Symptoms In Relatives Of Patients Research Articles

Patient-Reported Outcomes and Quality of Life After Single-Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S): a Cross-Sectional Study with 283 Patients from a Single Institution.

Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a safe and effective technique with good short- and mid-term weight control and associated medical problems remission for patients with a body mass index (BMI) > 45kg/m2. The aim of this study was to analyze patient-reported symptoms, specifically symptomatic gastroesophageal reflux disease symptoms (GERD), depositional habit, and quality of life (QOL) following SADI-S, using telemedicine and validated tests. A prospective unicentric cross-sectional study was conducted including all patients submitted to SADI-S in the University Hospital of Bellvitge from May 2014 to September 2019. A baseline control group was composed of 67 patients who were planning to undergo SADI-S in the following 4months. Patients were divided into four groups: pre-SADIS, < 2years, 2-3years, and > 3years after surgery. The information gathered via a telematic questionnaire was analyzed and compared with its presence in patients' clinical history derived from the last presential visit. The response rate to telematic tests was 86.9%. The mean BMI exhibited significant differences depending on the moment of evaluation: 50.8kg/m2, 30.0kg/m2, 31.1kg/m2, and 32.7kg/m2 at pre-SADIS, < 2, 2-3, and > 3years follow-up, respectively (p < 0.001). The proportion of GERD symptoms increased over time (17.9%, 18.8%, 26.9%, and 30.2%, p = 0.320). After SADIS, the percentage of patients with loose stools was progressively higher (17.4% vs 25.4% vs 30.2%, p = 0.04). Patients with < 2-year follow-up presented an improvement in both physical component (PCS) and mental component (MCS) summaries compared to the baseline group (PCS = 51.3, and MCS = 49.4). The mean BMI of patients with PCS ≥ 50 was 31.9kg/m2, compared with 41.7kg/m2 in the PCS < 50 group (p < 0.001). In the MCS ≥ 50 group, there were more patients with a BMI < 35kg/m2 than the MCS < 50 group (66.7% vs 48.7%, p = 0.004). Telematic follow-up offered a more systemic and detailed information: in the last presential visit only, 13.9% of patients had complete data regarding weight evolution, remission of associated medical problems, GERD symptoms, and depositional habit in comparison with the 82.9% of patients with telematic follow-up (p < 0.001). Weight control is the main factor related to long-term QOL after SADI-S. The incidence of GERD symptoms and diarrhea was up to 30% in patients with > 3-year follow-up. Monitoring postoperative patient-related symptoms with validated objective tests seems a feasible and useful resource for the long-term follow-up of patients submitted to SADI-S.

Efficacy of gastric aspiration to reduce postoperative vomiting after orthognathic surgery: double-blind randomised clinical trial

Orthognathic surgery is a treatment modality indicated to correct dentofacial deformities. Postoperative vomiting can be associated with multifactorial origin mainly correlated to patient-related symptoms, anaesthetic and surgical factors. Swallowed blood has been related to one of those multifactorial vomiting causes. This present study was to compare the efficacy of gastric aspiration after bimaxillary orthognathic surgery. A double blind randomised clinical trial was carried out and patients were divided in two groups (n = 44/39 respectively). There was statistically significant difference between the control and study groups in the overall incidence of vomiting (p = 0.031) A stratified analysis by sex between both groups was performed demonstrating a four-fold eduction in the odds for vomiting events independent of patient gender (OR = 0.24; 95% CI 0.07 to 0.72). Gastric aspiration after orthognathic surgery can reduce the effects of postoperative vomiting decreasing inpatient period and, consequently, hospitalisation costs.

O08 Symptoms in first degree relatives of patients with rheumatoid arthritis: evaluation of data from the symptoms in persons at risk of rheumatoid arthritis questionnaire

O08 Symptoms in first degree relatives of patients with rheumatoid arthritis: evaluation of data from the symptoms in persons at risk of rheumatoid arthritis questionnaire

Investigation of Nonmotor Symptoms in First-Degree Relatives of Patients with Different Clinical Types of Parkinson's Disease.

