Heart failure symptom burden,dietary intake,and inflammation:An integrative review of the literature

Heart failure(HF)is characterized by high symptom burden including,but not limited to fatigue,dyspnea,and edema.Up to 21.5%of HF patients experience significant depressive symptoms,much higher than 7.1%in adults without HF.Diet,metabolites,and other inflammatory mechanisms have gained notable attention in recent studies for contributions to symptoms in HF.Symptoms for black adults(B/As)with HF are often influenced by lifestyle factors,which may influence their higher mortality rates;few studies address these factors.Distinguishing the links between key elements with diet,inflammation,and symptoms may bring clarity for new dietary strategies in HF clinical care.The purpose of this integrative review is to examine the existing literature regarding relationships among physiologic pathways in HF along with physical and emotional symptoms in the context of inflammation,dietary intake,tumor necrosis factor‑alpha(TNF‑a),a biomarker of inflammation,and trimethylamine‑N‑Oxide(TMAO).Based on available evidence,inflammation may be a key link between physical symptoms,diet,depression,TMAO,and TNF‑a in persons with HF and warrants further examination to clarify pathological links to solidify evidence for better guidance with dietary modifications.The literature reviewed in this study demonstrates that more work is needed to examine dietary planning,social support,and differences between men and women in the B/A community.Results of this literature review call attention to the essential,personalized care needs related to symptom monitoring and dietary planning which is expected to decrease symptom burden in the HF population.

Symptom burden in advanced breast cancer patients and its association between death anxiety and psychological distress

Objective:Recent research has documented psychological distress in advanced breast cancer(ABC)patients,but few studies have examined how death anxiety is affected by the symptom burden.Therefore,this study aims to explore the association among symptom burden,death anxiety and psychological distress(depression and anxiety)in ABC patients.Methods:This cross-sectional study used the Death and Dying Anxiety Scale(DADDS),9-item Patient Health Questionnaire(PHQ-9),General Anxiety Disorder-7(GAD-7)and MD Anderson Symptom Inventory(MDASI)to assess death anxiety,depression,anxiety,and symptom burden,respectively.Bias-corrected bootstrapping methods were used to estimate indirect effects and 95%confidence intervals.Results:Two hundred ABC patients completed the questionnaires.All of the respondents were females,with a mean age of 50±10 years.Initial correlation analyses revealed significant associations of death anxiety with depression(r=0.57,P<0.001),anxiety(r=0.60,P<0.001)and symptom burden(r=0.43,P<0.001).Moreover,depression(r=0.53,P<0.001)and anxiety(r=0.45,P<0.001)were significantly correlated with symptom burden.An analysis using Hayes’PROCESS macro revealed the partial effecting role of death anxiety in the relationship between depression and symptom burden,and between anxiety and symptom burden(contributions to the total effect of 0.247 and 0.469,respectively).Conclusions:This study provides insight into the relationship between death anxiety and symptom burden.The results suggest that interventions addressing death anxiety may be more effective for alleviating the depression and anxiety experienced by ABC patients with a symptom burden.

Symptom burden amongst patients suffering from end-stage renal disease and receiving dialysis: A literature review

Patients suffering from end-stage renal disease and receiving dialysis experience a high symptom burden,which leads to an impaired quality of life and is associated with an increased risk of future hospitalisation and mortality.However,the symptom burden amongst patients undergoing dialysis was often underrecognised by clinical staff.In this paper,related works on symptom burden amongst patients with end-stage renal disease receiving dialysis,its concepts,assessment tools,status,and influencing factors were reviewed to draw clinical staff's attention for the relief of symptom burden amongst these patients and provide a reference for further research.

Palliative care needs and symptom burden in younger and older patients with end-stage renal disease undergoing maintenance hemodialysis:A cross-sectional study

Objectives:To investigate the current situation of palliative care needs and the symptom burden in patients with end-stage renal disease(ESRD)undergoing maintenance hemodialysis(MHD),and to explore whether there are differences between younger and older patients.Methods:This cross-sectional study was conducted in the hemodialysis centers of two tertiary hospitals from November 2021 to June 2022.Participants were selected by convenience sampling.Sociodemographics,clinical characteristics,the Palliative Care Outcome Scale(POS),the Dialysis Symptom Index(DSI),and health-related quality of life(EQ-5D-3L)were used for evaluation.Descriptive statistics,between-group comparisons,and correlation analysis were used to analyze the data.Results:A total of 236 patients were enrolled,including 118 younger and 118 older patients.The total median(P25,P75)POS score was 16.0(12.0,23.0),and the score was higher in older patients(P<0.01).The mean total number of symptoms in MHD patients was 15.04±5.06,and the overall median symptom severity score was 59.0(52.0,71.0);these scores were higher in the older group(P<0.01).The most common symptom was dry mouth(91.5%),followed by itching(83.1%),and dry skin(82.2%).Additionally,palliative care needs were significantly associated with symptom burden and health-related quality of life(HRQOL).Conclusions:The results showed that patients with ESRD undergoing MHD have a significant symptom burden and moderate palliative care needs,which are more severe in older patients.Therefore,interdisciplinary teams should be formed to actively manage patients’symptoms and meet the physical,psychological,social,and spiritual needs related to palliative care to improve patients’HRQOL.

