Academic literature on the topic 'Gastrointestinal problems (GasP)'

Patients with inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, commonly face the additional burden of extraintestinal manifestations (EIMs). The most frequently occurring of these EIMs are musculoskeletal problems, with axial spondyloarthritis reported as affecting as many as 12% of IBD patients. This inflammatory condition, which primarily affects the spine, results in pain, stiffness and reduced quality of life. The social consequences of the condition are significant, with patients more likely to have depression and/or retire early from work and less likely to have children. In recent years, there have been advances in the treatment of this chronic, debilitating condition. However, delay to diagnosis still remains high, at an average of 8.5 years. Gastrointestinal nurses have the potential to identify patients attending gastroenterology clinics who exhibit symptoms that are suggestive of spondyloarthritis. This could have an important influence on the time taken to get a diagnosis.

Forty years ago, archaea were described as a separate domain of life, distinct from bacteria and eukarya. Although it is known for quite a long time that methanogenic archaea are substantial components of the human gastrointestinal tract (GIT) and the oral cavity, the knowledge on the human archaeome is very limited. Various methodological problems contribute to the invisibility of the human archaeome, resulting in severe knowledge gaps and contradictory information. Similar to the bacteriome, the archaeal biogeography was found to be site-specific, forming (i) the thaumarchaeal skin landscape, (ii) the (methano)euryarchaeal GIT landscape, (iii) a mixed skin/GIT landscape in nose, and (iv) a woesearchaeal lung landscape, including numerous unknown archaeal clades. Compared with so-called universal microbiome approaches, archaea-specific protocols reveal a wide diversity and high quantity of archaeal signatures in various human tissues, with up to 1 : 1 ratios of bacteria and archaea in appendix and nose samples. The archaeome interacts closely with the bacteriome and the human body cells, whereas the roles of the human-associated archaea with respect to human health are only sparsely described. Methanogenic archaea and methane production were correlated with many health issues, including constipation, periodontitis and multiple sclerosis. However, one of the most burning questions — do archaeal pathogens exist? — still remains obscure to date.

Background: Although the Gulf War occurred almost 30 years ago, the chronic symptoms of Gulf War illness (GWI), which include respiratory, gastrointestinal, and skin problems, as well as fatigue, pain, and mood alterations, currently affect over 200,000 veterans. Meanwhile, healthcare providers lack clear guidelines about how to best treat this illness. The objective in this study was to learn about the perceptions and experiences of healthcare providers of GWI veterans in terms of medical symptoms, resources for treatment, and quality of care. Methods: We interviewed 10 healthcare providers across the United States and subsequently conducted a qualitative grounded theory study which entailed both systematic data analysis and generating a grounded theory framework. Results: Our findings indicated multiple challenges for providers of veterans with GWI, including gaps in knowledge about GWI, lack of treatment options, absence of consistent communication within the Department of Veterans Affairs (VA) system, and personalized care that was limited to validation. Conclusion: While this study had several limitations, it supported the notion that healthcare providers have inadequate knowledge and awareness about GWI, which leads to continued uncertainty about how to best care for GWI veterans. This could be remedied by the creation of a comprehensive curriculum for a Massive Open Online Course (MOOC) to serve as an educational tool for those attending to this largely overlooked veteran population.

