Worsening Of Symptoms Research Articles

Delayed Deep White Matter Ischemia After Resection of Gliomas by Awake Surgery

BACKGROUND AND OBJECTIVES: Deep white matter (DWM) is perfused by the medullary arteries from the cortex, and ischemia sometimes occurs after glioma resection. However, the clinical significance of postoperative medullary artery–related ischemia has not been well studied. We retrospectively reviewed cases of delayed DWM ischemia after awake craniotomy to elucidate the clinical characteristics, mechanisms, and management of delayed ischemia. METHODS: We identified 4 cases of intra-axial brain tumors, mainly gliomas, that underwent tumor resection by awake craniotomy at our hospital and developed DWM ischemic symptoms after surgery, despite no worsening of neurological symptoms at the end of surgery. RESULTS: Four patients (3 men and 1 woman) presented with glioblastoma, oligodendroglioma, astrocytoma, and brain metastasis. The median age at surgery was 47.5 years (41-73 years). The tumors were located in the watershed area in the frontal lobe (n = 2) and the parietal lobe (n = 2), all of which were left-sided (n = 4). DWM ischemic symptoms, such as motor dysfunction, aphasia, dysarthria, and dysgraphia, developed at an average of 24 hours (14-48 hours) after resection by awake craniotomy. All 4 patients showed symptom improvement within a week after surgery and completely recovered within a month. CONCLUSION: DWM ischemia is caused by sacrifice of the medullary artery, which feeds the tumor and adjacent brain tissue during tumor resection, and should be considered when delayed aphasia or paralysis occurs postoperatively. These symptoms are often transient and recovery usually occurs. Tumors located in the frontal or parietal lobes, particularly in the watershed area, should be carefully monitored for postoperative ischemia.

Associations between lifetime reproductive events among postmenopausal women with bipolar disorder.

The premenstrual phase of the menstrual cycle, childbirth and perimenopause often coincide with a worsening of mood symptoms in women with bipolar disorder (BD). To date, findings from the limited number of studies investigating associations between these events among women with BD have been inconsistent. This study aimed to investigate associations between episodes in relation to the perimenopause and (i) premenstrual symptoms and (ii) postpartum mood episodes in a large sample of postmenopausal women with BD. Among 567 postmenopausal women with BD, recruited as part of the UK Bipolar Disorder Research Network, relationships between reproductive event-associated mood symptoms/episodes were examined. Multivariate binary analyses were carried out to identify if history of premenstrual symptoms and/or postpartum episodes predicted the occurrence of mood episodes in relation to the perimenopause, controlling for potential confounders including number of mood episodes per illness year. History of premenstrual symptoms was associated with experiencing any type of mood episode, and depression specifically, during the perimenopause (OR 6.189, p < 0.001 and OR 2.709, p = 0.019 respectively). History of postpartum depression within 6 weeks of delivery was associated with depressive episodes during the perimenopause (OR 2.635, p = 0.027). Postpartum mania was not a significant predictor. Our findings suggest that women with BD with a history of premenstrual symptoms and postpartum depression are potentially at increased risk of experiencing episodes of depression in relation to the perimenopause. There are clinical and self-management implications in identifying a subgroup of women with BD who may be particularly vulnerable to episodes of mood disturbance during reproductive events.

Thoracic posture-related morphological changes in patients with pectus excavatum vs healthy controls.

Cases of severe pectus excavatum presenting with worsening cardiopulmonary symptoms in the upright position have been reported. However, the underlying mechanism remains unclear. We evaluated posture-related morphological changes of the thorax in patients with pectus excavatum. Chest morphology was evaluated preoperatively using upright and supine computed tomography in 21 patients with pectus excavatum and 35 healthy volunteers. The minimum anterior-posterior thoracic diameter, depression depth, and Haller index on horizontal sections, as well as the T6-12 plumb line distance on sagittal sections, were compared between the two positions. In patients with pectus excavatum (median age, 22 years; 18 males and 3 females), the minimum anterior-posterior diameter was smaller (4.5 vs 5.1 cm, P < 0.001) and the Haller index was greater (10.1 vs 6.4, P < 0.001) in the upright position than in the supine position. The T6-T12 plumb line distance was longer in the upright position (2.4 vs 0.8 cm, P < 0.001), while the depression depth showed no significant difference. Healthy volunteers exhibited similar changes. The degree of spinal curvature increased in the upright position due to the anterior shift of the lower thoracic vertebrae, resulting in a shorter anterior-posterior diameter, irrespective of chest wall deformity. One patient with dyspnoea only in the upright position exhibited compression of the right inferior pulmonary vein only on upright computed tomography. The minimum anterior-posterior diameter is shorter in the upright position. This may explain the worsening of cardiopulmonary symptoms in patients with severe pectus excavatum when in an upright position. UMIN000036438 https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041519.

