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Dunbar SB, McCauley LA, Yeager KA, Holstad MM, Corwin EJ, Hertzberg V. Multiple Chronic Conditions, Metabolites, and Symptoms. Nurs Res 2025; 74:4-8. [PMID: 39666466 DOI: 10.1097/nnr.0000000000000789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
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Lockwood MB, Sung C, Alvernaz SA, Lee JR, Chin JL, Nayebpour M, Bernabé BP, Tussing-Humphreys LM, Li H, Spaggiari M, Martinino A, Park CG, Chlipala GE, Doorenbos AZ, Green SJ. The Gut Microbiome and Symptom Burden After Kidney Transplantation: An Overview and Research Opportunities. Biol Res Nurs 2024; 26:636-656. [PMID: 38836469 DOI: 10.1177/10998004241256031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Many kidney transplant recipients continue to experience high symptom burden despite restoration of kidney function. High symptom burden is a significant driver of quality of life. In the post-transplant setting, high symptom burden has been linked to negative outcomes including medication non-adherence, allograft rejection, graft loss, and even mortality. Symbiotic bacteria (microbiota) in the human gastrointestinal tract critically interact with the immune, endocrine, and neurological systems to maintain homeostasis of the host. The gut microbiome has been proposed as an underlying mechanism mediating symptoms in several chronic medical conditions including irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, and psychoneurological disorders via the gut-brain-microbiota axis, a bidirectional signaling pathway between the enteric and central nervous system. Post-transplant exposure to antibiotics, antivirals, and immunosuppressant medications results in significant alterations in gut microbiota community composition and function, which in turn alter these commensal microorganisms' protective effects. This overview will discuss the current state of the science on the effects of the gut microbiome on symptom burden in kidney transplantation and future directions to guide this field of study.
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Affiliation(s)
- Mark B Lockwood
- Department of Biobehavioral Nursing Science, University of Illinois Chicago College of Nursing, Chicago, IL, USA
| | - Choa Sung
- Post-Doctoral Fellow, Department of Biobehavioral Nursing Science, University of Illinois Chicago College of Nursing, Chicago, IL, USA
| | - Suzanne A Alvernaz
- Graduate Student, Department of Biomedical Engineering, University of Illinois ChicagoColleges of Engineering and Medicine, Chicago, IL, USA
| | - John R Lee
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jennifer L Chin
- Medical Student, Touro College of Osteopathic Medicine, Middletown, NY, USA
| | - Mehdi Nayebpour
- Virginia BioAnalytics LLC, Washington, District of Columbia, USA
| | - Beatriz Peñalver Bernabé
- Graduate Student, Department of Biomedical Engineering, University of Illinois ChicagoColleges of Engineering and Medicine, Chicago, IL, USA
| | - Lisa M Tussing-Humphreys
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Hongjin Li
- Department of Biobehavioral Nursing Science, University of Illinois Chicago College of Nursing, Chicago, IL, USA
| | - Mario Spaggiari
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Alessandro Martinino
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Chang G Park
- Department of Population Health Nursing Science, Office of Research Facilitation, University of Illinois Chicago, Chicago, IL, USA
| | - George E Chlipala
- Research Core Facility, Research Resources Center, University of Illinois Chicago, Chicago, IL, USA
| | - Ardith Z Doorenbos
- Department of Biobehavioral Nursing Science, University of Illinois ChicagoCollege of Nursing, Chicago, IL, USA
| | - Stefan J Green
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
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Zhou Z, Ren J, Liu Q, Li S, Xu J, Wu X, Xiao Y, Zhang Z, Jia W, Bai H, Zhang J. A nomogram for predicting the risk of cancer-related cognitive impairment in breast cancer patients based on a scientific symptom model. Sci Rep 2024; 14:14566. [PMID: 38914627 PMCID: PMC11196746 DOI: 10.1038/s41598-024-65406-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
Cancer-related cognitive impairment is a significant clinical challenge observed in patients with breast cancer, manifesting during or after treatment. This impairment leads to deteriorations in memory, processing speed, attention, and executive functioning, which profoundly impact patients' occupational performance, daily living activities, and overall quality of life. Grounded in the Symptom Science Model 2.0, this study investigates the contributing factors to Cancer-related cognitive impairment in breast cancer patients and develops a predictive nomogram for this demographic. Employing both univariate and multivariate logistic regression analyses, this investigation delineates the predictive factors influencing outcomes in breast cancer patients. A nomogram was constructed leveraging these identified predictive factors, accompanied by internal validation through bootstrap resampling methodology (1000 