Integrative Review of Co-Occurring Symptoms Across Etiologies of Chronic Liver Disease and Implications for Symptom Management Research and Practice.

Purpose: Chronic liver disease affects over 30 million people worldwide, and despite advances in medical management that have increased survival, a majority of these individuals report multiple symptoms that severely impair function and quality of life. The purpose of this integrative review was to examine and summarize the current literature focused on self-reported symptoms in individuals with chronic liver disease in order to inform the development and delivery of symptom management strategies in clinical practice.

Design And Methods: Combinations of search terms related to the symptom experience were used to search three electronic databases.

An evidence-based practice case study: white coat hypertension.

White coat hypertension, also referred to as isolated clinical hypertension, is a condition in which blood pressure rises in the medical setting due to anxiety. White coat hypertension causes no more than 15 mmHg increase in systolic blood pressure or 7 mmHg increase in diastolic blood pressure in normotensive patients, and these increases in blood pressures should return to baseline within 3 visits to the medical provider. In this case, a 77-year-old white man presented to preoperative testing, with a blood pressure of 265/101 mmHg, claiming to have white coat hypertension.

"I just start crying for no reason": the experience of stress and depression in pregnant, urban, African-American adolescents and their perception of yoga as a management strategy.

Purpose: Perinatal health disparities are of particular concern with pregnant, urban, African-American (AA) adolescents, who have high rates of stress and depression during pregnancy, higher rates of adverse pregnancy and neonatal outcomes, and many barriers to effective treatment. The purpose of this study was to explore pregnant, urban, AA teenagers' experience of stress and depression and examine their perceptions of adjunctive nonpharmacologic management strategies, such as yoga.

Methods: This community-based, qualitative study used nontherapeutic focus groups to allow for exploration of attitudes, concerns, beliefs, and values regarding stress and depression in pregnancy and nonpharmacologic management approaches, such as mind-body therapies and other prenatal activities.

Decreased low back pain intensity and differential gene expression following Calmare®: results from a double-blinded randomized sham-controlled study.

In this double-blinded, randomized controlled trial we evaluated the effects of Calmare®, a non-invasive neurocutaneous electrical pain intervention, on lower back pain intensity as measured by the "worst" pain score and on pain interference using the Brief Pain Inventory-Short Form, on measures of pain sensitivity assessed by quantitative sensory testing, and on mRNA expression of pain sensitivity genes. Thirty participants were randomized to receive up to 10 sessions of Calmare® treatment (n = 15) or a sham treatment (n = 15) using the same device at a non-therapeutic threshold. At 3 weeks after conclusion of treatment, compared with the sham group, the Calmare® group reported a significant decrease in the "worst" pain and interference scores.

The effect of oral care on intracranial pressure in critically ill adults.

A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960s when ICP monitoring was first introduced in the clinical setting. Until recently, few studies have specifically examined the effect of oral care on ICP, and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP.

Inspiration for aspirations: Virginia nurse insights about BSN progression.

The Partnerships for Progression: Inspiration for Aspirations project was developed to create a culture of academic progression for nurses in Virginia. A survey was completed by 128 nurses who are currently enrolled in Registered Nurse to Bachelor of Science in Nursing programs throughout Virginia to learn why registered nurses pursue the bachelor of science degree (BSN) and to identify supports and obstacles that influence their experiences. Findings indicate that BSN progression is influenced by an interacting set of personal, work, and educational factors.

Biobehavioral examination of fatigue across populations: report from a P30 Center of Excellence.

Objectives: This article reports the cross-studies analysis of projects from the P30 Center of Excellence for Biobehavioral Approaches to Symptom Management. Although the projects investigated diverse populations, a consistent theoretical and empirical approach guided each project.

Methods: Common data elements included the following measures of psychobehavioral variables: the PROMIS Short-Form Fatigue Scale, the Center of Epidemiologic Studies Depression Scale, and the Perceived Stress Scale.