Natural History and Risk Factors of Hymenoptera Venom Allergy in Dogs

Hymenoptera, which includes honeybees, wasps, bumblebees, and hornets, is an order of the class Insecta, whose venom can induce anaphylactic reactions in dogs. While several studies have investigated the natural histories and risk factors of Hymenoptera venom allergy (HVA) in humans, only limited information is available on canine patients. Therefore, the aim of this study was to identify risk factors leading to severe systemic reactions (SSRs) and to explore the natural history of these patients. This was achieved with an inquiry into the case histories of 178 dogs that were stung by Hymenoptera and presented to the Vetsuisse Faculty Animal Hospital of the University of Zurich between 2018 and 2022. Dogs under two years old, dogs that weighed under 10 kg, purebred dogs, and dogs that were stung in the oral cavity were at a greater risk of developing SSRs. Almost two thirds of patients with SSRs experienced the same or worse symptoms after subsequent stings and &gt;40% of patients with local reactions developed SSRs when stung again. Next to providing valuable clinical information about HVA in dogs, these findings strongly support the recommendation of venom immunotherapy (VIT) for patients with HVA.

Association of improvement and worsening of depressive symptoms with arthritis

PurposeThe longitudinal association between changes in depressive symptoms (improvement/worsening) and arthritis is unclear.MethodsStudy data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) 2011–2018. The 10-item Center for Epidemiological Studies Depression Scale (CES-D-10) was used to examine participant depressive symptoms and data on self-reported history of arthritis were collected. Depressive symptoms improving is defined as depression at baseline and no depression at follow-up. Similarly, depressive symptoms worsening is defined as no depression at baseline and depression at follow-up. Cox proportional hazards models were used to evaluate the effects of improvement or deterioration in depressive symptoms on arthritis. Participants with missing data on depression and arthritis, having arthritis in 2011 CHARLS and lost to follow-up was excluded.ResultsA total of 8556 participants free of arthritis were included from 2011 to 2018. After adjustment for confounders, depressive symptoms were associated with a 54% increased risk of developing arthritis. Each 1-point increase in CES-D-10 score was associated with a 4% higher risk of arthritis. Participants with depressive symptoms at baseline but improved symptoms (without depressive symptoms) at follow-up had a 25% lower rate of arthritis, and a 1-point reduction in CES-D-10 score during 8 years of follow-up was associated with a 5% lower risk of developing arthritis. Participants with no depressive symptoms at baseline but depression at follow-up had a 66% higher rate of arthritis, and a 1-point increase in CES-D-10 score during 8 years of follow-up was associated with a 5% higher risk of arthritis.ConclusionsImprovement in depressive symptoms was associated with lower risk of arthritis and worsening of depression was associated with higher risk of arthritis. These findings suggest that the relationship between depression and arthritis is complex.

Intramuscular methylprednisolone in hand osteoarthritis: a retrospective cohort study

Abstract Objectives To explore patient characteristics associated with response to intramuscular methylprednisolone (MP) therapy in hand osteoarthritis (OA). Methods We performed an exploratory monocentric retrospective study. Patients with a clinical diagnosis of hand OA who visited our outpatient clinic between July 2016 and June 2021, and received at least once an intramuscular MP injection, were included. Clinical data, including laboratory and radiologic results, were retrieved from electronic patient records (EPRs). Patients’ reported response to MP and its duration in the first six months after injection was based on free text from the EPRs. Response was categorized into three groups: no response or worsening of symptoms, modest response, and good response. Duration of response was categorized as short-term (&amp;lt;2 weeks), or long-term (≥2 weeks). Multivariable logistic regression models were performed to determine factors associated with good response to therapy with methylprednisolone. Results Data from 262 hand OA patients (76% female) were analyzed. A good response was experienced by 150 patients (57.2%). Among those with modest to good response, the perceived response of 162 patients (80.6%) lasted 2 weeks or longer. Univariate regression analysis indicated that the level of CRP was associated with good response (odds ratio(OR) 1.08; 95% CI 1.00 to 1.17). However, multivariate regression analysis showed no statistical significant associations. Conclusion In this retrospective study, more than half of hand OA patients displayed good response to intramuscular MP administration. The possible relation between the presence of low-grade inflammation and the response to this therapy warrants further investigation.

