Indiana University-Purdue University Indianapolis (IUPUI) / Symptom research with advanced lung cancer patients has primarily focused on symptom severity, frequency, and distress; yet, little is known about advanced lung cancer patients’ priorities and success criteria for symptom improvement. To address these gaps in the literature, this study examined these outcomes using a modified Patient Centered Outcomes Questionnaire (PCOQ), which has largely been used with adults with chronic pain. Advanced lung cancer patients (N = 102) were recruited from the Indiana University Simon Cancer Center to participate in a one-time self-report survey, including demographic and medical questionnaires, symptom treatment history, standardized measures of symptom severity and quality of life, and the modified PCOQ focused on eight common symptoms in advanced lung cancer. Cancer information was collected from medical records. My primary aim was to evaluate the construct validity of the PCOQ. As hypothesized, symptom severity ratings on the PCOQ were positively correlated with standardized assessments of the same symptoms as well as functional status. Greater severity of most symptoms on the PCOQ was also correlated with worse quality of life, and greater severity of four symptoms was correlated with having more medical comorbidities. Positive, moderate correlations were found between the severity and importance of seeing improvement in cough, fatigue, sleep problems, and pain on the PCOQ. Patients considered low levels of symptom severity to be acceptable following symptom treatment; no differences were found across the eight symptoms. Latent profile analysis identified four patient subgroups based on the importance of seeing improvement in each of the symptoms: (1) those who rated all symptoms as low in importance (n = 12); (2) those who rated bronchial symptoms and sleep problems as low in importance and all other symptoms as moderately important (n = 29); (3) those who rated nausea and emotional distress as low in importance and all other symptoms as moderately important (n = 23); and (4) those who rated all symptoms as highly important (n = 33). These subgroups were unrelated to demographic and clinical factors, except for functional status. Findings suggest that symptom severity and importance are related yet distinct aspects of the advanced lung cancer symptom experience. Furthermore, patients have heterogeneous priorities for symptom management, which has implications for tailoring treatment.

No description available.

Bakgrund Attention-deficit hyperactivity disorder [ADHD] kännetecknas av symtom på ouppmärksamhet, impulsivitet och hyperaktivitet och hör till gruppen neuropsykiatriska diagnoser. Enligt rådande diagnostiska kriterier ska symtomdebut uppstått innan tolv års ålder och symtomen ska orsaka en varaktig och betydande funktionsnedsättning. Cirka tre procent av den vuxna befolkningen beräknas leva med ADHD. Syfte Syftet var att belysa vuxnas upplevelser av att leva med ADHD. Metod Studien var en icke-systematisk litteraturöversikt som har utgått från 17 vetenskapliga artiklar som har analyserats. Artiklarna har inhämtats från databaserna PubMed och CINAHL och är kvalitetsgranskade utifrån Sophiahemmets granskningsunderlag. Resultat Två huvudkategorier identifierades utifrån inkluderade artiklar; Upplevelser av social livskvalitet och Livskvalitet - resurser och behov. Utöver detta identifierades sju underkategorier; Begränsningar i dagliga livet; Utbildning arbete och relationer; Konsekvenser för hälsa och välbefinnande; Samsjuklighet; Betydelse av en diagnos; Strategier i symtomhantering; samt ADHD - positiva upplevelser. Resultatet visade på skillnader i symtomhantering relaterat till tidig eller sen diagnostik, vilket resulterat i skillnader gällande konsekvenser i livet. Slutsats Denna uppsats visade på en bredd av upplevelser relaterat till att erhålla en diagnos som vuxen samt erfarenheter av att leva med symtom innan diagnostisering. Studien fann att många personer med ADHD upplever begränsningar i dagliga livet. Fördjupad kunskap om konsekvenser av ADHD kan bidra till en bättre förståelse och vård för denna patientgrupp. / Background Attention-deficit hyperactivity disorder [ADHD] is characterized by symptoms of inattention, impulsivity and hyperactivity and belongs to the group of neuropsychiatric diagnosis. According to prevailing diagnostic criteria, the onset of symptoms must have occurred before the age of twelve and the symptoms must cause a lasting and significant functional impairment. About three percent of the adult population is estimated to live with ADHD. Aim The aim was to describe adults’ experiences of living with ADHD. Method The study was a non-systematic literature review based on 17 scientific articles that were analyzed. The articles have been obtained from the following databases PubMed and CINAHL and are quality checked based on Sophiahemmet review documents. Results Two main categories were identified based on included articles; Experiences of social quality of life, and Quality of life - resources and needs. In addition to this, seven subcategories were identified; Limitations in daily life; Education work and relationships; Implications for health and well-being; Comorbidity; Significance of a diagnosis; Strategies in symptom management and ADHD - positive experiences. The results showed differences in symptom management related to having received an early or late diagnosis, which resulted in differences regarding consequences in life. Conclusions This essay showed a breadth of experiences related to receiving a diagnosis as an adult as well as experiences of living with symptoms prior to diagnosis. The study found that many people with ADHD experience limitations in daily life. In-depth knowledge of the consequences of ADHD can contribute to a better understanding and care for this patient group.

