: The Mediterranean Diet Increases GLP-1 and Oxyntomodulin Compared with Vegetarian Diet in Type 2 Diabetes Subjects

Aim: To compare a Mediterranean dietetic pattern with a vegetarian pattern in terms of hunger-satiety perception through post-prandial assessment of appetite-related hormones glucagon-like peptide 1 (GLP-1) and Oxyntomodulin (OXM), as well as self-rated Visual Analogue Scale (VAS) quantification, in overweight/obese type-2 diabetes (T2D) subjects. Methods: Twelve T2D subjects (M:F = 7:5), mean age 63 ± 8.5 years, were enrolled in our randomized, controlled, crossover study. Participants were given a vegetarian meal high in complex carbohydrate and dietary fiber (HFV, 35g fiber/1000 Kcal) as well as a Mediterranean (MED) meal in two different days over a one-week washout period. The two meals were isocaloric. Appetite ratings, glucose/insulin and gastrointestinal hormone concentrations were measured at fasting and every 30’ until 4 hours following meal consumption. Results: GLP-1 and OXM levels were significantly higher following MED meal consumption compared with HFV meal (240’ AUC, P &amp;lt;.022 and P &amp;lt;.023, respectively). Both MED and HFV meal resulted in a biphasic secretion pattern of GLP-1 and OXM, although MED meal was related to a delayed, significantly higher second GLP-1 peak at 150’ compared with that of HFV meal (P &amp;lt;.05). MED meal was related to lower glucose trend compared with HFV meal (P &amp;lt;.039), whereas we did not observe significant changes in terms of self-reported VAS scores and insulin trend. Conclusions: In T2D overweight/obese subjects, a MED-like meal is more effective than a vegetarian meal in terms of post-prandial plasma glucose homeostasis and GLP-1 and OXM release. These changes were not confirmed by VAS appetite self-assessment over a 4 hours period. Disclosure A. Di Mauro: None. D. Tuccinardi: None. R. Del Toro: None. L. Monte: None. R. Giorgino: None. L. Rampa: None. G. Rossini: None. S. Kyanvash: None. A. Soare: None. M.M. Rosati: None. Y. Khazrai: None. A. Piccoli: None. N. Napoli: None. P. Pozzilli: Advisory Panel; Self; Abbott, AstraZeneca, Eli Lilly and Company. Research Support; Self; Medtronic, Sanofi. S. Manfrini: None.

The Efficacy of Subchondroplasty for the Treatment of Knee Pain Associated with Bone Marrow Lesions

CONTEXTSymptomatic bone marrow lesions on MRI in patients with knee osteoarthritis are strongly associated with progressive deterioration of the joint and an increased risk of progression requiring joint replacement surgery. This study evaluates the efficacy of knee arthroscopy with adjunctive subchondroplasty (i.e. cartilage stabilization) to improve self-rated visual analog scale (VAS) pain scores, rate of conversion to arthroplasty, and patient satisfaction levels.METHODSA retrospective chart review and phone survey was performed on 12 patients who had undergone knee arthroscopy with adjunctive subchondroplasty for knee pain associated with chronic subchondral bone marrow lesions on MRI. Follow-up for the 12 patients was 36 months on average (range of 12 to 51 months), self-reported paired preoperative and postoperative VAS scores were analyzed in addition to rate of conversion to arthroplasty and patient satisfaction.RESULTSThe results demonstrated statistically significant reductions in mean preoperative VAS scores versus six-week postoperative VAS scores from 7.58 to 1.83 (p < 0.001) in addition to significant reductions in mean preoperative VAS scores to final postoperative VAS scores from 7.58 to 1.60 (p < 0.001). There was no statistically significant association (p > 0.05) with patients’ demographic and clinical data (e.g., age, height, weight, BMI, length of symptoms) and rate of revision to total arthroplasty after receiving the arthroscopic subchondroplasty procedure. Out of the 12 patients, two (16.7%) patients went on to conversion to total knee arthroplasty.CONCLUSIONSIn this series, knee arthroscopy with adjunctive subchondroplasty for the treatment of osteoarthritis with symptomatic bone marrow lesions was associated with clinically significant improvements in VAS pain scores. Furthermore, patients who underwent subchondroplasty had a low rate (16.7%) of conversion to total knee arthroplasty at 36-month follow-up.

