scholarly journals Longitudinal Changes of Cytokines and Appetite in Older Hospitalized Patients

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2508
Author(s):  
Maryam Pourhassan ◽  
Nina Babel ◽  
Lars Sieske ◽  
Timm Henning Westhoff ◽  
Rainer Wirth
Keyword(s):  
Symptom Assessment ◽  
Serum Levels ◽  
Hospitalized Patients ◽  
Assessment System ◽  
Edmonton Symptom Assessment System ◽  
Tnf Α ◽  
Longitudinal Association ◽  
Few Data ◽  
Prospective Longitudinal ◽  
The Impact

There are few data on the longitudinal association of cytokine and appetite among older hospitalized patients. We aimed to investigate the impact of the changes of inflammatory cytokines on appetite in older hospitalized patients. A total of 191 patients (mean age 81.3 ± 6.6 years, 64% women) participated in this prospective longitudinal observational study. Appetite was evaluated using the Edmonton Symptom Assessment System on admission and after seven days. Serum cytokines such as IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-17, IL-18, IL-23 and IL-33, IFN-α2, IFN-γ, TNF-α and MCP-1 were measured both times. No significant differences in the mean serum levels of all the cytokines could be detected overtime in relation to appetite changes, except for IL-18. Appetite significantly deteriorated overtime in patients with increasing IL-18 levels and improved in those without significant changes in IL-18 levels. In a stepwise regression analysis, changes of IL-18 levels were the major independent predictor for the changes of patients’ appetite and explained 4% of the variance, whereas other cytokines and variables, such as age, sex, infection and disease, did not show any impact on appetite changes. We conclude that IL-18 seems to exert a significant impact on appetite in acutely ill older hospitalized patients and should, therefore, be considered as a potential target in the diagnosis, prevention and treatment of malnutrition.

The impact of routine Edmonton symptom assessment system use on receiving palliative care services: results of a population-based retrospective-matched cohort analysis

2020 ◽  
pp. bmjspcare-2020-002220
Author(s):  
Lisa Barbera ◽  
Rinku Sutradhar ◽  
Craig C Earle ◽  
Doris Howell ◽  
Nicole Mittman ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Analysis ◽  
Symptom Assessment ◽  
Assessment System ◽  
Matched Cohort ◽  
Edmonton Symptom Assessment System ◽  
Care Services ◽  
Patient Reported ◽  
Palliative Care Services ◽  
The Impact

BackgroundIn 2007, Cancer Care Ontario began standardised symptom assessment as part of routine care using the Edmonton Symptom Assessment System (ESAS).AimThe purpose of this study was to evaluate the impact of ESAS on receipt of palliative care when compared with a matched group of unexposed patients.DesignA retrospective-matched cohort study examined the impact of ESAS screening on initiation of palliative care services provided by physicians or homecare nurses. The study included adult patients diagnosed with cancer between 2007 and 2015. Exposure was defined as completing ≥1 ESAS during the study period. Using 4 hard and 14 propensity score-matched variables, patients with cancer exposed to ESAS were matched 1:1 to those who were not. Matched patients were followed from first ESAS until initiation of palliative care, death or end of study.ResultsThe final cohort consisted of 204 688 matched patients with no prior palliative care consult. The pairs were well matched. The cumulative incidence of receiving palliative care within the first 5 years was higher among those exposed to ESAS compared with those who were not (27.9% (95% CI: 27.5% to 28.2%) versus 27.9% (95% CI: 27.5% to 28.2%)), when death is considered as a competing event. In the adjusted cause-specific Cox proportional hazards model, ESAS assessment was associated with a 6% increase in palliative care services (HR: 1.06, 95% CI: 1.04 to 1.08).ConclusionWe have demonstrated that patients exposed to ESAS were more likely to receive palliative care services compared with patients who were not exposed. This observation provides real-world data of the impact of routine assessment with a patient-reported outcome.

scholarly journals Avaliação do instrumento Edmonton Symptom Assessment System em cuidados paliativos: revisão integrativa

2010 ◽  
Vol 31 (4) ◽  
pp. 785-793 ◽  
Author(s):  
Daiane da Rosa Monteiro ◽  
Maria Henriqueta Luce Kruse ◽  
Miriam de Abreu Almeida
Keyword(s):  
Retrieval System ◽  
Medical Literature ◽  
Symptom Assessment ◽  
Assessment System ◽  
Literature Analysis ◽  
Edmonton Symptom Assessment System

Cuidados Paliativos (CP) são prestados a pacientes fora de possibilidades terapêuticas de cura, tendo como foco o controle dos sintomas e melhora da qualidade de vida. A Edmonton Symptom Assessment System (ESAS) é um instrumento para avaliar e monitorar nove sintomas físicos e psicológicos em pacientes de CP. O estudo objetiva realizar revisão integrativa acerca da avaliação dos profissionais de saúde e/ou pacientes quanto ao uso da ESAS em pacientes oncológicos em Cuidados Paliativos. Foram localizados oito artigos no Medical Literature Analysis and Retrieval System Online (MEDLINE) entre 1998 e 2009. Os resultados mostraram que apesar de haver poucos estudos sobre este assunto, a ESAS é um instrumento válido para detectar e monitorar sintomas nos CP, apresentando algumas limitações. Os resultados apontam para a importância da continuidade do estudo de tradução e adaptação transcultural desta escala para o português do Brasil.

