Prevalence Study Of Symptoms Research Articles

Tight Application of a Surgical Tourniquet Prior to Inflation Increases Venous Pressure In the Upper Limb; Potentially Resulting in Increased Blood Loss and Poorer Visibility

Tourniquets are commonly used in extremity surgery to help provide a bloodless operative field to improve visibility and reduce length of procedures. With the development of WALANT (wide awake, local anaesthetic, no tourniquet) techniques, many surgeons undertake surgery without tourniquet inflation. The correct technique of pneumatic tourniquet application is poorly understood by healthcare staff. The application of a tight tourniquet when applied for optional use or use for only a portion of a procedure, rather than for inflation throughout can cause venous engorgement of an extremity leading to increased blood loss and reduced operative field visualisation thereby discouraging surgeons from persevering with WALANT strategies. To determine the effect of tourniquet application tension on limb volume prior to skin incision. 30 volunteers had the volume of their non-dominant forearm measured post-inflation of a surgical tourniquet using two different application techniques. Tight application was defined as the tourniquet fastened using a dynamometer to a tension of 100N. Loose application was defined as the tourniquet fastened using a dynamometer to a tension of 50N. The tourniquet was then inflated to 200mmHg after both application techniques. Exsanguination was performed by elevation of the arm for 1min prior to tourniquet inflation. At 5min the forearm volume was measured using a volume displacement technique. 93% of participants (28/30) had a higher volume of water displaced when the tourniquet was applied tightly. The mean difference between the loose and tight applications was 30.06mls. The increase in volume in tightly applied tourniquets is believed to result from increased intravascular volume. This increase in blood volume can lead to increased intra-operative blood loss and poor intra-operative visualisation when operating without tourniquet inflation. Loose application of the tourniquet pre-inflation appears to prevent sequestration of venous blood in the limb, therefore decreasing operative blood loss and improving view for operating. Level 1; Symptom Prevalence Study.

1604P A comparative study of symptom prevalence between adults and elderly patients with advanced cancer diagnosis under palliative care: A single institution experience

1604P A comparative study of symptom prevalence between adults and elderly patients with advanced cancer diagnosis under palliative care: A single institution experience

A Cross-Sectional Study of Symptom Prevalence, Frequency, Severity, and Impact of Long COVID in Scotland: Part II

BackgroundThere has been some effort to map the prevalence, frequency, and severity of symptoms of long COVID at local and national levels. However, what is frequently absent from such accounts is details of the impact the disease and its symptoms have had on those living with the condition. In this article, we present details of the impact on work, caring, and mental health gathered using a cross-sectional survey. MethodsData were collected using an online survey that was available from April 21, 2022, to August 5, 2022. Included participants had either self-diagnosed or confirmed long COVID, were living in Scotland, and were aged ≥18 years. Hospitalization during initial COVID-19 infection was an exclusion criterion. Participants were asked to report on the impact of their illness on everyday activities such as working, studying, or caring. They also completed an assessment of their current mood. ResultsPeople with long COVID were often severely impacted in their ability to work and study. Severe impact on work and study were predicted by more severe and more frequent fatigue, more severe pain, and more severe cognitive impairment. Respondents’ ability to care for child dependents was also associated with more severe and more frequent fatigue, and more severe cognitive impairments. More severe pain associated with greater impact on adult care. Negative mood correlated most strongly with frequency and severity of neurological symptoms, including lack of attention, loss of smell, impaired sense of smell, loss of taste, impaired sense of taste, and loss of appetite. ConclusionsLong COVID has a significant impact on ability to work, study, and care for dependents. The severity of this impact is associated with specific symptom burden, including fatigue, pain, and cognitive impairment.