Does sex predict quality of life after acute coronary syndromes: an Australian, state-wide, multicentre prospective cohort study

ObjectiveWomen have reported higher mortality and major adverse cardiovascular events (MACE) following acute coronary syndromes (ACSs) compared with men. With this in mind, we aimed to identify predictors of poor...

Association Between Surgical Trainee Daytime Sleepiness and Intraoperative Technical Skill When Performing Septoplasty.

Daytime sleepiness in surgical trainees can impair intraoperative technical skill and thus affect their learning and pose a risk to patient safety. To determine the association between daytime sleepiness of surgeons in residency and fellowship training and their intraoperative technical skill during septoplasty. This prospective cohort study included 19 surgical trainees in otolaryngology-head and neck surgery programs at 2 academic institutions (Johns Hopkins University School of Medicine and MedStar Georgetown University Hospital). The physicians were recruited from June 13, 2016, to April 20, 2018. The analysis includes data that were captured between June 27, 2016, and April 20, 2018. Attending physician and surgical trainee self-rated intraoperative technical skill using the Septoplasty Global Assessment Tool (SGAT) and visual analog scales. Daytime sleepiness reported by surgical trainees was measured using the Epworth Sleepiness Scale (ESS). Of 19 surgical trainees, 17 resident physicians (9 female [53%]) and 2 facial plastic surgery fellowship physicians (1 female and 1 male) performed a median of 3.00 septoplasty procedures (range, 1-9 procedures) under supervision by an attending physician. Of the 19 surgical trainees, 10 (53%) were aged 25 to 30 years and 9 (47%) were 31 years or older. The mean ESS score overall was 6.74 (95% CI, 5.96-7.52), and this score did not differ between female and male trainees. The mean ESS score was 7.57 (95% CI, 6.58-8.56) in trainees aged 25 to 30 years and 5.44 (95% CI, 4.32-6.57) in trainees aged 31 years or older. In regression models adjusted for sex, age, postgraduate year, and technical complexity of the procedure, there was a statistically significant inverse association between ESS scores and attending physician-rated technical skill for both SGAT (-0.41; 95% CI, -0.55 to -0.27; P < .001) and the visual analog scale (-0.75; 95% CI, -1.40 to -0.07; P = .03). The association between ESS scores and technical skill was not statistically significant for trainee self-rated SGAT (0.04; 95% CI, -0.17 to 0.24; P = .73) and the self-rated visual analog scale (0.19; 95% CI, -0.79 to 1.2; P = .70). The findings suggest that daytime sleepiness of surgical trainees is inversely associated with attending physician-rated intraoperative technical skill when performing septoplasty. Thus, surgical trainees' ability to learn technical skill in the operating room may be influenced by their daytime sleepiness. NA.

Pelvic floor dysfunction in the immediate puerperium, and 1 and 3 months after vaginal or cesarean delivery.

To identify and assess postpartum pelvic floor dysfunction (PFD) between vaginal delivery, elective cesarean delivery (ECD), and intrapartum cesarean delivery (ICD). The present prospective observational study included women aged at least 18years with no history of pelvic surgery or lower urinary tract malformation, and who had not undergone pelvic floor muscle (PFM) training in the preceding 12months, who underwent delivery at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil between August 1, 2016, and May 31, 2017. Participants were assessed at 48hours (phase 1), 1month (phase 2), and 3months (phase 3) after delivery. Assessments included the International Consultation on Incontinence Questionnaire, Short Form (ICIQ-SF); the Jorge-Wexner anal incontinence scale; a self-rated visual analog scale for pelvic pain; the pelvic organ prolapse quantification (POP-Q) system; and a PFM perineometer. A total of 227 women were assessed in phase 1 (141 vaginal deliveries; 28 ICDs; and 58 ECDs), 79 in phase 2, and 41 in phase 3. The ICIQ-SF, Jorge-Wexner scale, visual analog scale, and perineometer measurements did not identify significant differences in relation to the type of delivery (P>0.05). The type of delivery was not associated with differences in the short-term development of postpartum PFD.

The ability of early changes in motivation to predict later antidepressant treatment response.

