Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this report, a young female, who initially presented with left upper extremity pain, eventually underwent surgery for presumed thoracic outlet syndrome. Following surgery, she developed shortness of breath. Diagnostic studies revealed an elevated left hemidiaphragm secondary to injury to the phrenic nerve.
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PMID:Unilateral diaphragmatic paralysis following thoracic outlet surgery: a case report. 1547 51

Palliative sedation is given to relieve refractory discomfort (pain, shortness of breath, agitation) during the phase when life expectancy is estimated to be a week or less. It is a medical intervention which, although not expressly meant to shorten life, may well do so. There is an inherent uncertainty here which is the cause of considerable ethical unease. Figures show that in a limited number of cases palliative sedation is actually applied with the intention to hasten death. It may well be impossible to rid ourselves ofthis uncertainty conclusively.
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PMID:[Palliative sedation, the sympathetic alternative for euthanasia?]. 1596 Jan 38

The purposes of this study were to describe the quality of life (QOL) of terminally ill patients in a home-based hospice program and to examine the relationship between QOL data and patients' symptom distress, ability to function, interpersonal communication (support from family and friends), well-being (their affairs in order), and transcendence (religious comfort/support) as recorded in their charts. QOL was measured by the Missoula-Vitas Quality of Life Index (MVQOLI), an instrument designed specifically for use with terminally ill patients. The study was conducted over a three-year period with 129 terminally ill patients enrolled in a home-based hospice program of care. The MVQOLI was administered to patients within 20 days of their admission to hospice. A retrospective chart review was conducted to determine patients' levels of symptom distress, ability to function, social support, whether or not their affairs were in order, and religious comfort/support. The mean age of participants in this study was 67, with 54.3 percent male and 45.7 percent female. Cancer was the primary diagnosis for 92.2 percent of the sample, and 35 percent of these patients had a diagnosis of lung cancer. Of the 7.8 percent non-cancer diagnoses, five were diagnosed with AIDS, four with chronic obstructive pulmonary disease, and one with chronic heart failure. The results of this study revealed positive scores on the five dimensions of the MVQOLI QOL scale, indicating that within 20 days of admission to hospice, patients rated their QOL as good to very good. Data obtained from the chart review also indicated that patients did not experience a great deal of symptom distress (e.g., pain, nausea, shortness of breath, and restlessness). A significant correlation existed between age and QOL; number of interventions and pain levels; and marital status, well-being, interpersonal relationships, and transcendence. Shortness of breath and well-being were significantly correlated with QOL. There was no significant correlation between gender, race, or closeness to death and the five dimensions of the MVQOLI and chart review assessments.
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PMID:The quality of life of hospice patients: patient and provider perceptions. 1585 87

In the palliative care setting, the Edmonton Symptom Assessment Scale (ESAS) was developed for use in daily symptom assessment of palliative care patients. ESAS considers the presence and severity of nine symptoms common in cancer patients: pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath plus an optional tenth symptom, which can be added by the patient. The aim of this study was to validate the Italian version of ESAS and to evaluate an easy quality of life monitoring system that uses a patient's self-rating symptom assessment in two different palliative care settings: in-patients and home patients. Eighty-three in-patients and 158 home care patients were enrolled. In the latter group, the Italian validated version of the Symptom Distress Scale (SDS) was also administered at the admission of the patients. The two groups of patients have similar median survival, demographic and clinical characteristics, symptom prevalence and overall distress score at baseline. ESAS shows a good concurrent validity with respect to SDS. The correlation between the physical items of ESAS and SDS was shown to be higher than the correlation between the psychological items. The association of ESAS scores and performance status (PS) showed a trend: the higher the symptom score was, the worse was the PS level. Test-retest evaluation, applied in the in-patient group, showed good agreement for depression, well-being and overall distress and a moderate agreement for all the other items. In conclusion, ESAS can be considered a valid, reliable and feasible instrument for physical symptom assessment in routine "palliative care" clinical practice with a potentially different responsiveness in different situations or care settings.
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PMID:Edmonton symptom assessment scale: Italian validation in two palliative care settings. 1593 88

