Caring for depression in the dying is complex and challenging – survey of palliative physicians

Background Depression is prevalent in people with very poor prognoses (days to weeks). Clinical practices and perceptions of palliative physicians towards depression care have not been characterised in this setting. The objective of this study was to characterise current palliative clinicians’ reported practices and perceptions in depression screening, assessment and management in the very poor prognosis setting. Methods In this cross-sectional cohort study, 72 palliative physicians and 32 psychiatrists were recruited from Australian and New Zealand Society of Palliative Medicine and Royal Australian and New Zealand College of Psychiatrists between February and July 2020 using a 23-item anonymous online survey. Results Only palliative physicians results were reported due to poor psychiatry representation. Palliative physicians perceived depression care in this setting to be complex and challenging. 40.0% reported screening for depression. All experienced uncertainty when assessing depression aetiology. Approaches to somatic symptom assessment varied. Physicians were generally less likely to intervene for depression than in the better prognosis setting. Most reported barriers to care included the perceived lack of rapidly effective therapeutic options (77.3%), concerns of patient burden and intolerance (71.2%), and the complexity in diagnostic differentiation (53.0%). 66.7% desired better collaboration between palliative care and psychiatry. Conclusions Palliative physicians perceived depression care in patients with very poor prognoses to be complex and challenging. The lack of screening, variations in assessment approaches, and the reduced likelihood of intervening in comparison to the better prognosis setting necessitate better collaboration between palliative care and psychiatry in service delivery, training and research.

Self Efficiency And Symptom Control of Cancer Patients

Objective: This cross-sectional study was planned to evaluate the self-efficacy and symptom control of cancer patients and to determine the factors affecting them. Methods: The sample of the study consisted of 329 cancer patients who were treated in the Medical Oncology Clinic of a university hospital between April and June 2019 and accepted to participate in the study. Data were collected using the Patient Characteristics Information Form, Cancer Behavioral Inventory-Short Version (CBI-SV), and Edmonton Symptom Assessment Scale (ESAS). Percentage, mean, Mann Whitney U test, Kruskal Wallis analysis of variance were used in the analysis of the data. Results: The mean CBI-SV score of the patients was 79.10±17.55. It was determined that the highest mean score of ESAS of the patients was in the symptom of fatigue (3.53±2.81). Some symptoms were statistically lower in patients with good income, working, and non-smokers. Also it was determined that the self-efficacy levels of the patients with good income and quitting smoking were higher (p<0.05). At the same time, as the patients' self-efficacy scores increased, the severity of the symptoms they experienced decreased statistically (p<0.05). Conclusion: It was found that the patients' self-efficacy score was above the moderate level, the most intense symptom experienced by the patients was fatigue, and the severity of the symptoms decreased as the patients' self-efficacy level increased. In line with these results; the symptoms, self-efficacy perceptions and affecting factors of cancer patients should be evaluated by nurses at regular intervals, and care and consultancy services should be provided.

Acute and Subacute Clinical Markers After Sport-Related Concussion

ObjectiveThis study aimed to determine the association of a range of off-field symptoms reported by athletes retrospectively with on-field concussion signs and in-office symptoms among rugby union players.BackgroundPlayers with sports concussion experience multiple symptoms. Understanding the association between these symptoms and clinical markers of concussion would facilitate a targeted approach to symptom assessment and treatment.Design/MethodsCross-sectional study. We consecutively enrolled 92 adult rugby union players, within the first 72 hours after sport concussion. Ten symptoms assessed using a retrospective symptoms interview were examined for their association with observed concussion signs and post-concussion symptoms using the Post-Concussion Symptoms Scale (PCSS).ResultsOdds ratios revealed that athletes who was overtly symptomatic based on retrospective concussion interview at the time of the concussion were over 2.6 times more likely (p = 0.047) to have exhibited post-traumatic amnesia when compared with athletes who was asymptomatic. There were no differences between groups in terms of on-field loss of consciousness or confusion. Off-field symptoms reported by athlete were associated with symptoms reporting on the Beck Depression Inventory (OR 2.8; 95% CI 1.14–6.88), headache (OR 4.9; 95% CI 1.92–12.79), memory concerns (OR 3.15; 95% CI 1.06–9.34), pressure in head (OR 2.8; 95% CI 1.03–8.08), and visual disturbances (OR 3.9; 95% CI 1.05–14.50) within the first 72 hours after concussion.ConclusionsSymptomatic concussed rugby athletes have increased odds for sustaining on-field concussion signs that can be observed by others and persistent symptoms within the first 72 hours after concussion. Information from the on-field and off-field assessment is essential in understanding the severity of sports concussion.