A Cross-Sectional Study of Symptom Prevalence, Frequency, Severity, and Impact of Long-COVID in Scotland: Part I

BackgroundCommonly reported symptoms of long COVID may have different patterns of prevalence and presentation across different countries. While some limited data have been reported for the United Kingdom, national specificity for Scotland is less clear. We present a cross-sectional survey to examine the symptom prevalence, frequency, and severity of long COVID for people living with the condition in Scotland. MethodsAn online survey was created in the English language and was available between April 21, 2022 and August 5, 2022. Participants were included if they were ≥18 years old, living in Scotland, and had self-diagnosed or confirmed long COVID; and excluded if they were hospitalized during their initial infection. Within this article we quantify symptom prevalence, frequency, severity, and duration. ResultsParticipants (n = 253) reported the most prevalent long-COVID symptoms to be post-exertional malaise (95%), fatigue/tiredness (85%), and cognitive impairment (68%). Fatigue/tiredness, problems with activities of daily living (ADL), and general pain were most frequently occurring, while sleep difficulties, problems with ADL, and nausea were the most severe. Scottish Index of Multiple Deprivation associated with symptom number, severity, and frequency, whereas vaccine status, age, sex, and smoking status had limited or no association. ConclusionsThese findings outline the challenges faced for those living with long COVID and highlight the need for longitudinal research to ascertain a better understanding of the condition and its longer-term societal impact.

Screening versus multidimensional assessment of symptoms and psychosocial distress in cancer patients from the time of incurability.

Previous symptom prevalence studies show a diverse spectrum of symptoms and a large diversity in symptom intensities in patients being just diagnosed as having incurable cancer. It is unclear, how physical symptoms and psychosocial burden should be recorded in order to determine the variable need for palliative care and further support. Therefore, we compared two different strategies for detecting physical symptoms and psychosocial burden of patients with newly diagnosed incurable cancer and their effects on the further course of the disease. SCREBEL is a controlled, randomized, non-blinded, longitudinal study of the research network of the Palliative Medicine Working Group (APM) of the German Cancer Society (DKG). We compared: a less complex repeated brief screening for symptoms and burden in patients using the NCCN Distress Thermometer and IPOS questionnaire versus a multidimensional comprehensive assessment using the FACT-G and their entity-specific questionnaires, the PHQ4 scales, SCNS-34-SF, IPOS and NCCN Distress Thermometer. The primary study endpoint was quality of life (QoL), measured using FACT-G, after six months. Secondary study endpoints were QoL by using evaluation of secondary scores (NCCN DT, IPOS, PHQ4, SCNS-SF-34G) at time 6 months, the number of hospital days, the utilization of palliative care, emergency services, and psychosocial care structures. To assess effects and differences, multiple linear regression models were fitted and survival analyses were conducted. 504 patients were included in the study. 262 patients were lost to follow-up, including 155 fatalities. There were no significant differences between the low-threshold screening approach and a comprehensive assessment with respect to symptoms and other aspects of QoL. Using the IPOS, we were able to measure an improvement in the quality of life in the low-threshold screening arm by a decrease of 0.67 points (95%-CI:0.34 to 0.99) every 30 days. (p<0.001). Data on the involvement of emergency facilities and on supportive services were insufficient for analysis. A comprehensive, multidimensional assessment did not significantly differ from brief screening in preserving several dimensions of quality of life. These findings may positively influence the implementation of structured low-threshold screening programs for supportive and palliative needs in DKG certified cancer centers.DRKS -No. DRKS00017774 https://drks.de/search/de/trial/DRKS00017774.

An Analysis of Associated Conditions and the Relationship Between the Severity of Hand Manifestations With That of the Forearm in Ulnar Longitudinal Deficiency

A deeper investigation of medical and musculoskeletal conditions in patients with ulnar longitudinal deficiency (ULD) is needed. The association between the severity of the manifestations of ULD in the hands and forearms has not been firmly established. The purpose of this study was to describe the medical and musculoskeletal conditions associated with ULD and examine the relationship between hand and forearm anomalies. The Congenital Upper Limb Differences registry was queried for all patients with a diagnosis of ULD, as defined by the Oberg-Manske-Tonkin classification system, between 2014 and 2020. The patients' demographic information, medical and musculoskeletal comorbidities, radiographs, and clinical images were reviewed. The participants were classified using the Bayne, Cole and Manske, and Ogino classification systems. Of 2,821 patients from the Congenital Upper Limb Differences registry, 75 patients (2.7%) with ULD (14 bilateral), with 89 affected extremities, were included. Hand anomalies were present in 93% of the patients. Approximately 19% of the patients had an associated medical comorbidity, and 20% of the patients had an associated musculoskeletal condition. Cardiac anomalies were present in 8.0% of the patients, and 12% of the patients had a lower extremity abnormality. Radial head dislocation was observed in 13 of 18 patients with Bayne type II or III ULD compared with 8 of 43 patients with other types of unilateral ULD. There was a significant positive association among the Bayne and Ogino, Bayne and Cole/Manske, and Ogino and Cole/Manske classification systems in patients with unilateral ULD. Associated medical and musculoskeletal conditions are common in patients with ULD, of which cardiac and lower extremity abnormalities are most frequently observed. There is a significant positive association between the severity of forearm anomalies and that of hand anomalies in patients with unilateral ULD. All patients with ULD should undergo a thorough cardiac evaluation by their pediatrician or a pediatric cardiologist. Symptom prevalence study III.

