Levetiracetam Prophylaxis Therapy for Brain Tumor-Related Epilepsy (BTRE) Is Associated With a Higher Psychiatric Burden

Purpose: Brain tumor-related epilepsy (BTRE) is a condition characterized by the development of seizures in the context of an undergoing oncological background. Levetiracetam (LEV) is a third-generation anti-seizure medication (ASM) widely used in BTRE prophylaxis. The study evaluated LEV neuropsychiatric side effects (SEs) in BTRE prophylaxis.Method: Twenty-eight patients with brain tumors were retrospectively selected and divided into two groups. In one group, we evaluated patients with a BTRE diagnosis using LEV (BTRE-group). The other group included patients with brain tumors who never had epilepsy and used a prophylactic ASM regimen with LEV (PROPHYLAXIS-group). Neuropsychiatric SEs of LEV were monitored using the Neuropsychiatric Inventory Questionnaire (NPI-Q) at the baseline visit and the 6- and 12-month follow-up.Results: Eighteen patients of the BTRE-group and 10 patients of the PROPHYLAXIS-group were included. Compared to the BTRE-group, the PROPHYLAXIS-group showed a higher severity of neuropsychiatric symptoms. According to Linear Mixed Models (LMM), a multiplicative effect was observed for the interaction between group treatment and time. For the caregiver distress score (CDS), only a time-effect was observed.Conclusion: Prophylactic ASM with LEV is associated with an increased frequency of neuropsychiatric SE. Accurate epileptological evaluations in patients with brain tumors are mandatory to select who would benefit most from ASM.

The distress and needs of Chinese patients with pituitary adenoma: a preliminary survey

IntroductionIt is necessary to investigate the current psychological distress and needs status of patients with pituitary adenoma in China.Material and methodsPatients with pituitary adenoma treated in our hospital from May 2019 to December 2019 were included. The psychological distress and needs scale for pituitary adenoma patients was used to investigate the psychological distress and needs of patients. Besides, univariate and multiple linear regression analyses were conducted to analyze the influencing factors.ResultsA total of 254 valid questionnaires were included. The total psychological distress and need score of patients with pituitary adenoma was (23.89±18.41) and (21.91±20.03) points respectively. There were significant differences on the psychological distress score in different occupational status, personal income, types of pituitary adenomas, size of pituitary adenoma, invasiveness, endocrine level and history of surgery (all p<0.05). The size of pituitary adenoma, endocrine level and pituitary adenoma type were the influencing factors of patients' psychological distress(all p<0.05). There were significant differences on the need score in different age, occupational status, personal income, types of pituitary adenomas and endocrine level(all p<0.05). Endocrine level, other rare types of pituitary adenoma and age were the influencing factors of patients' needs (all p<0.05).ConclusionsOur study is one of the few studies focused on the psychological distress and needs status of Chinese patients with pituitary adenoma. Medical staff should pay attention to the psychological distress of patients with large, rare type of pituitary adenomas and abnormal endocrine level, and take corresponding interventions to alleviate their psychological distress.

Comparison of the Effect of Foot and Palm Reflexology Massage on Respiratory Distress Syndrome in Premature Infants under Noninvasive Ventilation

<b><i>Introduction:</i></b> Respiratory distress is one of the life-threatening conditions in preterm infants. Sensory deprivation in preterm infants hospitalized in the intensive care units affects their physiological and psychological development. Therefore, this study is an attempt to compare the effects of foot and palm reflexology on respiratory distress in infants subjected to noninvasive ventilation. <b><i>Methods:</i></b> In this clinical study, 150 infants hospitalized at Fatemieh Hospital in Hamadan were randomly assigned to 3 groups. In the intervention groups, the reflexology massage to foot and palm was performed for 10 min within 3 days in 6 rounds. In the control group, leg warming was performed. In each group, the personal information checklist, the respiratory distress score, oxygen saturation percentage, and respiratory rate before and after the daily intervention were examined. Data analysis was performed using the standard statistical tests in SPSS. <b><i>Results:</i></b> The results mirrored the statistically significant difference between the intervention and control groups 3 days into the intervention with regard to the average oxygen saturation percentage, respiratory rate, and the respiratory distress score (<i>p</i> &#x3c; 0.05). When eliminating the effect of confounding variables, therapeutic intervention applied to palm compared to foot had a greater effect on reducing respiratory distress score in the studied infants. <b><i>Conclusion:</i></b> The reflexology massage method, especially palm reflexology massage, contributes to the mitigation of respiratory distress in preterm infants subjected to noninvasive ventilation. Hence, this low-cost and efficient intervention program can be recommended as a complementary method for preterm infants with respiratory distress.

