April 19, 2005—Leaving Gifts

2021 ◽  
pp. 79-98
Author(s):  
Richard P. McQuellon
Keyword(s):  
Healthcare Providers ◽  
Dry Mouth ◽  
Shortness Of Breath ◽  
Breathing Exercise ◽  
Self Advocacy ◽  
Essential Component ◽  
Frequent Flyer ◽  
Intense Fear ◽  
Major Loss ◽  
Nasal Passages

In this dialogue, Nell lets go of possessions and gifts them to friends and relatives. She was especially pleased with transferring 120,000 frequent-flyer miles to her niece’s family so they could make their annual pilgrimage to Michigan from Seattle. This is the second time she has downsized in two years. When she and Al moved from their home to this apartment, they had to place furniture in storage or sell it. A major loss with the move was her highly valued garden with its associated activities, especially digging in the good earth. Nell once again spoke of her intense fear of suffocation and likened it to “skating in the dark.” She feels the same type of fear and panic when she cannot swallow due to dry mouth. Her shortness of breath has been a continual challenge; the addition of an oxygen apparatus has helped. Unfortunately, she had difficulty getting the machine to work properly because it was delivered without an essential component, the humidifier. Consequently, her nasal passages were drying out and bleeding. She subsequently needed to increase her self-advocacy efforts with the hospice healthcare providers. We practiced a breathing exercise to help her settle herself when she feels short of breath.

Assessing Symptom Burden and Depression in Subjects With Chronic Respiratory Insufficiency

2021 ◽  
pp. 082585972110495
Author(s):  
Heidi A. Rantala ◽  
Sirpa Leivo-Korpela ◽  
Lauri Lehtimäki ◽  
Juho T. Lehto
Keyword(s):  
Respiratory Insufficiency ◽  
Advanced Disease ◽  
Depression Scale ◽  
Symptom Burden ◽  
Depression Score ◽  
Assessment System ◽  
Dry Mouth ◽  
Depression Symptom ◽  
Shortness Of Breath ◽  
Chronic Respiratory Insufficiency

Objectives: Patients with chronic respiratory insufficiency suffer from advanced disease, but their overall symptom burden is poorly described. We evaluated the symptoms and screening of depression in subjects with chronic respiratory insufficiency by using the Edmonton symptom assessment system (ESAS). Methods: In this retrospective study, 226 subjects with chronic respiratory insufficiency answered the ESAS questionnaire measuring symptoms on a scale from 0 (no symptoms) to 10 (worst possible symptom), and the depression scale (DEPS) questionnaire, in which the cut-off point for depressive symptoms is 9. Results: The most severe symptoms measured with ESAS (median [interquartile range]) were shortness of breath 4.0 (1.0-7.0), dry mouth 3.0 (1.0-7.0), tiredness 3.0 (1.0-6.0), and pain on movement 3.0 (0.0-6.0). Subjects with a chronic obstructive pulmonary disease as a cause for chronic respiratory insufficiency had significantly higher scores for shortness of breath, dry mouth, and loss of appetite compared to others. Subjects with DEPS ≥9 reported significantly higher symptom scores in all ESAS categories than subjects with DEPS <9. The area under the receiver operating characteristic curve for ESAS depression score predicting DEPS ≥9 was 0.840 ( P < .001). If the ESAS depression score was 0, there was an 89% probability of the DEPS being <9, and if the ESAS depression score was ≥4, there was an 89% probability of the DEPS being ≥9. The relation between ESAS depression score and DEPS was independent of subjects’ characteristics and other ESAS items. Conclusions: Subjects with chronic respiratory insufficiency suffer from a high symptom burden due to their advanced disease. The severity of symptoms increases with depression and 4 or more points in the depression question of ESAS should lead to a closer diagnostic evaluation of depression. Symptom-centered palliative care including psychosocial aspects should be early integrated into the treatment of respiratory insufficiency.