Background Nonmotor symptoms (NMS) are prodromal characteristics of Parkinson's disease (PD). The first-degree relatives (FDR) of PD patients had a higher risk of PD and also had more NMS. Objective To delineate NMS in FDR of patients with different clinical types of PD. Methods A total of 98 PD probands were recruited; 256 siblings of them were enrolled in the FDR group. Various scales were used to assess NMS, including depression, anxiety, cognitive impairment, insomnia, constipation, excessive daytime sleepiness, rapid eye movement sleep behavior disorder (RBD), and restless legs syndrome (RLS). The incidences of NMS were further compared between the FDR groups of PD with different types. Results The FDR of early-onset PD (EOP) showed a higher incidence of moderate to severe depression (OR = 4.08; 95% CI: 1.12–14.92; P=0.033), anxiety (OR = 4.22; 95% CI: 1.87–9.52; P=0.001), and excessive daytime sleepiness (OR = 3.40; 95% CI: 1.00–11.48; P=0.049) than the FDR of late-onset PD (LOP). It was also found that RBD (OR = 11.65; 95% CI: 3.82–35.54; P < 0.001), constipation (OR = 4.94; 95% CI: 1.85–13.21; P=0.001), sleep disorders (OR = 4.51; 95% CI: 1.73–11.78; P=0.002), cognitive impairment (OR = 3.55; 95% CI: 1.62–7.77; P=0.002), and anxiety (OR = 2.49; 95% CI: 1.32–4.71; P=0.005) were more frequent in FDR of tremor-dominant PD (TDP) than in FDR of non-tremor-dominant PD (NTDP). Conclusions The siblings of patients with EOP and TDP have more NMS, presuming that they have a higher risk in the PD prodromal stage. Whether they have a greater possibility to progress into PD requires further investigation.

Nutritional support and dietary interventions following esophagectomy: challenges and solutions

Nutritional support and dietary interventions following esophagectomy: challenges and solutions Melanie Paul, Melanie Baker, Robert N Williams, David J Bowrey Department of Surgery, Leicester Royal Infirmary, Leicester, UK Background and aims: Provision of adequate nutrition after esophagectomy remains a major challenge. The aims of this review were to describe the challenges facing this patient population and to determine the evidence base underpinning current nutritional and dietetic interventions after esophagectomy. Methods: Medline, Embase and CINAHL databases were searched for English language publications of the period 1990&ndash;2016 reporting on the outcome of nutritional or dietetic interventions after esophagectomy or patient-related symptoms. Results: Four studies demonstrated that early reintroduction of oral fluids was safe and was associated with a shorter hospital stay and ileus duration. One of three studies comparing in-hospital enteral nutrition against usual care showed that enteral feeding was well tolerated and was associated with a shorter hospital stay. Eight studies comparing enteral with parenteral nutrition showed similar surgical complication rates. Enteral feeding was associated with a shorter duration of ileus and lower health care costs. In hospital, all types of enteral access (nasoenteral, jejunostomy) were equivalent in their safety profiles. Cohort studies indicate that technical (tube dysfunction) and feed (diarrhea, distention) problems were common with jejunostomies but are easily managed. The mortality risk associated with jejunostomy in hospital is 0.2% (reported range 0%&ndash;1%), principally due to small bowel ischemia. There have been no reports of serious jejunostomy complications in patients receiving home feeding. One study demonstrated the advantages of home feeding in weight, muscle and fat preservation. Studies reporting 12 months or more after esophagectomy indicate a high frequency of persistent symptoms, dumping syndrome 15%&ndash;75% (median 46%), dysphagia 11%&ndash;38% (median 27%), early satiety 40%&ndash;90% (median 65%) and reflux 19%&ndash;61% (median 29%). Conclusion: Patients should resume oral intake as soon as possible after surgery. In hospital, all forms of enteral access appear to be safe. Out of hospital, the ability to provide home feeding by feeding jejunostomy is likely where meaningful nutritional improvements can be made. Improving nutrition and related quality of life in the early months might improve the long-term outcome. Keywords: esophagectomy, enteral nutrition, nutrition, nutritional status, weight