IntroductionBaseline values and early changes of emotional reactivity, cognitive speed, psychomotor function, motivation, and sensory perception have not been studied to any extent in unipolar depression, although they could help to characterize different dimensions of illness that are harder to capture by clinicians, give new insights on how patients improve, and offer new early clinical markers for later treatment response.MethodsAbout 1,565 adult outpatients with major depressive disorder receiving agomelatine completed the clinician-rated 16-item quick inventory of depressive symptoms, Clinical Global Impression, and Multidimensional Assessment of Thymic States (MAThyS) rating scales at inclusion, Week 2 and Week 6. The MAThyS includes a 20-item self-rated visual analog scale (from inhibition [0] to activation [10], with [5] representing the usual state) leading to five a priori dimensions (emotional reactivity, cognitive speed, psychomotor function, motivation, and sensory perception).ResultsAll MAThyS dimension scores increased from inclusion to Week 2 and from inclusion to Week 6 (P<0.001). Improvement was around 2 points (out of 10) for motivation, 1.5 points for psychomotor function, and 0.5 points for other dimensions. Motivation showed a trend to being more severely impaired at inclusion in future nonresponders (t=1.25, df=1,563, P=0.10). Its improvement at Week 2 was the most discriminating MAThyS dimension between future responders and nonresponders, and represents the best predictor of future response, with the highest area under the receptor operating characteristic curve (area under curve =0.616, 95% confidence interval [0.588–0.643], P<0.001). Finally, improvements in motivation correlated the most strongly with clinician-rated 16-item quick inventory of depressive symptoms improvement (r=−0.491, df=1,563, P<0.001).ConclusionMotivation had the most capacity for early improvement, the best predictive value for response, and the largest global margin of progress in depressed outpatients. Assessing the evolution of self-reported motivation over time in major depressive disorder could offer an interesting complementary approach to predict response.

A comparison of patient and general population weightings of EQ‐5D dimensions

This paper examines the differences in health state evaluations given by patients when they are asked to value their own current states, and those given by members of the general population who were asked to value hypothetical health states. Patient data consist of 4137 observations on EQ-5D profiles and Visual Analogue Scale (VAS) obtained from 3376 patients, covering eight different conditions. General population data are taken from the EQ-5D valuation set. Two analyses were carried out. In the first, the patient self-rated VAS was compared with population VAS values for the same health states. In the second, the patient self-rated VAS values were modelled, and the regression coefficients were compared with the corresponding coefficients from the general population study. The first analysis resulted in a statistically significant mean difference of -0.012 (0.647 for patient VAS, 0.659 from the population value set). The second analysis found statistically significant differences between the coefficients for the EQ-5D health dimensions Pain/Discomfort, Mobility and Anxiety/Depression. Anxiety/Depression had the largest impact on the patient model compared with Pain/Discomfort in the general population model. A further regression analysis suggests that the magnitude of disagreement between patient self-rated VAS model and the population VAS model depends on the patients' condition.

Race and Ethnic Disparities in Valuing Health

Patient preferences are often cited as a possible explanation for disparities in treatment. However, no prior studies have examined whether there are racial and ethnic differences in preferences for health states in a general population sample. Data from 21,362 adult respondents to the 2002 Medical Expenditure Panel Survey were used to study variations in valuations of health states. Respondents' health states were valued based on the self-rated Visual Analogue Scale (VAS) and the Euro-Qol-5D using the US and UK societal scoring algorithms. Regression analyses determined whether valuations in health states varied by race or Hispanic origin, controlling for socioeconomic status and place of residence. Race and ethnicity were not associated with differences in valuations of health states. However, there were systematic differences in characteristics that were controlled, such as health status, age, poverty status, and region of the country. Blacks and Hispanics had slightly higher VAS scores than whites. The negative influence of pain/ discomfort on the VAS score was greater for blacks and Hispanics. Racial and ethnic differences in treatment preferences probably do not result from differences in health state valuations. Future research should explore whether differences in preferences for other attributes of treatment account for differences in treatment decisions. Cost-utility researchers using the EuroQol-5D or VAS need not account for blacks' and Hispanics' systematically valuing health states differently than whites do. However, caution may be warranted when considering interventions designed to manage pain or discomfort, because blacks and Hispanics gave greater weight to that domain of health status in their valuations.

