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No / Symptoms and signs (symptoms in brief) are the essential clinical manifestations for traditional Chinese medicine (TCM) diagnosis and treatments. To gain insights into the molecular mechanism of symptoms, this paper presents a network-based data mining method to integrate multiple phenotype-genotype data sources and predict the prioritizing gene rank list of symptoms. The result of this pilot study suggested some insights on the molecular mechanism of symptoms.

Background: Cannabis has been legalized in Canada since October 2018 and shown to be effective for chemotherapy-induced nausea (CIN). Purpose: Guided by the Ottawa Model of Research use, the aim was to determine factors influencing oncology nurses discussing cannabis use with patients experiencing CIN. Part I: A literature review to identify oncology nurses’ practices, knowledge, and attitude toward providing guidance on cannabis use for patients with CIN. Twelve articles were included. Results showed that health care professionals were hesitant to provide guidance for patients on using cannabis for medical purposes. But no studies specifically focus on nurses and CIN. Part II: A descriptive, cross-sectional study was conducted using survey methods. Twenty-five Canadian oncology nurses responded to the survey. Half (n=11) correctly answered the knowledge question about the effectiveness of cannabis. Most (n=18) did not feel confident providing guidance on use of cannabis for CIN. The top three barriers identified are social stigma, lack of knowledge, and lack of support in the workplace. Conclusion: Few Canadian oncology nurses discuss cannabis use for CIN. Identified barriers need to be addressed for oncology nurses to be prepared to discuss use of cannabis for CIN.

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Objectives: The first objective of this research was to examine whether symptom dimensions in obsessive-compulsive disorder (OCD) are associated with unique neuropsychological performance profiles. The second objective of this research was to further understand the strengths and weaknesses of two models of symptom dimensions in OCD from a quantitative perspective—conventional subtyping by overt symptom, and the core dimensions model. Finally, the third objective of this research was to investigate the efficacy and treatment acceptability of a cognitive remediation program targeting neurocognitive deficits associated with OCD. Methods: Study 1 reviewed critically studies describing the assessment of differences in neuropsychological functioning between symptom dimensions of OCD, the results of which informed succeeding studies examining: i) the characterization of symptom dimensions in OCD and; ii) the remediation of neuropsychological domains commonly affected in OCD. Accordingly, study 2 compared the suitability of two common statistical approaches, factor analysis and cluster analysis, commonly used in the existing literature to define symptom dimensions based on responses collected from the industry-standard symptom questionnaire, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), in characterizing symptom dimensions in OCD. Neuropsychological task data were then used to examine the validity of an alternative model of symptom dimensions in OCD (Study 3). Finally, we conducted a feasibility study (Study 4) examining the use of an established cognitive remediation protocol, Goal Management Training (GMT), to target the deficits in neurocognitive function identified in the preceding studies. Results: Much of the existing literature on neuropsychological task performance differences between symptom dimensions of OCD is limited by methodological issues, primarily those concerning methods for defining symptom dimensions. Here, a comparison of the two most common methods for defining dimensions revealed that neither cluster analysis nor factor analysis produced conceptually meaningful subgroups. By exemplifying differences in neuropsychological task performance between those with harm avoidance and those with incompleteness symptoms, however, concrete evidence was provided to support the core dimensions model of OCD. Pilot data point towards the feasibility and efficacy of GMT as a cognitive remediation program for OCD. Conclusions: Pursuing the definition of meaningful, distinct symptom dimensions of OCD is not recommended with the combination of current statistical practices and symptom measures. The early evidence presented here shows promise for the validity of the core dimensions model. Preliminary evidence suggests that the neuropsychological impairments observed in this population, although subtle, may be effectively addressed using Goal Management Training. / Thesis / Doctor of Philosophy (PhD)

No / Fatigue is a complex symptom commonly experienced by people with life-limiting illnesses. It has been identified in patients with, for example, cancer, heart failure, respiratory conditions, acquired immunodeficiency syndrome and renal failure. It is often rated by patients as having a greater effect on quality of life than pain. This article will explore the manifestations and consequences of fatigue. It will propose a minimum standard for its assessment and management and describe the implementation and evaluation of an audit, conducted in a hospice environment, designed to evaluate achievement of this standard. Although this audit was carried out in a hospice setting, the aim of the article is also to raise awareness of fatigue in all healthcare settings and to improve the assessment of this debilitating symptom.

No / Context. There is need for tools to help detect pain or lack of comfort in persons unable to communicate. However, pain and (dis)comfort tools have not been compared, and it is unclear to what extent they discriminate between pain and other possible sources of discomfort, or even if items differ. Objectives. To map and compare items in tools that assess pain and the broader notion of discomfort or comfort in people with severe dementia or at the end of life. Methods. Using qualitative content analysis with six classifications, we categorized each item of four thoroughly tested observational pain tools (Pain Assessment in Advanced Dementia [PAINAD], Pain Assessment Checklist for Seniors with Limited Ability to Communicate [PACSLAC], Doloplus-2, and draft Pain Assessment in Impaired Cognition [PAIC]), and four discomfort tools (including distress, comfort, and quality of life in severe dementia or at the end of life; Discomfort ScaleeDementia Alzheimer Type [DS-DAT], Disability Distress Assessment Tool [DisDAT], End-of-Life in DementiaeComfort Assessment in Dying with Dementia [EOLD-CAD], and Quality of Life in Late-Stage Dementia [QUALID] scale). We calculated median proportions to compare distributions of categories of pain and discomfort tools. Results. We found that, despite variable content across tools, items from pain and discomfort tools overlapped considerably. For example, positive elements such as smiling and spiritual items were more often included in discomfort tools but were not unique to these. Pain tools comprised more ‘‘mostly descriptive’’ (median 0.63 vs. 0.44) and fewer ‘‘highly subjective’’ items (0.06 vs. 0.18); some used time inconsistently, mixing present and past observations. Conclusion. This analysis may inform a more rigorous theoretical underpinning and (re)development of pain and discomfort tools and calls for empirical testing of a broad item pool for sensitivity and specificity in detecting and discriminating pain from other sources of discomfort.