Day-to-Day Decision Making by Adolescents and Young Adults with Cancer

2022 ◽  
pp. 275275302110687
Author(s):  
Kimberly A. Pyke-Grimm ◽  
Linda S. Franck ◽  
Bonnie Halpern-Felsher ◽  
Robert E. Goldsby ◽  
Roberta S. Rehm
Keyword(s):  
Decision Making ◽  
Young Adults ◽  
Participant Observation ◽  
Healthcare Providers ◽  
Adolescents And Young Adults ◽  
Structured Interviews ◽  
Self Advocacy ◽  
Daily Lives ◽  
Life Threatening Illness ◽  
The Impact

Background: Adolescents and young adults (AYAs) with cancer must negotiate the transition between childhood and adulthood while dealing with a life-threatening illness. AYA involvement in decision making varies depending on the type of decision and when decisions occur during treatment, and evidence suggests that AYAs want to be involved in decision making. Objective: To explore involvement of AYAs with cancer in day-to-day decisions affected by their cancer and treatment. Methods: This qualitative study used interpretive focused ethnography within the sociologic tradition, informed by symbolic interactionism. Semi-structured interviews and informal participant observation took place at two quaternary pediatric oncology programs. Results: Thirty-one interviews were conducted with 16 AYAs ages 15 to 20 years. Major day to day decision-making categories identified included: (1) mental mindset, (2) self-care practices, (3) self-advocacy, and (4) negotiating relationships. Participants described how they came to grips with their illness early on and decided to fight their cancer. They described decisions they made to protect their health, how they advocated for themselves and decisions they made about relationships with family and friends. Conclusions: Through day-to-day decisions, participants managed the impact of cancer and its treatment on their daily lives. Research should focus on developing and implementing interventions to empower AYAs to participate in day-to-day decisions that will affect how they manage their cancer, its treatment and ultimately their outcomes. Implications for Practice: Healthcare providers can facilitate AYA's participation in day-to-day decision making through encouraging autonomy and self-efficacy by providing support and through effective communication.

Recurrent episodes of intense fear, shortness of breath, racing heart, and sweating

2021 ◽  
pp. 111-118
Author(s):  
Christina L. Macenski
Keyword(s):  
Panic Disorder ◽  
Gold Standard ◽  
Panic Attack ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Panic Attacks ◽  
Shortness Of Breath ◽  
Intense Fear ◽  
Therapy Intervention ◽  
Norepinephrine Reuptake

Panic disorder consists of recurrent, unexpected panic attacks accompanied by persistent worry about future attacks and/or a maladaptive change in behavior related to the attacks. A panic attack is defined as an abrupt surge of intense fear or discomfort that reaches a peak within minutes that occurs in conjunction with several other associated symptoms such as palpitations, sweating, trembling, shortness of breath, and chest pain. Features of panic disorder that are more common in adolescents than in adults include less worry about additional panic attacks and decreased willingness to openly discuss their symptoms. All patients with suspected panic disorder should undergo a medical history, physical examination, and laboratory workup to exclude medical causes of panic attacks. Cognitive behavioral therapy (CBT) including interoceptive exposures is the gold standard therapy intervention. Medications including selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) can also help reduce symptoms.

Risk, Activism, and Empowerment

Oncology ◽  
2017 ◽  
pp. 739-762
Author(s):  
Mahmoud Eid ◽  
Isaac Nahon-Serfaty
Keyword(s):  
Breast Cancer ◽  
Media Coverage ◽  
Collaborative Work ◽  
Healthcare Providers ◽  
Cancer Awareness ◽  
Community Members ◽  
Self Advocacy ◽  
Low Health Literacy ◽  
The Right ◽  
Prevention Methods

The prevalence of breast cancer in Venezuela is particularly alarming, which is attributed to healthcare inequalities, low health literacy, and lagging compliance with prevention methods (i.e., screening and mammography). While the right to health is acknowledged by the Venezuelan constitution, activism beyond governmental confines is required to increase women's breast cancer awareness and decrease mortality rates. Through the development of social support and strategic communicative methods enacted by healthcare providers, it may be possible to empower women with the tools necessary for breast cancer prevention. This paper discusses issues surrounding women's breast cancer, such as awareness of the disease and its risks, self-advocacy, and the roles of activists, healthcare providers, and society. Specifically, it describes a four-year action-oriented research project developed in Venezuela, which was a collaborative work among researchers, practitioners, NGOs, patients, journalists, and policymakers. The outcomes include higher levels of awareness and interest among community members and organizations to learn and seek more information about women's breast cancer, better understandings of the communicated messages, more media coverage and medical consultations, increasing positive patient treatments, expansion of networking of NGOs, as well as a widely supported declaration for a national response against breast cancer in Venezuela.

scholarly journals Dissolvable Microneedle Patches to Enable Increased Access to Vaccines against SARS-CoV-2 and Future Pandemic Outbreaks

