Latest news with #Patients
South China Morning Post
2 days ago
- Health
- South China Morning Post
Empower Hong Kong's patients with advance care planning
Feel strongly about these letters, or any other aspects of the news? Share your views by emailing us your Letter to the Editor at [email protected] or filling in this Google form . Submissions should not exceed 400 words, and must include your full name and address, plus a phone number for verification Advertisement The Advance Decision on Life-sustaining Treatment Ordinance, which concerns advance medical directives (AMDs) and do-not-attempt cardiopulmonary resuscitation (DNACPR) orders, was passed in late 2024 and will come into operation around mid-2026. Yet public awareness of such advance decisions remains low. Advance care planning (ACP) is needed to facilitate such decisions. It is an empowering process for patients to plan for future healthcare needs while honouring their values and preferences. With the support of healthcare professionals, patients may indicate to family members their preferences for future medical and personal care, especially in scenarios where they are lacking in mental capacity. ACP helps meet the four principles of biomedical ethics in clinical medicine. Advertisement Respect for autonomy is the first principle. ACP provides an informed process to heighten patients' autonomy. After obtaining the necessary information from healthcare professionals, patients may decide on the kinds of healthcare which align with their values and preferences in terms of quality of life during the final journey.
Medscape
6 days ago
- Health
- Medscape
Mindfulness Therapy Aids IBD Patients With Mental Distress
TOPLINE: Mindfulness-based cognitive therapy reduced psychological distress and improved well-being of patients with inflammatory bowel disease (IBD), and it may offer benefits for sleep quality and inflammation. METHODOLOGY: Even in remission, many patients with IBD experience anxiety, depression, fatigue, and poor sleep, which can lower their quality of life, undermine self-care, and drive up healthcare use. Researchers conducted this trial in the Netherlands between July 2021 and May 2022 to strengthen the evidence for the effectiveness of mindfulness-based cognitive therapy in reducing psychological distress in patients with IBD who had been in remission for at least 3 months and experienced at least mild levels of distress. They randomly assigned 142 patients (mean age, 48.6 years; 64.1% women) to receive either mindfulness therapy plus usual treatment (n = 70; intervention group) or only usual treatment (n = 72; control group); the follow-up period lasted 12 months. The mindfulness therapy program included eight weekly group sessions of 2.5 hours, 30-45 minutes of daily home practice, and a 6-hour silent retreat day between sessions six and seven. Usual treatment included pharmacologic and surgical disease control treatments and the prevention of complications. The primary outcome was psychological distress post-intervention (3 months from baseline), measured using the Hospital Anxiety and Depression Scale (HADS) total score. Secondary outcomes included well-being, sleep, self-compassion, mindfulness skills, and disease activity. TAKEAWAY: Patients in the intervention group vs the control group showed reduced psychological distress (Cohen d [d], -0.61) and an improvement in the HADS total score (unstandardized coefficient B, -3.4; P < .001) at 3 months from baseline. The HADS total scores remained lower in the intervention group vs the control group during the entire 12-month follow-up duration. Compared with patients in the control group, those in the intervention group showed improved well-being (d, 0.41) and increases in mindfulness skills (d, 0.46) and self-compassion (d, 0.42). Patients in the intervention group vs the control group had a reduced total sleep time (d, -0.67) but an increased proportion of deep sleep (d, 0.7). No between-group difference was observed in the occurrence of disease flares, but patients in the control group showed a significant reduction in fecal calprotectin levels, an indicator of intestinal inflammation compared with patients in the control group (d, -0.49). IN PRACTICE: 'Our results demonstrate that MBCT [mindfulness-based