Prevalence and Subtypes of Tenosynovial Amyloid in Patients Undergoing Carpal Tunnel Release

The purpose of this study was to determine the prevalence and subtypes of amyloid in tenosynovial biopsies of patients undergoing carpal tunnel release (CTR). A retrospective review was performed involving patients who underwent CTR from June 2020 to July 2021. Prior to this period, a protocol had been established to obtain routine intraoperative tenosynovial biopsies. Tenosynovium was preserved in formalin and stained with Congo red for amyloid. Positive specimens were sent to an external laboratory for confirmation and subtyping by mass spectrometry. Men 50 years or older and women 60 or older were included for analysis. Acute, traumatic, and revision cases were excluded. Of 185 patients who underwent CTR with tenosynovial biopsy, 54 (29%) demonstrated positive Congo red stain, confirmed by the external laboratory. A subtype analysis revealed wild-type transthyretin (TTR) in 44 patients (80%), mixed wild-type TTR with κ light chains in 1 patient, and hereditary TTR in 1 patient. Patients with positive specimens were significantly older than those who tested negative (77 vs 68 years, respectively), and positivity increased by decade for both sexes. Male sex, atrial fibrillation, and spinal stenosis were significantly more prevalent among positive cases. There were no complications from the biopsies. We confirmed evidence of amyloidosis in the tenosynovium of 29% of men 50 years or older and women 60 or older who underwent CTR. The majority demonstrated wild-type TTR. As these patients are at risk of developing cardiomyopathy, there is an opportunity for early detection, monitoring, and interventions known to improve outcomes. Considering the low cost of Congo red staining and the potential value of subtyping with regard to treatment of cardiomyopathy, our findings support routine tenosynovial biopsy during CTR in patients who meet the age criteria. Differential diagnosis or symptom prevalence study II.

Zellweger spectrum disorder: A cross-sectional study of symptom prevalence using input from family caregivers

Zellweger spectrum disorders (ZSD) are rare, debilitating genetic diseases of peroxisome biogenesis that affect multiple organ systems and present with broad clinical heterogeneity. Although many case studies have characterized the multitude of signs and symptoms associated with ZSD, there are few reports on the prevalence of symptoms to help inform the development of meaningful endpoints for future clinical trials in ZSD. In the present study, we used an online survey tool completed by family caregivers to study the occurrence, frequency and severity of symptoms in individuals diagnosed with ZSD. Responses from caregivers representing 54 living and 25 deceased individuals with ZSD were collected over an 8-month period. Both perception of disease severity and prevalence of various symptoms were greater in responses from family caregivers of deceased individuals compared to those of living individuals with ZSD. Compared with previous reports for ZSD, the combined prevalence of seizures (53%) and adrenal insufficiency (45%) were nearly twice as high. Overall, this community-engaged approach to rare disease data collection is the largest study reporting on the prevalence of symptoms in ZSD, and our findings suggest that previous reports may be underreporting the true prevalence of several symptoms in ZSD. Studies such as this used in conjunction with clinician- led reports may be useful for informing the design of future clinical trials addressing ZSD.

