Educational and Psychological Support Combined with Minimally Invasive Surgery Reduces Perioperative Depression and Anxiety in Patients with Bladder Cancer Treated with Radical Cystectomy.

Abstract PurposeRadical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) is an extensive and morbid operation, often associated with a permanent alteration of body image. Combined with aggressive malignant potential of MIBC and considerable risk of complications, it may pose a serious threat to psychological well-being of patients. Educational deficiencies not infrequently encountered in everyday hospital practice, may lead to confusion and further aggravate procedure-related emotional distress. We conceived a preoperative informational and supportive program named “Cystocare”, with monthly meetings held by a team of urologists, stoma therapist, psychologists and cancer survivors to facilitate patients’ adaptation and coping. We aimed to evaluate whether participation in Cystocare meetings would alleviate emotional distress in patients undergoing RC.MethodsWe included 95 consecutive patients who agreed to participate and returned Hospital Anxiety and Depression Score (HADS) questionnaires before RC and on discharge. The intervention arm (A) comprised 32 patients who participated in meetings, the remaining 63 constituted controls (B). Patients from arm A were significantly younger than controls (mean age arm A: 64.7 SD 8.25; arm B: 68.8 SD 7.87), there were no further differences between study arms.ResultsWe found no differences between groups in median anxiety and depression scores preoperatively. In postoperative measurement, the intervention arm showed significantly lower median depression score than controls: 3 vs 8 points, p=0.015, while the anxiety score remained comparable. On multivariate analysis we found lower odds of preoperative anxiety in patients planned for laparoscopic RC OR=0.351 (95%CI: 0.139-0.884), p=0.026, lower risk of postoperative depression in patients from arm A OR=0.253 (95% CI: 0.087-0.732) p=0.011 and higher risk of postoperative anxiety in patients whose length of stay exceeded 7 days OR=9.48 (95%CI: 1,146-78,428) p=0.037. ConclusionsPreoperative educational and supportive intervention combined with minimally invasive approach to RC seem effective in alleviation of surgery-related anxiety and depression.

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Educational and Psychological Support Combined with Minimally Invasive Surgical Technique Reduces Perioperative Depression and Anxiety in Patients with Bladder Cancer Undergoing Radical Cystectomy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182413071 ◽

2021 ◽

Vol 18 (24) ◽

pp. 13071

Author(s):

Artur Lemiński ◽

Krystian Kaczmarek ◽

Aleksandra Bańcarz ◽

Alicja Zakrzewska ◽

Bartosz Małkiewicz ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Cost Effective ◽

Well Being ◽

Depression Score ◽

Anxiety And Depression ◽

Minimally Invasive Surgical ◽

Muscle Invasive ◽

Supportive Program ◽

Prolonged Hospital

Radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) is an extensive and morbid operation, often associated with permanent alteration of body image and disability. Combined with the aggressive malignant potential of MIBC and considerable risk of complications, it poses a serious threat to the psychological well-being of patients. Educational deficiencies causing uncertainty and confusion aggravate surgery-related anxiety and may lead to depression along with further social disability. We conceived a preoperative supportive program named “Cystocare” held by urologists, psychologists, stoma therapists and cancer survivors to facilitate patients’ adaptation and coping. We aimed to evaluate whether participation in Cystocare meetings would alleviate emotional distress in patients undergoing RC. We included 95 consecutive patients who filled Hospital Anxiety and Depression Score questionnaires before RC and on discharge. The intervention arm (A) comprised 32 Cystocare participants. The remaining 63 patients who received standard preparation constituted the control arm (B). Whilst there were no differences in median anxiety and depression scores preoperatively, in postoperative measurement, the intervention arm showed a lower median depression score than controls: 3 vs. 8 points, p = 0.015. On multivariate analysis we confirmed lower risk of postoperative depression in Cystocare participants: OR = 0.215 (95%CI: 0.066–0.699), p = 0.011, along with lower odds of preoperative anxiety in patients undergoing laparoscopic RC: OR = 0.365 (95%CI: 0.136–0.978), p = 0.045, and higher risk of prolonged hospital stay in patients experiencing postoperative anxiety OR = 17.114 (95%CI: 1.283–228.234) p = 0.032. Preoperative educational and supportive intervention complements laparoscopic RC in the alleviation of surgery-related anxiety and depression. The support group meetings provide an attractive and cost-effective opportunity to moderate emotional response in patients undergoing RC, and as such, deserve widespread adoption.