bootstrap samples). The efficacy of the predictive model was assessed by employing the Hosmer-Lemeshow goodness-of-fit test and calibration curves. The prevalence of cognitive impairment in breast cancer patients was identified to be 45.83%.Multivariate logistic regression analysis identified the independent predictors of Cancer-related cognitive impairment in breast cancer patients as place of residence, educational level, chemotherapy, benefit finding, post-traumatic growth, anxiety, fear of cancer progression, and fasting blood glucose levels. these factors were integrated into the nomogram. The Hosmer-Lemeshow goodness-of-fit test demonstrated that the prediction model was appropriately calibrated (χ2 = 11.520, P = 0.174). Furthermore, the model exhibited an area under the curve of 0.955 (95% CI 0.939 to 0.971) and a sensitivity of 0.906, evidencing its robust discriminative capacity and accuracy. Utilizing the Symptom Science Model 2.0 as a framework, this study comprehensively examines the multifaceted factors influencing Cancer-related cognitive impairment in breast cancer patients, spanning five critical domains: complex symptoms, phenotypic characterization, biobehavioral factors, social determinants of health, and patient-centered experiences. A predictive nomogram model was established, demonstrating satisfactory predictive accuracy and capability. This model is capable of identifying breast cancer patients with cognitive impairments with high precision. The findings furnish empirical evidence in support of the early detection, diagnosis, and intervention strategies for high-risk breast cancer patients afflicted with Cancer-related cognitive impairment.
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Affiliation(s)
- Zhongtao Zhou
- College of Nursing, Bengbu Medical University, Bengbu, Anhui, People's Republic of China
| | - Jiajia Ren
- College of Public Health, Bengbu Medical University, Bengbu, Anhui, People's Republic of China
| | - Qiankun Liu
- College of Nursing, Bengbu Medical University, Bengbu, Anhui, People's Republic of China
| | - Shuoshuo Li
- College of Nursing, Bengbu Medical University, Bengbu, Anhui, People's Republic of China
| | - Jiahui Xu
- College of Mental Health, Bengbu Medical University, Bengbu, Anhui, People's Republic of China
| | - Xiaoyan Wu
- College of Mental Health, Bengbu Medical University, Bengbu, Anhui, People's Republic of China
| | - Yuanxiang Xiao
- College of Mental Health, Bengbu Medical University, Bengbu, Anhui, People's Republic of China
| | - Zipu Zhang
- College of Clinical Medicine, Bengbu Medical University, Bengbu, Anhui, People's Republic of China
| | - Wanchen Jia
- College of Mental Health, Bengbu Medical University, Bengbu, Anhui, People's Republic of China
| | - Huaiyu Bai
- College of Nursing, Bengbu Medical University, Bengbu, Anhui, People's Republic of China
| | - Jing Zhang
- College of Mental Health, Bengbu Medical University, Bengbu, Anhui, People's Republic of China.
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Graves LY, Keane KF, Taylor JY, Wang TF, Saligan L, Bogie KM. Subacute and Chronic Spinal Cord Injury: A Scoping Review of Epigenetics and Secondary Health Conditions. Epigenet Insights 2023; 16:25168657231205679. [PMID: 37900668 PMCID: PMC10612389 DOI: 10.1177/25168657231205679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/11/2023] [Indexed: 10/31/2023] Open
Abstract
Background Epigenetics studies the impact of environmental and behavioral factors on stable phenotypic changes; however, the state of the science examining epigenomic mechanisms of regulation related to secondary health conditions (SHCs) and neuroepigenetics in chronic spinal cord injury (SCI) remain markedly underdeveloped. Objective This scoping review seeks to understand the state of the science in epigenetics and secondary complications following SCI. Methods A literature search was conducted, yielding 277 articles. The inclusion criteria were articles (1) investigating SCI and (2) examining epigenetic regulation as part of the study methodology. A total of 23 articles were selected for final inclusion. Results Of the 23 articles 52% focused on histone modification, while 26% focused on DNA methylation. One study had a human sample, while the majority sampled rats and mice. Primarily, studies examined regeneration, with only one study looking at clinically relevant SHC, such as neuropathic pain. Discussion The findings of this scoping review offer exciting insights into epigenetic and neuroepigenetic application in SCI research. Several key genes, proteins, and pathways emerged across studies, suggesting the critical role of epigenetic regulation in biological processes. This review reinforced the dearth of studies that leverage epigenetic methods to identify prognostic biomarkers in SHCs. Preclinical models of SCI were genotypically and phenotypically similar, which is not reflective of the heterogeneity found in the clinical population of persons with SCI. There is a need to develop better preclinical models and more studies that examine the role of genomics and epigenomics in understanding the diverse health outcomes associated with traumatic SCI.