Early Detection of Wild Rocket Tracheofusariosis Using Hyperspectral Image-Based Machine Learning

Fusarium oxysporum f. sp. raphani is responsible for wilting wild rocket (Diplotaxis tenuifolia L. [D.C.]). A machine learning model based on hyperspectral data was constructed to monitor disease progression. Thus, pathogenesis after artificial inoculation was monitored over a 15-day period by symptom assessment, qPCR pathogen quantification, and hyperspectral imaging. The host colonization by a pathogen evolved accordingly with symptoms as confirmed by qPCR. Spectral data showed differences as early as 5-day post infection and 12 hypespectral vegetation indices were selected to follow disease development. The hyperspectral dataset was used to feed the XGBoost machine learning algorithm with the aim of developing a model that discriminates between healthy and infected plants during the time. The multiple cross-prediction strategy of the pixel-level models was able to detect hyperspectral disease profiles with an average accuracy of 0.8. For healthy pixel detection, the mean Precision value was 0.78, the Recall was 0.88, and the F1 Score was 0.82. For infected pixel detection, the average evaluation metrics were Precision: 0.73, Recall: 0.57, and F1 Score: 0.63. Machine learning paves the way for automatic early detection of infected plants, even a few days after infection.

Difficulties in Addressing Artificial Hydration and Nutrition Therapy for Terminal Cancer Patients: What to do if Patients/Families’ Wishes Differ From the Medically Appropriate Treatment Plans?

Purpose: Artificial hydration and nutrition therapy (AHNT) initiated by patients/families sometimes differs from medically appropriate treatment plans. We aimed to identify the causes of these differences and examine the ensuing responses and outcomes. Methods: Of 133 adult cancer patients receiving end-of-life care in the last 2 years, these discrepancies occurred in 41 patients. We retrospectively examined the following issues: (1) The reason why these discrepancies occurred. (2) Based on the causes identified in (1), the following actions were taken: 1) If the consent to change to medically appropriate AHNT was obtained, physical findings using Japan Palliative Oncology Study (JPOS) group and Edmonton Symptom Assessment System (ESAS) were compared before and 1 week after the intervention. 2) If consent was not obtained, time-limited trial (TLT) was conducted, and these results were compared. (3) The communication between patients/families and medical professionals was compared using Support Team Assessment Schedule. Results. (1) Causes: a) the lack of understanding of the disease condition in 26 cases and b) faulty expectation of AHNT in 15 cases. (2) In 30 cases of 1) (20 of a) and 10 of b)) and 11 of 2) in which TLT was performed, JPOS and ESAS improved significantly. (3) The communication above was improved significantly in 1) and 2) ( P = .0027 and .0039, respectively). Conclusion. Providing medically appropriate AHNT with the consent of patients/families is expected to not only alleviate distressing symptoms but also improve the communication between patients/families and medical professionals, as well as improve the quality of palliative care.

