Ziel: In dieser Arbeit wurden die Auswirkung der milden und moderaten Hyponatriämie (125-133 mmol/l) auf das Befinden der betroffenen Patienten im Hinblick auf neurokognitive Funktion und klinische Symptomatik untersucht. In mehreren Studien wurde über eine erhöhte Sturzneigung sowie eine Minderung der Konzentrationsfähigkeit bei einem nur leicht erniedrigten Serumnatriumspiegel berichtet. Methoden: Die Testungen fanden im Longitudinalvergleich mit jeweils den gleichen Patienten vor und nach Anhebung des Serumnatriumspiegels statt, sodass bis auf das Serumnatrium keine Beeinflussung gegeben war. Die Patienten waren im Durchschnitt 61 Jahre alt und besaßen einen durchschnittlichen Serumnatriumwert von 128,7 mmol/l; die Ätiologie der Hyponatriämie war heterogen (normovolämische und hypervolämische Hyponatriämie). Um die Aufmerksamkeitsdefizite aufzudecken, fanden Testungen der Patienten (n=16) mit vier verschiedenen Untertests der TAP, einem Standardprogramm der Psychologie, statt: „Alertness“ mit „phasischer Alertness“, „Daueraufmerksamkeit“, „Geteilte Aufmerksamkeit“ und „Go/Nogo“. Um die Konzentrationsfähigkeit gegen eine Störung wie Stress beurteilen zu können, wurde die „Wiener Form A“, ein Subtyp des Wiener Testsystems verwendet, ein ebenfalls in der Psychologie genutzter Test (n=12). Verwendet wurde außerdem ein selbst designter Fragebogen (n=18), der auf die in der Literatur berichteten Symptome einer leichten Hyponatriämie zugeschnitten war. Ein und dieselben Patienten wurden jeweils vor und nach Anhebung des Serumnatriumwertes getestet. Ergebnisse: Es zeigte sich, dass bei verschiedenen klinischen Symptomen wie Krämpfen (p= 0,018) und Gangunsicherheit (p= 0,092) signifikante Verbesserungen gefunden wurden. Auch bei dem unspezifischeren Symptom Müdigkeit (p= 0,04) konnte eine Tendenz zur Besserung nach Anhebung des Serumnatriumspiegels verzeichnet werden. In den Aufmerksamkeitstests war – im Gegensatz zu einer Vorstudie, in der ebenfalls die TAP zur Beurteilung der neurokognitiven Funktion herangezogen worden war - weder die „Alertness“, also die Reaktionsgeschwindigkeit, noch die Reaktions-Selektionsleistung beim Test „Go/Nogo“ signifikant alteriert. Auch die „Daueraufmerksamkeit“ und „Geteilte Aufmerksamkeit“ wurden nicht signifikant beeinflusst. Ebenso wenig wie die verschiedenen Aufmerksamkeitfunktionen beeinflusst werden, ist die Reaktionsfähigkeit unter Stress wesentlich herabgesetzt. Denn der Stressreiz im Test „Wiener Form A“ führte bei den Patienten in Hyponatriämie zu keinem signifikant schlechteren Ergebnis als der gleiche Test mit denselben Patienten bei angehobenem Serumnatriumwert. Zusammefassung: Zusammenfassend kann aus der vorliegenden Studie gefolgert werden, dass eine milde und moderate Hyponatriämie keine Auswirkungen auf die neurokognitive Funktion hat und insofern die Sturzneigung bei älteren Patienten wohl nicht beeinflusst. Bei bestimmten klinischen Symptomen konnte eine teilweise signifikante Verbesserung verzeichnet werden, jedoch gibt es zu viele mögliche Einflussfaktoren, als dass man eine endgültige Aussage treffen könnte. Die Ergebnisse aus Vorstudien müssen in Frage gestellt werden. Um den tatsächlichen Einfluss einer milden und moderaten Hyponatriämie auf die Aufmerksamkeitsfunktion zu klären sowie die Beeinträchtigung bei bestimmten klinischen Symptomen beweisen zu können, bedarf es weiterer Studien in randomisiertem Doppelblinddesign mit höherer Patientenzahl. / Objective: Objective of the study was to determine the effect of mild and moderate hyponatremia (125-133 mmol/l) on the neurocognitive function and clinical symptomatology. In several studies mild and moderate hyponatremia is considered to be one reason of fall inclination as well as responsible for cognitive impairment. Methods: Tests took place with the identical patients before and after increase of the level of serum sodium, so that except the serum sodium no other factor was influencing the performance. The patients were 61 years old and showed a mean serum sodium level of 128.7 mmol/l; the aetiology of hyponatriemia was heterogeneous (normovolemic and hypervolemic hyponatrmia). To detect the cognitive impairment, tests with patients (n=16) were performed in four different subtests of the “TAP”, a standard programme in psychological studies: "Alertness" with "Phasic Alertness", "Long-term attention", „Divided attention“and "Go/Nogo". To be able to assess the cognitive impairment regarding stress, we used the „Viennese form A“. It is a subtype of the "Viennese test system", which is also used in psychological studies (n=12). Moreover, we used a self-designed questionnaire (n=18) which relates to symptoms, reported in the literature of mild hyponatremia. The patients were tested each before and after increase of the serum sodium level. Results: Significant differences were shown in clinical symptoms like “ Muscle cramps” (p = 0.018) and “Gait impairment” (p = 0.092). Also the unspecific symptom “Tiredness” (p = 0.04) trended to result in improvement. In the attention tests there were no differences found neither in "Alertness", the reaction velocity, nor in the reaction-selection achievement of "Go/Nogo" - in contrast to an earlier study in which also TAP had been used for the evaluation of the neurocognitive function. "Long-term attention" and „Divided attention“ were not influenced significantly, too. Also the cognitive impairment regarding stress was not differently altered. So the test „Viennese form A“ performed by patients in hyponatremia did not bring significantly worse results than the same test performed in the same patients with raised serum sodium level. Conclusion: The present study shows that a mild and moderate hyponatremia has no effect on the neurocognitive function and hence does not influence negatively gait disturbance in elder patients. In certain clinical symptoms a partly significant improvement could be found. However, there are many possible factors of influence, so that a final statement can´t be deduced from the results. The results from an earlier study are different. To define the actual influence of a mild and moderate hyponatremia on the attention function and to prove the interference with certain clinical symptoms, it requires further studies in randomised double blind design with a higher number of patients.