Predicting the Negative Emotional Symptoms in Relatives of Patients Residing in Intensive Care Unit

&#x0D; &#x0D; &#x0D; Abstract&#x0D; Balanced emotions are essential for wellbeing. Having a relative admitted to the intensive care unit (ICU) associated with negative emotional symptoms, and the severity of such symptoms is associated with patients' health status, patients and relatives' characteristics as well. Purposes: To assess the level of depression, anxiety and stress, as well as to identify the predictors of negative emotional symptoms among relatives of Jordanian ICU patients. Methods: Descriptive correlation design was used, and 140 first degree relatives were recruited through convenience sampling. Depression, Anxiety and Stress Scale was used to collect data about relatives’ negative emotional symptoms. Standard multiple regression was conducted to determine the extent to which variance in depression, anxiety and stress could be explained by patients' health status, patients' sociodemographics, and relatives' sociodemographics. Results: Approximately, 56%, 70%, and 76% of relatives are suffering from depression, anxiety and stress respectively. Relatives have been found suffering from mild depression plus moderate anxiety and stress. Patients' Glasgow Coma Scores is the most significant predictor for relatives' stress level. Patients' age and insurance are predictors of relatives' depression, anxiety and stress. Whereas, relatives' gender and age; are the most significant predictors for their negative emotional symptoms. Conclusions: Interestingly, variances in relatives' negative emotional symptoms were explained by patients' sociodemographics and relatives' sociodemographics, more than patients' health status. Therefore, patients' and relatives' sociodemographics should be considered in dealing with relatives' psychological status.This will help nurses to minimize the devastating impact of the negative emotional symptoms on relatives of ICU patients. Keywords: Emotional Symptoms, Intensive, Care Unit.&#x0D; &#x0D; &#x0D;

EPA-0399 – Impact of group psychoeducation on anxious and depressive symptoms in relatives of patients with addictive behaviours

Family psychoeducation is an effective intervention extensively used in the treatment of mental disorders. To examine the efficacy of group psychoeducation in anxious and depressive symptoms in relatives of patients with addictive behaviours. To investigate satisfaction levels in relatives. Seventy relatives of 53 outpatients were included into group psychoeducation between January and July 2012. This 8 session structured psychoeducational group is designed as follows: 1.5 hours every 3 weeks. To assess psychopathological symptoms, we used the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI), at baseline and at the end of the follow-up period. Family satisfaction levels were assessed by using the Visual Analogue Scale (VAS). 59% of relatives were men, and mean age was 55 years. 45% of the patients had a cocaine dependence disorder, 34% alcohol dependence disorder, and 93% co-dependence disorders. 74% had a dual diagnosis (Psychosis, affective disorders, or personality disorders). 90% had psychosocial stress (60% moderate or severe). Anxious symptoms were found in 30% of the relatives, being psychic anxiety most common in women than in men. Furthermore, depressive symptoms were found in 30% of relatives (mild:30%; moderate:25%, severe:15%). Women were more likely to have moderate-severe depression and men mild-depression disorders. After 8 sessions, mean satisfaction levels assessed by EVA Scale were 9.2 Statistically significant gender differences in anxious and depressive symptoms were found in relatives. Satisfaction levels were higher than expected, and a significant reduction in anxiety and depression was found after the group psychoeducation.

A potent steroid cream is superior to emollients in reducing acute radiation dermatitis in breast cancer patients treated with adjuvant radiotherapy. A randomised study of betamethasone versus two moisturizing creams

