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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Depression often presents with physical symptoms, primarily fatigue, pain, or sleep disturbance. Depressed mood may or may not be present. Supportive counseling and pharmacotherapy are more effective than either modality alone. The newer drugs are better tolerated than earlier agents, and they achieve much greater patient adherence. Depression is considered a chronic disease. The likelihood of recurrence increases with the number of episodes, often calling for prolonged maintenance of medication. Most patients with mild to moderate depression can be effectively managed by their primary care physician, with referral required only for those who are unresponsive to therapy or who are suicidal.
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PMID:Depression. 1031 45

Congestive heart failure (CHF) is a chronic disorder characterised by fatigue, shortness of breath and congestion. Treatment is designed to relieve symptoms, halt or delay progression of the disease, prolong life and, ultimately, improve quality of life. The purpose of this paper is to identify recent trends in the assessment of health-related quality-of-life (HR-QOL) outcomes in randomised, controlled trials evaluating treatment effectiveness in patients with CHF. 41 studies using HR-QOL as an explicit outcome and published in English between 1990 and September 1998 were reviewed. Trends in the measurement of HR-QOL and evidence of treatment effectiveness are presented followed by a discussion of the implications for future research. Results suggest that pharmacological and nonpharmacological treatment regimens can have a positive impact on HR-QOL. However, treatment-related improvement in exercise capacity in patients with CHF was not consistently associated with improvement in all domains of HR-QOL. The primary HR-QOL domain affected by treatment appears to be the performance of daily activities, which may or may not be accompanied by enhanced well-being. This suggests that functional status should be considered a primary HR-QOL end-point in clinical intervention trials. Preference-based or utility assessment, ethnic group differences in treatment effectiveness, caregiver burden and cost effectiveness are understudied outcomes in CHF research.
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PMID:Evaluating Health-related quality-of-life outcomes in patients with congestive heart failure. A review of recent randomised controlled trials. 1034 57

BACKGROUND: In an elderly population of surgical patients, poor mobility, poor diet and chronic disease contribute to a significant risk of malnutrition. Malnutrition is associated with muscle weakness, fatigue, poor wound healing and immunological dysfunction. The aim of the study was to establish the prevalence of malnutrition in vascular surgical patients and to compare postoperative infection rates in well nourished and malnourished patients. METHODS: A nutritional assessment was performed on 71 patients (49 men; median age 65 (range 26-85) years) attending preassessment for vascular surgical procedures. Nutritional status was measured using validated indicators of malnutrition: estimated weight changes over 3 months; body mass index; mid-arm muscle circumference (MAMC) calculated using triceps skin fold thickness (TSF) and mid-arm circumference (MAC) (MAMC = MAC - (3.14 x TSF)); and serum albumin concentration. Fifty-nine patients were followed after vascular surgery. The incidence of postoperative infections was related to preoperative nutritional status. RESULTS: Nineteen patients (27 per cent) had normal values for all nutritional indicators examined. The remaining 52 patients (73 per cent) had one (37), two (12), three (two) or four (one) nutritional indicators within the range for malnutrition. Among the 59 patients who underwent surgery there were five chest infections, seven wound infections, one urinary tract infection and one infected central line in 13 patients following six femorodistal bypasses, four abdominal aortic aneurysm repairs and three miscellaneous arterial procedures. The incidence of septic complications was zero in 14 patients with normal nutritional indicators and 41 per cent (13 of 32) in patients with indicators of malnutrition (P < 0.05, Fisher's exact test). CONCLUSION: Malnutrition is prevalent among vascular patients and may contribute to postoperative morbidity. Malnourished patients should be identified and referred to the dietician at the earliest opportunity to minimize the morbid effects of undernutrition.
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PMID:Vascular surgical society of great britain and ireland: contribution of malnutrition to postoperative morbidity in vascular surgical patients 1036 Dec 8