Session ID: SU-G2-4 / Joint 4th International Conference on Soft Computing and Intelligent Systems and 9th International Symposium on advanced Intelligent Systems, September 17-21, 2008, Nagoya University, Nagoya, Japan

Indiana University-Purdue University Indianapolis (IUPUI) / Little research has explored the degree to which specific intervention components predict improved health outcomes for cancer patients and their family caregivers. The present study examined relations of intervention components (i.e., coping skills) to symptoms in a telephone symptom management (TSM) intervention delivered concurrently to symptomatic lung cancer patients and their family caregivers. Guided by Social Cognitive Theory (SCT) and cognitive behavioral therapy (CBT) frameworks, patient-caregiver dyads were taught coping skills including: a mindfulness exercise (i.e., noticing sounds and thoughts), pursed lips breathing, guided imagery, cognitive restructuring, and assertive communication. Symptom measures were administered at baseline and 2 and 6 weeks post-intervention. The measures assessed patient and caregiver depressive and anxiety symptoms as well as patient pain severity, distress related to breathlessness, and fatigue interference. Data were examined from patient-caregiver dyads enrolled in TSM (N = 51 dyads). Patients and caregivers were predominantly female (55% and 73%, respectively) and Caucasian (87%). The average patient was 63 years of age (SD = 8) and the average caregiver was 56 years of age (SD = 14). Seven autoregressive panel models tested relations of coping skills to symptoms. All models had at least adequate fit to the data (χ2 ps > 0.05, RMSEA values < 0.06). For patients, more assertive communication practice during the intervention was related to less pain severity, fatigue interference, and depressive and anxiety symptoms at 6 weeks post-intervention. Additionally, more guided imagery practice during the intervention was related to less fatigue interference and anxiety at 6 weeks post-intervention. In contrast, more cognitive restructuring practice during the intervention was related to more distress related to breathlessness and depressive and anxiety symptoms at 6 weeks post-intervention. Similarly, more practice of a mindfulness exercise during the intervention was related to more fatigue interference and anxiety at 6 weeks post-intervention. For caregivers, more guided imagery practice was related to more anxiety at 2 weeks post-intervention. All other pathways from coping skills to symptoms at 2 and 6 weeks post-intervention were non-significant for both patients and caregivers. Findings suggest intervention effectiveness may have been reduced by competing effects of certain coping skills. For lung cancer patients, future studies should consider focusing on assertive communication and guided imagery, as these two coping skills were most consistently associated with reduced symptoms. However, more studies are needed to better understand these findings and particular caution should be used when applying CBT-based interventions that have not been validated in lung cancer populations.