Fear of COVID-19: Effects on mental health in under-resourced patients with cancer.

152 Background: Given the high risk of COVID-19 mortality, patients with cancer are not only vulnerable to physical consequences of COVID-19 infection, but also to adverse psychological outcomes, including fear of COVID-19. Without intervention, psychological distress in patients with cancer can lead to worsening symptoms, poor quality of life, and lower survival. We sought to evaluate the association between fear of COVID-19 and psychological distress for under-resourced patients with cancer during the pandemic. Methods: This observational, longitudinal survey study, fielded during early (May 20- July 11, 2020) and later pandemic (December 2-December 23, 2020), evaluated the pandemic’s impact on patients with cancer receiving Patient Advocate Foundation (PAF) services from July 2019 – April 2020. Questions focused on individual experiences with COVID-19 and psychological, emotional, physical, and material effects from the pandemic. The validated Fear of COVID-19 Scale was used to determine fear of COVID-19. Psychological distress was determined using a four-item questionnaire by Holingue et al. (score range 4 – 16). Means and 95% confidence intervals (CI) were estimated using generalized estimating equation modeling with repeated measures to assess the effect of fear of COVID-19 on psychological distress early and later in the pandemic. Models adjusted for age, sex, race/ethnicity, region, annual household income, household size, marital status, employment status, Area Deprivation Index category, Rural-Urban Commuting Code category, cases per 100,000 in county of residence, cancer type, and number of comorbidities. Results: Amongst 1199 survey respondents, 94% considered themselves high risk for COVID-19. 448 respondents completed both the first and second survey. The majority of respondents were female (72%) and age 56-75 (55%); 40% were Black, Indigenous, or Persons of Color. In adjusted models of respondents who completed the early pandemic survey, respondents with more fear of COVID-19 had a higher mean psychological distress score (10.21; 95% CI 9.38-11.03) compared to respondents with less fear (7.55; 95% CI 6.75-8.36). Among those who completed the later pandemic survey, median fear of COVID-19 decreased (20 vs 19)median distress scores remained the same (8); respondents with more fear of COVID-19 had a higher mean psychological distress score (9.98; 95%CI 9.04-10.92) compared to respondents with less fear (7.87; 95%CI 6.98-8.76). Conclusions: Fear of COVID-19 was linked to psychological distress and persisted throughout the pandemic among under-resourced patients with cancer. Timely psychosocial support is critical to meet increased care needs experienced by patients with cancer during the COVID-19 pandemic. Given these results, fear of COVID-19 could be considered as a trigger to integrate psychological interventions in patients with cancer to treat psychological distress.

Psychometric examination of the Russian version of the Depression, Anxiety, and Stress scales-21

The Depression, Anxiety, and Stress Scales-21 (DASS-21) is one of the most common instruments for assessing psychological distress [2]. The aim of this study was to examine the psychometric properties of the Russian DASS-21. The participants were 1,153 Russian-speaking adults aged 18 to 84 years. In addition to the Russian DASS-21, the participants completed the Symptom Check List-90-Revised (SCL-90-R) and Short Form Health Survey (SF-36). A series of confirmatory factor analyses showed the bifactor structure of the Russian DASS-21, full invariance by gender and partial invariance by age. The Russian DASS-21 scores were negatively correlated with the SF-36 scores and positively associated with the SCL-90-R scores, suggesting the convergent validity. The Cronbach’s alpha coefficients were 0.90, 0.85 and 0.91 for the depression, anxiety, and stress subscales, and 0.95 for the general psychological distress score, indicating the internal reliability. Thus, the Russian DASS-21 is a valid and reliable instrument and can be used for screening and monitoring psychological distress in Russian-speaking respondents.