Vaccines ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 320
Author(s):  
Jesse O’Shea ◽  
Mark R. Prausnitz ◽  
Nadine Rouphael
Keyword(s):  
Supply Chain ◽  
Severe Acute Respiratory Syndrome ◽  
Herd Immunity ◽  
Healthcare Providers ◽  
Ease Of Use ◽  
Cold Chain ◽  
Manufacturing Cost ◽  
Pandemic Preparedness ◽  
Vaccine Candidates ◽  
Essential Component

Vaccines are an essential component of pandemic preparedness but can be limited due to challenges in production and logistical implementation. While vaccine candidates were rapidly developed against severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), immunization campaigns remain an obstacle to achieving herd immunity. Dissolvable microneedle patches are advantageous for many possible reasons: improved immunogenicity; dose-sparing effects; expected low manufacturing cost; elimination of sharps; reduction of vaccine wastage; no need for reconstitution; simplified supply chain, with reduction of cold chain supply through increased thermostability; ease of use, reducing the need for healthcare providers; and greater acceptability compared to traditional hypodermic injections. When applied to coronavirus disease 2019 (COVID-19) and future pandemic outbreaks, microneedle patches have great potential to improve vaccination globally and save many lives.

scholarly journals PENGARUH PURSED LIPS BREATHING TERHADAP PEAK EXPIRATORY FLOW RATE PENDERITA PENYAKIT PARU OBSTRUKSI KRONIS

2018 ◽  
Vol 7 (2) ◽  
pp. 56-60
Author(s):  
Emdat Suprayitno
Keyword(s):  
Treatment Group ◽  
Intervention Group ◽  
Public Health Problem ◽  
T Test ◽  
Control Group ◽  
Shortness Of Breath ◽  
Control Groups ◽  
Breathing Exercise ◽  
And Control ◽  
Paired T Test

Chronic obstructive pulmonary disease (COPD) is a public health problem. Shortness of breath is a major problem on patient COPD. The shortness of breath caused decrease of PEF value. The intervention can be done to patients COPD is pursed lips breathing exercise. The method of this research was true experiment, pretest-posttest design with control group involving 30 respondents with random sampling. Treatment group were 15 respondents that provided PLB exercise three times a week for 4 weeks. Control group were 15 respondents that only getting standard treatment from the hospital. Data analysis was performed with paired t test test and independent t test. The results of paired t test on PEF value are p=0.000 for intervention group and p=0.334 for control groups. The result of independent t test in intervention and control groups PEF value p= 0.000. There was influence pursed lips breathing exercise to increased PEF value. There was difference PEF value on treatment group and control group after pursed lips breathing exercise

scholarly journals A Review of the Pathophysiology of Psychological Disorders in Persons with Parkinson’s Disease

2005 ◽  
Author(s):  
Neil Kenney ◽  
Efrain Gonzalez
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Basal Ganglia ◽  
Biopsychosocial Model ◽  
Healthcare Providers ◽  
Psychological Disorders ◽  
Interdisciplinary Care ◽  
Psychological Disturbance ◽  
Essential Component

An understanding of the physiological etiologies of psychological disturbance continues to evolve as an essential component of training and practice for healthcare providers. The epidemiology of psychological disorders in persons with Parkinson’s disease (PD) is reviewed. The anatomy of the basal ganglia, etiology of PD, and pathophysiological bases for depression, anxiety, dementia, apathy, psychosis and delusions in persons with PD are then discussed. In consideration of the strong biological and environmental bases of psychopathology in persons with PD, it is proposed that a biopsychosocial model be considered for optimal delivery of interdisciplinary care to this population.

scholarly journals Clinical features and prognostic factors of intensive and non-intensive 1014 COVID-19 patients: an experience cohort from Alahsa, Saudi Arabia

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Saad Alhumaid ◽  
Abbas Al Mutair ◽  
Zainab Al Alawi ◽  
Khulud Al Salman ◽  
Nourah Al Dossary ◽  
...  
Keyword(s):  
White Blood Cells ◽  
Healthcare Providers ◽  
Clinical Decision ◽  
Shortness Of Breath ◽  
Icu Patients ◽  
Icu Admission ◽  
Care Services ◽  
Multiple Treatments ◽  
The Right ◽  
Diabetes And Obesity