The current study examines racial differences in the management of Attention Deficit Hyperactivity Disorder (ADHD) among Black adolescents. This study also examines Black adults' reflection upon adolescent symptoms of ADHD. Drawing on literature from racial/ethnic disparities in diagnosis and treatment of ADHD, health care service utilization, health behaviors, structural racism and medicalization, this study examines the health behavior and health care utilization practices of Black people, analyzing the avenues through which racism structures the management of symptoms. This study also explores the ways in which management of adolescent symptoms of ADHD shape Black adults' self-management of symptoms in adulthood. To investigate such ideas data from the National Comorbidity Survey- Adolescent Supplement (NCS-A) and the Parent Self-Administered Questionnaire (PSA-Q) were analyzed to offer a descriptive picture of differences in management and treatment of adolescent ADHD symptoms. Ten interviews were conducted with Black adults to offer depth to reported interpersonal causes of racial differences in management and treatment and assist in placing such causes within a framework of structural racism. Interview questions focused on participant's articulation of the socio-political landscape in which adolescent symptoms of ADHD were experienced. Additional questions targeted processes around parent's management of symptoms, the school systems management of symptoms, participant's relationships to medical care providers and avenues to treatment. Quantitative findings suggest there are racial differences present in the management of adolescent ADHD and qualitative findings offer that these differences are reflective of a structural system of power and privilege that shapes Black people's engagement with and access to care for symptoms of ADHD. This research contributes to existent knowledge about reported racial differences in management of symptoms of ADHD, and has implications for the ways in which literature approaches racial disparities in diagnosis and treatment of ADHD among Black adolescents. / Doctor of Philosophy / The current study examines racial differences in the management of Attention Deficit Hyperactivity Disorder (ADHD) among Black adolescents. This study also examines Black adults’ reflection upon adolescent symptoms of ADHD. Drawing on literature from racial and ethnic disparities in diagnosis and treatment of ADHD, health care service utilization, health behaviors, structural racism and medicalization, this study examines the health behavior and health care utilization practices of Black people. This study also explores the relationship between adolescent and adult management of ADHD symptoms. To investigate differences by race data from the National Comorbidity Survey- Adolescent Supplement (NCS-A) and the Parent Self-Administered Questionnaire (PSA-Q) were analyzed. In addition, interviews were conducted with Black adults to offer depth and give context to the ways in which race and racism shaped quantitative findings. Interview questions focused on participant’s adolescent management of symptoms by familial networks and school systems, as well as participant’s adult relationships to medical care providers and symptom management. Quantitative findings suggest racial differences are present in the management of adolescent ADHD and qualitative findings offer that these differences are reflective of the ways in which racism shapes Black people’s engagement with and access to care for symptoms of ADHD. This research contributes to existent knowledge about reported racial differences in management of symptoms of ADHD, and has implications for the ways in which literature approaches racial disparities in diagnosis and treatment of ADHD among Black adolescents.