In summary, sexual dysfunction is a common finding in both men and women with chronic renal failure. Common disturbances include erectile dysfunction in men, menstrual abnormalities in women, and decreased libido and fertility in both sexes. These abnormalities are primarily organic in nature and are related to uremia as well as the other comorbid conditions that frequently accompany the chronic renal failure patient. Fatigue and psychosocial factors related to the presence of a chronic disease are also contributory factors. Disturbances in the hypothalamic-pituitary-gonadal axis can be detected before the need for dialysis but continue to worsen once dialytic therapy is initiated. Impaired gonadal function is prominent in uremic men, whereas the disturbances in the hypothalamicpituitary axis are more subtle. By contrast, central disturbances are more prominent in uremic women. Therapy is initially directed toward optimizing the delivery of dialysis, correcting anemia with recombinant erythropoietin, and controlling the degree of secondary hyperparathyroidism with vitamin D. For many practicing nephrologists, sildenafil has become the first-line therapy in the treatment of impotence. In the hypogonadal man whose only complaint is decreased libido, testosterone may be of benefit. Regular gynecologic follow-up is required in uremic women to guard against potential complications of unopposed estrogen effect. Uremic women should be advised against pregnancy while on dialysis. Successful transplantation is the most effective means of restoring normal sexual function in both men and women with chronic renal failure.
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PMID:Sexual dysfunction in uremia. 1036 78

There seems to be a lack of understanding between practitioners and patients on the topic of insomnia. One adult out of four complains of insomnia; however only one insomniac out of four has ever complained about it to their practitioner during a visit made for another problem and only one out of twenty has come to discuss specifically the problem of his or her insomnia. Only a few patients with insomnia take a treatment for it. This gap between the patient's feeling and the practitioner's answer has to be better understood if we want to know why insomnia seems to be so prevalent and what impact it has on society. One aspect may be a question of definition. Insomnia may be considered an ordinary complaint (after one poor night) or as a chronic disease. Practitioners have poor knowledge about sleep disorders and may be embarrassed about coping with an impairment they never specifically learned to manage. The second aspect concerns the impact of insomnia on daytime alertness and performance. While patients usually complain of an impaired daytime functioning with a feeling of fatigue, sleepiness, and risk of mistakes, many studies of insomniacs do not reveal any increased sleepiness or decrease of performance (measured by objective tests) the day following a poor night. Practitioners may therefore find it difficult to understand the real impact of insomnia on daytime functioning. The third aspect is related to the large co-morbidity between insomnia and psychiatric diseases, especially depression and anxiety. It does make it harder for practitioners to define whether the sleep impairment suffered by their patient is the cause for other symptoms or the consequence of an underlying disease. Thus, it makes it all the more difficult for the practitioner to determine which treatment is the most appropriate. These aspects have to be clarified if one wants to estimate the real impact of insomnia on society. It could be useful to both practitioners and patients to have a better understanding on the relationship between poor sleep and daily lives.
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PMID:Public health and insomnia: economic impact. 1080 89

Fatigue is an extremely common complaint among patients with chronic disease. However, because of the subjective nature of fatigue, and the lack of effective therapeutics with which to treat fatigue, this symptom is often ignored by clinicians, who instead focus on hard, objective disease end-points. Recently, the symptom of fatigue has received greater attention as part of overall health-related quality of life assessments in patients with chronic disease. Furthermore, new methods are being developed to help quantify fatigue, and are being utilized more frequently in the clinical setting. Moreover, studies in patients and using animal models of disease have provided some insight into changes within the brain which appear to be linked to the genesis of central fatigue. This review focuses on fatigue in chronic disease and outlines possible mechanisms which may give rise to central fatigue in chronic disease. Moreover, methods for measuring fatigue and an approach to the fatigued patient are discussed. Hopefully, a broader understanding of this distressing symptom will lead to the development of specific therapies for treating fatigue in these patients.
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PMID:Fatigue in chronic disease. 1088 52