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Affiliation(s)
- Letitia Y Graves
- School of Nursing, University of Texas Medical Branch, Galveston, TX, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Kayla F Keane
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Jacquelyn Y Taylor
- Columbia School of Nursing and Center for Research on People of Color, New York, NY, USA
| | - Tzu-fang Wang
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Leorey Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Kath M Bogie
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
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Zhang R, Wang DM, Liu YL, Tian ML, Zhu L, Chen J, Zhang J. Symptom management in adult brain tumours: A literature review. Nurs Open 2023. [PMID: 37120840 DOI: 10.1002/nop2.1795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023] Open
Abstract
AIM To review the literature related to symptom management, clinical significance and related theoretical framework systems in adult patients with brain tumours. BACKGROUND As understanding of symptoms or symptom clusters and underlying biologic mechanisms has grown, it is apparent that symptom science is moving forward. Although some progress has been made in the symptom science of solid tumours such as breast and lung neoplasms, insufficient attention has been paid to symptom management for patients suffering from brain tumours. Further research is needed to achieve effective symptom management for these patients. DESIGN A literature review with a systematic search of symptom management in adult brain tumours. METHODS Electronic data bases were searched to obtain relevant published literature on symptom management in adults with brain tumours. This was then analysed and a synthesis of relevant findings is presented. FINDINGS Four significant general themes relating to symptom management of brain tumours in adults were identified: (1) The potential theoretical foundation related to symptom management was revealed. (2) Widely accepted validated scales or questionnaires for the assessment of single symptoms or symptom clusters were recommended. (3) Several symptom clusters and the underlying biologic mechanisms have been reported. (4) Specific symptom interventions for adults with brain tumours were collected and classified as evidence-based or insufficient evidence. CONCLUSION There are still many challenges in the effective management of symptoms in adults with brain tumours. The guiding role of theoretical frameworks or models related to symptom management should be utilized in future research. Using the concept of symptom clustering for research into symptoms found in patients with brain tumours, exploring common biological mechanisms for specific symptom clusters and making full use of modern big data resources to build a strong evidence base for an effective intervention or management program may inform the management of symptoms among these patients leading to better results. NO PATIENT OR PUBLIC CONTRIBUTION This is a literature review. IMPLICATIONS FOR SYMPTOM MANAGEMENT The ultimate goal is obviously not only improving the survival rate of patients with brain tumours, but also enhancing their quality of life. Several important findings from our review include the theoretical foundations, validated assessment tools, the assessment of symptom clusters and the underlying biologic mechanism, and the identification of the evidence base for symptom interventions. These are of relevance for managers, researchers and practitioners and may function as a reference to help the effective symptom management for adults with brain tumours.