There is evidence of a relationship between pain and associated symptoms, specifically constipation and dyspnea, and quality of life. Literature supports that endstage lung cancer patients suffer more symptoms than those with other types of cancers, and the course of treatment is primarily palliative, as many of these diagnosed patients cannot be cured. The purpose of this secondary analysis of data was to evaluate the relationships between pain and other common symptoms in end stage lung cancer patients in hospice care, and the relationships among pain, dyspnea, constipation and quality of life. The study sample included fifty lung cancer patients admitted to a hospice program, reporting pain. A series of Pearson’s correlations were used to analyze relationships between the variables pain intensity, pain distress, dyspnea intensity, dyspnea distress, constipation intensity and the relationships of these variables with quality of life. The results showed positive significant correlations between pain intensity and pain distress (r = .44, p = .002), dyspnea intensity and dyspnea distress (r = .47, p = .001), and constipation intensity and quality of life (r = -.57, p = .013). Pain and the relief of pain have been studied extensively in cancer patients, yet little research has been done in the way of side effects of opioid use, specifically constipation. This study reinforces to vi nursing the importance of a thorough assessment upon admission to hospice, and at each subsequent nursing visit, which includes a bowel habit history, current medications in use, potential risk for developing constipation and management of constipation once it is present. Hospice patients with lung cancer are reporting a decrease in quality of life secondary to constipation. Prevention or rapid alleviation of this symptom will provide comfort and allow the patient to focus on important end of life tasks.

Inledning: Syftet med denna studie är att, utifrån ett insamlat material vid S:t Lukas mottagningar i Stockholmsområdet, undersöka symptomförändring från start till avslutning i psykodynamiskt inriktade psykoterapier. Frågeställningar: Den övergripande frågeställningen är om patienter och terapeuter bedömer att terapierna haft någon effekt och i så fall vilken. Vidare om bakgrundsfaktorer och självbild påverkat symptombelastningen. Metod: Studien har genomförts med hjälp av självskattningsformulär som fyllts i före och efter behandling. Patienterna har fyllt i Symptom Checklist (SCL-90) och terapeuterna ett frågeformulär där de skattat patienternas besvär. Efter inomgruppsjämförelser har jämförelser gjorts med ett normerings-material. Resultat: Det sker en signifikant symptomlindring under terapierna. Störst är förändringen när det gäller depression, ångest och interpersonell sensitivitet samt i det sammantagna genomsnittsvärdet. Patienternas bakgrund påverkar inte utfallet nämnvärt. Studien visar att patienter med höga värden för självkritik och hat vid terapistart upplever störst symptomlindring. Diskussion: De positiva behandlingsresultaten går tyvärr inte att generalisera p.g.a. ett betydande bortfall. En angelägen utmaning för framtida studier är att begränsa och kontrollera bortfallet. En annan angelägen fråga att följa upp är om påvisad symptomlindring fortsätter efter avslutad terapi i överensstämmelse med andra jämförbara studier.

Inledning: Syftet med undersökningen är att få en bild av självskattade symptomförändringar hos de unga vuxna som genomfört en psykodynamisk psykoterapi på Stadsmissionens Terapicenter för Unga, under perioden 2008-september 2013. Frågeställningar: Den övergripande frågeställningen var om och i vilken grad patienternas självskattade symptom förändrats under behandlingstiden. Utgångshypotesen för undersökningen var att den skulle visa en signifikant förbättrad självupplevd psykisk hälsa hos de unga vuxna som ingår i studien. Metod: Studien har genomförts genom att en statistisk analys gjorts av insamlat självskattningsmaterial i SCL-90, för perioden 2008 - september 2013, från Stadsmissionens Terapicenter för unga. Materialet består av enkätsvar från 209 personer. Resultat: Resultaten visar att det sker en positivt signifikant symptomförändring under behandlingstiden. Störst är den positiva symptomförändringen i det generella genomsnittsvärdet, GSI, samt vad gäller depression, ångest, interpersonell känslighet och tvång. Resultaten visar också att det finns ett betydande bortfall som inte är slumpmässigt, då bortfallet tenderar att överrepresenteras av personer med en högre nivå av psykiska besvär. Diskussion: De positiva behandlingsresultaten går tyvärr inte att generalisera på grund av ett betydande bortfall, dessutom saknades i hög utsträckning persondata i databasen vilket bidrar till en brist i resultatdiskussionen. En bredare och mer kontrollerad bortfallsinformation, såväl som ytterligare persondata, skulle vara till gagn för framtida utvärderingar.

The purpose of this study was to gain understanding of the early symptom experience of ischemic stroke in women. This is the only study of which the researcher is aware in which narrative inquiry was used to examine the period of time from symptom onset until emergency department arrival in women. Data collection was achieved by in-depth interviews during which participants’ stories of stroke were elicited. Individual narrative accounts were created and analyzed using within and across case techniques. The participants were nine women ranging in age from 24-86 years (average age 53). Four participants were Caucasian, three were Hispanic, one was African American and one woman was of mixed race. The participants experienced the onset of stroke as the inability to carry out accustomed activities in usual ways. There was a tendency to objectify the body. Only two participants considered stroke as a possible cause for their symptoms, and the other women attributed symptoms everyday bodily experiences and/or other health conditions. Most participants did not perceive themselves at risk for stroke although all but one woman had risk factors. The participants displayed a variety of responses to symptoms, including trying to continue with usual activities and seeking help as well as deciding not to tell anyone about their symptoms. Symptom response was related to women’s evaluation of and emotional response to symptoms. The actions taken by the participants in response to symptoms were informed by the meaning of the symptoms, and meaning was formed within the context of each woman’s life situation. Few women made the decision to seek medical care on their own, and in every case family members or co-workers were reported to take an active role in getting the participant to the hospital. Some family members were reported to consult with one another before making the decision to call EMS or transporting the participant to the emergency department. Consistent with what was expected from extant research the majority of the participants did not arrive at the hospital in time to be offered treatment with t-PA. Recommendations for future research, stroke education and practice were discussed. / text