Association of Mitochondrial Dysfunction and Fatigue: A Review of the Literature.

Fatigue is often described by patients as a lack of energy, mental or physical tiredness, diminished endurance, and prolonged recovery after physical activity. Etiologic mechanisms underlying fatigue are not well understood; however, fatigue is a hallmark symptom of mitochondrial disease, making mitochondrial dysfunction a putative biological mechanism for fatigue. Therefore, this review examined studies that investigated the association of markers of mitochondrial dysfunction with fatigue and proposes possible research directions to enhance understanding of the role of mitochondrial dysfunction in fatigue.

Shared symptoms and putative biological mechanisms in chronic liver disease: implications for biobehavioral research.

Liver disease affects over 25 million people in the United States and, despite advances in medical management resulting in increased survival, a majority of these individuals report multiple co-occurring symptoms that severely impair functioning and quality of life. The purpose of this review is to (1) propose defining these co-occurring symptoms as a symptom cluster of chronic liver disease (CLD), (2) discuss putative underlying biological mechanisms related to CLD, including the liver-gut-brain axis and influence of the microbiome, and (3) discuss the implications for biobehavioral research in this patient population. Biobehavioral research focusing on the interrelated, and possibly synergistic, mechanisms of these symptoms may lead to the development and testing of targeted symptom management interventions for improving function and quality of life in this growing patient population.

Depressive symptoms and cytokine levels in Serum and Tumor Tissue in patients with an Astrocytoma: a pilot study.

Background: Preoperative depressive symptoms are associated with poor outcomes in patients with an astrocytoma. Cytokines are associated with depressive symptoms in the general population and are important mediators of tumor growth and progression.The aims of this study were to: (1) characterize depressive symptoms, other treatment-related symptoms and biological mediators; and (2) determine whether preoperative depressive symptoms were associated with the selected biological mediators.

An evidence-based quality improvement perspective for a chronic obstructive pulmonary disease case-finding program.

Chronic obstructive pulmonary disease (COPD) is a persistent progressive respiratory disease that is increasing in prevalence and cost in the United States health care system. Delays in recognition, diagnosis, and treatment are associated with poorer clinical outcomes. These delays are seen more often in populations experiencing economic hardship, lack of access to care, and lack of insurance, such as those seen in an indigent care clinic.

Psychosocial assessment of candidates and risk classification of patients considered for durable mechanical circulatory support.

Background: The psychosocial assessment of candidates for transplantation (PACT), developed to assess candidates for heart transplant, has not been routinely used to assess left ventricular assist device (LVAD) candidacy. We examined the efficacy of the PACT to assess psychosocial outcomes in LVAD patients.

Methods: We reviewed patients who received LVAD implants between June 2006 and April 2011 and retrospectively applied the PACT.

Utility of high-frequency ultrasound: moving beyond the surface to detect changes in skin integrity.

Ultrasound imaging is a versatile modality frequently used in clinical medicine, most likely due to its low cost, low risk to patients, and the ability to provide images in real time. Ultrasound used typically in clinical settings has frequencies between 2 and 12 MHz. Lower frequencies produce greater resolution but are limited in depth penetration; higher frequencies produce greater resolution, but depth of penetration is limited.

A Conceptual Model of Psychoneurological Symptom Cluster Variation in Women with Breast Cancer: Bringing Nursing Research to Personalized Medicine.

Personalized medicine applies knowledge about the patient's individual characteristics in relation to health and intervention outcomes, including treatment response and adverse side-effects, to develop a tailored treatment plan. For women with breast cancer, personalized medicine has substantially improved the rate of survival, however, a high proportion of these women report multiple, co-occurring psychoneurological symptoms over the treatment trajectory that adversely affect their quality of life. In a subset of these women, co-occurring symptoms referred to as symptoms clusters, can persist long after treatment has ended.

The perceived benefits of a virtual community: effects of learning style, race, ethnicity, and frequency of use on nursing students.