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Affiliation(s)
- Rong Zhang
- School of Nursing, Wuhan University, Wuhan, China
- Department of Neuro-Oncology Center, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Dong-Mei Wang
- Department of Neuro-Oncology Center, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yong-Li Liu
- Nursing Department, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Man-Li Tian
- College of Nursing, Hubei University of Medicine, Shiyan, China
| | - Ling Zhu
- Department of Neuro-Oncology Center, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jing Chen
- Department of Neuro-Oncology Center, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jun Zhang
- School of Nursing, Wuhan University, Wuhan, China
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Saatchi B, Agbayani CJG, Clancy SL, Fortier MA. Measuring irritability in young adults: An integrative review of measures and their psychometric properties. J Psychiatr Ment Health Nurs 2023; 30:35-53. [PMID: 35716348 PMCID: PMC10084147 DOI: 10.1111/jpm.12851] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/20/2022] [Accepted: 06/15/2022] [Indexed: 01/13/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Irritability is a transdiagnostic psychiatric symptom among different mental health diagnoses, such as depression, anxiety, personality and substance abuse disorders. Despite the prevalence of irritability across various psychiatric disorders, there is a lack of assessment measures developed and validated to specifically assess irritability. Existing evidence suggests that young adults with depression combined with irritability experience higher disease burden compared with depressed peers with low levels of irritability. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This integrative review demonstrates that the Brief Irritability Test (BITe) is a more precise and reliable tool for measuring irritability in young adults, particularly in that it differentiates irritability from related but distinct symptoms such as anger, aggression and hostility. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Utilizing valid and reliable tools to measure irritability could help identify the presence of irritability as a distinct construct, which could lead to the development of tailored/personalized mental health interventions that will adequately address the impact of irritability on functioning. The findings have implications for symptom science, one focus of nursing research that evaluates symptom experiences and their impact on quality of life and functioning. Irritability is consistent with this framework as it has disabling effects on educational, financial and social functioning, as well as vulnerability to psychiatric disorders and health-related quality of life. ABSTRACT: Introduction Irritability is associated with a higher burden of psychiatric symptoms and impairments in young adults' educational, financial and social functioning. Still, it has been measured mainly by subscales within larger tools. Few specific measures have been developed to capture this construct validly and reliably, hindering the differentiation of irritability from similar constructs like anger and aggression. Aim This integrative review was undertaken to identify the irritability measures used in young adults between 2000 and 2021. Method The 5-stage method was proposed by Whittemore and Knafl (Journal of Advanced Nursing, 52, 546, 2005). Results Of 1258 results, 15 articles that included young adults as their participants and measured irritability with a specific tool were identified to be reviewed. Discussion Among the existing tools, the Brief Irritability Test (BITe) is a more precise and specific tool in young adults for measuring irritability and differentiating irritability from similar constructs. Implications for practice The findings have potential implications for better assessment and understanding of irritability in nursing research and practice, leading to the development of nursing interventions tailored to the affected young adult populations and improving the quality of life in these groups.
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Affiliation(s)
- Babak Saatchi
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
| | | | - Stephen L Clancy
- Research Librarian for Health Sciences and Nursing Science, Science Library, University of California, Irvine, USA
| | - Michelle A Fortier
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
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Bell T, Crowe M, Novack T, Davis RD, Stavrinos D. Severity and correlates of brain fog in people with traumatic brain injury. Res Nurs Health 2023; 46:136-147. [PMID: 36504287 PMCID: PMC10851910 DOI: 10.1002/nur.22280] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/03/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
Brain fog is one symptom that has been underexplored in traumatic brain injury (TBI). We explored the cognitive and affective correlates of brain fog in people with symptomatic mild TBI (n = 15), moderate-to-severe TBI (n = 15), and a healthy control group (n = 16). Measures across the studies assessed "brain fog" (Mental Clutter Scale), objective cognition (Useful Field of View® and Cogstate Brief Battery®), post-concussive symptoms (Post-Concussion Symptom Scale), and depressive symptoms (Profile of Moods Scale). Brain fog was higher in symptomatic mild TBI and moderate-to-severe TBI compared with healthy controls. Greater brain fog corresponded to greater depressive symptoms in symptomatic mild TBI. Greater brain fog corresponded to poorer episodic memory and working memory in moderate-to-severe TBI. Brain fog appears to reflect challenges in recovery, including depressive symptoms and worse cognitive function. Screening for brain fog might be worthwhile in people with brain injuries.