scholarly journals Systemic Inflammatory Responses in Children with Acute Otitis Media Due to Streptococcus pneumoniae and the Impact of Treatment with Clarithromycin

2003 ◽  
Vol 10 (4) ◽  
pp. 721-724 ◽  
Author(s):  
Gunter Scharer ◽  
Frank Zaldivar ◽  
Guillermo Gonzalez ◽  
Ofelia Vargas-Shiraishi ◽  
Jasjit Singh ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Otitis Media ◽  
Antibiotic Treatment ◽  
Statistical Significance ◽  
Objective Assessment ◽  
Acute Otitis Media ◽  
Serum Levels ◽  
Asymptomatic Children ◽  
Tnf Α ◽  
The Impact

ABSTRACT This pilot study was designed to determine the serum cytokine profile of acute otitis media (AOM) due to Streptococcus pneumoniae and the impact of clarithromycin (Abbott Laboratories, Inc). Serum levels of interleukin-1β (IL-1β), tumor necrosis factor alpha (TNF-α), IL-6, and IL-8 were measured at diagnosis and 3 to 5 days after start of antibiotic treatment in 10 patients (mean age, 18.3 ± 13.9 months) who had middle ear fluid culture positive for S. pneumoniae. The mean concentrations of all cytokines were elevated at diagnosis of AOM compared to levels in healthy controls, yet only IL-6 reached statistical significance (P = 0.05). IL-6 showed a statistically significant decrease in mean serum concentration at visit 2 (P = 0.03). IL-8 displayed a similar pattern to IL-6, but the difference between samples from day 1 and day 2 did not reach statistical significance. The cytokines IL-1β and TNF-α appear to be elevated in the serum of patients with S. pneumoniae AOM, but there was no significant change between mean serum levels obtained pre- and postinitiation of antibiotic treatment in the time frame studied. The results suggest a systemic inflammatory response as evidenced by increased IL-6. A significant decrease of IL-6 and improvement of clinical symptoms were observed. Determining cytokine levels, especially IL-6, in AOM could offer a powerful tool for objective assessment of response to treatment, minimizing unnecessary treatment of asymptomatic children who may still have some otoscopic findings suggestive of AOM at follow-up visits.

scholarly journals Prescreening of Patient-reported Symptoms using the Edmonton Symptom Assessment System (ESAS) in Outpatient Palliative Cancer Care

2019 ◽  
Author(s):  
Garden Lee ◽  
Han Sang Kim ◽  
Si Won Lee ◽  
Eun Hwa Kim ◽  
Bori Lee ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Care ◽  
Severe Symptom ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Assessment System ◽  
Advanced Cancer Patients ◽  
Edmonton Symptom Assessment System ◽  
Patient Reported

Abstract Background: Although early palliative care is associated with a better quality of life and improved outcomes in end-of-life cancer care, the criteria of palliative care referral are still elusive. Methods: We collected patient-reported symptoms using the Edmonton Symptom Assessment System (ESAS) at the baseline, first, and second follow-up visit. The ESAS evaluates ten symptoms: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, appetite, and wellbeing. A total of 71 patients were evaluable, with a median age of 65 years, male (62%), and the Eastern Cooperative Oncology Group (ECOG) performance status distribution of 1/2/3 (28%/39%/33%), respectively. Results: Twenty (28%) patients had moderate/severe symptom burden with the mean ESAS ≥5. Interestingly, most of the patients with moderate/severe symptom burdens (ESAS ≥5) had globally elevated symptom expression. While the mean ESAS score was maintained in patients with mild symptom burden (ESAS<5; 2.7 at the baseline; 3.4 at the first follow-up; 3.0 at the second follow-up; P =0.117), there was significant symptom improvement in patients with moderate/severe symptom burden (ESAS≥5; 6.5 at the baseline; 4.5 at the first follow-up; 3.6 at the second follow-up; P <0.001). Conclusions: Advanced cancer patients with ESAS ≥5 may benefit from outpatient palliative cancer care. Prescreening of patient-reported symptoms using ESAS can be useful for identifying unmet palliative care needs in advanced cancer patients.

scholarly journals Dyspnea is associated with overall symptom burden in patients with chronic respiratory insufficiency

2020 ◽  
Author(s):  
Heidi Anniina Rantala ◽  
Sirpa Leivo-Korpela ◽  
Juho T. Lehto ◽  
Lauri Lehtimäki
Keyword(s):  
Respiratory Insufficiency ◽  
Depression Scale ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Assessment System ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Edmonton Symptom Assessment System ◽  
Symptom Screening ◽  
Chronic Respiratory Insufficiency