Background: It is important for nursing faculty to consider the variability in learning style among nursing students.

Aim: The researchers sought to compare differences in perceived learning benefits among nursing students who had different learning styles and in frequency of use of a virtual community learning intervention. METHOD Using a comparative approach, learning style was measured with the Kolb Learning Style Inventory.

Decoding the role of epigenetics and genomics in pain management.

Persistent pain is a costly epidemic, affecting >50 million Americans with estimated expenditures of >$200 billion annually for direct care and lost productivity. Recent advances in epigenetic/genomic understanding of pain and analgesic response may lead to improvements in pain management and help curtail costs by providing more precise detection of the pain mechanisms involved and thereby more personalized and effective treatments. However, the translation of epigenetic and genomic strategies for pain management into clinical practice will depend on understanding their potential applications.

Understanding nurses' experiences of providing end-of-life care in the US hospital setting.

Hermeneutic phenomenological methods were used to explore nurses' perspectives on the phenomenon of end-of-life care within the hospital setting. Three main themes described participants' experiences: "Confronting Challenges," "Coming to Understand End-of-Life Care," and "Transforming the Understanding of End-of-Life Care into Nursing Practice." Recommendations for education, practice, and research were derived.

Epigenetic alterations and an increased frequency of micronuclei in women with fibromyalgia.

Fibromyalgia (FM), characterized by chronic widespread pain, fatigue, and cognitive/mood disturbances, leads to reduced workplace productivity and increased healthcare expenses. To determine if acquired epigenetic/genetic changes are associated with FM, we compared the frequency of spontaneously occurring micronuclei (MN) and genome-wide methylation patterns in women with FM (n = 10) to those seen in comparably aged healthy controls (n = 42 (MN); n = 8 (methylation)). The mean (sd) MN frequency of women with FM (51.

Arthrocentesis: the latest on joint pain relief.

Arthrocentesis is a procedure in the diagnostic workup and treatment of joint pain that has few complications. Analysis of joint fluid yields important treatment data. Corticosteroid and local anesthetic injections provide longer pain relief.

Psychoneuroimmunology-Based Stress Management during Adjuvant Chemotherapy for Early Breast Cancer.

Objective. In a randomized trial of women with early stage breast cancer undergoing adjuvant chemotherapy, two stress management interventions, tai chi training and spiritual growth groups, were compared to a usual care control group, to evaluate psychosocial functioning, quality of life (QOL), and biological markers thought to reflect cancer- and treatment-specific mechanisms. Method.

Potential epigenetic mechanism(s) associated with the persistence of psychoneurological symptoms in women receiving chemotherapy for breast cancer: a hypothesis.

Due to recent treatment advances, there have been improvements in the proportion of women surviving a diagnosis of breast cancer (BC). However, many of these survivors report persistent adverse side effects following treatment, such as cognitive dysfunction, depressive symptoms, anxiety, fatigue, sleep disturbances, and pain. Investigators have examined circulating levels of inflammatory markers, particularly serum cytokines, for a potential causal relationship to the development/persistence of these psychoneurological symptoms (PNS).

Effects of a guided imagery intervention on stress in hospitalized pregnant women: a pilot study.

Using repeated-measures pre-/posttest design, the effects of guided imagery on maternal stress in 19 hospitalized pregnant women were examined. Mean stress and systolic blood pressure measurements postintervention were significantly lower than mean levels before listening to the guided imagery CD. All participants identified benefits of this holistic intervention.

Psychologic and biologic factors associated with fatigue in patients with persistent radiculopathy.

Fatigue is a common symptom associated with neuropathic pain (NP) and can have negative consequences on psychosocial functioning, physical endurance, and quality of life. Recent evidence indicates that immune activation modulated through the increased release of proinflammatory cytokines can predict fatigue in some patient populations. Although earlier studies have shown that immune activation is a pathophysiologic feature of NP, there have been no studies to examine the relationship between immune activation and fatigue in persons with NP.