Background and purposeThe aim was to investigate whether treatment with potent local steroids can reduce signs and symptoms of acute radiation dermatitis in breast cancer patients undergoing adjuvant radiotherapy (RT) compared to emollient creams. Material and methodsThe study was randomised and double-blinded. Patients with breast cancer who had undergone mastectomy or breast-conserving surgery were included when they started adjuvant 3-D planned RT.In all, 104 patients were randomised 2:1:1 to three treatment groups, i.e. betamethasone+Essex® cream, Essex® cream or Canoderm® cream. The patients themselves treated the irradiated area during the radiation period (5weeks) and two weeks after cessation of RT. Signs of RT dermatitis were measured qualitatively with RTOG clinical scoring and quantitatively by colorimeter. In addition, the patients’ symptoms were recorded as well as the Fitzpatrick skin type.There was a statistically significant difference (p=0.05) in skin reactions when assessed with RTOG in favour of the group treated with the potent steroid. Patient-related symptoms did not differ between the treatment groups.The effect of the steroid was prominent in three subgroups, i.e. (i) patients treated with ablation of the breast, (ii) patients receiving RT to the armpit and the supraclavicular fossa, and (iii) patients with Fitzpatrick skin type 1. ConclusionsTreatment with betamethasone cream is more efficient than moisturizers for the control of acute RT dermatitis in patients treated with adjuvant RT for breast cancer.

Does the ICU experience predict psychological symptoms in relatives of patients with severe sepsis and end-of-life decisions?

Does the ICU experience predict psychological symptoms in relatives of patients with severe sepsis and end-of-life decisions?

Rates of Malposition and Expulsion of the Levonorgestrel-Releasing Intrauterine System Among Women with Inherited Bleeding Disorders

Abstract 3367 Introduction:Menorrhagia, or excessive menstrual bleeding (EMB), is defined as menstrual blood loss of greater than or equal to 80 ml per menstrual cycle1,2. EMB is an important public health problem affecting as many as 10–15% of pre-menopausal women3 and is a common presenting symptom in women referred to a gynecologist4,5. Although there are many etiologies of EMB, inherited bleeding disorders may be identified in as many as 10–20% of women with EMB6,7. The levonorgestrel-releasing intrauterine system (LNG-IUS) is an intrauterine device that secretes 20 mcg of levonorgestrel per day and is indicated for contraception and for the treatment of heavy menstrual bleeding8. There have been limited data for the use of the LNG-IUS among women with inherited bleeding disorders and expulsion and malposition rates are not well known. Expulsion occurs in approximately 5–10% of women without an inherited bleeding disorder9,10. The purpose of this study is to examine the proportion of levonorgestrel-releasing intrauterine systems resulting in expulsion or malposition among women with inherited bleeding disorders. Methods:Women with an inherited bleeding disorder were retrospectively identified from the records of the Women and Bleeding Disorders clinic at a tertiary care hospital in Kingston, Canada. Women were included if they were seen for EMB and treated with an LNG-IUS between May 2005 and June 2012. All LNG-IUS insertions during this time were performed by one of 2 gynecologists experienced in LNG-IUS insertion. The primary outcome was a combined endpoint of expulsion and/or malposition. Expulsion or malposition was suspected if LNG-IUS strings were not apparent on direct visualization, if the LNG-IUS was visible at the cervix os, or if the ongoing patient-related symptoms or concerns suggested possible malposition. Suspected expulsion and malposition were confirmed by endovaginal ultrasound. Results:108 women were seen in the Kingston Women and Bleeding Disorders clinic between May 2005 and June 2012. During this time, there were 23 LNG-IUS inserted in 20 women for the management of EMB. Follow-up was complete for 19/23 LNG-IUS insertions. The median age was 31 years (range 18 to 43). The most common diagnosis in the study population was type 1 Von Willebrand disease (VWD) (13/20, 65%). While there was no pre-medication used in the large majority of cases, 2 patients received treatment at the time of insertion: 1 with tranexamic acid (type 1 VWD) and 1 with recombinant factor VIII (hemophilia A carrier). During this study period, there were 5 episodes of LNG-IUS expulsion or device malposition resulting in removal [5/19 (26.3%), 95% CI 11.8% to 48.8%]. An additional 5 women had their device removed for other reasons: 1 due to pain, and 4 due to failure of the LNG-IUS to satisfactorily reduce menstrual bleeding. The proportion of devices requiring removal in this population was 10/19 (52.6%, 95% CI 31.7% to 71.7%). The median time to device removal was 218 days (range 30 to 636). Among women whose LNG-IUS remained in proper position there was a significant increase in hemoglobin concentration associated with LNG-IUS insertion [122 g/L (SD 11.9) vs.129.5 g/L (SD 8.5), p=0.04, paired sample t-test]. Conclusions:In this retrospective study, over half (52.6%) of women with an inherited bleeding disorder had an LGN-IUS removed due to poor patient satisfaction, malposition, or expulsion. In this group of women with bleeding disorders (and no premedication at the time of the insertion), the proportion of LNG-IUS resulting in expulsion or malposition was 26.3%, which is higher than that reported among women without a bleeding disorder. Women with inherited bleeding disorders may be at increased risk of expulsion due to heavy menstrual blood flow and/or uterine contractions. Further study into the causes of higher complication rates and interventions such as premedication or prolonged treatment with anti-fibrinolytic agents targeted at improving outcomes in this population is required. Disclosures:James:CSL-Behring, Baxter, Bayer: Honoraria, Research Funding.