Abstract Background COVID-19 is a worldwide pandemic and has placed significant demand for acute and critical care services on hospitals in many countries. Objectives To determine the predictors of severe COVID-19 disease requiring admission to an ICU by comparing patients who were ICU admitted to non-ICU groups. Methods A cohort study was conducted for the laboratory-confirmed COVID-19 patients who were admitted to six Saudi Ministry of Health’s hospitals in Alahsa, between March 1, 2020, and July 30, 2020, by reviewing patient’s medical records retrospectively. Results This cohort included 1014 patients with an overall mean age of 47.2 ± 19.3 years and 582 (57%) were males. A total of 205 (20%) of the hospitalized patients were admitted to the ICU. Hypertension, diabetes and obesity were the most common comorbidities in all study patients (27.2, 19.9, and 9%, respectively). The most prevalent symptoms were cough (47.7%), shortness of breath (35.7%) and fever (34.3%). Compared with non-ICU group, ICU patients had older age (p ≤ 0.0005) and comprised a higher proportion of the current smokers and had higher respiratory rates (p ≤ 0.0005), and more percentage of body temperatures in the range of 37.3–38.0 °C (p ≥ 0.0005); and had more comorbidities including diabetes (p ≤ 0.0005), hypertension (p ≥ 0.0005), obesity (p = 0.048), and sickle cell disease (p = 0.039). There were significant differences between the non-ICU and ICU groups for fever, shortness of breath, cough, fatigue, vomiting, dizziness; elevated white blood cells, neutrophils, alanine aminotransferase and alkaline aminotransferase, lactate dehydrogenase, and ferritin, and decreased hemoglobin; and proportion of abnormal bilateral chest CT images (p < 0.05). Significant differences were also found for multiple treatments (p < 0.05). ICU patients group had a much higher mortality rate than those with non-ICU admission (p ≤ 0.0005). Conclusion Identifying key clinical characteristics of COVID-19 that predict ICU admission and high mortality can be useful for frontline healthcare providers in making the right clinical decision under time-sensitive and resource-constricted environment.

Comparison of Symptom Burden in Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2652-2652 ◽  
Author(s):  
Loretta A. Williams ◽  
Hycienth Ahaneku ◽  
Jorge E. Cortes ◽  
Guillermo Garcia Manero ◽  
Hagop M. Kantarjian ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myelodysplastic Syndrome ◽  
Myeloid Leukemia ◽  
Symptom Burden ◽  
Dry Mouth ◽  
Shortness Of Breath ◽  
General Activity ◽  
Specific Symptom ◽  
Core Symptom ◽  
Acute Myeloid