Erlotinib (Tarceva, OSI-774; Pfizer, Inc.) is an orally-active, targeted inhibitor of the epidermal growth factor receptor (EGFR/HER1), which is part of a key regulatory pathway in cancer. Patients with advanced, incurable non-small cell lung cancer (NSCLC) may derive a clinical benefit from first- and second-line chemotherapy, but third-line treatment with available cytotoxic agents is not effective. Remarkably, EGFR/HER1 antagonists have demonstrated activity as second- and even third-line treatment for this disease. Erlotinib is the first of this novel class of drug to demonstrate a statistically significant and clinically relevant difference in overall survival, progression free survival and time to disease related symptoms (cough, pain, shortness of breath) compared with treatment with best supportive care in patients who have failed standard first- or second-line chemotherapy. This paper reviews the pharmacology, preclinical and clinical data to support the use of erlotinib in NSCLC.
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PMID:Erlotinib in non-small cell lung cancer: a review. 1595 27

Clinical observation and preliminary reports suggest that higher scores for symptoms such as pain may be associated with shorter survival. We undertook a survival analysis to determine whether symptom expression in outpatients with complex cancer is related to the duration of their survival. Participants were 225 outpatients with cancer evaluated in our comprehensive cancer center for pain management or palliative care over a 10-week period ending June 2000. In addition to age and other clinical and demographic information, the patients completed the Anderson Symptom Assessment System (ASAS), which assesses pain, fatigue, nausea, depression, anxiety, drowsiness, shortness of breath (dyspnea), appetite, sleep, and feeling of well-being on a 0-10 scale. Univariate analyses showed that higher symptoms of dyspnea, drowsiness, problems with appetite, and nausea were significantly associated with shorter survival whereas pain, depression and other ASAS items were not. In multivariate analyses, only higher levels of dyspnea and drowsiness showed a significant association (P=0.01 and P=0.02, respectively) with shorter survival. Knowledge about these symptoms may be important in formulating adaptive randomization techniques for clinical trials and for research concerning estimates of survival.
J Pain Symptom Manage 2005 Jun
PMID:Association between symptom distress and survival in outpatients seen in a palliative care cancer center. 1596 65

A community-based study of 425 older African Americans assessed whether their knowledge and behaviors were consistent with current recommendations regarding out-of-hospital sudden heart attack. More than 90% of the study participants were able to recognize major symptoms of sudden heart attack such as chest pain, shortness of breath, weakness, fatigue, fainting, and sweating, and, to a lesser extent, atypical pain, nausea, lightheadedness, and unexplained anxiety. When asked what they would do first in case they witness sudden heart attack, 97% responded that they would call emergency medical services. In contrast, of the participants who actually witnessed sudden heart attack, 80% called emergency medical services, whereas 20% waited to see if the symptoms would go away; called a neighbor, relative, or a friend before contacting emergency medical services; or took the victim to the hospital. These findings show that reported behavioral intentions were satisfactory, but actual bystanders' actions were not always consistent with current recommendations regarding sudden heart attack.
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PMID:Bystanders of out-of-hospital sudden heart attack: knowledge and behaviors among older African Americans. 1601 57

To prospectively assess patient-rated symptoms in patients with brain metastases treated with whole brain radiotherapy, these patients were asked to rate their symptoms on the Edmonton Symptom Assessment Scale (ESAS) before, and 1, 2, 4, 8, and 12 weeks following the radiation treatment. ESAS evaluates pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, sense of well-being, and shortness of breath on a scale of 0-10 (0=absence of symptom and 10=worst possible symptom). Patients with a language barrier or significant cognitive impairment were excluded. The mean difference of ESAS symptoms at each follow up were compared with baseline and P < 0.01 was considered statistically significant. One hundred seventy patients (102 female and 68 male) were included between January 1999 and January 2002. Their median age was 66 years (range 33-84) and the median Karnofsky performance score (KPS) at baseline was 60 (range 20-90). The most common primary cancer sites were lung (99; 58%), breast (32; 19%), gastrointestinal (16; 9%), unknown (14; 8%) and others (9; 6%). One-third had significant weight loss (> or =10% over the last 6 months). All patients were prescribed dexamethasone at varying doses during radiotherapy. The dose fractionations were 20 Gy in 5 fractions, 138 (81%); 30 Gy in 10 fractions, 7 (4%); and others, 25 (15%). The baseline mean +/- SD for ESAS scores were: pain 2.4 +/- 2.8, fatigue 5.3 +/- 2.8, nausea 1.3 +/- 2.2, depression 2.8 +/- 2.7, anxiety 3.6 +/- 3.0, drowsiness 3.5 +/- 2.9, appetite 3.0 +/- 3.2, sense of well-being 3.8 +/- 2.7, and shortness of breath 2.3 +/- 2.5. For the entire cohort, after the delivery of palliative radiotherapy for brain metastases, there were statistically significant deteriorations in the mean differences from the baseline for the following ESAS domains: fatigue 1.0 to 1.8; drowsiness 1.2 to 1.8; and appetite 2.2 to 2.4. The data demonstrate that certain parameters of quality of life worsen after whole brain radiotherapy.
J Pain Symptom Manage 2005 Jul
PMID:Prospective assessment of patient-rated symptoms following whole brain radiotherapy for brain metastases. 1604 3