Bladder Symptoms Prvoked by Short, Rapid Acting Loop Diuretics: A Frequent But Often Overlooked Problem.

Bladder dysfunction entails overactive bladder (OAB) defined as symptoms of urinary urgency, frequency, and/or nocturia with or without incontinence if there is no obvious pathology or infection or lower urinary tract symptoms (LUTS) that includes recognized causes of bladder dysfunction. Literature search. Symptoms of OAB are reported in about 15% of the adult US population. This is increased 2- to 3- fold in patients with congestive heart failure (CHF), hypertension, cardiovascular disease (CVD), chronic kidney disease (CKD) or the elderly where it often accompanies prescription for short, rapid acting loop diuretics. However, less than 2% of patients seeking care for OAB receive treatment. The fear of urinary incontinence from short, rapid acting loop diuretics may contribute to medication nonadherence and less well controlled, apparently resistant hypertension. The bladder contracts to rapid stretch. Thus, less rapid acting diuretics such as thiazides or extended-release formulations of loop diuretics may be preferable for those with bladder dysfunction. Alternatively, the use of a mineralocorticosteroid receptor antagonist, angiotensin receptor antagonist/neprilysin inhibitor or sodium glucose linked transport type 2 inhibitor may allow a reduction in dose of a short, rapid acting loop diuretic for those with bladder dysfunction. A worsening of symptoms from bladder dysfunction by short, rapid acting loop diuretics occurs frequently in patients with CVD, CHF, hypertension and CKD where it can contribute to impaired quality of life and poor adherence and thereby to worsening outcomes.

FIBROMIALGIA E DEPRESSÃO: IMPACTOS NA QUALIDADE DE VIDA

This work investigates the relationship between fibromyalgia and depression, two conditions that significantly affect individuals' quality of life and are often interconnected. Fibromyalgia is characterized by widespread chronic pain, fatigue, and sleep disturbances, while depression manifests as persistent feelings of sadness, loss of interest, and changes in appetite and sleep. The main objective of the research was to analyze how these conditions relate to and influence each other. The methodology involved a literature review of studies on the topic, including scientific articles, theses, and research reports. The analysis focused on the prevalence of depressive disorders in patients with fibromyalgia, the interactions between physical and psychological symptoms, and the treatment strategies aimed at improving the quality of life of affected individuals. The results revealed a strong relationship between fibromyalgia and depression, with a high prevalence of depressive disorders in patients suffering from chronic pain. Depression not only intensifies the perception of pain but can also lead to the worsening of physical symptoms and a reduction in quality of life. The simultaneous diagnosis of these conditions is often challenging, as the symptoms overlap, making it difficult to choose the appropriate treatment. Furthermore, conventional treatments, which often focus solely on pain relief, are not entirely effective. Another important aspect identified was the role of social support in coping with both conditions. Patients who receive support from family and the community tend to have a better response to treatment, highlighting the importance of care that considers both physical and emotional aspects. The concluding considerations indicate that the interaction between fibromyalgia and depression is complex and requires integrated attention that includes not only medical care but also psychological and social support. It suggests that a broader approach to treating these conditions can lead to more positive outcomes, improving patients' quality of life. Finally, the need to raise awareness about the importance of social support and integrated treatment is emphasized to facilitate recovery and proper management of fibromyalgia and depression.

Validating the recording of exacerbations of asthma in electronic health records: a systematic review protocol

IntroductionAsthma exacerbations or ‘attacks’ can vary in severity from mild worsening of symptoms to life-threatening changes that require urgent hospital care. Understanding these exacerbations is crucial to improving treatment and...