This study evaluated the efficacy of various attention-related, neuropsychological, and symptom validity measures in the detection of feigned ADHD in an undergraduate sample. Performance was compared between a group of presumed normal students (HON), a group of diagnostically "clean" ADHD students asked to respond to the best of their ability (ADHD), and a group of motivated, coached feigners (FGN). Feigners were educated about symptoms and characteristics of ADHD, provided with a scenario to help them relate to the plight of a student who might seek diagnosis, admonition to feign believably, and a significant monetary incentive for "successful feigning" ($45). They were not forewarned about the specific types of tests they would take nor alerted to the presence of malingering detection instruments. Results illustrated that the ADHD symptom-report measures, though sensitive to ADHD, were quite susceptible to faking. The ARS and CAARS—S:L (using a stringent cut score of four or more scale elevations) were successfully faked by 80% and 67% of students, respectively. The Conners CPT, in contrast to those measures, had both limited sensitivity to ADHD and specificity for FGN in this sample. Very high specificity and moderate sensitivity were noted for symptom validity measures across the board, translating into high positive predictive values. Binary logistic regression results indicate that the TOMM Trial 1 coupled with the DMT, LMT, or NV-MSVT may be used to identify feigners with high predictive accuracy.

Thesis advisor: Ellen Mahoney / The diagnosis of a primary malignant brain tumor (PMBT) can be devastating for individuals and their families due to the limited treatment options and poor prognosis. Patients often rely on family members to manage their care; however, many caregivers feel under-prepared and overwhelmed by the experience. Though caring for a person with a PMBT is challenging and complex, little research has addressed the family caregiver's performance. The purpose of this study was to identify the extent to which preparedness and caregiver role strain explained the family caregiver’s performance in symptom management. An adapted theoretical framework, The Theory of Unpleasant Symptoms for Family Caregivers, guided this study. The study employed a descriptive, correlational research design in which the researcher obtained cross-sectional data during one collection period. The participants were adults who identified themselves as family caregivers of persons with a PMBT. Forty caregivers were enrolled in the study at the Brain Tumor Center at Beth Israel Deaconess Medical Center. Results from the regression analyses indicated that caregiver role strain and preparedness explained 31% of the variance (adjusted R2) in perceived psychological symptom distress and 29% (adjusted R2) of the variance in perceived physical symptom distress. Caregiver role strain was the major contributor to psychological (B=.68, p=.000) and physical symptoms (B=.48, p=0.001), indicating that higher levels of caregiver role strain were predictive of higher levels of perceived symptom distress and this relationship was strong. Preparedness contributed less to the explained variance in psychological (B=-.24, p=.20) and physical symptoms (B=-.21, p=.14). The negative beta indicates that higher preparedness was related to lower perceived symptom distress, but this relationship was small when compared with role strain. This study informs clinicians in neuro-oncology that care giver role strain is often high in family caregivers of patients with a PMBT and can have a negative impact on caregiver performance. These findings also support the need for more tailored nursing interventions to assist caregivers with ways to decrease caregiver role strain and improve caregiver preparedness. / Thesis (PhD) — Boston College, 2008. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Using an existing data set comprised of 368 individuals newly diagnosed with cancers of the head and neck, we investigated the predictive validity of the Head and Neck Patient Symptom Checklist (HNSC) by comparing scores on the HNSC to scores on the Patient-Generated Symptom Global Assessment (PG-SGA), and by examining the ability of HNSC scores and four demographic variables to predict dietary intake, weight loss, and functional capacity. HNSC sensitivity (0.79 0.98), specificity (0.99 1.00), positive predictive value (92% 100%), and negative predictive value (94% - 100%) were excellent. Pain, loss of appetite and difficulty swallowing predicted 82% of reduced dietary intake. Advanced tumor stage, loss of appetite and difficulty swallowing predicted 79% of weight loss. Loss of appetite, difficulty swallowing, feeling full and lack of energy predicted 78% of reduced functional capacity. The HNSC appears to be valid and could aid with early symptom identification, intervention and improved outcomes.