The investigation of symptoms burden and treatment status in patients with bone metastasis

Objective:This survey was a non-intervention study,which aimed to investigate symptom burden and treatment status in cancer patient with bone metastasis,and to make out whether patients received the normative treatment.Methods:We designed a questionnaire,the main items of which include patient's symptom burden,previous and ongoing treatment.We used it to investigate 120 patients from six different medical agencies.We examined the association between symptoms using Spearman's rank correlation.SPSS software was used to analyze data.Results:The data of one hundred one questionnaires were completed and fitted for analysis.The five most prevalent symptoms were fatigue(84.2%),unhappiness(83.2%),pain(77.2%),dry mouth(77.2%) and lack of appetite(73.3%).Three symptom clusters were identified.Cluster 1 included anxiety and unhappiness and accounted for 61.4% in all patients.Cluster 2 included pain,fatigue and constipation and accounted for 39.6% in all patients.Cluster 3 included nausea,vomiting,lack of appetite and accounted for 27.7% in all patients.Cronbach's alpha coefficient demonstrated high internal reliability in the clusters,with a coefficient ranging from 0.65 to 0.84.The proportion of patients receiving analgesic therapy,bisphosphates therapy,palliative chemotherapy and radiotherapy were 70.3%,63.4%,58.4% and 36.6% respectively.Pain in various degree was obviously alleviated(P < 0.01) after analgesic therapy.Among the surveyed patients,64 patients received bisphosphates therapy,while the administration of zoledronic acid accounted for the most large proportion.The average duration of bisphosphates administration was 5.79 months(SD = 7.43).Patients who received radiotherapy adopted multiple fractions treating mode.Conclusion:Symptom burden was common and severe in patients with bone metastasis,which often appeared as symptom cluster,and significantly affected their quality of life(QOL).The normative treatment should be strengthened to manage and control patients' symptoms and improve their QOL.The analgesic therapy was normative in patients with bone metastasis.Reasons impeding patients to receive bisphosphates were in varieties.More propaganda should be done to generalized bisphosphates therapy for patients with bone metastasis.

Alcohol intolerance and myalgic encephalomyelitis/chronic fatigue

BACKGROUND The literature is mixed about the occurrence of alcohol intolerance among patients with myalgic encephalomyelitis/chronic fatigue syndrome(ME/CFS).Surveys that asked respondents with ME/CFS whether they experienced alcohol intolerance within a recent time frame might produce inaccurate results because respondents may indicate that the symptom was not present if they avoid alcohol due to alcohol intolerance.AIM To overcome this methodologic problem,participants in the current study were asked whether they have avoided alcohol in the past 6 mo,and if they had,how severe their alcohol intolerance would be if they were to drink alcohol.METHODS The instrument used was a validated scale called the DePaul symptom questionnaire.Independent t-tests were performed among the alcohol intolerant or not alcohol intolerant group.The alcohol intolerant group had 208 participants,and the not alcohol intolerant group had 96 participants.RESULTS Using specially designed questions to properly identify those with alcohol intolerance,those who experienced alcohol intolerance vs those who did not experience alcohol intolerance experienced more frequent/severe symptoms and domains.In addition,using a multiple regression analysis,the orthostatic intolerance symptom domain was related to alcohol intolerance.CONCLUSION The findings from the current study indicated that those with ME/CFS are more likely to experience alcohol intolerance.In addition,those with this symptom have more overall symptoms than those without alcohol intolerance.

Symptom Assessment and Management in Patients with Lung Cancer Undergoing Conventional or Traditional Chinese Medicine Care

Patients with lung cancer may experience various symptoms as the disease progresses,which may reduce the benefits of cancer treatment,reduce treatment compliance,delay cancer treatment,reduce the quality of life(QoL),and impact survival.This review discusses comprehensive symptom assessment and management,which are crucial for high-quality lung cancer treatment.Traditional Chinese medicine(TCM)is important in relieving cancer-related symptoms in patients with lung cancer.Including patient-reported outcomes(PROs)in clinical trials and practice can provide a better assessment of symptom burden and the effectiveness of symptom management.Patient-centered care with TCM in lung cancer patients may include six steps:Symptom screening,etiology investigation,comprehensive assessment,integrative management,reassessment,and regular symptom follow-up monitoring.PRO measures can be used to evaluate symptom intensity,the degree to which symptoms interfere with activities of daily living,and the QoL.Clearly defined and reliable PRO measures can enhance patient satisfaction and improve symptom control.Quantitative PRO measures developed from the TCM perspective should be considered one of the important outcome measurements in TCM care.A multidisciplinary collaborative symptom management model,including TCM and conventional therapy,will be the future goal for treating patients with lung cancer.

Advanced Chronic Obstructive Pulmonary Disease： Innovative and Integrated Management Approaches

Chronic obstructive pulmonary disease （COPD） is a leading cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. By the year 2020, COPD will be the third leading cause of mortality and the fifth leading cause of disability worldwide, In a population based study conducted at multiple international sites, approximately 10% of participants 40 years of age or older were found to have airflow obstruction of at least moderate severity according to spirometric criteria. In China, the overall prevalence of COPD in individuals 40 years of age or older was 8.2%.m COPD is a slowly progressive respiratory disease, which, although preventable and treatable, is not curable. The final years for patients with advanced COPD are characterized by progressive functional decline, frequent exacerbations, poor quality of life, increasing dependency on informal caregivers and on the health care system. According to the literature, 5-year survival from diagnosis is estimated to be 78% in men and 72% in women with mild disease, but only 30% in men and 24% in women with advanced COPD.