Syfte: Syftet var att utvärdera effekten av sjuksköterskans föreslagna omvårdnadsåtgärder på cytostatikarelaterade biverkningar hos cancerpatienter som genomgår cytostatikabehandling. Metod: Examensarbetet utfördes som en litteraturöversikt. Resultatet grundar sig på 13 stycken kvantitativa artiklar. För datainsamlingen användes databaserna PubMed och Cinahl. Resultat: Resultatet visade att sjuksköterskan kan utföra omvårdnadsåtgärder som minskar patienters upplevelse av cytostatikarelaterade biverkningar. Effekterna som framkom av sjuksköterskans omvårdnadsåtgärder presenteras under rubrikerna; oral kryoterapi vid oral mukosit, personcentrerad patientutbildning med underrubriken utbildning utifrån ett teoretiskt perspektiv, automatiserad och sjuksköterske- assisterad symtombehandling samt musikterapi, bildspråk och avslappning. Slutsats: Sjuksköterskan kan genom olika omvårdnadsåtgärder hjälpa patienter att lindra symtom från cytostatikarelaterade biverkningar. / Aim: To evaluate the impact of the nurse's suggested nursing interventions on chemotherapy-related side effects in cancer patients undergoing chemotherapy treatment. Method: The work was conducted as a literature review. The results are based on 13 quantitative articles. For data collection the databases PubMed and Cinahl was used. Results: The results showed that nurses can perform nursing interventions that reduce patients' experience of chemotherapy-related side effects. The effects that emerged from the nursing interventions are presented under the headings; oral cryotherapy for oral mucositis, person-centered patient education with the subtitle education from a theoretical perspective, self-care, automated and nurses assisted symptom management, music therapy, imagery and relaxation. Conclusion: Nurses can through various nursing interventions help patients to relieve symptoms from chemotherapy-related side effects.

Background and Objectives: Alterations in the habitual sleep/wake patterns of women with breast cancer and their informal caregivers may be concurrently exacerbated and co-vary during the patient’s treatment. The current study set out to longitudinally ex-plore sleep-wake patterns of patient-caregiver dyads in the context of adjuvant chemotherapy (CTh) for breast cancer. Taking into consideration the complexity of mechanisms interfering with a care dyad’s sleep, diverse sleep-impairing factors were also investigated. Design and Methods: Descriptive, observational, repeated-measures dyadic study. Forty eight newly diagnosed women receiving outpatient adjuvant CTh for early stage breast cancer (stage I-IIIA) and their nominated primary informal caregiver completed self-reported sleep measures at pre-treatment (week prior to CTh), post-CTh cycle 1, post-CThC4, and approximately 30 days after the end of CTh (total of =6 cycles received). Additional data on the dyads’ sleep hygiene practices (SH), patient physical burden, caregiving burden (CRACB), psychological burden (PSYCH), nocturnal sleep disturbances (SDSTRB), and maladaptive coping strategies were collected at each assessment point. Results: Prior to CTh, 65% of dyads consisted of at least one poor sleeper, a rate further increasing to approximately 88% at CThC4. Multivariate hierarchical linear modelling revealed curvilinear trajectories for most dyads’ sleep/wake parameters that nevertheless reached significance (p<.05) for patients only. In both groups, sleep/wake impairment reached its peak at mid-treatment (CThC4); yet, patients consistently reported significantly more sleep problems than their carers. Partial convergence also emerged as suggested by positive correlations and no between-groups differences in daily disturbance, daytime napping duration, total sleep time, and overall sleep/wake impairment at pre-treatment. At CThC4, rates of change in sleep latency and daytime napping duration were also similar. In exploratory analyses, increased CRACB, poor SH, and SDSTRB consistently predicted poorer outcomes in the dyad members’ own sleep-wake patterns. Cross-partner effects most frequently emerged with regard to the dyads’ PSYCH, as well as for CRACB. Among the most interesting findings, increased patient PSYCH adversely affected caregiver perceived sleep quality and daytime napping. Reversely, increased CRACB was related to worse patient sleep quality, reduced sleep time, and difficulty to fall asleep. Some links might be suggested for own poor sleep hygiene and worse partner outcomes on daytime functioning, sleep efficiency, or wake after sleep onset. Conclusions and Future Implications: This is one of the first studies to show that a dyadic approach in the assessment of sleep/wake patterns in patients with breast cancer and their informal carers is a promising method to enhance exploration of potentially concurrent sleep/wake-impairment and associations with sleep-impairing factors that may co-vary in dyad members. Replication of the current findings in future dyadic sleep research is warranted. Meanwhile, clinicians will need to engage in concurrent systematic and ongoing sleep assessments that synthesise and contrast data to establish a care dyad’s level of sleep quality.

