Anna Simpson

Background: People with cystic fibrosis (CF) report a variety of gastrointestinal (GI) symptoms, independent of pancreatic enzyme insufficiency (PEI), reminiscent of other chronic GI disorders. There are currently no accepted or validated assessment tools and neither the range, frequency nor severity of GI symptoms has been systematically described in CF. We present results of a cross‐sectional study using established tools and compare them to current measures of quality of life (QOL).Methods: Consecutive patients attending specialist CF appointments were asked to complete questionnaires including the GI Symptom Rating Scale (GSRS); Irritable Bowel Syndrome Symptom Severity Score (IBS‐SSS) and Cystic Fibrosis Questionnaire (CFQ‐R). Questionnaire terminology was altered to replace references to ‘IBS’ with ‘GI symptoms’.Results: In total, 107 patients were recruited (mean age, 27.8 ± 9.6 years; 60 female), and 94 (88%) had PEI. Body mass index was 22.1 ± 3.6 kg/m², forced expiratory volume in one second was 59 + 27.7% predicted. Fifty‐three (49.5%) were p.Phe508del homozygous. Overall 69/107 (65%) reported significant GI symptoms independent of PEI or adherence to pancreatic enzyme replacement therapy (PERT), with the four most frequent being attributable to the lower GI tract: bloating/distension, flatulence, abdominal pain and borborygmi (gurgling). There was no numerical correlation between any CFQ‐R domain (particularly Digestion domain) and GSRS or SSS.Conclusion: This is the first systematic study measuring GI symptoms in CF using validated GI tools. Symptoms are not related to PERT or genotype and appear to be captured well by the GSRS. Further research will study longitudinal changes with treatment, and therapeutic trials in CF may use these tools to demonstrate a positive impact on ‘non‐respiratory’ symptoms and QOL.

Rationale, aims and objectives: Young people (YP) with chronic illness have increased risk of mental health problems. This paper evaluates the feasibility, acceptability and effectiveness of incorporating routine electronic mental health screening into the standard multidisciplinary healthcare of YP with chronic liver disease and liver transplant.Methods: One hundred and eighty-seven YP (mean age 18 years, 53% female) attending routine appointments in a tertiary service in the UK completed mental health screening prior to their clinic appointment. These standardized measures (the 9-item Patient Health Questionnaire [PHQ9] and the 7-item Generalised Anxiety questionnaire [GAD7]) were completed using an informatics system that facilitates routine collection of patient-reported outcomes, with real-time feedback to guide clinical care. Responses are immediately uploaded to medical notes and evaluated by the clinical team. Fifty-three YP completed an additional feasibility measure. YP screening positive were assessed by the clinical team, with appropriate support offered. Level of clinician agreement with screening programme was ascertained by the team’s clinical psychologist.Results: YP reported that completing the electronic screening was acceptable, a positive experience and that routine mental health screening in this manner would not affect the way they felt about coming to clinic. Clinician judgement corroborated 31 of the 33 YP who screened as positive for anxiety/depression. Screening did not effectively identify all YP warranting psychosocial input.Conclusions: Screening using electronic measures, with responses uploaded in real-time to medical notes for consultant review, can facilitate the rapid identification of mental health problems in YP with physical health problems, in an acceptable and time/cost-effective way. This should be combined with the support of embedded mental health practitioners within physical healthcare environments.

Background National Institute for Health and Care Excellence guidance recommends assessment of psychological and social well‐being in people with psoriasis. Objectives To screen systematically for depression and anxiety in patients with psoriasis in routine clinical practice and to identify at‐risk groups for psychiatric morbidity. Methods Consecutive patients attending a single, tertiary centre over a 10‐month period were invited to complete the Patient Health Questionnaire Depression Scale (PHQ‐9), Generalized Anxiety Disorder Scale (GAD‐7) and Dermatology Life Quality Index (DLQI) as part of IMPARTS: Integrating Mental and Physical Healthcare: Research, Training and Services. Information on demographics, treatment and clinical disease severity was collated from electronic patient records. Regression models were used to identify at‐risk groups for psychiatric morbidity. Results Of 607 patients included (56·2% on biologics), 9·9% (95% confidence interval 7·5–12·3%) screened positive for major depressive disorder (MDD) and 13·1% (79/604) (95% confidence interval 10·4–15·8%) for generalized anxiety disorder (GAD; GAD‐7 score > 9). Suicidal ideation was reported in 35% of those with MDD; DLQI was < 10 in 38·3% and 45·6% cases of MDD and GAD, respectively. After adjusting for covariates, the risk of MDD or GAD was significantly higher in women and those with severe clinical disease, psoriatic arthritis and previous depression/anxiety. The risk of GAD was significantly increased with Asian ethnicity and use of topical treatments only. Conclusions Systematic screening for anxiety and depression identifies clinically important levels of depression and anxiety that may be missed using DLQI data alone. Women and those with severe disease, psoriatic arthritis and/or a prior history of psychiatric morbidity may be at particular risk.

This cross-sectional study aimed to determine the prevalence and impact of depression on health care costs in patients with complex chronic pain. The sample included 1204 patients attending a tertiary pain management service for people with chronic disabling pain, unresponsive to medical treatment. As part of routine care, patients completed a web-based questionnaire assessing mental and physical health, functioning, and service use in the preceding 3 months. Depression was assessed using the 9-item Patient Health Questionnaire. Self-report health care utilisation was measured across 4 domains: general practitioner contacts, contacts with secondary/tertiary care doctors, accident and emergency department visits, and days hospitalised. The participation rate was 89%. Seven hundred and thirty-two patients (60.8%; 95% CI 58.0-63.6) met criteria for probable depression, and 407 (33.8%) met the threshold for severe depression. Patients with depression were more likely to be unable to work because of ill health and reported greater work absence, greater pain-related interference with functioning, lower pain acceptance, and more generalised pain. Mean total health care costs per 3-month period were £731 (95% CI £646-£817) for patients with depression, compared with £448 (95% CI £366-£530) for patients without depression. A positive association between severe depression and total health care costs persisted after controlling for key demographic, functional, and clinical covariates using multiple linear regression models. These findings reveal the extent, severity, and impact of depression in patients with chronic pain and make evident a need for action. Effective treatment of depression may improve patient health and functioning and reduce the burden of chronic pain on health care services.

"A comparison of antennule structure in a surfaceand a cave-dwelling crayfish, genus Orconectes (Decapoda, Astacidae)" published on 01 Jan 2003 by Brill.