Relevance of Diagnosed Depression and Antidepressants to PROMIS Depression Scores Among Hand Surgical Patients

We aimed to test the utility of screening for depressive symptoms in the hand surgical office focusing on chances of heightened depressive symptoms in patients with no history of diagnosed depression and by quantifying ongoing depressive symptoms among patients diagnosed with depression accounting for antidepressant use. The clinical importance of this study was predicated on the documented negative association between depressive symptoms and hand surgical outcomes. This cross-sectional study analyzed 351 patients presenting to a tertiary hand center between April 21, 2016, and November 22, 2017. Adult patients completed self-administered Patient-Reported Outcomes Measurement Information System (PROMIS) Depression computer adaptive tests at registration. Health records were examined for a past medical history of diagnosed depression and whether patients reported current use of prescription antidepressants. Mean PROMIS Depression scores were compared by analysis of variance (groups: no diagnosed depression, depression without medication, depression with medication). Four points represented a clinically relevant difference in PROMIS Depression scores between groups and Depression scores greater than 59.9 were categorized as having heightened depressive symptoms. Sixty-two patients (18%) had been diagnosed with depression. Thirty-four of these patients (55%) reported taking antidepressant medications. The PROMIS Depression scores indicated greater current depressive symptoms among patients with a history of diagnosed depression when not taking antidepressants (11 points worse than unaffected) and also among patients taking antidepressants (7 points worse than unaffected). Heightened depressive symptoms were detected in all groups but were more prevalent among those diagnosed with depression (36% with no medication, 29% with antidepressant medication) compared with unaffected patients (7%). Depression screening for heightened depressive symptoms identifies 1 in 14 patients without diagnosed depression and 1 in 3 patients diagnosed with depression as having currently heightened depressive symptoms. Hand surgeons can use PROMIS Depression screening in all patients and using this to guide referrals for depression treatment to ameliorate one confounder of hand surgical outcomes. Symptom prevalence study II.

Skin pain and psoriasis

To the Editor: Some studies suggest that patients with psoriasis may experience skin pain,1Misery L. Saint Aroman M. Zkik A. et al.Chronic pain in patients with skin disorders.Acta Derm Venereol. 2017; 97: 986-988Crossref PubMed Scopus (7) Google Scholar, 2Ljosaa T.M. Rustoen T. Mörk C. et al.Skin pain and discomfort in psoriasis: an exploratory study of symptom prevalence and characteristics.Acta Derm Venereol. 2010; 90: 39-45Crossref PubMed Scopus (57) Google Scholar, 3Sampogna F. Gisondi P. Melchi C.F. Amerio P. Girolomoni G. Abeni D. Prevalence of symptoms experienced by patients with different clinical types of psoriasis.Br J Dermatol. 2004; 151: 594-599Crossref PubMed Scopus (151) Google Scholar, 4Verhoeven E.W. Kraaimaat F.W. van de Kerkhof P.C. et al.Prevalence of physical symptoms of itch, pain and fatigue in patients with skin diseases in general practice.Br J Dermatol. 2007; 156: 1346-1349Crossref PubMed Scopus (84) Google Scholar, 5Patruno C. Napolitano M. Balato N. et al.Psoriasis and skin pain: instrumental and biological evaluations.Acta Derm Venereol. 2015; 95: 432-438Crossref PubMed Scopus (30) Google Scholar but they have included small numbers of patients without any comparison with healthy individuals. We performed a survey of a large representative sample of the French population to evaluate the presence, frequency, and characteristics of skin pain among patients with psoriasis. Methods are provided in the supplemental data (available via Mendeley at https://doi.org/10.17632/8p53bcj4x8.1#file-fd03878a-d22a-43ad-9f01-eec2071b76c3.) Among the 5000 people interviewed, 244 reported having psoriasis (129 men, 53%; 115 women, 47%; mean age, 47.96 ± 15 years), with a prevalence of 4.8% (95% confidence interval, 4.2-5.4), and 3247 did not report having any skin disease (men, 49.6%; women, 50.4%; mean age, 47.25 ± 16.4 years) and were considered control individuals. Skin pain (visual analog scale: 5.83/10 vs 4.34/10, respectively), pruritus, and tingling were more frequently reported by patients than control individuals (Table I). Patients reporting skin pain were younger than those not reporting skin pain (43.69 ± 14.43 years vs 49.9 ± 14.82 years, respectively; P < .05). The proportion of women with skin pain was higher than the proportion of men (39.45% vs 28.35%, respectively; P < .05). Patients with painful psoriasis were more likely to have consulted a dermatologist in the previous 3 months than those without (67.1% vs 34.6%, respectively; P < .001), and significant differences in the mental composite score-12 (39.18 vs 42.97, respectively; P < .05) and Dermatology Life Quality Index (DLQI) scores (13.62 vs 7.66, respectively; P < .000001) were noted.Table IMain characteristics of patients with psoriasis and control patientsCharacteristicsPatients with psoriasis, %Control patients, %PSkin pain33.26.0<.0001Neuropathic component of pain (in case of pain)63.948.2<.005Pruritus95.153.3<.000001Tingling71.954.9<.005 Open table in a new tab Univariate analysis showed that patients reporting skin pain were more often older than 50 years (odds ratio [OR], 0.48; 95% CI, 0.28-0.83; P < .01), had more frequent consultations with dermatologists (OR, 3.86; 95% CI, 2.20-6.67; P < .001), and had more alterations in quality of life as measured by the DLQI (OR, 4.70; 95% CI, 2.65-8.34; P < .001) and MCS-12 (OR, 0.43; 95% CI, 0.21-0.88; P < .05). Multivariate analysis showed differences only for the DLQI and consultations with a dermatologist (Fig 1). To our knowledge, this study is the largest comparative study on skin pain in patients with psoriasis. One third of patients with psoriasis reported skin pain, half reported tingling, and a large majority reported pruritus. In patients with skin pain, a neuropathic component was suggested in a majority of patients using the Douleur Neuropathique (DN4) questionnaire. Patients with skin pain more frequently consulted dermatologists, and their quality of life was more altered. Skin pain is very rarely evaluated in clinical trials, and there is a need to include it in patient-related outcomes. Because skin pain intensity was almost 6 out of 10, painkillers are justified in addition to effective treatments for psoriasis. Our study showed that patients with painful psoriasis were younger, which was quite surprising, and more frequently were women. The main limitation of this study was that the diagnosis of psoriasis was reported by patients, but many studies previously used surveys to assess or approach the prevalence of skin diseases. In summary, this study showed that skin pain is reported by one third of patients with psoriasis, with an intensity of 6 out of 10 and with consequences on quality of life. The management of skin pain is an unmet need, and additional clinical trials should be conducted to alleviate pain for patients.