Levels of female sex hormones in patients with premenstrual bronchial asthma

According to the clinical recommendations of the Ministry of Health of the Russian Federation in 2021, at least 348 million patients worldwide suffer from bronchial asthma (BA). The treatment of patients with BA has objective difficulties due to the progression of obstruction and insufficient diagnosis of pathogenetic forms of BA. It is known that in women, hormonal status, namely female sex hormones such as estradiol and progesterone, contributes to the course and development of BA. This article presents an original clinical study of 48 patients suffering from mild to moderate asthma with a regular menstrual cycle, and the relationship between the increase in symptoms of asthma and the phase of the menstrual cycle is estimated. According to the results of the study, all patients were divided into groups with regular asthma (RA) and premenstrual asthma (PMA). A significant increase in the level of estradiol was obtained (934.50 (405.00; 1010.25) pmol/l) in patients with PMA in the second phase of the menstrual cycle in relation to the control group (494.00 (328.00; 487.00) pmol/l) and the group of patients with RA (694.50 (495.25; 993.00) pmol/l). No significant and significant changes in progesterone, prolactin, LH, or FSH were detected. The revealed decrease in respiratory function in patients with PMA in the second phase of the menstrual cycle emphasizes and probably explains the worsening of symptoms of asthma in this group of patients, which, with possible hormonal correction, can lead to stabilization of the course of asthma.

National early warning score predicts 90 days all-cause mortality among patients with acute heart failure

Abstract Background Acute heart failure (AHF) is defined as new-onset or worsening of symptoms and signs of heart failure including symptoms or signs related to congestion and volume overload. Patients presenting with AHF are a heterogeneous group as AHF is not a specific disease but a shared clinical presentation of different cardiac abnormalities. Due to the heterogeneity of the patient population, a prognostic tool is needed to identify AHF patients with a high risk of death. The National Early Warning Score (NEWS) is a system for scoring the vital signs that are measured at the patient's bedside and is developed to predict acute mortality within 24 hours. The NEWS has previously been used to evaluate all cost mortality for patients admitted to the Emergency Department (ED). There is limited data regarding the role of the NEWS in predicting adverse outcomes in patients with acute heart failure. Purpose To evaluate NEWS measured at the ED and clinical outcomes in patients with AHF. Methods This prospective, observational cohort study included consecutive patients with AHF admitted through the emergency department (ED) at a large public hospital from 10 March 2020 to 31 March 2022 and had a follow-up period of 365 days. Trained cardiologists assessed all patients for the presence of AHF. According to the cut-off value for the NEWS, high-risk groups are defined by a NEWS score &amp;gt; 7. The patients were categorized into two groups, high-risk and low-risk, depending on the scores they received from the NEWS assessment. The primary outcome was all-cause mortality at 90 days. We used multivariable Cox regression (hazard ratios [HRs]) to compare survival, adjusting for age, sex, smoking, known heart failure (HF), and lactate levels at admission. Results In the study period from March 10, 2020, to March 31, 2022, 408 patients were identified with AHF. Upon arrival to the ED, the median first NEWS was 4 (IQR 2-6). 323 patients were categorized in the low-risk group and 69 patients in the high-risk group. 16 patients had missing values upon arrival at the ED. The high-risk group exhibited significantly faster heart rate, lower saturation, and higher oxygen demand compared. A Kaplan-Meier plot revealed a statistically significant difference in all-cause mortality over 90 days between low-risk and high-risk groups among AHF patients (log rank, p-value &amp;lt; 0.001). After multivariable adjustment, NEWS&amp;gt;7 (HR, 1.69; CI, 1.18 to 2.45) (p-value= 0.004) and higher age (HR, 1.04; CI 1.03 to 1.07) were statistically associated with higher all-cause mortality (p &amp;lt;0.001). Conclusion In this prospective, observational cohort study of AHF patients presenting at the ED an initial NEWS &amp;gt;7 was associated with a significant all-cause mortality after 90 days.GRAPHIC ABSTRACT

An observational study on the efficacy of intralesional steroids in patients with idiopathic granulomatous lobular mastitis in a tertiary care centre