cognitive therapy] could be a valuable addition to the currently limited number of psychological treatment options for patients with IBD with psychological distress. The group format of MBCT allows for the simultaneous treatment of more patients, potentially making it more cost-effective than individual therapy. Additionally, group therapy provides opportunities for peer support,' the authors of the study wrote. SOURCE: This study, led by Milou M. ter Avest, MD, Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Nijmegen, the Netherlands, was published online in Inflammatory Bowel Diseases. LIMITATIONS: This study was limited by its unblinded design, risking expectation bias in self-reports. Mindfulness teachers had varied competence levels, which may have introduced bias. The study did not assess sleep disorders such as obstructive sleep apnea, narcolepsy, or restless legs syndrome that may have affected the sleep metrics. Additionally, electroencephalography headbands were not available for all patients, and technical and self-application issues may have led to unusable nights and data loss. DISCLOSURES: This trial was supported by ZonMw (the Netherlands Organisation for Health Research and Development) and the MindMore Foundation. Two authors reported serving on the advisory boards of various pharmaceutical companies, and one of them also reported receiving a grant from Royal DSM. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
7 days ago
- Health
- Medscape
Fact or Fiction: Noncolorectal Gastrointestinal Cancer
Noncolorectal gastrointestinal (GI) cancers present unique challenges in diagnosis, management, and prognosis. Knowledge of risk factors, presenting features, and contemporary treatment guidelines is essential for timely recognition and effective care. Pancreatic cancer is primarily diagnosed among older adults. Nearly 90% of cases occur in individuals older than 55 years. Besides age, additional risk factors include smoking, diabetes, and obesity. Learn more about pancreatic cancer epidemiology. Due to nonspecific symptoms, most patients with gastric cancer present with advanced disease, contributing to a worldwide 5-year survival rate of approximately 10%. Further, a study of patients with gastric cancer younger than 50 years found that 87% were symptomatic at diagnosis. Learn more about gastric cancer presentation. The incidence of esophageal adenocarcinoma in the US rose dramatically from the 1970s until 2006, then leveled off, and it is also continuing to increase in other countries due to certain lifestyle factors. Surveillance, Epidemiology, and End Results data from 2012-2022 show that incidence rates have remained steady at about 5.0-5.1 per 100,000 in males and 0.6-0.8 per 100,000 in females. Although rising obesity and metabolic syndrome rates probably contributed to prior increases, this does not fully explain the subsequent plateau. Learn more about esophageal cancer epidemiology. Current National Comprehensive Cancer Network (NCCN) guidelines recommend adjuvant chemotherapy after resection of biliary tract cancer; capecitabine is the preferred regimen. American Society of Clinical Oncology guidelines also recommend that patients should undergo adjuvant chemotherapy with capecitabine for 6 months after biliary tract cancer resection. Adjuvant chemotherapy or chemoradiation has been shown to improve survival in patients with biliary tract cancer, with the benefit being particularly notable among those with lymph node involvement. Learn more about biliary tract cancer treatment protocols. Studies have shown that the combination of an immune checkpoint inhibitor (ICI) and a vascular endothelial growth factor (VEGF) inhibitor, rather than a TKI plus cytotoxic chemotherapy, is associated with favorable survival outcomes and has recently become the standard initial treatment for advanced HCC. Although TKI may still be used as systemic therapy, c urrent NCCN guidelines recommend atezolizumab (an ICI) plus bevacizumab (a VEGF inhibitor) as one of the preferred initial systemic therapy regimens for advanced HCC; tremelimumab-actl plus durvalumab (both monoclonal antibody therapies) is another preferred initial option. Learn more about HCC treatments. Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.