The Influence of Injury Definition on Injury Burden in Preprofessional Ballet and Contemporary Dancers.

Study Design Cohort study. Background Multiple operational definitions of injury exist in dance research. The influence that these different injury definitions have on epidemiological estimations of injury burden among dancers warrants investigation. Objective To describe the influence of injury definition on injury prevalence, incidence, and severity in preprofessional ballet and contemporary dancers. Methods Dancers registered in full-time preprofessional ballet (n = 85; 77 female; median age, 15 years; range, 11-19 years) and contemporary (n = 60; 58 female; median age, 19 years; range, 17-30 years) training completed weekly online questionnaires (modified Oslo Sports Trauma Research Centre questionnaire on health problems) using 3 injury definitions: (1) time loss (unable to complete 1 or more classes/rehearsals/performances for 1 or more days beyond onset), (2) medical attention, and (3) any complaint. Physical therapists completed injury report forms to capture dance-related medical attention and time-loss injuries. Percent agreement between injury registration methods was estimated. Injury prevalence (seasonal proportion of dancers injured), incidence rates (count of new injuries per 1000 dance-exposure hours), and severity (total days lost) were examined across each definition, registration method, and dance style. Results Questionnaire response rate was 99%. Agreement between registration methods ranged between 59% (time loss) and 74% (injury location). Depending on definition, registration, and dance style, injury prevalence ranged between 9.4% (95% confidence interval [CI]: 4.1%, 17.7%; time loss) and 82.4% (95% CI: 72.5%, 89.8%; any complaint), incidence rates between 0.1 (95% CI: 0.03, 0.2; time loss) and 4.9 (95% CI: 4.1, 5.8; any complaint) injuries per 1000 dance-hours, and days lost between 111 and 588 days. Conclusion Time-loss and medical-attention injury definitions underestimate the injury burden in preprofessional dancers. Accordingly, injury surveillance methodologies should consider more inclusive injury definitions. J Orthop Sports Phys Ther 2018;48(3):185-193. Epub 13 Dec 2017. doi:10.2519/jospt.2018.7542 Level of Evidence Symptom prevalence study, level 1b.