Piloting the REDUCE score to decrease acute care utilization.

252 Background: Emergency department visits and hospitalizations are common in patients with cancer, with nearly three quarters of patients with advanced disease hospitalized at least once in the year after their diagnosis. Efforts to prospectively identify patients at highest risk for this acute care utilization (ACU) are needed. While many risk scoring systems have been developed for this purpose, few have been effectively integrated into clinical practice. We piloted a prospective risk assessment tool using a quality improvement framework. Methods: We utilized our previously published REDUCE score (Reducing ED Utilization in the Cancer Experience) to pilot clinical interventions to reduce ACU using PDSA cycles. Cycle 1 included a chart review and targeted outreach by a nurse navigator to high risk patients identified by REDUCE. Outreach resulted in communication of patient needs to the care team, which may or may not have resulted in additional interventions. Cycle 2 involved initial identification by REDUCE followed by further assessment with a distress screening. Those who were high risk and had high distress (score ≥4) were discussed by an interdisciplinary team (including supportive medicine physicians, social work, nurses, nurse practitioners) to determine an appropriate intervention. Results: Of the patients in Cycle 1 (N = 138), 26.1% had ACU after outreach by a nurse navigator, while in Cycle 2 (N = 169) 7.1% had ACU after the intervention determined by the interdisciplinary team. The average distress score among all patients in Cycle 2 was 6.0 and the REDUCE score was 2.87, while the subset of patients who experienced ACU had an average distress score of 6.4 and a REDUCE score of 3.22. Conclusions: The REDUCE score may be a valuable tool to assist in identifying patients at risk for ACU. We found that combining the risk score with a biopsychosocial screening tool and multidisciplinary team discussion may prove more valuable than the risk score alone, with Cycle 2 findings suggesting that there is a directional correlation between REDUCE score and distress screening results. More work is needed to understand the relative impact of the REDUCE score and the biopsychosocial screening and team discussion on decreasing ACU.

A multi-centre quantitative assessment of moral distress amongst intensive care unit professions in the UK

Background:Moral distress is a damaging experience that impacts adversely on healthcare professional wellbeing, however remains poorly studied in the UK. This study aimed to explore how widespread and severe moral distress is amongst intensive care professionals in the UK.Methods:Prior to the COVID-19 pandemic, a paper questionnaire that quantitatively assessed moral distress using the validated Measure of Moral Distress for Healthcare Professionals (MMD-HP) was distributed at four intensive care units of varying size and speciality facilities.Results:227 questionnaires were returned, including 165 nurses and 40 doctors with a mean age and ICU experience of 38.1 and 10.1 years, respectively. The median moral distress score was 108 (IQR = 78.2, range 0 to 288). Moral distress was greatest in situations related to delivering aggressive treatment that was perceived as futile or not in the patient’s best interests, closely followed by situations related to lack of resources compromising care. Moral distress was independently influenced by profession (p = 0.02) (nurses 117.0 vs doctors 78.0) and had no relationship with participant age and ICU experience. One-third indicated their intention to leave their current post due to moral distress and this was greater amongst nurses than doctors (37.0% vs 15.0%). Multiple logistic regression models included profession, gender, hospital type, age and ICU experience as covariates and had good discrimination and ability to predict intention to leave. Moral distress was associated with an intention to leave their current post in unadjusted and adjusted analyses (adjOR = 1.011 per 1 unit increase in moral distress, 1.006–1.017, p < 0.0001) and a previous post (adjOR = 1.009, 1.004–1.014, p = 0.001).Conclusions:Moral distress appears widespread amongst UK ICU professionals and is worse amongst nurses. Moral distress due to resource-related issues was more severe than comparable studies in North America. Its relationship with an intention to leave a post and the high proportion of ICU nurses considering leaving their current post due to moral distress is concerning, particularly as this study was performed prior to the COVID-19 pandemic. Addressing moral distress should be a priority, however the ideal interventions remain unclear.

