Norbert Grulke

The relationship of phantom limb pain to other phantom limb phenomena in upper extremity amputees

Abstract In thirty‐two unilateral upper extremity amputees with and without phantom limb pain, various phantom limb phenomena were investigated. In general, the incidence of non‐painful phantom limb sensations was higher in patients with phantom limb pain than in pain‐free amputees. Kinesthetic and kinetic phantom limb sensations were reported more frequently than exteroceptive cutaneous sensations. There was a significant positive correlation between phantom limb pain and stump pain. Patients more frequently assigned sensory than affective pain qualities to their phantom limb pain, whereas no differences between pain qualities were observed for stump pain. No support was found for a relationship between the presence of telescoping (i.e., shrinkage of the phantom limb) and phantom limb pain. These findings point to central as well as to peripheral factors contributing to phantom limb pain.

Distress in patients undergoing allogeneic haematopoietic stem cell transplantation is correlated with distress in nurses

PURPOSE To date, no studies have reported on the relationship between the emotional distress of patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) and the distress of their nurses. METHODS 113 patients rated their distress by means of a daily questionnaire during their inpatient hospitalisation for HSCT. At the same time, nurses were asked to assess their distress caused by the additional care needs and increased emotional demands placed on them by the patients. Surveys covered a treatment period from day -5 to day +29 post-HSCT. RESULTS The correlation between the distress level of the patients and that of the nurses was r=0.40 (p<0.001). The partial coefficient of this correlation was r=0.43 (p<0.001) when an indicator of the physical state of the patients, as assessed by their treating physicians, was controlled. CONCLUSIONS Distress, as experienced by patients and nurses, is positively correlated. We assume that such a relation holds beyond other individual, organisational, structural, and occupational influences that play decisive and limiting roles in the patient-nurse relationship. Reducing the distress of one of these parties could also positively affect the distress levels of the other party. Therefore, patient distress should be monitored since it may add to nurse distress. Types of patient interventions, as well as the people responsible for performing these interventions, must be discussed. On the other hand, interventions aimed at reducing nurse distress (regardless of the cause of the distress) could reduce patient distress and improve their satisfaction with the treatment, and their quality of life.

Two-question depression-screeners – the solution to all problems?

ZusammenfassungDepression ist bereits heute epidemiologisch eine beachtenswerte Größe in der Medizin. Voraussichtlich wird die Zahl der Patienten, die an einer Depression leiden, zukünftig noch deutlich zunehmen. Ein einfaches, schnelles Screening zur Entdeckung von Depressiven wäre deshalb hilfreich. In letzter Zeit wurden vier Artikel publiziert, die jeweils einen Zwei-Fragen-Screener empfehlen. METHODE: Es werden die Sensitivität, Spezifität, Likelihood Ratios, negative und positive Vorhersagewerte der Screener verglichen. ERGEBNISSE: Die Prävalenz für Depression reichte in vier klinischen und einer bevölkerungsrepräsentativen (Deutschland) Stichprobe von 6.9 % bis 18.1 %. Sensitivität und Spezifität erreichten Werte zwischen 72.6 % und 96.6 % beziehungsweise zwischen 56.9 % und 90.0 %. Gegenüber den positiven Vorhersagewerten (17.8 % bis 38.5 %) waren alle negativen Vorhersagewerte hoch (< 97 %). SCHLUSSFOLGERUNG: Alles in allem scheinen Zwei-Fragen-Screener gut geeignet, Major Depression auszuschließen. Möglicherweise kann routinemäßiges Screening die Anzahl der Fälle nicht diagnostizierter Depression mindern.SummaryDepression constitutes a considerable issue in medicine and it is anticipated that the amount of people suffering from affective disorders will increase significantly. It would be useful to have a simple, fast screening procedure which would help detect depression. In four recently published articles a two-question depression-screener is recommended. METHOD: Sensitivity, specificity, likelihood ratios, negative and positive predictive values were compared. RESULTS: For four different clinical samples and one sample that was representative of the German population the prevalence for depression ranged from 6.9 % to 18.1 %. Sensitivity and specificity reached values from 72.6 % to 96.6 % and from 56.9 % to 90.0 % respectively. All negative predictive values were high (< 97 %) opposed to positive predictive values (17.8 % to 38.5 %). CONCLUSION: Overall, it seems that the two-question screenings are well suited for the exclusion of a major depression. It is possible that regular screening could further lower the percentage of undiagnosed cases.