Medscape
21-07-2025
- Health
- Medscape
Sleep Apnea Can Raise Risk for Retinal Vein Disease
TOPLINE: Obstructive sleep apnea (OSA) was associated with a notably higher risk of developing retinal vein occlusion across different demographic groups, with the greatest increase observed in people of Hispanic or Latino heritage. Among patients with preexisting retinal vein occlusion, the sleep disorder was associated with further ocular complications. METHODOLOGY: Researchers reviewed electronic health records of adults receiving ophthalmologic care and grouped them by the absence (n = 3,279,582; mean age, 50.2 years; 56.9% women) or presence (n = 19,918; mean age, 68.3 years, 53.0% women) of retinal vein occlusion at baseline; the first group also was stratified on the basis of sex, age, and ethnicity. Within each cohort, patients with OSA were compared with those without the condition to estimate the risk for incident retinal vein occlusion (first group) and the risk for complications or the need for invasive treatment (second group). Complications of retinal vein occlusion included swelling of the macula, abnormal growth of new blood vessels in the retina, or bleeding in the vitreous region; invasive treatments included pars plana vitrectomy, intravitreal injections of anti-VEGF, or laser therapy of the retina. TAKEAWAY: OSA was linked to a 28% increased risk for incident retinal vein occlusion in women (risk ratio [RR], 1.28; 95% CI, 1.14-1.45) and a 35% increased risk for the condition in men (RR, 1.35; 95% CI, 1.19-1.52). The association between OSA and retinal vein occlusion was the most prominent in the Hispanic/Latino population, followed by the non-Hispanic White and Black populations; however, the association was not observed in Asian patients. Among patients with retinal vein occlusion at baseline, those with OSA faced higher risks for swelling of the macula (RR, 3.70; 95% CI, 3.17-4.31), bleeding in the vitreous region (RR, 2.29; 95% CI, 1.64-3.20), and abnormal growth of new blood vessels in the retina (RR, 2.22; 95% CI, 1.69-2.91); they also received more intravitreal injections of anti-VEGF agents and underwent laser therapy of the retina. IN PRACTICE: 'Clinicians should consider regular ophthalmology screening of all patients with OSA and, conversely, incorporating OSA screening into regular follow-up appointments for patients with' retinal vein occlusion, the researchers reported. Whether early initiation of continuous positive airway pressure can mitigate the risk for retinal problems in patients with OSA 'would be a valuable area for further research,' they added. SOURCE: This study was led by Hejin Jeong, Case Western Reserve University School of Medicine, Cleveland. It was published online on July 16, 2025, in Eye. LIMITATIONS: Although polysomnography was used to diagnose OSA, data on the number of apnea-hypopnea events and drops in blood oxygen were not available. Since OSA can be significantly underdiagnosed, misclassification bias may have occurred. DISCLOSURES: This study received support from the Clinical and Translational Science Collaborative of Cleveland, Research to Prevent Blindness Challenge Grant, and Cleveland Eye Bank Foundation Grant. Some authors disclosed receiving personal fees, research grants, and having other ties with many pharmaceutical companies. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Health Line
19-07-2025
- Health
- Health Line
Parkinson's Disease: Recognizing Symptoms
Key takeaways Parkinson's disease is characterized by three phases, which include pre-motor, motor, and cognitive symptoms, though not everyone experiences all symptoms or in a specific order. Motor symptoms of Parkinson's, such as tremors, slowed movement, and impaired balance, can significantly affect a person's daily life and become more pronounced over time. Beyond motor issues, Parkinson's can also cause non-motor symptoms like constipation, depression, and sleep disturbances, as well as cognitive changes affecting memory, attention, and thinking speed. Parkinson's is a progressive neurological disease. People with Parkinson's experience various physical, cognitive, and psychological symptoms. Often, the early symptoms of Parkinson's are so subtle that the disease goes unnoticed for years. As the disease progresses, a lack of motor skills becomes more apparent. This is followed by cognitive impairments, including trouble following directions and loss of thought. Understanding the symptoms of Parkinson's is key to getting the right treatment. In this article, we'll talk about what the different stages of Parkinson's can look like and go over the symptoms in-depth. Stages of Parkinson's symptoms Parkinson's symptoms can be divided into three categories or phases: pre-motor, motor, and cognitive. These phases don't necessarily happen in chronological order, and not all Parkinson's patients will experience all