No description available.

Bakgrund Mer än tio miljoner människor i världen lever med Parkinsons sjukdom, och prevalensen ökar med en åldrande befolkning. Parkinsons sjukdom är en kronisk neurologisk sjukdom som medför en mängd funktionsnedsättande symtom, både motoriska och icke-motoriska, vilka har stor påverkan på en persons dagliga liv. Den medicinska behandling som finns kan endast lindra symtom delvis och därför finns det ett behov av komplementära behandlingar, exempelvis musikterapi, som kan lindra symtom hos personer med Parkinsons sjukdom. Syfte Syftet med denna litteraturstudie är att belysa musikterapi i form av sång som symtomlindrande omvårdnadshandling vid Parkinsons sjukdom. Metod Studiedesignen är en icke-systematisk litteraturöversikt. Totalt 15 vetenskapliga artiklar inkluderades, däribland 13 kvantitativa och 2 kvalitativa. Resultatet sammanställdes i form av en integrerad analys. Resultat Två huvudkategorier, motoriska och icke-motoriska symtom, samt sex underkategorier till dessa identifierades i studien. Resultatet visade positiva effekter av sångterapi på såväl motoriska som icke-motoriska symtom. Förbättringar av motoriska symtom gällde framför allt kommunikations- och talförmåga. En viss förbättring av sväljförmåga och gångförmåga observerades dock.  Vad gäller icke-motoriska symtom så framkom ett flertal positiva effekter på psykisk, social och existentiell hälsa/livskvalitet; sångterapi visade sig kunna förbättra humör och minska depressiva symtom, oro/ångest, stress och apati. Dessutom hittades förbättringar vad gäller förmågan och viljan att socialisera sig med andra. Slutsats Resultatet av denna studie visar att sångterapi kan ha en symtomlindrande funktion i omvårdnaden av personer med Parkinsons sjukdom vad gäller såväl motoriska som icke-motoriska symtom. De huvudsakliga symtomlindrande effekterna av sångterapi gällde tal och kommunikation samt psykisk, social och existentiell hälsa/ livskvalitet. Dock behövs mer omfattande studier inom området, särskilt RCT-studier. / Background More than ten million people around the world are living with Parkinson’s disease, and the prevalence is increasing with an ageing population. Parkinson’s disease is a chronic neurological disease that entails a variety of functional impairments. the symptoms are motor as well as non-motor, all of which have a large impact on a person’s daily life. The existing medical treatment can relieve symptoms only partly; on account of this there is a need of complementary treatments, for example music therapy, for added symptom relief. Aim The aim of this literature review is to illustrate music therapy by singing as a symptom relieving nursing act. Method The study design is a non-systematic literature review. A total of 15 scientific articles were included, 13 quantitative studies and 2 qualitative studies. The result was compiled in the form of an integrative analysis. Results Two main categories, motor, and non-motor symptoms, and six subcategories were identified. Results of this study shows positive effects of singing therapy on motor and non-motor symptoms.  Improvements of motor symptoms mainly concerned communication and speech abilities. Some improvement of swallowing abilities and gait function could be observed.  Regarding non-motor symptoms several positive effects were displayed for mental, social, and existential health/quality of life; singing therapy improved temper and reduced depressive symptoms, anxiety, stress, and apathy. Improvements regarding the ability and will to socialize with other people were also found. Conclusions This study shows that singing therapy could have a symptom relieving function in nursing care for individuals with Parkinson´s disease, for both motor and non-motor symptoms. The main symptom relieving effects concerned communication and speech abilities and mental, social, and existential health/quality of life. However, there is a need for further studies, especially randomized controlled studies.