Ultrasound Is Not Useful in Monitoring Lipedematous Alopecia: A Clinical, Trichoscopic, Histologic, and Ultrasound Analysis of 2 Cases

<b><i>Introduction:</i></b> Lipedematous scalp (LS) is a rare condition characterized by thickened adipose tissue in the subcutaneous layer of the scalp resulting in a soft, spongy, or thick consistency of the scalp. When associated with hair loss, this condition is called lipedematous alopecia (LA). Various imaging modalities have been used to diagnose LS and LA along with histopathology. <b><i>Case Presentation:</i></b> We present 2 cases of LS: a 56-year-old female with a 1-year history of hair thinning, pain, and tenderness at the vertex scalp and a 60-year-old female with a 5-year history of lichen planopilaris presenting with a 1-year history of itching and soreness on the crown of her head. Ultrasound (US) was used for diagnosis, treatment response surveillance, routine clinical examination, and symptom assessment. Follow-up US revealed no improvement in scalp thickness in either case despite symptom improvement and visual improvement in hair growth. <b><i>Discussion/Conclusion:</i></b> US has been reported as a helpful tool in the diagnosis of LS; however, treatment response was better approximated by hair growth and symptom alleviation. We found that once the diagnosis with made with US, clinical monitoring is adequate as symptom improvement and hair growth may not correlate with a change in scalp thickness.

Symptom clusters in patients receiving chemotherapy: A systematic review

Background and purposeSince 2001, symptom cluster research has grown considerably. However, because multiple methodological considerations remain, ongoing synthesis of the literature is needed to identify gaps in this area of symptom science. This systematic review evaluated the progress in symptom clusters research in adults receiving primary or adjuvant chemotherapy since 2016.MethodsEligible studies were published in English between 1 January 2017 and 17 May 2021; evaluated for and identified symptom clusters ‘de novo;’ and included only adults being treated with primary or adjuvant chemotherapy. Studies were excluded if patients had advanced cancer or were receiving palliative chemotherapy; symptoms were measured after treatment; symptom clusters were pre-specified or a patient-centred analytic approach was used. For each study, symptom instrument(s); statistical methods and symptom dimension(s) used to create the clusters; whether symptoms were allowed to load on more than one factor; method used to assess for stability of symptom clusters and associations with secondary outcomes and biomarkers were extracted.ResultsTwenty-three studies were included. Memorial Symptom Assessment Scale was the most common instrument and exploratory factor analysis was the most common statistical method used to identify symptom clusters. Psychological, gastrointestinal, and nutritional clusters were the most commonly identified clusters. Only the psychological cluster remained relatively stable over time. Only five studies evaluated for secondary outcomes.DiscussionWhile symptom cluster research has evolved, clear criteria to evaluate the stability of symptom clusters and standardised nomenclature for naming clusters are needed. Additional research is needed to evaluate the biological mechanism(s) for symptom clusters.PROSPERO registration numberCRD42021240216.

Symptom Locus and Symptom Origin Incongruity in Runner’s Dystonia – Case Study of an Elite Female Runner

Objectives: Runner’s dystonia is a task-specific dystonia that occurs in the lower limbs and trunk, with diverse symptomatology. We aimed to identify the origin of a dystonic movement abnormality using combined three-dimensional kinematic analysis and electromyographic (EMG) assessment during treadmill running.Participant: A 20-year-old female runner who complained of right-foot collision with the left-leg during right-leg swing-phase, which mimicked right-ankle focal dystonia.Results: Kinematic and EMG assessment of her running motion was performed, which showed a significant drop of the left pelvis during right-leg stance-phase, and a simultaneous increase of right hip adductor muscle activity. This resulted in a pronounced adduction of the entire right lower limb with respect to the pelvis segment. Trajectories of right foot were seen to encroach upon left-leg area.Discussion: These findings suggested that the symptom of this runner was most likely a form of segmental dystonia originating from an impaired control of hip and pelvis, rather than a distal focal ankle dystonia.Conclusion: We conclude that, for individualized symptom assessment, deconstructing the symptom origin from its secondary compensatory movement is crucial for characterizing dystonia. Kinematic and EMG evaluation will therefore be a prerequisite to distinguish symptom origin from secondary compensatory movement.