Management of Xerostomia in Older Patients

Xerostomia is a subjective sensation of mouth dryness that may frequently occur in older patients. To compare the clinical efficacy and acceptability of a new oxygenated glycerol triester (OGT) oral spray taken five times daily with that of a commercially available saliva substitute Saliveze in the treatment of xerostomia. Forty-one institutionalised patients (28 women, 13 men; mean age 84 +/- 7 years) were randomly assigned to receive either OGT or Saliveze in a 2-week, randomised, parallel-group study. Clinical assessment of xerostomia included evaluation of mouth dryness using a self-rated, 10cm long visual analogue scale (VAS), objective assessment of oral tissue condition using a four-point ordinal scale and subjective assessment of symptoms of xerostomia using dichotomous responses to a questionnaire. The primary endpoint was the day (D) 14 patient-based mouth dryness score measured on a self-rated VAS. At D14, OGT resulted in significantly greater efficacy with respect to mouth dryness (mean between-treatment difference 2.1 +/- 0.1, 95% CI 1.9, 2.3; p = 0.001), swallowing difficulty (1.8 +/- 0.3, 95% CI 1.5, 2.1; p = 0.001), speech difficulty (1.1 +/- 0.2, 95% CI 1.0, 2.4; p = 0.04) and overall sensation of symptom relief (2.7 +/- 1.2, 95% CI 1.9, 3.8; p = 0.001). Objective assessment of oral tissues also showed significantly better improvement with OGT spray with respect to dryness (p = 0.01), stickiness (p = 0.005) and dullness (p = 0.001) of oral mucosa; severity of mucositis (p = 0.01); and thickening of the tongue (p = 0.03). A significant difference in taste acceptability was also noted in favour of OGT (1.4 +/- 0.6, 95% CI 1.2, 1.9; p = 0.04). OGT lubricant oral spray was superior to Saliveze in improving xerostomia and oral tissue condition in older institutionalised patients.

Daily and spaced treatment with transcranial magnetic stimulation in major depression: a pilot study

Objective: Transcranial magnetic stimulation is an emerging treatment of treatmentresistant depression. Current protocols rely on daily treatments. This study was designed to determine whether the time period over which treatment is delivered is an important factor in efficacy.Method: Sixteen adult patients with treatment-resistant major depression were randomly assigned to one of the two treatment groups, both of which received 2 weeks of treatment. One group received daily treatment (10 treatments, on business days). The other group received three treatments in week one, and two treatments in week two (five treatments, on spaced business days). Mood was rated using the Hamilton Depression Rating Scale (HDRS) and a self-rated visual analogue scale. Response was defined as a 50% reduction in HDRS rating, and remission was defined as achieving an HDRS score of 8 or less. The groups were compared throughout the 2-week study period.Results: At entry, there were no demographic differences between the groups. Multivariate tests showed a significant main effect for time (Pillai trace = 0.76, F(4,56) = 8.56, p < 0.001, power = 0.99) reflecting the improvement in both measures of depression during treatment. There was no significant difference between the groups overall (Pillai trace = 0.25, F(2,13) = 2.12, p = 0.16, power = 0.36). Additionally, there was no significant interaction between time and treatment group (Pillai trace = 0.18, F(4,56) = 1.35, p = 0.26, power = 0.39) indicating that the significant improvement in depression over time was similar for both treatment groups. There were no significant differences in response and remission rates between the groups.Conclusion: The time period of treatment appeared to be an important outcome factor. This suggests that less than daily transcranial magnetic stimulation treatment may be a useful clinical alternative.

Daily and Spaced Treatment with Transcranial Magnetic Stimulation in Major Depression: A Pilot Study

Transcranial magnetic stimulation is an emerging treatment of treatment-resistant depression. Current protocols rely on daily treatments. This study was designed to determine whether the time period over which treatment is delivered is an important factor in efficacy. Sixteen adult patients with treatment-resistant major depression were randomly assigned to one of the two treatment groups, both of which received 2 weeks of treatment. One group received daily treatment (10 treatments, on business days). The other group received three treatments in week one, and two treatments in week two (five treatments, on spaced business days). Mood was rated using the Hamilton Depression Rating Scale (HDRS) and a self-rated visual analogue scale. Response was defined as a 50% reduction in HDRS rating, and remission was defined as achieving an HDRS score of 8 or less. The groups were compared throughout the 2-week study period. At entry, there were no demographic differences between the groups. Multivariate tests showed a significant main effect for time (Pillai trace=0.76, F(4,56)=8.56, p<0.001, power=0.99) reflecting the improvement in both measures of depression during treatment. There was no significant difference between the groups overall (Pillai trace=0.25, F(2,13)=2.12, p=0.16, power=0.36). Additionally, there was no significant interaction between time and treatment group (Pillai trace=0.18, F(4,56)=1.35, p=0.26, power=0.39) indicating that the significant improvement in depression over time was similar for both treatment groups. There were no significant differences in response and remission rates between the groups. The time period of treatment appeared to be an important outcome factor. This suggests that less than daily transcranial magnetic stimulation treatment may be a useful clinical alternative.