220 Background: With the rising number of survivors across many cancer sites, increasing attention is being paid to assessing, preventing, and managing cancer and treatment related symptoms. This presentation will discuss the breadth of the symptom management portfolio within the community research programs funded by the NCI: The Community Clinical Oncology Program (CCOP) and the NCI Community Oncology Research Program (NCORP) from 2008 to 2018. Trends in types of symptoms and study designs will be described to identify research gaps. Methods: Symptom management research was operationally defined as any clinical study focusing on cancer and treatment related symptoms and/or related psychological, social and spiritual problems. The primary endpoint is measured by a patient reported outcome (PRO). Using this definition, a search was conducted of the NCI database to capture clinical studies implemented in the CCOP and NCORP networks from 2008 to 2018. Results: Between 2008 and 2018, 68 clinical studies were conducted in the NCI community research programs that met this definition. During this period of time, the most frequently studied symptom was neurotoxicities (n = 13), comprised of chemotherapy induced peripheral neuropathy (n = 3), neurocognition (n = 9) and ototoxicity (n = 1). Gastrointestinal symptoms (n = 10), pain (n = 9) and fatigue (6) were the following most frequent. The least studied symptoms included genitourinary symptoms (n = 1), vaginal health (n = 1), sexual desire (n = 1), psychosocial (n = 2) and lymphedema (n = 2). The predominant trial design was phase II or III randomized clinical trial with the remaining longitudinal, cohort design. Further delineation of these data will be presented. Conclusions: The prevalence of the symptoms studied within the NCI community programs mirrors the symptom literature in terms of frequency. Cancer survivors have reported a number of symptoms not adequately addressed by their clinicians such as sexual health and psychosocial issues. This gap also mirrors the frequency of research conducted in the community networks. Future research in the network focusing on these understudied areas should be considered by investigators.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a popular measure of psychosocial functioning and psychopathology in the assessment of individuals in a variety of settings. However, the method of construction employed with the MMPI more than 60 years ago with psychiatric patients challenges the applicability of the scales for determining the psychosocial functioning of individuals from different settings. The restandardisation conducted in 1987 made no effort to eradicate the item overlap that was a result of the criterion keying method with contrasted groups. Although restandardized and updated with more contemporary language and content, the original psychiatric constructs were retained in order to maintain continuity with its predecessor. The aims of this investigation were to develop a new structure for the MMPI-2 constructed at the item-level, empirically derived and which specifically represents the dimensions that are relevant and appropriate in evaluating the psychosocial functioning of personal injury claimants. This task included comparisons with a comparable scale-level analysis and developing optimal scoring strategies where items in components and facets are allocated weightings based upon their strength of association. Study 1 was conducted using a sample of 2989 personal injury claimants assessed in Australia and the United States of America. The final sample of 3230, included 241 normal individuals, was utilized to develop a scale-level structure from 79 standard MMPI-2 scales and subscales. A nine-component solution consisting of General Maladjustment /Emotional Distress, Asocial Beliefs, Social Vulnerability, Somatic Complaints, Psychological Disturbance, Impulsive Expression, Antisocial Practices, Stereotypic Fears and Family Difficulties was derived using principal component analysis. However, intercorrelation between components in the structure signaled the need to develop a structure that would eradicate problems that were perpetuated by item overlap. The second study was conducted with a set of best practice procedures with the same clinical sample of 2989 personal injury claimants as Study 1. Forty-one components were derived through principal component analysis. Through the application of a set of criteria, a 35-component solution was retained. The pattern coefficients from the allocation of items to components determined the weightings to be applied to each item. Further analysis of the 35 components derived a substructure of 37 facets. The 35 components included only 442 of the 567 items, with the reliability coefficients of the first 25 components that ranged between .5 and .97, and the remaining 10 components that ranged from .29 to .49. The latter unreliable components were not included in the final Structural Summary, leaving 25 components (400 items) and their 33 facets for interpretation. Hence, in demonstrating the utility of the newly-derived structure, only 25 components and their 33 facets were interpreted. The 25 components were grouped conceptually into six domains. In the emotional domain were Psychological Distress (PsyDist), Anger, Fears, Psychotic Symptoms (PsyS), Paranoia (Par), Irritability (Irrit), Elation (Elat), Fear of the Dark (FD), and Financial Worry (FinWo). Somatic Complaints (SomC), Sexual Concerns (SexCon), and Gastrointestinal Problems (GasP) made up the measures in the physiological domain. In the behavioural domain were Cognitive Difficulties (CogDiff), Stimulus-Seeking (StimuS), Discipline (Dis), and Delinquency (Del) whilst the interpersonal domain was formed by Social Withdrawal (SoW), Negative Interpersonal Attitude (NIA), Timidity (Tim), Lie, Dissatisfaction with Self (DWS) and Family Relationship Difficulties (FReD). Alcoholism (Alco) was the only measure in the substance abuse domain, and the gender domain was comprised of Masculinity (Mas) and Femininity (Fem). The third study established preliminary normative means and standard deviations using a small opportunistic Australian university student sample (N = 219). No substantial gender differences were found but gender norms were maintained to facilitate comparisons with the traditional MMPI-2 approach. Comparisons of frequency of 'true' item response between the Australian university student sample and the U.S. restandardisation sample found relatively little differences and permitted evaluation of between sample differences on components and facets. The utility of the structure was demonstrated with the illustration of two clinical case examples, and a comparison was made with the standard MMPI-2 scales and subscales. The Structural Summary for the MMPI-2 demonstrated discriminative measures of psychosocial functioning that were a result of no item overlap, and the ability to attend to the different levels of intensity of self-report items because of differential weightings.

This chapter in the Oxford Handbook of Emergency Medicine encompasses all medicine practised in the emergency department (ED). It explores electrocardiogram interpretation, chest pain, cardiac ischaemia, acute coronary syndrome, ST segment elevation MI (STEMI), myocardial infarction, acute pericarditis, bradyarrhythmia, tachycardia, broad complex and regular narrow complex tachyarrhythmia, atrial fibrillation, hypertensive problems, implantable cardiac devices, and aortic dissection. It examines haemoptysis and administering oxygen, the dyspnoeic patient, hyperventilation, blood gas, pulmonary oedema, pleural effusion, asthma, chronic obstructive pulmonary disease (COPD), pneumonia, pulmonary aspiration, and spontaneous pneumothorax. It discusses deep venous thrombosis and pulmonary embolism, gastrointestinal bleeding, gastrostomy, and refeeding syndrome. Jaundice is explored, alongside ascites and liver failure. It discusses headache, subarachnoid haemorrhage, migraine, giant cell arteritis, space-occupying lesions, acute confusional state (delirium), transient global amnesia, and the unconscious patient. Falls in the elderly are examined, along with collapse and syncope, acute generalized weakness, stroke, intracerebral haemorrhage, transient ischaemic attacks, seizures, and status epilepticus. It explores hypoglycaemia, hyperglycaemic crises, sodium derangements, Addisonian crisis, and thyrotoxic crisis. It discusses acute kidney injury, chronic kidney disease, urinary tract infection, hyperkalaemia, and hypokalaemia. It ends with an exploration of porphyria, bleeding disorders, anticoagulants, blood transfusion, and sickle-cell disease.