Background: Granulomatous lobular mastitis (GLM) is a rare benign disease of the breast which usually affects young women of childbearing age. The patients usually present with a painful breast mass or with multiple discharging sinuses of breast. Diagnosis is usually established by means of clinical examination followed by radiological, microbiological and histopathological evaluation. The ideal management of patients with GLM is still a matter of debate and treatment modalities such as surgery, systemic and intra-lesional steroids, as well as immunosuppressive agents are being used in clinical practice. In our study, we assessed the clinical response of patients with GLM, treated with intra-lesional steroid injection. Methods: In this prospective observational study, from December 2021 to December 2023, a total of 29 patients who were diagnosed as having GLM and who opted for intra-lesional steroid therapy as the solo treatment, were enrolled. After obtaining informed consent, intra-lesional steroid injection was administered in all the 29 patients. The treatment response was assessed after a period of 3 months from the date of injection. Results: A complete resolution of symptoms and signs was found in majority of the patients (75.9%), 4 (13.8%) had a partial resolution and 2 (6.9%) had persistence of symptoms. One patient (3.4%) was lost to follow up. None had any worsening of symptoms. Conclusions: Intra-lesional steroid can be effectively used in the treatment of GLM and this modality can be completed in a few minutes in an Outpatient setting and is extremely cost effective.

Development of a risk index for cognitive decline predicted by adverse radiation events and diet in older oral cancer patients

Professor Norimasa Ogama, Faculty of Nursing, Soka University, is interested in how symptoms such as dry mouth and changes in taste in elderly oral cancer patients could predict the risk of decline in cognitive function with the use of different sensory food experiences. He is developing an index to predict this. While previously at the Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Ogama saw a range of problems among patients caused by radiation and chemotherapy, including reduced eating and swallowing function, changes in body image and ongoing issues with being able to eat and speak. He began to consider how it might be possible to improve quality of life for such patients, including the ability to enjoy food. This inspired him to work to develop an oral rehabilitation programme that takes into account post-operative life evaluation and its influencing factors in order to significantly increase patientsâ–™ life satisfaction. Ogama and the team are developing a risk index for cognitive decline predicted by the adverse events of radiation and the diet of elderly patients with oral cancer. The goal is to accurately determine the risk of cognitive decline early based on changes to eating preferences and the taste of food, as well as worsening of oral mucositis and symptoms of dry mouth due to radiation therapy. This will be done through the concept of ‘eating deliciously’, based on personal preferences and characteristics.

Utilization and subjective effectiveness of post-COVID-19 therapies in patients with chronic fatigue

Abstract Background A significant proportion of people who have had a SARS-CoV-2 infection suffer from persistent symptoms for more than three months, referred to as post-COVID-19 condition (PCC). Chronic fatigue syndrome (CFS) is common in people with PCC. Little is known about the use of therapeutic measures for people with CFS, and the effect of active exercise in particular is a subject of controversial debate. Methods From November 2023 to January 2024, an online survey was conducted among a random sample of statutorily-insured people with PCC (ICD10 U09.9). Patients with CFS were identified using the DSQ-PEM. The utilization of various physical, psychological and alternative medical therapies and their subjective effectiveness on a scale from 1 (significantly worsened) to 5 (significantly improved) were recorded. Mann-Whitney-U-tests were carried out. Results Preliminary analyses of 1,699 participants with persisting PCC revealed an indication for CFS in 310 participants. Looking at the active exercises, there is no difference in the utilization of functional training between people with and people without CFS (14.6 % vs. 14.5 %, p = 1.0), while rehabilitation sport is utilized significantly more frequently by people with CFS (26.5% vs. 18.7%, p = 0.003). While 45-48% of CFS patients benefited from active therapies, 20-30% showed a worsening of their symptoms. On average, people with CFS also showed significantly less improvement from rehabilitation sports (M 3.28 vs. 3.72, p = 0.002) and functional training (M 3.16 vs. 3.81, p = 0.002) than people without CFS. Conclusions People with CFS due to PCC are significantly more likely to utilize therapeutic services than people with PCC without CFS. Active therapies seemed to benefit almost half of CFS patients but led to worsening of symptoms in up to 20-30%. Further studies are needed to provide evidence-based treatment recommendations for this vulnerable population. Key messages • People with PCC and CFS benefit less from active therapies than people with PCC without CFS. Utilization of active therapies worsen symptoms in a relevant minority of 20-30% of CFS patients. • Further research should focus on evidence-based treatment recommendations for people with PCC and CFS.

