Factors connected with anxiety and other neuropsychiatric symptoms in advanced gastric cancer

Objective: The aim of study was to determine factors connected with neuropsychiatric symptoms and anxiety in patients with terminal stomach cancer. Methods: We analyzed retrospectively 134 terminal stomach cancer patients admitted to Palliative Care Unit. Results: Patients with anxiety had greater chance for emergency admission, higher NRS result, occurrence of cachexia,occurrence of neuropsychiatric symptoms,longer duration of treatment, higher albumin concentration and lower glucose concentration. Patients with neuropsychiatric symptoms had greater chance for emergency admission, higher PS scale note, occurrence of dyselectrolytemia, lower albumin concentration. Patients with those symptoms had more than 7 times greater chance for death. Conclusion: It is important to know factors connected with neuropsychiatric symptoms and anxiety because thanks to that we could avoid those dangerous clinical symptoms.

Impact of severe SARS-CoV-2 infection on nutritional status and subjective functional loss in a prospective cohort of COVID-19 survivors

The nutritional sequelae of COVID-19 have not been explored in a large cohort study.ObjectivesTo identify factors associated with the change in nutritional status between discharge and 30 days post-discharge (D30). Secondary objectives were to determine the prevalence of subjective functional loss and severe disability at D30 and their associated factors.MethodsCollected data included symptoms, nutritional status, self-evaluation of food intake, Performance Status (PS) Scale, Asthenia Scale, self-evaluation of strength (SES) for arms and legs at discharge and at D30. An SES <7 was used to determine subjective functional loss. A composite criteria for severe disability was elaborated combining malnutrition, subjective functional loss and PS >2. Patients were classified into three groups according to change in nutritional status between discharge and D30 (persistent malnutrition, correction of malnutrition and the absence of malnutrition).ResultsOf 549 consecutive patients hospitalised for COVID-19 between 1 March and 29 April 2020, 130 died including 17 after discharge (23.7%). At D30, 312 patients were at home, 288 (92.3%) of whom were interviewed. Of the latter, 33.3% were malnourished at discharge and still malnourished at D30, while 23.2% were malnourished at discharge but no longer malnourished at D30. The highest predictive factors of persistent malnutrition were intensive care unit (ICU) stay (OR=3.42, 95% CI: 2.04 to 5.75), subjective functional loss at discharge (OR=3.26, 95% CI: 1.75 to 6.08) and male sex (OR=2.39, 95% CI: 1.44 to 3.97). Subjective functional loss at discharge (76.8%) was the main predictive factor of subjective functional loss at D30 (26.3%) (OR=32.6, 95% CI: 4.36 to 244.0). Lastly, 8.3% had a severe disability, with a higher risk in patients requiring an ICU stay (OR=3.39, 95% CI: 1.43 to 8.06).ConclusionPatients who survived a severe form of COVID-19 had a high risk of persistent malnutrition, functional loss and severe disability at D30. We believe that nutritional support and rehabilitation should be strengthened, particularly for male patients who were admitted in ICU and had subjective functional loss at discharge.Trial registration numberNCT04451694.

Prognostic factors, symptoms and consequences of dehydration and dyselectrolytemia in patients with terminal stomach cancer

Background: Dyselectrolytaemia and dehydration are common symptoms in people with terminal stomach cancer. Aims: To determine factors related to dyselectrolytemia and dehydration in patients with terminal stomach cancer. Methods: An analysis of 134 patients with terminal stomach cancer admitted to the palliative care unit was conducted, through an audit of the patients' medical records. The average age of women was 63.1 years and that of men was 64.9 years. Findings: Dehydrated patients were more likely to: have dyselectrolytaemia; have a higher PS scale score; be taking opioids as an analgesic; have a high sodium concentration; experience dyspnoea, constipation, nausea and vomiting during hospitalisation; and require glucocorticoids administration both during and before hospitalisation. Patients with dyselectrolytaemia were more likely to: be admitted to the palliative care unit from the emergency department; experience cachexia and dehydration during hospitalisation and constipation at discharge; have a lower albumin level; and have a higher glucose level. Patients with dyselectrolytaemia also had a shorter duration of treatment and a 2.48 greater chance for death compared with those who did not have it. Conclusions: Knowledge of the adverse factors connected with dehydration and dyselectrolytaemia will allow health professionals to avoid dangerous clinical symptoms and prolong the life of those with terminal stomach cancer, as they might be able to foresee the occurrence of these conditions based on the medication the patient has been taking and symptoms they have been experiencing. Nurses will have a greater understanding of the importance of fluid therapy to resolve ionic disturbances and the need to address dehydration and dyselectrolytemia as a means to prolong and improve quality of life.

Longitudinal prospective associations between psychological symptoms and heavy episodic drinking from adolescence to midlife

Aim: This study examined whether development of psychological symptoms (PS) differed between persons with different longitudinal profiles of heavy episodic drinking (HED) from adolescence to midlife. In addition, the reciprocal associations between PS and HED were studied. Methods: Participants of a Finnish cohort study in 1983 at age 16 ( N = 2194) were followed up at ages 22 ( N = 1656), 32 ( N = 1471), and 42 ( N = 1334). HED was assessed with frequency of intoxication (16–22 years) and having six or more drinks in a session (32–42 years). Using latent class analysis, the participants were allocated to steady high, increased, moderate, and steady low groups according to their longitudinal profiles of HED. The PS scale (16–42 years) covered five mental complaints. The latent growth curve of PS was estimated in the HED groups for comparisons. In addition, the prospective associations between symptoms and HED were examined using cross-lagged autoregressive models. Results: PS grew from 16 to 32 years, but declined after that, with women having higher level of PS than men. PS trajectory followed a path at highest and lowest level in the steady high and steady low HED groups, respectively. Symptoms predicted later HED, but the association in the opposite direction was not found. Conclusions: The more the HED trajectory indicated frequent HED, the higher was the level of PS throughout the follow-up. Results support the self-medication hypothesis, suggesting that alcohol is used to ease the burden of PS. More attention should be paid to alcohol use of people with mental symptoms in health services.