ED06.06 Decisions in Case of Intractable Symptoms

ED06.06 Decisions in Case of Intractable Symptoms

Pain During Prolonged Sitting Is a Common Problem in Persons With Patellofemoral Pain.

Study Design Retrospective cohort. Background Although persons with patellofemoral pain (PFP) often report pain with prolonged sitting, little is known about the prevalence and characteristics of sitting pain. Objectives To describe the proportion of persons with PFP who experience problems with prolonged sitting and to determine patient characteristics associated with sitting pain. Methods Four hundred fifty-eight participants with a diagnosis of PFP from 4 separate studies were included. Item 8 of the Anterior Knee Pain Scale was used to define the presence of problems with prolonged sitting with knee flexion, based on 3 categories: (1) "no difficulty," (2) "pain after exercise," or (3) "problems with prolonged sitting." Differences in demographic and clinical variables between categories were evaluated using Kruskal-Wallis tests (P<.05). Results Two hundred forty-nine (54.4% of the study sample) participants reported problems with prolonged sitting, and 121 (26.4%) reported sitting pain after exercise. Compared to those with no difficulty sitting (n = 88), participants classified as having problems with prolonged sitting were significantly younger (P = .038), more likely to be female (P = .033), had a lower body mass index (P = .027), reported higher pain severity (P<.001) and lower Anterior Knee Pain Scale scores (P<.001), and more frequently reported problems with squatting (P<.001). Conclusion Problems with prolonged sitting are evident in more than half of persons with PFP. Findings highlight the need to identify and adequately manage PFP associated with prolonged sitting. Further research should explore mechanisms of sitting pain and evaluate targeted interventions to reduce PFP with prolonged sitting. Level of Evidence Symptom prevalence study, level 2b. J Orthop Sports Phys Ther 2016;46(8):658-663. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6470.

The Population Burden of Chronic Symptoms that Substantially Predate the Diagnosis of a Life-Limiting Illness.

Many people in our communities live with symptoms for years or decades, something of relevance to hospice/palliative care clinicians and researchers. The proportion of people in the community at large who have a chronic symptom is likely to approximate the proportion of people referred to hospice/palliative care services with that same chronic symptom that pre-dates their life-limiting illness. Such patients may have different responsiveness to, and expectations from, symptomatic therapies, thus requiring more advanced approaches to symptom control. For researchers evaluating the impact of hospice/palliative care services, failing to account for people with long-term refractory symptoms pre-dating their life-limiting illness may systematically underestimate services' benefits. Observational symptom prevalence studies reported in hospice/palliative care to date have not accounted for people with long-term refractory symptoms, potentially systematically overestimating symptoms attributed to life-limiting illnesses. Cross-sectional community prevalence rates of key chronic refractory symptoms largely unrelated to their life-limiting illness reflect the likely prevalence on referral to hospice/palliative care: fatigue (up to 35%); pain (12%-31%); pain with neuropathic characteristics (9%); constipation (2%-29%); dyspnea (4%-9%); cognitive impairment (>10% of people >65 years old; >30% of people >85 years old); anxiety (4%); and depression (lifetime incidence 2%-15%; one year prevalence 3%). Prospective research is needed to establish (1) the prevalence and severity of chronic symptoms that pre-date the diagnosis of a life-limiting illness in people referred to hospice/palliative care services, comparing this to whole-of-population estimates; and (2) whether this group is disproportionately represented in people with refractory symptoms.

The Symptom Burden of Patients with Hematological Malignancy: A Cross-Sectional Observational Study