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Occurence of post-traumatic stress symptoms, anxiety and depression in the acute phase of transient ischemic attack and stroke

10.21203/rs.3.rs-104881/v1 ◽

2020 ◽

Author(s):

Helge HO Müller ◽

Katharina Czwalinna ◽

Ruihao Wang ◽

Caroline Lücke ◽

Alexandra P. Lam ◽

...

Keyword(s):

Acute Phase ◽

Psychiatric Symptoms ◽

Depression Score ◽

Anxiety And Depression ◽

Post Traumatic Stress ◽

Stroke Patients ◽

Stress Symptoms ◽

Post Traumatic ◽

Ischemic Attack ◽

And Coping

Abstract Background Rates of post-traumatic stress symptoms, anxiety and depression are increased in patients having experienced a transient ischemic attack (TIA) or stroke several months ago. However, data of psychiatric symptoms in the acute phase within the first days after ictus are lacking. Methods In 20 patients with stroke and 33 patients with TIA we assessed disease severity by means of the NIHSS, levels of depression and anxiety by HADS, PTSD-like symptoms by PC-PTSD, quality of life (HrQoL) by SF-12, and coping style by brief COPE Inventory within the first 5 days after ictus. Results NIHSS on admission was lower in patients with TIA (0 ± 1) than in patients with stroke (3 ± 2, p < 0.001). HADS depression score was significantly higher in patients with stroke (7.0 ± 4.5) than in patients with TIA (4.9 ± 4.0). HADS anxiety score, HrQoL and coping styles were similar between TIA and stroke patients (p > 0.05). 5 and 3 of 33 TIA patients as well as 4 and 3 of 20 stroke patients had at least 11 points in the HADS anxiety and depression score respectively (p = 0.001). 2 of 33 TIA patients and 2 of 20 stroke patients had more than 2 points in the PC-PTSD (p = 0.646). We did not find consistent correlations between the NIHSS and the psychometric parameters. Conclusions Within the first five days after patients having experienced a TIA or stroke PTSD-like, anxious and depressive symptoms are more common than in the general population. As the acute psychological status after ictus is predictive for psychiatric comorbidity years later physicians should pay attention and adequately treat psychiatric symptoms already in the acute phase of stroke.

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Uromonitor®as a novel sensitive and specific urine-based test for recurrence surveillance of patients with non-muscle invasive bladder cancer

10.1101/410738 ◽

2018 ◽

Author(s):

Cristina Sampaio ◽

Rui Batista ◽

Pedro Peralta ◽

Paulo Conceição ◽

Amílcar Sismeiro ◽

...

Keyword(s):

Bladder Cancer ◽

Standard Procedure ◽

Cost Effective ◽

Urine Samples ◽

High Rate ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Invasive Approach ◽

Muscle Invasive

AbstractBladder cancer is the most frequent malignancy of the urinary system and is ranked the seventh most diagnosed cancer in men worldwide. About 70-75% of all newly diagnosed patients with bladder cancer will present disease confined to the mucosa or submucosa, the non-muscle invasive bladder cancer (NMIBC) subtype. Of those, approximately 70% will recur after transurethral resection (TUR). Due to this high rate of recurrence, patients are submitted to an intensive follow-up program that should be maintained throughout many years, or even throughout life, resulting in an expensive follow-up, with cystoscopy being the most cost-effective procedure for NMIBC screening. Currently, the gold standard procedure for detection and follow-up of NMIBC is based on the association of cystoscopy and urine cytology. As cystoscopy is a very invasive approach, over the years, many different non-invasive (both in serum and urine samples) assays have been developed in order to search genetic and protein alterations related to the development, progression and recurrence of bladder cancer.TERTpromoter mutations andFGFR3hotspot mutations are the most frequent somatic alterations in bladder cancer and constitute the most reliable biomarkers for bladder cancer. Based on these findings, an ultra-sensitive assay called Uromonitor®was developed that corresponds to a urine-based assay capable of detecting trace amounts of the two most common alterations in NMIBC,TERTpromoter andFGFR3mutation, in urine samples. The Uromonitor®test was performed in a cohort of 72 patients, firstly diagnosed with bladder cancer and under surveillance for NMIBC, to access its sensitivity and specificity in the detection of NMIBC recurrence. Uromonitor®was shown to be highly sensitive and specific in detecting recurrence of bladder cancer in patients under surveillance of non-muscle invasive bladder cancer.