This thesis in the field of microdata analysis aims to introduce dose optimizing algorithms for the pharmacological management of Parkinson’s disease (PD). PD is a neurodegenerative disease that mostly affects the motor functions of the patients and it is characterized as a movement disorder. The core symptoms of PD are: bradykinesia, postural instability, rigidity, and tremor. There is no cure for PD and the use of levodopa to manage the core symptoms is considered the gold standard. However, long term use of levodopa causes reduced medication efficacy, and side effects, such as dyskinesia, which can also be attributed to overmedication. When that happens precise individualized dosing schedules are required. The goal of this thesis is to examine if algorithmic methods can be used to find dosing schedules that treat PD symptoms and minimize manifestation of side effects. Data from three different sources were used for that purpose: data from a clinical study in Uppsala University hospital in 2015, patient admission chart data from Uppsala University hospital during 2011-2015, and data from a clinical study in Gothenburg University during 2016-2017. The data were used to develop the methods and evaluate the performance of the proposed algorithms.The first algorithm that was developed was a sensor-based method that derives objective measurements (ratings) of PD motor states. The construction of the sensor index was based on subjective ratings of patients’ motor functions made by three movement disorder experts. This sensor-based method was used when deriving algorithmic dosing schedules. Afterwards, a method that uses medication information and ratings of the patients’ motor states to fit individual patient models was developed. This method uses mathematical optimization to individualize specific parameters of dose-effects models for levodopa intake, through minimizing the distance between motor state ratings and dose-effect curves. Finally, two different dose optimization algorithms were developed and evaluated, that had as input the individual patient models. The first algorithm was specific to continuous infusion of levodopa treatment, where the patient’s state was set to a specific target value and the algorithm made dosing adjustments to keep that patients motor functions on that state. The second algorithm concerned oral administration of microtables of levodopa. The ambition with this algorithm was that the suggested doses would find the right balance between treating the core symptoms of PD and, at the same time, minimizing the side effects of long term levodopa use, mainly dyskinesia. Motor state ratings for this study were obtained through the sensor index. Both algorithms followed a principle of deriving a morning dose and a maintenance dose for the patients, with maintenance dose being an infusion rate for the first algorithm, and oral administration doses at specific time points for the second algorithm.The results showed that the sensor-based index had good test-retest reliability, sensitivity to levodopa treatment, and ability to make predictions in unseen parts of the dataset. The dosing algorithm for continuous infusion of levodopa had a good ability to suggest an optimal infusion rating for the patients, but consistently suggested lower morning dose than what the treating personnel prescribed. The dosing algorithm for oral administration of levodopa showed great agreement with the treating personnel’s prescriptions, both in terms of morning and maintenance dose. Moreover, when evaluating the oral medication algorithm, it was clear that the sensor index ratings could be used for building patient specific models.

It is well-established that personality not only affects physical health and longevity, but also mental health and coping mechanisms. One area of limited research is the relationship between cancer pain and personality. This study examined how personality traits affect reported cancer pain severity in older patients (N = 150) receiving outpatient treatment at a comprehensive cancer center. Participants were interviewed regarding their pain severity, personality, affect, and self-efficacy for pain management. Symptom data were collected from the Brief Pain Inventory, while personality data were gathered from the Ten Item Personality Inventory and the Positive and Negative Affect Schedule. Self-efficacy for pain management was collected from the Chronic Pain Self-efficacy Scale. Analyses included descriptives, Chi-square tests, t-tests, stepwise linear regressions, and moderation analyses. The mean age of the sample was 65.38 ± 7.72 years. Seventy-nine percent of the sample was White. Analyses indicated that the average pain was 4.15 ± 2.01 (0-10 scale; with 10 being worst pain), with the sample recording means of 6.53 ± 2.57 and 2.45 ± 2.15 on worst and least pain, respectively. Regression analyses showed extraversion (â = -0.21, p < .01) and openness to experience (â = 0.18, p < .05) to be significant predictors of higher current and average pain severity, respectively. Agreeableness (â = 0.18, p < .05) was found to be a significant predictor of higher self-efficacy for pain management. Conscientiousness and extraversion were significant moderators in the relationship between self-efficacy for pain management and worst pain severity. These findings indicate that different personality types and personal affect may influence reports of pain severity. More empirical research is needed to understand the impact of personality and its relationship with pain severity and self-efficacy for pain management in more diverse and marginalized cancer populations across the age continuum. Finally, the results may be used to design more individualized interventions on pain management, depending on personality type, an application that has never been done in older adults with cancer.