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Affiliation(s)
- Tyler Bell
- Department of Psychiatry, University of California, San Diego
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham
| | - Thomas Novack
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham
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Abstract
BACKGROUND The National Institute of Nursing Research developed the National Institutes of Health symptom science model (SSM) in 2015 as a parsimonious conceptual model to guide symptom science research. OBJECTIVES This concept development paper synthesizes justifications to strengthen the original model. METHODS A literature review was performed, discussions with symptom science content expert stakeholders were held, and opportunities for expanding the current model were identified. Concept elements for a revised conceptual model-the SSM 2.0-were developed. RESULTS In addition to the four original concept elements (complex symptom presentation, phenotypic characterization, biobehavioral factors [previously biomarker discovery], and clinical applications), three new concept elements are proposed, including social determinants of health, patient-centered experience, and policy/population health. DISCUSSION There have been several calls to revise the original SSM from the nursing scientific community to expand its utility to other healthcare settings. Incorporating three additional concept elements can facilitate a broader variety of translational nursing research symptom science collaborations and applications, support additional scientific domains for symptom science activities, and produce more translatable symptom science to a wider audience of nursing research scholars and stakeholders during recovery from the COVID-19 pandemic. The revised SSM 2.0 with newly incorporated social determinants of health, patient-centered experience, and policy/population health components now empowers nursing scientists and scholars to address specific symptom science public health challenges particularly faced by vulnerable and underserved populations.
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Rodney T, Mangano E, Casida J. Update on Posttraumatic Stress Disorder and Implications for Acute and Critical Care APRNs. AACN Adv Crit Care 2022; 33:274-279. [PMID: 36067261 DOI: 10.4037/aacnacc2022439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Tamar Rodney
- Tamar Rodney is Assistant Professor, Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205
| | - Emma Mangano
- Emma Mangano is Assistant Professor, Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Jesus Casida
- Jesus Casida is Associate Professor, Johns Hopkins School of Nursing, Baltimore, Maryland
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Kalantar-Zadeh K, Lockwood MB, Rhee CM, Tantisattamo E, Andreoli S, Balducci A, Laffin P, Harris T, Knight R, Kumaraswami L, Liakopoulos V, Lui SF, Kumar S, Ng M, Saadi G, Ulasi I, Tong A, Li PKT. Patient-centred approaches for the management of unpleasant symptoms in kidney disease. Nat Rev Nephrol 2022; 18:185-198. [PMID: 34980890 DOI: 10.1038/s41581-021-00518-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/22/2022]
Abstract
Patients with chronic kidney disease (CKD) frequently experience unpleasant symptoms. These can be gastrointestinal (constipation, nausea, vomiting and diarrhoea), psychological (anxiety and sadness), neurological (lightheadedness, headache and numbness), cardiopulmonary (shortness of breath and oedema), dermatological (pruritus and dry skin), painful (muscle cramps, chest pain and abdominal pain) or involve sexual dysfunction, sleep disorders and fatigue. These symptoms often occur in clusters, with one of them as the lead symptom and others as secondary symptoms. Uraemic toxins (also called uremic toxins) are often considered to be the main cause of CKD-associated symptom burden, but treatment of uraemia by dialysis often fails to resolve them and can engender additional symptoms. Indeed, symptoms can be exacerbated by comorbid conditions, pharmacotherapies, lifestyle and dietary regimens, kidney replacement therapy and ageing. Patients with kidney disease, including those who depend on dialysis or transplantation, should feel actively supported in their symptom management through the identification and targeting of unpleasant symptoms via a tailored palliative care approach. Such an approach may help minimize the burden and consequences of kidney disease, and lead to improved patient outcomes including health-related quality of life and better life participation.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- The International Federation of Kidney Foundation - World Kidney Alliance (IFKF-WKA), Mexico City, Mexico. .,Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA.
