Research Priorities in Geriatric Palliative Care: Nonpain Symptoms.

Research Priorities in Geriatric Palliative Care: Nonpain Symptoms.

J Palliat Med. 2013 Jul 26;
Combs S, Kluger BM, Kutner JS

Abstract Research addressing the burden, assessment, and management of nonpain symptoms associated with advanced illness in older adults is limited. While nonpain symptoms such as fatigue, sleep, dyspnea, anxiety, depression, cognitive impairment, nausea, and anorexia-cachexia are commonly noted by patients and clinicians, research quantifying their effects on quality of life, function, and other outcomes are lacking and there is scant evidence regarding management. Most available studies have focused on relatively narrow conditions (e.g., chemotherapy-induced nausea) and there are almost no data relevant to patients with multiple morbidities or multiple concurrent symptoms. Assessment and treatment of nonpain symptoms in older adults with serious illness and multiple comorbidities is compromised by the lack of data relevant to their care. Recommended research priorities address the documented high prevalence of distressing symptoms in older adults with serious illness, the unique needs of this population due to coexistence of multiple chronic conditions along with physiologic changes related to aging, the lack of evidence for effective pharmacologic and nonpharmacologic interventions, and the need for validated measures that are relevant across multiple care settings. HubMed – depression

Initial clinical presentation of Takotsubo cardiomyopathy with-a focus on electrocardiographic changes: A literature review of cases.

World J Cardiol. 2013 Jul 26; 5(7): 228-41
Sanchez-Jimenez EF

To review the initial presentation and demonstrate the importance of Takotsubo cardiomyopathy.A PubMed search using the terms “Takotsubo cardiomyopathy (TC)” and “apical ballooning syndrome” yielded 211 publications. Only those that were relevant were fully reviewed. The gender, age, precipitating stressor, main complaint at presentation, electrocardiogram (ECG) at admission and serum cardiac markers of patients diagnosed with TC, were extracted as available. The data were organized in tables and graphics, and the incidence of the disorder was calculated and analyzed.A total of 250 clinical cases were examined. The predominant gender that was affected was female, with a prevalence of 87.5%. The mean age of presentation was 64 ± 14 years. The cases were divided by age into 10-year intervals. The age interval of 60-69 years showed the highest frequency of TC, accounting for 79 cases. The most common precipitating stressor was physical (50% of cases). Chest pain was the primary complaint at presentation (58.8% of cases) followed by dyspnea (30% of cases). The ST segment changes category was the most common (60%), followed by T wave changes (39.6%). Of the 60% of cases with ST segment changes, 12% had concomitant T wave changes. This means that for 27.6% of the cases, the primary abnormality in the ECG was T wave changes; 87.6% of cases with TC had a change in the ST segment, in the T wave or in both. The percentage of ECGs presenting with changes in the anterior wall was 54.4% (35.6% of ST segment elevation + 1.6% of ST segment depression + 17.2% of T wave inversion). The percentage of patients presenting with changes in the lateral segment of the heart was 46.8%, while the percentage of patients with changes in the inferior heart was 21.6% and the percentage of patients with changes in the apical region was only 16%. The prevalence of elevated creatinine kinase and/or troponin on initial presentation was 89.3%.It is essential that every physician consider Takotsubo cardiomyopathy as a possible differential diagnosis when a patient is classified with acute coronary syndrome. To do so, it is necessary to know the clinical presentation of this syndrome in its early stages. HubMed – depression

Judgment of emotional information expressed by prosody and semantics in patients with unipolar depression.

Front Psychol. 2013; 4: 461
Schlipf S, Batra A, Walter G, Zeep C, Wildgruber D, Fallgatter A, Ethofer T

It was the aim of this study to investigate the impact of major depressive disorder (MDD) on judgment of emotions expressed at the verbal (semantic content) and non-verbal (prosody) level and to assess whether evaluation of verbal content correlate with self-ratings of depression-related symptoms as assessed by Beck Depression Inventory (BDI). We presented positive, neutral, and negative words spoken in happy, neutral, and angry prosody to 23 MDD patients and 22 healthy controls (HC) matched for age, sex, and education. Participants rated the valence of semantic content or prosody on a 9-point scale. MDD patients attributed significantly less intense ratings to positive words and happy prosody than HC. For judgment of words, this difference correlated significantly with BDI scores. No such correlation was found for prosody perception. MDD patients exhibited attenuated processing of positive information which generalized across verbal and non-verbal channels. These findings indicate that MDD is characterized by impairments of positive rather than negative emotional processing, a finding which could influence future psychotherapeutic strategies as well as provide straightforward hypotheses for neuroimaging studies investigating the neurobiological correlates of impaired emotional perception in MDD. HubMed – depression

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