Demonstrating the psychometric properties of a problem‐related distress screener in a community sample of 319 cancer survivors

The purpose was to test the psychometric properties of a 36-item community-based problem-related distress screening tool, among 319 cancer survivors recruited across 14 affiliates of the Cancer Support Community. Internal reliability was estimated using Cronbach's alpha coefficient. Test-retest reliability was assessed using the intra-class correlation coefficient (ICC). Concurrent validity was determined by correlations with the Functional Assessment of Cancer Therapy-General Well-Being Scale (FACT-G), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Distress Thermometer (DT) and receiver operating characteristic (ROC) curve analysis using the CES-D (≥16) and DT (≥4) as the criterion. Non-parametric analysis of variance was used to establish discriminant validity. The distress screener demonstrated high internal consistency (Cronbach's alpha = 0.91) and strong test-retest reliability (ICC ≥ 0.75). Summary scores of the distress screener correlated substantially with the FACT-G (R(2) = 0.58, p < 0.001), CES-D (R(2) = 0.48, p < 0.001), and DT (R(2) = 0.35, p < 0.001) indicating strong concurrent validity and were able to discriminate groups of clinical relevance. ROC analyses showed a cutoff score of 8 for problem items rated ≥3 had optimal sensitivity and specificity relative to the CES-D and DT. The distress screener shows strong psychometric properties and can be considered a valuable community-based instrument to screen for psychological distress related to social, emotional, physical, and other patient-related symptoms and problems. This study is the first to address the chasm between hospital and community-based screening by validating a community-based instrument and has begun to demonstrate the feasibility of screening in the community.

Eye symptoms in relatives of patients with primary adult‐onset dystonia

Using a validated questionnaire, we screened eye symptoms (burning sensation, grittiness, dry eye) in 333 first-degree relatives of 140 probands with different forms of primary adult-onset dystonia, 208 healthy subjects, and 293 patients with primary blepharospasm. The rate of eye symptoms was similar in the relatives of focal dystonia patients and in healthy subjects (adjusted HR, 1.1; 95% CI, 0.7-1.7; P = .69), thus suggesting a common origin of eye symptoms in both groups. A higher rate was observed in blepharospasm patients (adjusted HR, 2; 95% CI, 1.4-2.9; P < .0001). Relatives of focal dystonia patients who developed blepharospasm were more likely to have preceding eye symptoms than were relatives who developed focal dystonia other than blepharospasm (BSP) or relatives who did not develop dystonia. Eye symptoms reported by relatives of patients with focal dystonia probably result from eye diseases and are not part of the clinical spectrum of blepharospasm.