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Ecological Momentary Assessment of Adolescent Problems, Coping Efficacy, and Mood States Using a Mobile Phone App: An Exploratory Study

JMIR Mental Health ◽

10.2196/mental.6361 ◽

2016 ◽

Vol 3 (4) ◽

pp. e51 ◽

Cited By ~ 17

Author(s):

Rachel Kenny ◽

Barbara Dooley ◽

Amanda Fitzgerald

Keyword(s):

Mobile Phone ◽

Emotional Distress ◽

Help Seeking ◽

Well Being ◽

Mood States ◽

Coping Efficacy ◽

Standardized Measures ◽

And Coping ◽

Ecological Momentary ◽

Ema Data

Background Mobile technologies have the potential to be used as innovative tools for conducting research on the mental health and well-being of young people. In particular, they have utility for carrying out ecological momentary assessment (EMA) research by capturing data from participants in real time as they go about their daily lives. Objective The aim of this study was to explore the utility of a mobile phone app as a means of collecting EMA data pertaining to mood, problems, and coping efficacy in a school-based sample of Irish young people. Methods The study included a total of 208 participants who were aged 15-18 years, 64% female (113/208), recruited from second-level schools in Ireland, and who downloaded the CopeSmart mobile phone app as part of a randomized controlled trial. On the app, participants initially responded to 5 single-item measures of key protective factors in youth mental health (formal help-seeking, informal help-seeking, sleep, exercise, and sense of belonging). They were then encouraged to use the app daily to input data relating to mood states (happiness, sadness, anger, stress, and worry), daily problems, and coping self-efficacy. The app automatically collected data pertaining to user engagement over the course of the 28-day intervention period. Students also completed pen and paper questionnaires containing standardized measures of emotional distress (Depression, Anxiety, and Stress Scale; DASS-21), well-being (World Health Organization Well-Being Index; WHO-5), and coping (Coping Strategies Inventory; CSI). Results On average the participants completed 18% (5/28) of daily ratings, and engagement levels did not differ across gender, age, school, socioeconomic status, ethnicity, or nationality. On a scale of 1 to 10, happiness was consistently the highest rated mood state (overall mean 6.56), and anger was consistently the lowest (overall mean 2.11). Pearson correlations revealed that average daily ratings of emotional states were associated with standardized measures of emotional distress (rhappiness=–.45, rsadness=.51, ranger=.32, rstress=.41, rworry=.48) and well-being (rhappiness=.39, rsadness =–.43, ranger=–.27, rstress=–.35, rworry=–.33). Inferential statistics indicated that single-item indicators of key protective factors were related to emotional distress, well-being, and average daily mood states, as measured by EMA ratings. Hierarchical regressions revealed that greater daily problems were associated with more negative daily mood ratings (all at the P<.001 level); however, when coping efficacy was taken into account, the relationship between problems and happiness, sadness, and anger became negligible. Conclusions While engagement with the app was low, overall the EMA data collected in this exploratory study appeared valid and provided useful insights into the relationships between daily problems, coping efficacy, and mood states. Future research should explore ways to increase engagement with EMA mobile phone apps in adolescent populations to maximize the amount of data captured by these tools. Trial Registration Clinicaltrials.gov NCT02265978; http://clinicaltrials.gov/ct2/show/NCT02265978 (Archived by WebCite at http://www.webcitation.org/6mMeYqseA).

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Urinary Metabolic Signatures Detect Recurrences in Non-Muscle Invasive Bladder Cancer

Cancers ◽

10.3390/cancers11070914 ◽

2019 ◽

Vol 11 (7) ◽

pp. 914 ◽

Cited By ~ 1

Author(s):

Alba Loras ◽

M. Carmen Martínez-Bisbal ◽

Guillermo Quintás ◽

Salvador Gil ◽

Ramón Martínez-Máñez ◽

...

Keyword(s):

Bladder Cancer ◽

1H Nmr ◽

Partial Least Square ◽

Proton Nuclear Magnetic Resonance ◽

Invasive Bladder Cancer ◽

Low Grade ◽

Muscle Invasive Bladder Cancer ◽

Invasive Approach ◽

Muscle Invasive

Patients with non-muscle invasive bladder cancer (NMIBC) undergo lifelong monitoring based on repeated cystoscopy and urinary cytology due to the high recurrence rate of this tumor. Nevertheless, these techniques have some drawbacks, namely, low accuracy in detection of low-grade tumors, omission of pre-neoplastic lesions and carcinomas in situ (CIS), invasiveness, and high costs. This work aims to identify a urinary metabolomic signature of recurrence by proton Nuclear Magnetic Resonance (1H NMR) spectroscopy for the follow-up of NMIBC patients. To do this, changes in the urinary metabolome before and after transurethral resection (TUR) of tumors are analyzed and a Partial Least Square Discriminant Analysis (PLS-DA) model is developed. The usefulness of this discriminant model for the detection of tumor recurrences is assessed using a cohort of patients undergoing monitoring. The trajectories of the metabolomic profile in the follow-up period provide a negative predictive value of 92.7% in the sample classification. Pathway analyses show taurine, alanine, aspartate, glutamate, and phenylalanine perturbed metabolism associated with NMIBC. These results highlight the potential of 1H NMR metabolomics to detect bladder cancer (BC) recurrences through a non-invasive approach.