symptoms. The premotor phase is the phase of Parkinson's in which non-motor symptoms are present. These symptoms include: Motor symptoms generally involve movement and include: tremor rigidity bradykinesia (slow movement) postural instability (balance problems) walking or gait difficulties involuntary muscle contractions (dystonia) vocal symptoms Approximately 50 percent of people with Parkinson's will experience some form of cognitive impairment, with severity varying among individuals. Cognitive changes can include: problems with attention slowed mental processing trouble with problem-solving or executive functioning memory deficits language abnormalities visuospatial difficulties Symptoms of Parkinson's disease Parkinson's is a chronic and progressive disorder, meaning that symptoms grow worse over time. There's a wide range of symptoms and symptom severity: while some people become severely disabled, others have only minor motor problems. Tremors A tremor is an unintentional, rhythmic muscle movement involving one or more parts of the body. Tremors primarily occur in the hands but can also affect: arms head face voice torso legs There are two main categories of tremor: resting tremor, and action tremor. Resting tremor occurs when muscles are relaxed, like when your hands are sitting in your lap, and lessen during sleep or when the body part is in use. Action tremors occur with the voluntary movements of a muscle. Tremors typically affect only one side of the body but may affect both sides as the disease progresses. Fatigue, stress, and intense emotion may worsen tremors. Slowed movement (bradykinesia) Bradykinesia means slowness of movement and is a hallmark symptom of Parkinson's. It can manifest in various ways, including: difficulty initiating movements like standing up slowed automatic movements like blinking general slowness in physical actions like walking the appearance of 'abnormal stillness' in facial expressions Speech changes Among people with Parkinson's, 89 percent experience speech and voice disorders. These disorders include changes to the voice that might make it sound soft, monotone, or hoarse. People with Parkinson's may not be aware that their speech is soft and difficult to understand, and may feel as though they are shouting when they are actually speaking normally. Impaired posture and balance Postural instability is the most difficult Parkinson's symptom to treat, and one of the most important criteria for diagnosing Parkinson's. Postural instability is the inability to balance due to loss of postural reflexes and often leads to falls. Patients with impaired posture and balance might revert to a stooped posture and have a shuffling gait. Muscle rigidity Muscle rigidity refers to stiffness in the arms or legs. Rigidity may occur on one or both sides of the body and can lead to a decreased range of motion, causing achiness or pain in affected muscles or joints Loss of automatic movements People with Parkinson's commonly experience a gradual loss of automatic movements, which can lead to a decreased frequency of blinking, swallowing, and drooling. Writing changes Small, cramped handwriting called micrographia is a common early symptom of Parkinson's. Handwriting size may get smaller as you continue to write, and your signature may change over time. Constipation Constipation is defined as having fewer than three bowel movements per week. In people with Parkinson's, constipation often begins before motor symptoms. It's believed that constipation in some people with Parkinson's may be due to improper functioning of the autonomic nervous system, which controls the muscle activity of the gut and enables bowel movements. Diminished sense of smell Hyposmia, or reduced sense of smell, is often an early sign of Parkinson's, predating motor symptoms by several years. It occurs in about 90 percent of early-stage Parkinson's cases. REM-sleep behavior disorder REM-sleep behavior disorder (RBD) is a sleep disorder where a person physically acts out vivid dreams with sounds or sudden arm and leg movements during REM sleep. Symptoms include: kicking, punching, or flailing during sleep making noises like yelling, talking, or laughing being able to vividly recall dreams RBD often precedes or follows the onset of Parkinson's and may be associated with the development of hallucinations and dementia. One study found that 66 percent of people with RBD developed a neurodegenerative disease within 7.5 years, suggesting a strong connection between RBD and the risk of neurodegenerative diseases like Parkinson's. Anxiety and depression Some people diagnosed with Parkinson's may experience some form of depression or an anxiety disorder. Some symptoms of depression — like sleep issues, low energy, and slowed thinking — overlap with symptoms of Parkinson's, making it difficult to diagnose. Depression and anxiety may also pre-date other symptoms of