A proactive communication strategy reduced post-traumatic stress disorder symptoms in relatives of patients dying in the ICU

A proactive communication strategy reduced post-traumatic stress disorder symptoms in relatives of patients dying in the ICU

Multiple medically unexplained physical symptoms and health care utilizationOutcome of psychological intervention and patient-related predictors of change

Abstract Objectives To test the effect of psychological intervention on multiple medically unexplained physical symptoms, psychological symptoms, and health care utilization in addition to medical care as usual. To identify patient-related predictors of change in symptoms and care utilization. Methods In a randomized controlled trial, subjects were assigned to one of two conditions: psychological intervention by a qualified therapist plus care as usual by a general practitioner (GP) or care as usual only. Participants ( N =98) were administered a standardized interview and several outcome measures at intake and after 6 months and 12 months after intake. GPs rated medically unexplained and explained symptoms and consultations over a period of 1 1/2 years. Results ANOVAs for repeated measures showed that self-reported and GP-registered unexplained physical symptoms decreased from pretest to posttest to follow-up. Psychological symptoms and consultations decreased from pretest to posttest. GP-registered explained symptoms did not decrease. However, intervention and control groups did not differ in symptom reduction. Path analysis revealed two paths to a decrease in self-reported unexplained physical symptoms: from more negative affectivity via more psychological attribution and more pretreatment anxiety, and from more somatic attribution via more psychological attribution and more pretreatment anxiety. Conclusion Intervention and control groups did not differ in symptom reduction. Reduction of self-reported medically unexplained symptoms was well predicted by patient-related symptom perception variables, whereas the prediction of change in registered symptoms and consultations requires a different model.

Multiple medically unexplained physical symptoms and health care utilization: Outcome of psychological intervention and patient-related predictors of change

Objectives To test the effect of psychological intervention on multiple medically unexplained physical symptoms, psychological symptoms, and health care utilization in addition to medical care as usual. To identify patient-related predictors of change in symptoms and care utilization. Methods In a randomized controlled trial, subjects were assigned to one of two conditions: psychological intervention by a qualified therapist plus care as usual by a general practitioner (GP) or care as usual only. Participants ( N=98) were administered a standardized interview and several outcome measures at intake and after 6 months and 12 months after intake. GPs rated medically unexplained and explained symptoms and consultations over a period of 1 1/2 years. Results ANOVAs for repeated measures showed that self-reported and GP-registered unexplained physical symptoms decreased from pretest to posttest to follow-up. Psychological symptoms and consultations decreased from pretest to posttest. GP-registered explained symptoms did not decrease. However, intervention and control groups did not differ in symptom reduction. Path analysis revealed two paths to a decrease in self-reported unexplained physical symptoms: from more negative affectivity via more psychological attribution and more pretreatment anxiety, and from more somatic attribution via more psychological attribution and more pretreatment anxiety. Conclusion Intervention and control groups did not differ in symptom reduction. Reduction of self-reported medically unexplained symptoms was well predicted by patient-related symptom perception variables, whereas the prediction of change in registered symptoms and consultations requires a different model.

Mental status of soldiers and function of three levels psychiatric intervention for military rescuers of Chi-Chi earthquake, Taiwan

To test the effect of psychological intervention on multiple medically unexplained physical symptoms, psychological symptoms, and health care utilization in addition to medical care as usual. To identify patient-related predictors of change in symptoms and care utilization.In a randomized controlled trial, subjects were assigned to one of two conditions: psychological intervention by a qualified therapist plus care as usual by a general practitioner (GP) or care as usual only. Participants (N=98) were administered a standardized interview and several outcome measures at intake and after 6 months and 12 months after intake. GPs rated medically unexplained and explained symptoms and consultations over a period of 1 1/2 years.ANOVAs for repeated measures showed that self-reported and GP-registered unexplained physical symptoms decreased from pretest to posttest to follow-up. Psychological symptoms and consultations decreased from pretest to posttest. GP-registered explained symptoms did not decrease. However, intervention and control groups did not differ in symptom reduction. Path analysis revealed two paths to a decrease in self-reported unexplained physical symptoms: from more negative affectivity via more psychological attribution and more pretreatment anxiety, and from more somatic attribution via more psychological attribution and more pretreatment anxiety.Intervention and control groups did not differ in symptom reduction. Reduction of self-reported medically unexplained symptoms was well predicted by patient-related symptom perception variables, whereas the prediction of change in registered symptoms and consultations requires a different model.