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Predictors of Emotional Distress and Wellbeing 2–5 Years After Stroke

ISRN Stroke ◽

10.1155/2013/467398 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

H. Bergersen ◽

A.-K. Schanke ◽

K. S. Sunnerhagen

Keyword(s):

Emotional Distress ◽

General Health Questionnaire ◽

Depression Scale ◽

Well Being ◽

Anxiety And Depression ◽

Independent Mobility ◽

Hospital Anxiety ◽

Gender Education ◽

Comprehensive Rehabilitation

Objectives. To identify predictors of emotional distress and psychological wellbeing in stroke survivors 2–5 years after discharge from comprehensive rehabilitation. Material and Methods. The Hospital Anxiety and Depression Scale (HADS), the General Health Questionnaire (GHQ-30), and questions regarding life situations were mailed to former patients. Multiple regression analyses were performed. Results. The responses from 68 participants (37% women), of an average age of 58 years old, were used. Emotional distress (HADS > 10) was identified in 41%. Well-being (GHQ-30 < 6) was identified in 46%. Not surprisingly, there was a strongly negative association between well-being (GHQ-30 < 6) and emotional distress (HADS > 10) at follow up. Dependency in toileting during rehabilitation predicted emotional distress 2–5 years later. Finally, well-being at followup was predicted by age > 65 years, independent mobility, perceiving proxies as supportive, and being in employment. Conclusions. Dependence in the activities of daily living 3–6 months after-injury predicted emotional distress 2–5 years after-stroke. Being over 65 years, having an occupation, proxy support and being less dependent all predicted well-being. Emotional distress and well-being were clearly negatively associated. Gender, education, marital status, and type of stroke were not associated with the outcome measures.

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Minimally Invasive Robotic-Assisted Cystolithotomy in a Complicated Urinary Diversion: A Feasible and Safe Approach

Case Reports in Urology ◽

10.1155/2021/8345092 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

A. Haffar ◽

C. Crigger ◽

T. Trump ◽

M. Jessop ◽

M. W. Salkini

Keyword(s):

Bladder Cancer ◽

Minimally Invasive ◽

Urinary Diversion ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Robotic Assisted ◽

Increased Risk ◽

Muscle Invasive ◽

Invasive Techniques ◽

Safe Approach

Urinary diversion following radical cystectomy and neoadjuvant chemotherapy is the gold standard for the management of muscle-invasive bladder cancer. Urinary diversions are at an increased risk of urolithiasis as a result of various factors. Traditional surgical intervention has included open cystolithotomy which has given way to minimally invasive techniques as of late. We describe a case of a robotic-assisted cystolithotomy from a neobladder in a 54-year-old female patient with muscle-invasive bladder cancer. This is the first description of a robotic-assisted removal of a stone in an orthotopic neobladder. This approach has many advantages, especially in the removal of larger stones. Further study is needed to investigate the efficacy and success of this approach.

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Effect of neoadjuvant chemotherapy on health-related quality of life in patients with muscle invasive bladder cancer: Results from JCOG0209, a randomized phase III study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e17006 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e17006-e17006

Author(s):

Naotaka Nishiyama ◽

Hiroshi Kitamura ◽

Shiro Hinotsu ◽

Taiji Tsukamoto ◽

Taro Shibata ◽

...

Keyword(s):

Quality Of Life ◽

Bladder Cancer ◽

Well Being ◽

Health Related Quality ◽

Muscle Invasive Bladder Cancer ◽

Related Quality ◽

Health Related ◽

Muscle Invasive ◽

One Year

e17006 Background: Although neoadjuvant chemotherapy (NAC) provides survival benefits in muscle-invasive bladder cancer (MIBC), the impact of NAC on health-related quality of life (HRQoL) has not been investigated by a randomized trial. The purpose of this study is to compare HRQoL in patients with MIBC who received NAC followed by radical cystectomy (RC) or RC alone based on patient-reported outcome data. Methods: Patients were randomized to receive 2 cycles of neoadjuvant methotrexate, doxorubicin, vinblastine, and cisplatin (MVAC) followed by RC or RC alone. HRQoL was measured using the Functional Assessment of Cancer Therapy – Bladder (FACT-BL, version 4) questionnaire before the protocol treatments, after NAC, after RC, and one year after registration. Results: A total of 99 patients were analyzed. No statistically significant differences in postoperative HRQoL were found between the arms. In the NAC arm, the scores after NAC were significantly lower than the baseline scores in physical well-being, functional well-being, FACT-General total, weight loss, diarrhea, appetite, body appearance, embarrassment by ostomy appliance, and total FACT-BL. However, there was no difference in scores for these domains, except for embarrassment by ostomy appliance, between the two arms after RC and one year after registration. Conclusions: Although HRQoL declined during NAC, no negative effect of NAC on HRQoL was apparent after RC. These data support the view that NAC can be considered as a standard of care for patients with MIBC regarding HRQoL. Clinical trial information: C000000093.