Abstract Objective Patients with chronic respiratory insufficiency suffer from many symptoms together with dyspnea. We evaluated the association of dyspnea with other symptoms in patients with chronic respiratory insufficiency due to chronic obstructive pulmonary disease or interstitial lung disease. Results This retrospective study included 101 patients. Dyspnea was assessed with modified Medical Research Council dyspnea questionnaire (mMRC) and other symptoms with Edmonton Symptom Assessment System (ESAS) and Depression Scale (DEPS). Patients with mMRC 4 (most severe dyspnea) compared to those with mMRC 0–3 reported higher median (IQR) symptom scores on ESAS in e.g. dry mouth (7.0 (4.0–8.0) vs. 3.0 (1.0–6.0), P < 0.001), tiredness (6.0 (3.0–7.0) vs. 3.0 (1.0–5.0), P < 0.001) and anxiety (3.0 (0.0-5.5) vs. 1.0 (0.0–3.0), P = 0.007). Patients with mMRC 4 were more likely to reach the DEPS threshold for depression compared to those with mMRC 0–3 (42.1% vs. 20.8%, P = 0.028). In conclusion, patients with chronic respiratory insufficiency need comprehensive symptom screening with relevant treatment, as they suffer from many severe symptoms worsening with increased dyspnea.

The Edmonton Symptom Assessment System: A narrative review of a standardized symptom assessment tool in head and neck oncology

Oral Oncology ◽  
2021 ◽  
Vol 123 ◽  
pp. 105595
Author(s):  
Christopher W. Noel ◽  
David Forner ◽  
Douglas B. Chepeha ◽  
Elif Baran ◽  
Kelvin K.W. Chan ◽  
...  
Keyword(s):  
Head And Neck ◽  
Assessment Tool ◽  
Symptom Assessment ◽  
Narrative Review ◽  
Assessment System ◽  
Head And Neck Oncology ◽  
Edmonton Symptom Assessment System ◽  
System A

scholarly journals Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients

2020 ◽  
Vol 9 (4) ◽  
pp. 995 ◽  
Author(s):  
Yuri Battaglia ◽  
Luigi Zerbinati ◽  
Giulia Piazza ◽  
Elena Martino ◽  
Michele Provenzano ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Psychological Symptoms ◽  
Symptom Assessment ◽  
Assessment System ◽  
Psychiatric Diagnoses ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Edmonton Symptom Assessment System ◽  
Screening Performance ◽  
Icd 10

An average prevalence of 35% for psychiatric comorbidity has been reported in kidney transplant recipients (KTRs) and an even higher prevalence of other psychosocial syndromes, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), has also been found in this population. Consequently, an easy, simple, rapid psychiatric tool is needed to measure physical and psychological symptoms of distress in KTRs. Recently, the Edmonton Symptom Assessment System (ESAS), a pragmatic patient-centred symptom assessment tool, was validated in a single cohort of KTRs. The aims of this study were: to test the screening performances of ESAS for the International Classification of Diseases-10th Revision (ICD-10) psychiatric diagnoses in KTRs; to investigate the optimal cut-off points for ESAS physical, psychological and global subscales in detecting ICD-10 psychiatric diagnoses; and to compare ESAS scores among KTR with ICD-10 diagnosis and DCPR diagnosis. 134 KTRs were evaluated and administered the MINI International Neuropsychiatric Interview 6.0 and the DCPR Interview. The ESAS and Canadian Problem Checklist (CPC) were given as self-report instruments to be filled in and were used to examine the severity of physical and psychological symptoms and daily-life problems. The physical distress sub-score (ESAS-PHYS), psychological distress sub-score (ESAS-PSY) and global distress score (ESAS-TOT) were obtained by summing up scores of six physical symptoms, four psychological symptoms and all single ESAS symptoms, respectively. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. Receiving Operating Characteristic (ROC) analysis was used to examine the ability of the ESAS emotional distress (DT) item, ESAS-TOT, ESAS-PSY and ESAS-PHYS, to detect psychiatric cases defined by using MINI6.0. The area under the ROC curve for ESAS-TOT, ESAS-PHYS, ESAS-PSY and DT item were 0.85, 0.73, 0.89, and 0.77, respectively. The DT item, ESAS-TOT and ESAS-PSY optimal cut-off points were ≥4 (sensitivity 0.74, specificity 0.73), ≥20 (sensitivity 0.85, specificity 0.74) and ≥12 (sensitivity 0.85, specificity 0.80), respectively. No valid ESAS-PHYS cut-off was found (sensitivity <0.7, specificity <0.7). Thirty-nine (84.8%) KTRs with ICD-10 diagnosis did exceed both ESAS-TOT and ESAS-PSY cut-offs. Higher scores on the ESAS symptoms (except shortness of breath and lack of appetite) and on the CPC problems were found for ICD-10 cases and DCRP cases than for ICD-10 no-cases and DCPR no-cases. This study shows that ESAS had an optimal screening performance (84.8%) to identify ICD-10 psychiatric diagnosis, evaluated with MINI; furthermore, ESAS-TOT and ESAS-PSY cut-off points could provide a guide for clinical symptom management in KTRs.

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