Context Current literature suggests that contact with specialist palliative care for patients diagnosed with hematological malignancy is infrequent. As part of an investigation into patterns of care, the symptom profile of this patient group required elucidation. Objectives The purpose of this study was to determine the patterns of symptoms and level of distress in patients diagnosed with a hematological malignancy. Methods One hundred eighty patients diagnosed with a hematological malignancy attending a tertiary referral hospital completed the Memorial Symptom Assessment Scale-Short Form. Comparisons were made to published symptom prevalence studies of those with nonhematological malignancies. Results Patients with hematological malignancy had a considerable physical and psychological symptom burden, with an overall mean of 8.8 (±5.9) symptoms. The mean number of symptoms was significantly greater in those on treatment ( P < 0.05), those with poorer performance status ( P < 0.001), inpatients ( P < 0.01), and those with a more advanced disease stage ( P < 0.001) than their respective counterparts. Symptom prevalence ranged from 69% for fatigue to 9% for vomiting. Global, physical, and psychological distress scores were high and varied significantly according to disease stage, Eastern Cooperative Oncology Group status, and patient location. The mean number of symptoms and level of distress were comparable to those patients with metastatic nonhematological malignancy. Conclusion Patients with hematological malignancy are likely to have symptom control needs similar to those with metastatic cancer. Because such symptom burden appears to affect those at all phases of illness, comprehensive symptom assessment is suggested throughout. The introduction of palliative care services during times of increased symptom burden may assist hematologists and other carers in the management of their patients’ distress and quality of life.

Skin Pain and Discomfort in Psoriasis: An Exploratory Study of Symptom Prevalence and Characteristics

Few studies have investigated subjective sensory skin symptoms in patients with psoriasis. The aim of this study was to investigate prevalence and characteristics of psoriasis-related skin pain and discomfort, and evaluate differences in demographic/clinical characteristics among patients with or without skin symptoms. A total of 139 patients was recruited for this exploratory, descriptive, cross-sectional study. Data were obtained through interviews and questionnaires. While 42.6% reported skin pain, 36.7% reported skin discomfort. Mean average symptom intensity score (0-10 numeric rating scale) was 4.4 for pain and 3.5 for discomfort. Unpleasant, surface, sensitive, itchy, and hot/burning were the most common symptom qualities. Sleep was the most severely affected function. No differences were found in demographic characteristics. However, larger proportions of patients with skin symptoms had more severe psoriasis (p < 0.05). In conclusion, pain and discomfort are more common and more severe in patients with psoriasis than previously estimated.

Symptom Variability During Repeated Measurement Among Hospice Patients With Advanced Cancer

In this prospective study, we explored symptom variability in patients with cancer during repeated measurements. Patients with cancer admitted to an inpatient hospice completed a daily questionnaire throughout their admission. The questionnaire consisted of 5 visual analogue scales (VAS) for anxiety, depression, nausea, pain, and sedation and 3 verbal rating scales (VRS) for depression, pain, and vomiting. Data from those who completed 5 consecutive days were used for the primary analysis. We used all available data points to compare VAS and VRS. An index was developed to assess for daily symptom variability. A total of 125 hospice inpatients were enrolled; 46 (38%) completed 3 consecutive daily questionnaires and 30 (24%), 5 days. We found (1) a statistically significant decrease in severity of symptoms present on admission, (2) new symptoms developed, (3) consequently overall symptom prevalence on days 1 and 5 appeared unchanged, (4) high daily symptom variability as demonstrated by the variability index and also changing daily symptom interrelationships, (5) demographic characteristics influenced symptom patterns on admission and subsequently, (6) severe pain predicted more frequent and severe symptom burden only on admission, (7) severe depression predicted more frequent and severe symptom burden on admission and thereafter, (8) VAS scores for depression and pain did not correspond with discrete VRS categories (mild, moderate, severe). (1) Symptom studies in advanced disease while difficult to conduct yield valuable information, (2) symptom relationships changed daily; strict timing of data collection is crucial for data analysis, (3) symptom monitoring following admission is an overlooked measure of risk assessment, (4) symptom prevalence studies alone for treatment follow-up may be misleading, (5) depression is an important predictor of symptoms and need to be more aggressively assessed and treated, (6) demographic characteristics may help identify symptom patterns and better direct treatment, (7) VRS rather than VAS was more reliable for assessing symptoms in hospice cancer patients.