Development and validation of a novel nomogram to predict worsening of gastroesophageal reflux symptoms after laparoscopic sleeve gastrectomy using Lasso-logistic regression

Background Gastroesophageal reflux disease (GERD) is among the most common complications of bariatric surgery. This study aimed to analyse the risk factors affecting the worsening of GERD symptoms after laparoscopic sleeve gastrectomy (LSG), and to establish and validate a related nomogram model. Methods The study recruited 236 participants and randomly divided them into training and validation sets in a ratio of 7:3. LASSO regression technique was used to select the optimal predictive features, and multivariate logistic regression was used to construct the column line graphs. The performance of the nomogram was evaluated and validated by analyzing the area under the receiver operating characteristic (ROC) curve, calibration curve, and decision curve. Results In this study, Lasso-logistic regression was applied to select 5 predictors from the relevant variables, which were body mass index (BMI), diabetes, hiatal hernia, GERD, and triglyceride levels. These 5 predictor variables constructed a model with moderate predictive power, with an area under the ROC curve of 0.779 for the training set and 0.796 for the validation set. Decision curve analysis showed that in external validation, if the risk thresholds were between 4 and 98% and 14–95%, then the nomogram can be applied to the clinic. Conclusions We have developed and validated a nomogram that effectively predicts the risk of worsening gastroesophageal reflux symptoms following LSG.

Intraoperative neuromonitoring of visual evoked potentials in a pregnant patient with meningioma: a case report

BackgroundMeningioma in the parasellar region may lead to visual impairment, so intraoperative neurological monitoring is essential for enucleation surgery. However, intraoperative neurological monitoring in pregnant women is challenging, as the anesthesia management must consider the effects and risks to the fetus. Remimazolam is a newly introduced intravenous anesthetic that has little effect on blood pressure. However, the effects of remimazolam on intraoperative neuromonitoring are little known. We treated a pregnant patient with parasellar meningioma who developed visual impairment, using remimazolam for anesthesia and intraoperative neurophysiological monitoring of the visual evoked potential.Case presentationA 34-year-old woman who was 20 weeks pregnant presented with visual acuity disturbances. Neuroimaging demonstrated a parasellar meningioma, and rapid tumor growth and worsening of symptoms subsequently occurred. Craniotomy for tumor removal was performed under anesthesia with remimazolam, which allowed monitoring of the visual evoked potentials. Her visual acuity was restored postoperatively, and no adverse events occurred in the fetus.ConclusionOur experience with intraoperative neuromonitoring of a pregnant woman in the third trimester showed that anesthesia with remimazolam allows safe brain surgery combined with intraoperative visual evoked potential monitoring. Further research is needed to determine the effects of remimazolam on the fetus, as well as the safe dosage and duration of exposure.

Stability of severe asthma phenotypes

Introduction. Severe asthma (SA) is a heterogeneous disease with several phenotypes. There are lack of data about its stability.Aim. To assess stability of SA phenotypes in adult patients during 5 years follow-up.Materials and methods. Prospective study included 117 adult outpatients with allergic SA, 51 severe asthmatics with aspirin-induced disease, 59 patient with persistent airflow limitation (PAL) and 35 patients with SA and concomitant COPD, 65 steroid-dependent severe asthmatics and 89 patients with SA and frequent (≥2 per year) exacerbations. Spirometry and bronchodilator reversibility testing were carried out; fractional exhaled nitric oxide (FeNO) was measured; hypersensitivity to common inhalant allergens (skin prick and blood specific IgE testing) and peripheral blood eosinophil counts were estimated. Asthma control and asthma-related quality of life were assessed by using ACQ-5 and SGRQ questionnaire.Results. During 5-year prospective study stability of aspirin-induced SA and SA with COPD was 100%. Allergic phenotype was stable in 81% of SA cases and in patients with changed atopic status we revealed worsening of symptoms and accelerated lung function decline. Stability of SA phenotype with PAL without COPD was 86% and steroid-dependent SA was stable in 55% of cases. After 5 years of treatment frequent exacerbations remained in 28% of severe asthmatics.Conclusion. The most stable phenotypes of SA were aspirin-induced and asthma with concomitant COPD. Less stable were allergic SA, steroid-dependent SA and phenotype with persistent airflow limitation. The least stable was SA phenotype with frequent exacerbations.