Moral distress amongst intensive care unit professions in the UK: A qualitative study

Background: Working in intensive care presents psychological challenges to healthcare professionals, including moral distress. Concerningly, moral distress is associated with burnout and a tendency to leave the profession. The COVID-19 pandemic has further highlighted the challenges to staff wellbeing and the importance of identifying and mitigating moral distress. However moral distress remains poorly studied in the UK. Our aim was to explore the experience and response to moral distress amongst intensive care professionals in the UK and identify interventions to support professionals and improve staff wellbeing. Methods: Prior to the COVID-19 pandemic, 15 interviews were performed with intensive care professionals from four units of varying size and specialty facilitates recruited from a pool of responders to a questionnaire survey. Participants were purposively sampled for hospital, profession, grade, and quantitative moral distress score. Transcripts were analysed using thematic analysis. Results: Participants included a range of intensive care professions, working experience, overall moral distress score, and were representative of the larger questionnaire sample. Moral distress occurred across all professions, levels of seniority, and in all units. Moral distress occurred in many situations, most commonly related to providing care against the patient’s wishes/interests, or resource constraints compromising care. Its experience resulted in multiple negative feelings and could lead to withdrawal from engaging with patients/families and avoiding a career in intensive care. Participants described a range of individualised coping strategies tailored to the situations faced. The most common and highly valued strategies were informal and relied on working within a supportive environment along with a close-knit team, although participants acknowledged there was a role for structured and formalised intervention. A lack of agency was central to the experience of moral distress. Conclusions: Moral distress is commonly encountered by UK intensive care professionals and can have an important negative impact on professional wellbeing and patient care. Interventions to support intensive care professionals should recognise the individualistic nature of coping with moral distress. Addressing moral distress may support a healthy and sustainable intensive care workforce. Achieving this requires a supportive environment and a close-knit supportive team which has implications for how intensive care services are organised.

Symptom Burden of Patients with Advanced Pancreas Cancer (APC): A Provincial Cancer Institute Observational Study

Patients with advanced pancreatic cancer (APC) experience many disease-related symptoms. ESAS-r measures the severity of 9 symptom domains and has been validated for use in the ambulatory oncology setting. We aimed to describe symptom burden at baseline for patients with APC treated with modern chemotherapy (CT), and to determine whether symptom burden at baseline is prognostic. Patients diagnosed with APC between 2012–2016, treated with ≥1 cycle of CT, who completed ≥1 ESAS-r were identified. Descriptive statistics were used to report symptom burden and common moderate-to-severe symptoms. A joint model was used to describe the trajectory of ESAS-r during follow-up while controlling for death. Multivariable Cox regression was used to identify independent predictors of death. Of 123 patients identified, the median age was 65 and 61% had metastatic disease. The median baseline ESAS-r total symptom distress score (TSDS) was 24. A total of 86% of patients had at least one symptom score of ≥4 at baseline, with the most common being: fatigue, nausea, anxiety, and shortness of breath. Median overall survival was 10.2 months. Baseline TSDS was not predictive for worse survival in the era of modern CT. Patients with APC have a high burden of cancer-associated symptoms and a high prevalence of moderate-to-severe symptoms. Early intervention has the potential to improve quality of life in this group of patients and should be investigated.

Diagnostic Ability of Methods Depicting Distress of Tumor-Bearing Mice

Subcutaneous tumor models in mice are the most commonly used experimental animal models in cancer research. To improve animal welfare and the quality of scientific studies, the distress of experimental animals needs to be minimized. For this purpose, one must assess the diagnostic ability of readout parameters to evaluate distress. In this study, we evaluated different noninvasive readout parameters such as body weight change, adjusted body weight change, faecal corticosterone metabolites concentration, burrowing activity and a distress score by utilising receiver operating characteristic curves. Eighteen immunocompromised NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ mice were used for this study; half were subcutaneously injected with A-375 cells (human malignant melanoma cells) that resulted in large tumors. The remaining mice were inoculated with SCL-2 cells (cutaneous squamous cell carcinoma cells), which resulted in small tumors. The adjusted body weight and faecal corticosterone metabolites concentration had a high diagnostic ability in distinguishing between mice before cancer cell injection and mice bearing large tumors. All other readout parameters had a low diagnostic ability. These results suggest that adjusted body weight and faecal corticosterone metabolites are useful to depict the distress of mice bearing large subcutaneous tumors.