Parkinson's. Low blood pressure when standing Orthostatic hypotension (OH) refers to a persistent drop in blood pressure that occurs when you move from sitting to standing, or from lying down to sitting up or standing. It can cause: dizziness lightheadedness weakness difficulty thinking headache feeling faint OH is defined as a blood pressure drop of 20 millimeters of mercury in systolic blood pressure, or a drop of 10 millimeters in diastolic blood pressure. Drooling Sialorrhea, or excessive drooling, is a common symptom of Parkinson's. People with Parkinson's often have trouble with automatic actions, like swallowing, which can result in saliva pooling in the mouth. This can happen when the head is down, when the mouth is held open involuntarily or when a person is distracted and doesn't swallow automatically. Increased urination urgency and frequency Bladder problems are a common occurrence in people with Parkinson's, occurring in 30-40 percent of people with the disease. The most common urinary symptom is a frequent and urgent need to urinate even when the bladder is empty, as well as trouble delaying urination. Trouble emptying the bladder is a less common feature of Parkinson's urinary dysfunction. It may be caused by difficulty in relaxing the urethral sphincter muscles that allow the bladder to empty. Difficulty swallowing or eating Parkinson's affects the muscles in the face, mouth, and throat that control speaking and swallowing. Dysphagia, or difficulty swallowing, is a symptom of Parkinson's that can lead to trouble eating. It can lead to malnutrition, dehydration, or aspiration — which happens when food or saliva 'goes down the wrong pipe' and is inhaled into the lungs. Aspiration can lead to aspiration pneumonia, the leading cause of death in Parkinson's. Erectile dysfunction Sexual dysfunction is common in people with Parkinson's disease, with 54-79 percent of men reporting erectile dysfunction. Erectile dysfunction in people with Parkinson's is believed to be linked to the disease's effects on the central nervous system, as well as issues with blood circulation and control of pelvic muscles. Eye problems Vision changes are common as people grow older, but some vision changes may be specifically linked to Parkinson's. Parkinson's can cause the following: dry eyes as a result of decreased blinking double vision due to the eye's inability to work together trouble reading involuntary closure of the eyes trouble voluntarily opening the eyes Some Parkinson's medications, particularly anticholinergics, can cause blurry or double vision. Slowed thinking Cognitive impairment in people with Parkinson's can range from feelings of distraction and trouble planning tasks to more severe cognitive impairment that interrupts everyday life. Cognitive changes in people with Parkinson's are believed to be linked to drops in dopamine as well as changes in the brain levels of acetylcholine and norepinephrine. Signs of slowed thinking include: taking longer to complete tasks difficulty retrieving information from memory delays in responding to stimuli Impaired memory The basal ganglia and frontal lobes of the brain, two areas that help with information recall, may be damaged in people with Parkinson's. This can result in trouble with normal tasks like using a phone or making a meal. People with Parkinson's may also have trouble remembering words, known as the 'tip of the tongue' phenomenon. Difficulty paying attention People with Parkinson's often report difficulty with completing tasks that require them to concentrate and maintain their attention. This can make it hard to focus on situations that require divided attention, like group conversations. Dementia Some people with Parkinson's will eventually develop Parkinson's disease dementia. People with dementia have permanent cognitive and motor impairments that significantly impact their daily life. Mental impairment must affect at least two brain functions to be considered dementia. Mental impairment can range from mild to severe and could cause personality changes. When to see a doctor If you're experiencing early non-motor symptoms of Parkinson's — like depression, constipation, or loss of smell — you may be concerned about Parkinson's risk. In this case, you should schedule an appointment with a neurologist who can conduct a neurological exam. If you have motor symptoms of Parkinson's — like tremors, rigidity, or postural instability — your doctor will likely conduct a dopamine transporter imaging test, known as a DaTscan, which can determine if you have a dopamine deficiency. Remember: Non-motor symptoms like depression and constipation are common in the general population. So, just because you have them doesn't mean you have or will develop Parkinson's. If you're concerned about symptoms, keep track of how often they affect you so you can give as much information as possible to your doctor.