We report a case of fourteen years old boy with cat scratch disease. He was treated at Pediatric Clinic in January and February 2000. Cat scratch disease is benign infectious chronic disease which appears in all ages. It begins after contact with cat and its scratch. Yearly incidence of this disease for whole population is 0.77-0.86/100.000. The cause is bacillus Bartonella which is also called genus Rochalimaea. It is Gram negative, mobile, aerobe bacillus with ten flagellas on one pole. Our patient was admitted at hospital because of high temperature, paleness, fatigue, bad appetite and pains in his joint. Ultrasound and magnet resonance scans of liver and spleen showed enlarged but regulary contured liver and two focal changes with diameter 16 mm, 12 mm and 7 mm in spleen. All those focal changes were described as abscesses. Diagnose was set up according increasing titre of IF-Bartonella hensalae IgG 1:256 (positive). This diagnostic test was performed at Institute for microbiology and Immunology at Medical Faculty in Ljubljana. Disease had long lasting course, and was cured by antibiotics without surgical intervention.
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PMID:[Cat-scratch disease]. 1121 17

Many patients with chronic diseases such as chronic renal failure, chronic inflammatory bowel disease and rheumatoid arthritis are anaemic. Recently congestive heart failure (CHF) has also been found to be associated with anaemia. In all these diseases this anaemia or chronic disease is at least partially due to excessive production of cytokines and leukotrines that interfere both with the effect of erythropoietin (EPO) at the bone marrow and the release of stored iron in the reticuloendothelial system. Treating this anaemia with subcutaneous EPO and IV iron improves the weakness, fatigue, cachexia, nutritional state, mood, cognitive function and quality of life. In the case of CHF it also improves cardiac function and patient functional class, prevents deterioration of renal function and markedly reduces hospitalization. Very few agents in medicine improve so many aspects of the patient so well and so quickly. Unfortunately (for the suffering patient) this anaemia is often ignored and goes untreated.
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PMID:The pathological consequences of anaemia. 1142 23

The purpose of this qualitative research was to explore the lived experiences of women with Sjogren's Syndrome (SS), a chronic autoimmune syndrome in which invading lymphocytes attack moisture-producing glands of the body. This syndrome, affecting 4 million Americans, involves extreme dryness of the eyes and mouth and other systemic complications such as fatigue and muscle and joint pain. Ten women, ranging in age from 27 to 83, with SS were interviewed to understand their coping strategies and attitudes. This study used Strauss' framework to view the quality of life of the chronically ill-specifically, those with SS. Nine questions were asked to elicit information on limitations with daily living, relationships, emotions about lifestyle changes, and comparisons with others living with chronic disease. In addition to SS, 8 of the 10 women also had fibromyalgia, and 4 had other conditions such as lupus and rheumatoid arthritis (secondary Sjogren's). Their responses were categorized into four groups: helping, hindering, hoping, and hurting. This led to the development of the 4H Model of Chronic Autoimmune Disease with subcategories such as: supporting, joining, comparing, coping, health promoting, fearing, becoming a chronic sufferer, feeling, wishing, appearing, impeding, restricting, isolating, suffering, doctoring, and diagnosing. J Prof Nurs 17:194-202, 2001.
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PMID:Seeing the glass half full: living with Sjogren's Syndrome. 1146 41

Psychosomatic symptoms are by definition clinical symptoms with no underlying organic pathology. Common symptoms seen in pediatric age group include abdominal pain, headaches, chest pain, fatigue, limb pain, back pain, worry about health and difficulty breathing. These, more frequently seen symptoms should be differentiated from somatoform or neurotic disorders seen mainly in adults. The prevalence of psychosomatic complaints in children and adolescents has been reported to be between 10 and 25%. These symptoms are theorized to be a response to stress. Potential sources of stress in children and adolescents include schoolwork, family problems, peer pressure, chronic disease or disability in parents, family moves, psychiatric disorder in parents and poor coping abilities. Characteristics that favour psychosomatic basis for symptoms include vagueness of symptoms, varying intensity, inconsistent nature and pattern of symptoms, presence of multiple symptoms at the same time, chronic course with apparent good health, delay in seeking medical care, and lack of concern on the part of the patient. A thorough medical and psychosocial history and physical examination are the most valuable aspects of diagnostic evaluation. Organic etiology for the symptoms must be ruled out. Appropriate mental health consultation should be considered for further evaluation and treatment.
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PMID:Psychosomatic disorders in pediatrics. 1151 81


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