| | - Mark B Lockwood
- Department of Behavioral Health Science, University of Illinois at Chicago, College of Nursing, Chicago, IL, USA
| | - Connie M Rhee
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA
| | - Ekamol Tantisattamo
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA
| | - Sharon Andreoli
- James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Tess Harris
- Polycystic Kidney Disease Charity, London, UK
| | | | | | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Siu-Fai Lui
- The International Federation of Kidney Foundation - World Kidney Alliance (IFKF-WKA), Mexico City, Mexico.,Hong Kong Kidney Foundation, Hong Kong, China
| | | | - Maggie Ng
- The International Federation of Kidney Foundation - World Kidney Alliance (IFKF-WKA), Mexico City, Mexico.,Hong Kong Kidney Foundation, Hong Kong, China
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol & Richard Yu PD Research Centre, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
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Lockwood MB, Steel JL, Doorenbos AZ, Contreras BN, Fischer MJ. Emerging Patient-Centered Concepts in Pain Among Adults With Chronic Kidney Disease, Maintenance Dialysis, and Kidney Transplant. Semin Nephrol 2021; 41:550-562. [PMID: 34973699 PMCID: PMC8740641 DOI: 10.1016/j.semnephrol.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patient reports of moderate to severe pain are common across the spectrum of chronic kidney disease. The synergistic effects of comorbid depression and anxiety can lead to maladaptive coping responses to pain, namely pain catastrophizing and illness-related post-traumatic stress disorder. If underlying depression and anxiety and associated maladaptive coping responses are not treated, patients can experience an increased perception of pain, worsened disability, decreased quality of life, withdrawal from social activities, and increased morbidity and mortality. Meanwhile, interest in nonpharmacologic treatments for pain that targets coping as well as comorbid anxiety and depression has been increasing, particularly given the significant societal damage that has resulted from the opioid epidemic. Evidence-based, nonpharmacologic treatments have shown promise in treating pain in areas outside of nephrology. Currently, little is known about the effects of these treatments among adults with CKD, and particularly end-stage kidney disease, when chronic pain can become debilitating. In this review, we examine patient-centered concepts related to pain that have received little attention in the nephrology literature. We also describe emerging areas of research, including omics technologies for biomarker discovery and advanced symptom clustering methods for symptom phenotyping, which may be useful to future kidney disease research and treatment.
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Affiliation(s)
- Mark B Lockwood
- Department of Behavioral Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, IL.
| | - Jennifer L Steel
- Center for Excellence in Behavioral Medicine, Department of Surgery, University of Pittsburg, Pittsburg, PA
| | - Ardith Z Doorenbos
- Department of Biobehavioral Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, IL
| | - Blanca N Contreras
- Section of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Michael J Fischer
- Department of Internal Medicine, University of Illinois Hospital and Health Sciences Center, Chicago, IL; Renal Section, Medical Service, Jesse Brown VA Medical Center, Chicago, IL; Center of Innovation for Complex Chronic Health Care, Edward Hines, Jr. VA Hospital, Hines, IL
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Delirium Severity Trajectories and Outcomes in ICU Patients. Defining a Dynamic Symptom Phenotype. Ann Am Thorac Soc 2021; 17:1094-1103. [PMID: 32383964 DOI: 10.1513/annalsats.201910-764oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Rationale: Delirium severity and duration are independently associated with higher mortality and morbidity. No studies to date have described a delirium trajectory by integrating both severity and duration.Objectives: The primary aim was to develop delirium trajectories by integrating symptom severity and duration. The secondary aim was to investigate the association among trajectory membership, clinical characteristics, and 30-day mortality.Methods: A secondary analysis of the PMD (Pharmacologic Management of Delirium) randomized control trial (ClinicalTrials.gov Identifier: NCT00842608; N = 531) was conducted. The presence of delirium and symptom severity were measured at least daily for 7 days using the Confusion Assessment Method for the intensive care unit (CAM-ICU) and CAM-ICU-7 (on a scale of 0-7, with 7 being the most severe). Delirium trajectories were defined using an innovative, data-driven statistical method (group-based trajectory modeling [GBTM]) and SAS v9.4.Results: A total of 531 delirious participants (mean age 60 yr [standard deviation = 16], 55% female, and 46% African American) were analyzed. Five distinct delirium trajectories were described (CAM-ICU-7: mean [standard deviation]); mild-brief (CAM-ICU-7: 0.5 [0.5]), severe-rapid recovers (CAM-ICU-7: 2.1 [1.0]), mild-accelerating (CAM-ICU-7: 2.2 [0.9]), severe-slow recovers (CAM-ICU-7: 3.9 [0.9]), and severe-nonrecovers (CAM-ICU-7: 5.9 [1.0]). Baseline cognition and race were associated with trajectory membership. Trajectory membership independently predicted 30-day mortality while controlling for age, sex, race, cognition, illness severity, and comorbidities.Conclusions: This secondary analysis described five distinct delirium trajectories based on delirium symptom severity and duration using group-based trajectory modeling. Trajectory membership predicted 30-day mortality.