Abstract Objective: Patient report of symptom burden from acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) is scarce. Symptom burden is the combined impact of symptoms from disease and treatment on daily functioning. We are developing a measure of symptom burden in AML and MDS. The purpose of this interim analysis is to compare the symptom burden of patients with AML and MDS. Methods: Patients with AML or MDS rated the 13 core symptom items, 6 proposed AML/MDS-specific symptom items, and 6 interference items of the MD Anderson Symptom Inventory on a 0-10 scale (0 = not present or no interference; 10 = as bad as can be imagined or complete interference). Patient clinical and demographic information was collected from medical records. The symptom burden of AML/MDS was determined and compared using descriptive statistics and t-tests. Results: Mean ages of the 45 AML patients and 48 MDS patients were 62.4 (standard deviation [SD] = 11.3) and 68.5 years (SD = 9.2; p = 0.005), respectively; 61% and 60% (p = not significant), respectively, were male; 76% and 92% (p = 0.043), respectively, were white. The composite mean severity score of the core symptom items was 2.75 (SD = 1.58) and 1.84 (SD = 1.52; p = 0.006), the composite mean of the AML/MDS specific items was 2.51 (SD = 1.87) and 1.49 (1.60; p = 0.005), and the composite mean score of the interference items was 3.96 (SD = 2.72) and 2.81 (SD = 2.69; p = 0.042) for the AML and MDS patients, respectively. The means, ranks, significance of difference in ratings, and prevalence of the individual symptom and interference items for the AML and MDS patients are in Table 1. Cronbach α for all symptom items was 0.94 and for all interference items was 0.92. Conclusions: Patients with AML and MDS experience similar symptoms. However, patients with AML report significantly more severe pain, fatigue, nausea, lack of appetite, dry mouth, vomiting, fever, and headache than patients with MDS. Only prevalence of shortness of breath and diarrhea was higher in MDS patients, but there was no difference in reported mean severity of these symptoms. Except for general activity, rating of symptom interference with daily activities is similar for the two groups. Lack of recognition of symptoms experienced by patients with AML and MDS can lead to inadequate management of symptoms, interfere with patients' ability to function and enjoy life, and impact the tolerability of and adherence to treatment regimens. Validation of this measure of symptom burden for patients with AML and MDS to allow more accurate and consistent monitoring of symptoms by clinicians and in clinical research is ongoing. Table 1. Individual MDASI Item Means and Significance for AML and MDS Patients Core Symptom Items N Mean SD p-value Rank Prevalence (%) Pain MDS 48 2.00 2.760 0.009* 9 58 AML 45 3.69 3.309 3 69 Fatigue MDS 47 3.45 2.947 0.037* 1 79 AML 45 4.69 2.653 1 91 Nausea MDS 48 .50 1.368 <0.001* 17 23 AML 45 2.67 3.233 9 58 Disturbed Sleep MDS 48 2.38 3.050 0.124 4 56 AML 45 3.38 3.172 7 71 Distress MDS 48 2.19 2.498 0.476 7 63 AML 45 2.56 2.455 10 71 Shortness of Breath MDS 48 2.15 2.518 0.543 8 65 AML 45 1.84 2.215 17 53 Problems Remembering MDS 48 1.94 2.025 0.663 10 71 AML 45 2.13 2.292 14 71 Lack of Appetite MDS 48 1.33 2.035 <0.001* 13 48 AML 45 3.73 3.460 2 76 Drowsiness MDS 48 2.85 3.032 0.187 2 71 AML 45 3.69 3.021 3 78 Dry Mouth MDS 48 2.31 2.746 0.045* 6 69 AML 44 3.59 3.223 5 73 Sadness MDS 48 1.83 2.127 0.394 11 60 AML 45 2.22 2.255 11 73 Vomiting MDS 48 0.00 0.000 0.009* 19 0 AML 45 .73 1.912 19 22 Numbness or Tingling MDS 48 1.08 2.071 .712 15 33 AML 45 .93 1.814 18 33 AML/MDS-Specific Symptom Items Malaise MDS 48 2.46 2.843 0.133 3 65 AML 46 3.35 2.838 8 78 Fever MDS 48 .50 1.544 0.006* 18 19 AML 46 1.91 3.002 16 41 Headache MDS 48 .81 1.483 0.011* 16 35 AML 46 2.22 3.339 11 44 Diarrhea MDS 48 1.56 2.567 0.512 12 48 AML 46 1.96 3.211 15 41 Muscle Weakness MDS 48 2.35 2.899 0.063 5 60 AML 46 3.43 2.664 6 83 Rash or Skin Problems MDS 48 1.23 2.469 0.065 14 38 AML 46 2.22 2.666 11 59 Interference Items General Activity MDS 46 3.20 3.449 0.031* 3 65 AML 46 4.83 3.696 2 80 Mood MDS 48 2.38 2.687 0.066 5 65 AML 44 3.48 2.984 5 80 Work MDS 48 3.54 3.638 0.086 1 67 AML 46 4.87 3.781 1 78 Relations with Others MDS 48 1.69 2.683 0.154 6 48 AML 46 2.54 3.082 6 52 Walking MDS 48 2.88 3.112 0.275 4 71 AML 46 3.57 2.971 4 78 Enjoyment of Life MDS 48 3.21 3.261 0.055 2 73 AML 46 4.54 3.397 3 80 * Significant at p < 0.05. Disclosures No relevant conflicts of interest to declare.

scholarly journals Neonate Born to a Mother with a Diagnosis of Suspected Intra-Amniotic Infection versus COVID-19 or Both

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Rishi Lumba ◽  
Juan Remon ◽  
Moi Louie ◽  
Michelle Quan ◽  
Sourabh Verma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Horizontal Transmission ◽  
Healthcare Providers ◽  
Signs And Symptoms ◽  
Shortness Of Breath ◽  
Clinical Criteria ◽  
Sputum Production ◽  
Low Threshold ◽  
Fetal Tachycardia ◽  
Made In

A diagnosis of intra-amniotic infection is typically made based on clinical criteria, including maternal intrapartum fever and one or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. The diagnosis can also be made in patients with an isolated fever of 39°C, or greater, without any other clinical risk factors present. Coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, has been noted to have varying signs and symptoms over the course of the disease including fever, cough, fatigue, anorexia, shortness of breath, sputum production, and myalgia. In this report, we detail a case of a newborn born to a mother with a clinical diagnosis of intra-amniotic infection with maternal fever and fetal tachycardia, who was then found to be SARS-CoV-2 positive on testing. Due to the varying presentation of COVID-19, this case illustrates the low threshold needed to test mothers for SARS-CoV-2 in order to prevent horizontal transmission to neonates and to healthcare providers.

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