Staphylococcal species, usually Staphylococcus aureus or Staphylococcus epidermidis, account for 70% to 95% of pacemaker and cardiac defibrillator infections. Infection limited to the generator pocket may cause pain, redness and swelling that is often accompanied by drainage or fistula formation. In this instance, the generator should be removed and reimplanted at another site as cure is rare with antimicrobial therapy alone. Infection of the leads usually tracks along the wire to include the endocardial surface and may involve the tricuspid valve and pocket. Clinical manifestations vary from mild chronic non-specific symptoms to septic shock with marked localizing signs. Septic embolization to the lungs is common and may cause cough, chest pain and shortness of breath that may be misdiagnosed. Blood culture and trans-oesophageal echocardiography (TOE) are the most important investigations.TOE has a sensitivity of >90%. Lead infection without vegetations may occur and these infections should be treated as for endocarditis. Antimicrobial therapy is an important part of treatment but lead infections are unlikely to cured unless the device is removed. Vancomycin is suitable as initial antimicrobial therapy as this covers both S. aureus and coagulase-negative staphylococci. Flucloxacillin, dicloxacillin or a first-generation cephalosporin are preferred if the organism is sensitive. The addition of low-dose gentamicin may improve bacterial killing. The duration of antimicrobial therapy and timing of replacement of the device have not been determined but 2 weeks treatment before removal and 2-4 weeks treatment after replacement is commonly administered.
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PMID:Diagnosis and management of staphylococcal infections of pacemakers and cardiac defibrillators. 1627 Oct 62

This randomized controlled trial investigated the effect of reporting physical symptoms by using a systematic symptom monitoring instrument, the Symptom Monitor, on symptom prevalence and severity among patients with cancer in the palliative phase. The overall objective was to achieve symptom relief through systematic and regular symptom reporting by patients themselves. One hundred forty-six patients with cancer in the palliative phase were randomized to either the intervention group (n = 69 with Symptom Monitor) or the control group (n = 77 without Symptom Monitor). Ten physical symptoms with regard to prevalence and severity were monitored. After 2 months, the prevalence of symptoms was lower in the intervention group compared to the control group (prevalent differences 2.1-24.3%) for 9 out of 10 symptoms (except coughing). The intervention group scored a statistically significantly lower prevalence in constipation and vomiting (prevalence differences 24.3% and 18.0%, respectively). In four symptoms (fatigue, lack of appetite, shortness of breath, and nausea), the intervention group had a lower, although not statistically significant, severity score (median differences 0.5-1). In four symptoms (pain, coughing, sleeplessness, and diarrhea), the severity score was the same in both groups (medians 2-4). In two symptoms (constipation and vomiting), the severity score was lower in the control group (median differences -1 and -2). A comparison between the study groups on improved, deteriorated, or steady-state cases showed that the severity score had deteriorated less for 8 out of 10 symptoms in a larger proportion of patients in the intervention group. Although statistical significance was not reached, the prevalence as well as severity of symptoms in the palliative phase of cancer can be influenced by using the Symptom Monitor.
J Pain Symptom Manage 2006 Jan
PMID:Using the symptom monitor in a randomized controlled trial: the effect on symptom prevalence and severity. 1644 79


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