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IMPACT OF ACNE VULGARIS ON PSYCHOSOCIAL STATUS

American Journal of Dermatological Research and Reviews ◽

10.28933/ajodrr-2020-08-3105 ◽

2020 ◽

pp. 36

Author(s):

Keyword(s):

Body Satisfaction ◽

Acne Vulgaris ◽

Life Quality ◽

Depression Scale ◽

Well Being ◽

Self Esteem ◽

Depression Score ◽

Anxiety And Depression ◽

Healthy Controls ◽

Severe Group

Background: Most previous research has focused on acne vulgaris characteristics and their association with psychological disorders, such as anxiety and depression. Objective: In the present study, we aimed to show whether acne characteristics are associated with several aspects of psychological well-being namely self-esteem, body satisfaction, anxiety-depression and dermatological life quality. Methods: This was a study of 200 patient with acne and190 healthy controls that was carried out in Antalya, Turkey. Main outcome measures were the Rosenberg’s Self-Esteem Scale, Body Image Concern Inventory (BICI), hospital anxiety and depression scale (HAD) and dermatological life quality index (DLQI). Also we recorded global acne grading score (GAGS) of acne patients. Results: The findings of statistical analysis indicated that patients with acne had lower levels of self-esteem, high depression and HAD score compared with healthy controls (respectively p=0.01, p˂0.01, p=0.01). Also the DLQI scores of severe and very severe group had higher than mild and moderate group (p= 0.013) Conclusion: The emotional well-being of the patients presenting with the acne needs to be recognized more fully, particularly in relation to the low self-esteem, high depression score. The psychosocial impact of acne vulgaris should be valued in the management of patients with this condition. The results of this study raise implications for clinical practice and suggest that a multidisciplinary approach to the management of patient with acne.

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Psychological distress and alcohol use among adolescents

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1781 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s882-s882

Author(s):

N. Charfi ◽

M. Turki ◽

N. Smaoui ◽

M. Maalej Bouali ◽

L. Zouari ◽

...

Keyword(s):

Alcohol Consumption ◽

Alcohol Use ◽

Physical Abuse ◽

Emotional Distress ◽

Close Association ◽

Depression Scale ◽

Well Being ◽

Anxiety And Depression ◽

Public Health Burden ◽

Supportive Environment

IntroductionAnxiety and depression, as well as alcohol use are widespread among teenagers, and constitute a huge public health burden worldwide.ObjectiveTo study the link between alcohol consumption and emotional distress (anxiety and depression) among adolescents.MethodsWe conducted a cross-sectional study in May and June 2016. The sample consisted of 314 pupils from 4 colleges and schools in Sfax (Tunisia). Alcohol Use Disorders Test (AUDIT) was used to evaluate alcohol dependence. Anxiety and depression levels were evaluated using the “Hospital Anxiety and Depression Scale” (HADS).ResultsThe mean age was 16 years with a sex ratio of 1.08. Among the participants, 18.9% reported having drunk alcohol at least once and 42.37% of them still consume. The main reasons for alcohol initiation were the search of new experiences (78%) or pleasure and well-being (39%) and the curiosity (49.15%). According to AUDIT, 1.7% of alcohol users presented an alcohol misuse and 20% presented dependence.The prevalence of anxiety and depression were respectively 56.1% and 23.7%. Anxiety was correlated to alcohol experimentation (P = 0.03) and non-supportive environment (P = 0.003). Depression was correlated to alcohol experimentation (P = 0.001), AUDIT score (P = 0.009), somatic histories (P = 0.02), physical abuse (P = 0.02), non-supportive environment (P = 0.016) and graduating class level (P = 0.005).ConclusionOur study highlights the close association between alcohol consumption and emotional distress in adolescence, which seems to be bi-directional. When attempting to reduce the risk of alcohol consumption, we should focus a particular attention on adolescents studying in graduating class, reinforce adolescents’ family support and prevent physical abuse.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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