Prognostic factors, symptoms, and consequences of electrolyte imbalances in patients who suffered from cancer.

74 Background: Dyselectrolytemia is a common problem in patients with terminal cancer. It worsens the quality of life and increases the amount of complications. The aim of our study was to determine factors connected with dyselectrolytemia in patients with terminal cancer. Methods: 310 terminal cancer patients admitted to Palliative Care Unit were retrospectively analyzed. Detailed physical examination, medical history and laboratory parameters were taken upon admission. Univariate and multivariate logistic regression analysis were used to determine possible predictors, symptoms and consequences of dyselectrolytemia. Results: On admission 67,74% of patients had dyselectrolytemia. They were more frequently admitted to hospital from Emergency Department (OR=Odds Ratio=2,879, p=probability value=0,00004), had higher PS scale note (OR=1,627, p=0,0001), were more often cachectic (OR=1,915, p=0,0083), had more often constipation (OR=1,728,p=0,0275), were more often dehydrated (OR=2,609 ,p=0,0007), had lower albumin level (OR=0,909, p=0,00001). They had 275% higher risk of death (OR=2,758, p=0,0001). Multivariate logistic regression analysis after adjustment for possible confounders reviled that admission to hospital from Emergency Department (OR=2,652, p=0,01), higher PS scale note (OR=1,445, p=0,001), opioids administration (OR=2,747, p=0,003), dehydration (OR=1,966 , p=0,038) and higher risk of death (OR=2,432, p=0,002) remained independently associated with dyselectrolytemia. Conclusions: Higher PS scale note, occurrence of dehydration, admission to hospital from Emergency Department and opioids administration are factors associated with dyselectrolytemia. Patients with electrolytes imbalances had 275% higher risk of death. Project "Extension of life and improvement of its quality and reduction of cancer patients' mortality due to proper control of water and electrolyte management and elimination of risk factors for dehydration and dyselectrolytemia." Co-financed by the European Social Fund under the project of the Ministry of Science and Higher Education of Poland entitled "Best of the best! 2.0 ".

Disentangling the Trait and State Components of Professional Skepticism: Specifying a Process for State Scale Development

SUMMARY In recent years, professional skepticism (PS) has drawn extensive attention from both regulators and academics. While prior research theorizes that both stable personality traits and temporary states influence PS (e.g., Hurtt 2010; Nelson 2009), this literature tends to focus on either trait PS or contextual factors that influence judgments and behavior without disentangling the trait and state components of PS. We propose that state PS is a distinct construct from trait PS and provide the first measure of state PS. We validate our process for measuring state PS using rigorous analyses, demonstrating convergent and divergent validity with data collected from both professional and student samples. Furthermore, we replicate the Hurtt (2010) trait PS scale, which forms the basis for our state PS measure. Future researchers can employ our measure or, alternatively, replicate our process for measuring state PS in various experimental contexts. Data Availability: Contact the corresponding author.

Early events in the photochemistry of 5-diazo Meldrum's acid: formation of a product manifold in C–N bound and pre-dissociated intersection seam regions

Photolysis of 5-diazo Meldrum's acid yields three different primary products in a sub-ps scale. High-level computations show that this is due to the presence of an extended seam of intersection associated to different reaction paths.

A pilot study comparing objective physical activity to the physical component of the Eastern Cooperative Oncology Group (ECOG) performance status scale

e20501 Background: The ECOG performance status (PS) scale is widely used in oncology for clinical decision-making, being a good predictor of survival, prognosis, and treatment response. It has never been formally compared to objective measures of physical activity (PA). Accelerometers are now established as detailed valid measures of PA. The aim of this study was to compare the ECOG PS scale to objectively measured PA. Methods: Accelerometer data (RT3) as well as self-report (International Physical Activity Questionnaire (IPAQ)) was collected for at least 3 days immediately before cancer outpatient assessment on 15 patients (6 males, 9 females) with a mean age of 65 years (range 47–51), all with solid tumours. RT3 and self-report data were compared to the ECOG PS score assigned by the treating physician. Time ‘up and about’ is all activity, however minimal, detected by the RT3, except lying flat. Institutional ethics committee approval was gained. Results: Most subjects were assigned an ECOG score of 1. In all subjects, the score assigned over-estimated PA levels ( Table ). Spearman's rank correlation coefficient showed poor correlation between percentage waking time ‘up and about’ and the ECOG PS score assigned (p = -0.1), and between the IPAQ and ECOG scores (p = 0.1). Conclusions: Although ECOG PS is recognized as a good predictor of clinical outcome, a poor correlation was found between ECOG PS assigned, objective PA, and self-report. Subjects were far more sedentary than estimated using physician-assigned ECOG PS. A large study to investigate these relationships further is ongoing. [Table: see text] No significant financial relationships to disclose.