My virtual escape from patient life: a feasibility study on the experiences and benefits of individualized virtual reality for inpatients in palliative cancer care

BackgroundCancer patients benefit from Virtual Reality (VR) in burdensome situations, but evidence is scarce for palliative situations. Based on earlier work in palliative care, individualized VR interventions like seeing the patient’s home may address a patient’s wish to be at home and thus have a greater effect compared to standard VR content. Yet, some patients and relatives may be concerned about their privacy. Also, patient stakeholders raised concerns about triggering depressed mood or homesickness.AimTo test the feasibility and safety of individualized vs. standard 360°video VR interventions in palliative cancer inpatients.MethodsProspective observational study with patient-reported outcome measurement using validated instruments of well-being (MDBF), symptoms and psychosocial burden (IPOS), cybersickness (SSQ), presence experience (SPES), subjective benefit (2 items), content analysis of interviews, and field notes. Individualized VR content was recorded with action camcorder-technology to protect the patients’ privacy.ResultsSeventeen patients participated, median age 65 years (range 20–82), 9 women (53%), 8 single or widowed (47%), 4 childless (23.5%), 4 academics (23.5%), with a median length of stay of 9 days (1–75) in the hematology (10), palliative care (3), or radiotherapy (2) unit of a German university hospital. Eight patients (53.3%) chose their own home environments or family for individualized VR-content. All participants enjoyed the intervention. Compared to standard VR content the individualized VR tended to have a stronger effect on well-being and emotional touch. It was not inferior in terms of psychosocial burden and cybersickness. No subjective and relevant side effects occurred. The patients well tolerated the assessments. However, most patients demanded a lighter headset and a desire for more interactivity.ConclusionsIndividualization of VR content shows potential for enhancement of immersion, which improves the VR experience and does not harm in terms of depressed mood or worsening of symptoms. The patients’ and family desire for privacy is feasible with the support of family members who recorded the individualized videos, which is easily manageable today. We suggest a pragmatic randomized clinical trial to compare the effects of individualized vs. standard VR-content.Trial registrationRegistered at German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS); registration number: DRKS00032172; registration date: 11/07/2023.

Use of long-acting triple therapy for chronic obstructive pulmonary disease (COPD) in practice: The ELETHON physicians' survey

Gaps in optimal COPD management have been identified in clinical practice, with discrepancies between guideline recommendations and routine care. The reasons for such discrepancies are incompletely understood. The ELETHON survey aimed to identify physicians' attitudes towards general concepts of COPD management and, in particular, initiation of inhaled triple therapies. ELETHON was a nationwide cross-sectional survey with general practitioners (GP) and pulmonary specialists (PS) working in the ambulatory outpatient setting in Germany, using a structured 17-item questionnaire (single or multiple choice questions) addressing the topics of secondary prevention, exacerbation detection, strategies for therapy escalation, choice of inhaled triple therapies and evaluation of treatment benefits. Questionnaires filled by n=2028 GPs and n=371 PS were analyzed. In both groups, secondary prevention was deemed important in COPD care (GP/PS 76.4%/90.6%), with inhalation technique, vaccination status, and appropriate inhaled pharmacotherapy as key components. Activity/rehabilitation was rarely mentioned by GPs (48.3% vs. 84.5%). Exacerbations and symptomatic worsening were the main triggers for therapy escalation, but were not recorded in a structured way. "Hospitalization" and "≥2 ambulatory exacerbations" were mentioned most frequently as thresholds. Neither GPs nor PS measured eosinophils in the majority of patients. Fixed triple combinations were preferred, with availability of different treatment steps in the same device as important decision aid. Treatment success was evaluated by exacerbations, quality of life, symptoms, lung function and rescue medication use, while COPD Assessment Test (CAT) score was rarely used by GPs and PS. The ELETHON survey identified gaps in COPD management in Germany. While secondary prevention is deemed important, escalation of inhaled therapy is undertaken rather late, the reported importance of vaccinations does not match current quota in German COPD patients, and non-pharmacological measures are often unused. Exacerbation and symptom documentation is rather subjective, validated questionnaires and blood eosinophils are of minor relevance. These results provide evidence of barriers and hidden potentials towards optimization of routine ambulatory care for COPD patients in Germany.

Structural and functional changes of binocular corneal innervation and ocular surface function after unilateral SMILE and tPRK

AimsTo evaluate the bilateral changes in the sub-basal nerve plexus of the cornea and ocular surface function after unilateral small incision lenticule extraction (SMILE) and transepithelial photorefractive keratectomy (tPRK) procedures.Methods34...