Rates of polycystic ovary syndrome (PCOS) symptoms in relatives of patients with PCOS

Objective: In the few studies that exist, the symptoms of PCOS are reported to occur with increased frequency among family relatives without the syndrome. These include premature fronto-temporal balding which has been described as a possible male phenotype. This study was conducted to determine whether family members of PCOS patients have an increased prevalence of hirsutism, anovulation, infertility and males’ with balding prior to age 30.

Systematic review and analysis of postdischarge symptoms after outpatient surgery.

OVER the past decade, the percentage of surgical procedures being performed in outpatient centers has increased. In response, outpatient anesthetic practice and research have focused on providing anesthetics that minimize symptoms (e.g., nausea and vomiting) in the postanesthesia care unit and hasten time to discharge. Much effort has been placed on development of newer agents with a more favorable recovery profile. Similarly, examination of the economic parameters (e.g., length of recovery room stay, cost-effectiveness of drugs) after ambulatory surgery has focused on the immediate predischarge, postoperative period. A significant portion of research in this area has concentrated on minimizing immediate postoperative symptoms to facilitate patient discharge from the hospital. On the other hand, relatively few studies have evaluated the impact of patient-reported symptoms after discharge from the postanesthesia care unit. Postdischarge symptoms (those occurring after discharge from the ambulatory surgical unit) may have an important impact on patient recovery after ambulatory surgery and the economic burden on patients and their caregivers; however, there has not been a systematic examination of postdischarge symptoms. It is important to know the frequency with which patients experience postdischarge symptoms so that providers can better inform patients and researchers can better estimate the burden of these symptoms and potential for the incidence of postdischarge symptoms to serve as a measure of quality of care. Quantification of the incidence of postdischarge symptoms would be the first step in the process in determining the extent of the problem and if perioperative interventions (e.g., intraoperative anesthetic technique, multimodal analgesia, or pharmacologic agents) would be effective in diminishing the impact of these patient-related symptoms on functional recovery and health-related quality of life. Therefore, we conducted a systematic review and analysis to evaluate the incidence of patient-reported symptoms after outpatient surgery.

Sex differences in cobalamin (vitamin B 12 ) opinions of Swedish physicians

The aim of the study was to elucidate possible sex differences in knowledge, competence and attitudes behind decision-making on cobalamin-associated problems (vitamin B 12 ). The study was conducted by postal questionnaires to Swedish physicians in 1996-98. The participants were recruited by random sampling of general practitioners (1996, 1998), and a total sampling of geriatricians (1998). The overall response rate was 71%. The study group comprised 480 female physicians and 526 male physicians. The responses to 24 statements in the questionnaire were measured by means of visual analogue scales. Group differences were evaluated by medians and shapes of distributions. The female doctors appeared to value patient-related symptoms and signs more than male doctors. Conversely, male doctors relied on laboratory tests more than female doctors. As reflected by questionnaire answers, female doctors appeared to be more informed than male doctors on cobalamin-associated clinical problems. Group differences between the sexes were marginal from a numerical point of view. It is suggested that the statistical differences observed should be regarded as negligible until confirmed by further studies.

Postoperative nausea and vomiting (PONV). Clinical significance, basic principles, prevention and therapy

The incidence of postoperative nausea and vomiting (PONV) of in- and outpatient surgical patients is about 30% (range 2-45%). Based on etiology, anatomy and physiology, this review article provides a critical evaluation of the present PONV literature with the aim of outlining current prophylaxis and treatment strategies. PONV is often associated with postoperative pain and its treatment. Patients are often more compromised by PONV than by postoperative pain. Surveys demonstrate that 78% of the surgeons consider PONV to be a relevant problem in clinical practice; 82% argue for better management of PONV. However, only 28% of the general surgical patients with PONV received sufficient antiemetic therapy. Studies demonstrate that the prophylactic use of antiemetics in patients at risk can lead to complete symptom control in 85% of the cases. Combination therapy of different antiemetic strategies can further increase the rate up to 96%. There is a need for surgeons to pay more attention to patient-related symptoms.