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Poulsen I, Langhorn L, Egerod I, Aadal L. Sleep and agitation during subacute traumatic brain injury rehabilitation: A scoping review. Aust Crit Care 2021; 34:76-82. [PMID: 32698985 DOI: 10.1016/j.aucc.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Sleep disturbance and agitation are frequent conditions during the subacute period of recovery in moderate to severe traumatic brain injury (TBI). Clarity is needed regarding the association between the two conditions to improve fundamental nursing care. AIM The aim of our scoping review was to identify the evidence for potential associations between sleep disturbance and agitation during subacute inpatient rehabilitation of adult patients with moderate to severe TBI. DESIGN We conducted a five-step scoping review. METHODS Sources of evidence were PubMed, CINAHL, PsycINFO, Cochrane, and Web of Science databases. Eligibility criteria were as follows: English or Scandinavian language articles describing sleep and/or agitation during inpatient rehabilitation of adult patients with moderate to severe TBI and published in the period 2000-2019. RESULTS We identified 152 articles of which we included six. The included articles were all affiliated with the USA using quantitative methodology. The association between sleep disturbance and agitation is highly complex, with disturbed sleep affecting cognitive and emotional functions. Sleep disturbance was associated with posttraumatic amnesia (PTA)/posttraumatic confusional state, cognitive function, and agitation. Our review suggested a bidirectional association between these symptoms during early TBI rehabilitation. We inferred that improved sleep might be a contributing factor to the resolution of PTA, cognitive impairment, and agitation. CONCLUSION The association between sleep disturbance and agitation is still undetermined, but we assume that improved sleep may protect against neuropsychiatric problems in patients with moderate to severe TBI. Larger controlled interventional studies are needed to provide the evidence of modifiable factors for improving sleep during inpatient TBI rehabilitation. Owing to the current lack of publications, it is probably too early to perform a systematic review on the topic. RELEVANCE TO CLINICAL PRACTICE We recommend systematic implementation of sleep hygiene during inpatient rehabilitation of patients with TBI to reduce PTA, agitation, and long-term neuropsychiatric problems.
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Affiliation(s)
- Ingrid Poulsen
- RUBRIC (Research Unit on Brain Injury Rehabilitation), Department of Neurorehabilitation, Traumatic Brain Injury, Rigshospitalet, Copenhagen University Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark; Research Unit for Nursing and Health Care, Health, Aarhus University, Denmark.
| | - Leanne Langhorn
- Department of Neurosurgery, Department of Anesthesiology and Intensive Care, North Section, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
| | - Ingrid Egerod
- Intensive Care Unit 4131, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen O, Denmark.
| | - Lena Aadal
- Department of Clinical Medicine, Aarhus University Hammel Neurorehabilitation and Research Centre, Voldbyvej 15, DK-8450 Hammel, Denmark.
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Shen Q, Mahoney D, Peltzer J, Rahman F, Krueger KJ, Hiebert JB, Pierce JD. Using the NIH symptom science model to understand fatigue and mitochondrial bioenergetics. ACTA ACUST UNITED AC 2020; 7. [PMID: 33628458 DOI: 10.7243/2056-9157-7-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The symptom of fatigue is prevalent among patients with chronic diseases and conditions such as congestive heart failure and cancer. It has a significant debilitating impact on patients' physical health, quality of life, and well-being. Early detection and appropriate assessment of fatigue is essential for diagnosing, treating, and monitoring disease progression. However, it is often challenging to manage the symptom of fatigue without first investigating the underlying biological mechanisms. In this narrative review, we conceptualize the symptom of fatigue and its relationship with mitochondrial bioenergetics using the National Institute of Health Symptom Science Model (NIH-SSM). In particular, we discuss mental and physical measures to assess fatigue, the importance of adenosine triphosphate (ATP) in cellular and organ functions, and how impaired ATP production contributes to fatigue. Specific methods to measure ATP are described. Recommendations are provided concerning how to integrate biological mechanisms with the symptom of fatigue for future research and clinical practice to help alleviate symptoms and improve patients' quality of life.
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Affiliation(s)
- Qiuhua Shen
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
| | - Diane Mahoney
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
| | - Jill Peltzer
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
| | - Faith Rahman
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
| | - Kathryn J Krueger
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
| | - John B Hiebert
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
| | - Janet D Pierce
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
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