Lower Urinary Tract Symptoms in the Danish Population: A Population-Based Study of Symptom Prevalence, Health-Care Seeking Behavior and Prevalence of Treatment in Elderly Males and Females

Objective: To estimate the prevalence of LUTS in the elderly Danish population. Furthermore to evaluate the quality of life, the health-care seeking behavior and the prevalence of treatment with relation to LUTS. Methods: A mailed questionnaire was sent to a random sample of 8700 men and 1000 females above 50-years. The questionnaire included five demographic questions, the I-PSS and questions concerning previous physician contact and treatment with relation to LUTS. Results: The questionnaire was returned by 61.5% of the males and 47.7% of the females. The median I-PSS was 4 in males and 3 in females. Overall 28% of males and 20% of females had significant LUTS (I-PSS > 7). A significant increase in the total burden of symptoms with increasing age was found in males whereas a clear age-trend was not found in females. Overall 9.2% of males and 8.2% of females had seen a physician within the last two years for voiding problems. A high proportion of subjects with moderate or even severe symptoms had not seen a physician within two years due to voiding problems. Of males 13.3% had previous been or were currently being treated for voiding problems while the corresponding number in females was 10.9%. These subjects had significantly more symptoms than untreated age-matched subjects. Conclusion: Lower urinary tract symptoms are common in elderly Danish males and females. Overall the same pattern for health-care seeking behavior with regard to LUTS is seen in males and females and the overall treatment prevalence is similar. For both genders it is worth noting that a substantial proportion of subjects with a high symptom burden had not visited their physician within two years and further that subjects who have been treated for LUTS have a higher symptom levels than their untreated peers.

Prevalence of crab asthma in crab plant workers in Newfoundland and Labrador

Objectives. The aim of the study was to determine the prevalence of snow crab sensitisation and occupational asthma. Study design. Prevalence study of symptoms, pulmonary function testing and allergy testing to crab was conducted in four crab plants of different design in Newfoundland and Labrador, Canada. Methods. Plants workers in four crab plants were interviewed and offered skin testing, RAST, pulmonary function testing and peak flow monitoring before and during crab processing. Results. 38% (n=78) had atopy. 18% (n=39) had certain or highly probable crab asthma. The prevalence of sensitisation in different crab plants varied from 50% (n=19) to 15% (n=16) and the prevalence of certain or highly probable crab asthma varied from 50% (n=19) to 9% (n=3). Conclusion. Crab asthma and sensitisation to snow crab is a major health problem for snow crab plant workers in Newfoundland and Labrador.

Symptoms during cancer pain treatment following WHO-guidelines: a longitudinal follow-up study of symptom prevalence, severity and etiology

Most patients with advanced cancer develop diverse symptoms that can limit the efficacy of pain treatment and undermine their quality of life. The present study surveys symptom prevalence, etiology and severity in 593 cancer patients treated by a pain service. Non-opioid analgesics, opioids and adjuvants were administered following the WHO-guidelines for cancer pain relief. Other symptoms were systematically treated by appropriate adjuvant drugs. Pain and symptom severity was measured daily by patient self-assessment; the physicians of the pain service assessed symptom etiology and the severity of confusion, coma and gastrointestinal obstruction at each visit. The patients were treated for an average period of 51 days. Efficacy of pain treatment was good in 70%, satisfactory in 16% and inadequate in 14% of patients. The initial treatment caused a significant reduction in the average number of symptoms from four to three. Prevalence and severity of anorexia, impaired activity, confusion, mood changes, insomnia, constipation, dyspepsia, dyspnoea, coughing, dysphagia and urinary symptoms were significantly reduced, those of sedation, other neuropsychiatric symptoms and dry mouth were significantly increased and those of coma, vertigo, diarrhea, nausea, vomiting, intestinal obstruction, erythema, pruritus and sweating remained unchanged. The most frequent symptoms were impaired activity (74% of days), mood changes (22%), constipation (23%), nausea (23%) and dry mouth (20%). The highest severity scores were associated with impaired activity, sedation, coma, intestinal obstruction, dysphagia and urinary symptoms. Of all 23 symptoms, only constipation, erythema and dry mouth were assessed as being most frequently caused by the analgesic regimen. In conclusion, the high prevalence and severity of many symptoms in far advanced cancer can be reduced, if pain treatment is combined with systematic symptom control. Nevertheless, general, neuropsychiatric and gastrointestinal symptoms are experienced during a major part of treatment time and pain relief was inadequate in 14% of patients. Cancer pain management has to be embedded in a frame of palliative care, taking all the possibilities of symptom management into consideration.