I get tired for no reason: a single item screening for cancer-related fatigue.

This study examined the criterion validity and sensitivity and specificity of a single item to rapidly screen patients in ambulatory oncology clinics for cancer-related fatigue. In an effort to expand the utility of the Zung Self-Rating Depression Scale (ZSDS) as a screen for other symptoms, the utility of the single fatigue item was examined. The fatigue item reads "I get tired for no reason" and is rated on a four-point scale ranging from "none or a little of the time" to "most or all of the time." Fifty-two subjects were administered the Zung, the Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale, and the Fatigue Symptom Inventory (FSI). The Zung item was highly correlated with the ZSDS (r= 0.63, p < 0.0001) and the FACT-An (r = -0.70, p < 0.0001), as well as to the individual items of the FSI, ranging from 0.41 (p < 0.003) to 0.71 (p < 0.0001). All 10 subjects considered to be depressed based on the ZSDS were also considered to fatigued on the FACT-An. Setting the ZSDS item cutoff point at level 3--"A good part of the time"--yielded a sensitivity of 78.95% and a specificity of 87.88%. It is concluded that a single item can be a fast and accurate way of screening cancer patients for fatigue to trigger additional follow-up, thus expanding the utility of a depression screening tool for problems other than the purely psychiatric.

An attempt to employ the Zung Self-Rating Depression Scale as a "lab test" to trigger follow-up in ambulatory oncology clinics: criterion validity and detection.

We examined issues of criterion validity and detection of depression employing the Zung Self-Rating Depression Scale (ZSDS) as a "lab test" to trigger follow-up interviews of ambulatory oncology patients by oncology staff and the possibility of subsequent algorithm-based antidepressant treatment. Sixty oncology patients were screened with the ZSDS and then interviewed using the Mini-International Neuropsychiatric Interview (MINI). We examined the sensitivity and specificity of various cutoffs on the ZSDS and a briefer version, the Brief Zung Self-Rating Depression Scale (BZSDS) as they predicted results of the MINI, which was used as the criterion. Mean age of patients was 58.3 years (SD = 11.9). Thirty-two were female (53.3%) and 28 were male (46.7%). The correlation of the ZSDS (r = -0.66, P <.0001) and BZSDS (r = -0.57, P <.0001) with the MINI overall suggested acceptable levels of criterion validity. Additionally, we examined various cutoff scores on the ZSDS and BZSDS to explore the false negative and false positive rates that are associated with each. For example, using the mild cutoff on the Zung (score > 48) to determine depression or adjustment disorder, 14 false negatives and 2 false positives were found. When the more stringent moderate cutoff (score > 56) was used, 25 false negatives and 0 false positives were found. Oncology staff can utilize such data to make decisions about where to set cut-offs that trigger follow-up based on the amount of error that is allowable in their attempts to identify depressive symptoms in their patients. We discuss that such decisions might be based on many factors including the resources available in a particular site for follow-up or the comfort of particular oncologists and nurses managing and prescribing psychotropic medications, or in providing supportive counseling.

Oncology staff recognition of depressive symptoms on videotaped interviews of depressed cancer patients: implications for designing a training program.

We examined oncologists' and nurses' ability to recognize depressive symptoms in two cancer patients who were interviewed on videotape. The study was conducted in a rural community, hospital-based outreach network. Staff were given a one-hour in-service on the use of the Mini International Neuropsychiatric Interview (MINI)-a brief diagnostic interview-to provide a differential diagnosis (no psychiatric diagnosis, major depressive disorder, or adjustment disorder with depressed mood). Next, the staff viewed a videotape of an investigator (S.P.) utilizing the MINI to interview two depressed breast cancer patients. Staff subsequently rated depressive symptoms on the MINI and made a diagnosis. Findings indicated a high concordance among staff regarding symptom ratings on a straightforward example of major depressive disorder. Concordance on diagnosis, severity level, and specific symptoms declined slightly on a more difficult case involving primarily cognitive symptoms and a diagnosis of adjustment disorder. Following brief didactic training on depressive disorders, oncologists and nurses were able to identify depressive symptoms in cancer patients on videotape. Learning to use a semistructured interview can increase oncologists' awareness of depressive symptoms and may be a good training model.

Factor analysis of the Zung Self-Rating Depression Scale in a large ambulatory oncology sample.

Screening cancer patients for depression with self-report inventories presents clinical and methodological challenges. Many investigators separate "somatic" from "cognitive" symptoms when adapting such measures to oncology settings. However, this practice has rarely been empirically validated through factor-analytic studies. The following study describes a factor analysis of the Zung Self-Rating Depression Scale (ZSDS) from a large ambulatory sample of cancer patients (N = 1,109). A four-factor solution emerged, consisting of a cognitive symptom factor, a manifest depressed mood factor, and two somatic factors (eating and non-eating related). These factors accounted for 20% (cognitive), 13% (mood), 8% (non-eating), and 7% (eating) of the variance on the Zung, respectively. The authors discuss the implications of these results as they pertain to screening cancer patients for depression.

Longitudinal study of FM system use in nonacademic settings: effects on language development.

OBJECTIVE: The overall objective of the present study was to assess the efficacy of FM system use in the home setting for a group of preschool children with mild-to-severe sensorineural hearing loss. Changes in language acquisition were monitored and compared with similar measures from a group of children who used hearing aids. Secondarily, the perceived benefits and practical problems associated with FM system use across a variety of nonacademic situations were documented. DESIGN: Ten children with mild-to-severe sensorineural hearing loss participated in a 2-yr longitudinal study investigating the efficacy of FM system use in the home setting. The subjects were divided into two groups: one group was instructed to use FM systems at home as often as possible while the other used only their personal hearing aids. Changes in language acquisition were monitored in both groups. Subjective benefit and the practical problems associated with use of FM systems outside of traditional academic environments were monitored via daily use logs, a weekly observation inventory, and a situational listening profile. RESULTS: The majority of children in both groups improved in all measures of language development over the study interval. Although there were relatively large individual differences in performance for some measures, no statistically significant differences between the FM and hearing aid users were found. However, some children in the FM group made unusually large gains in some aspects of language development over the study interval. In addition, both parents and children reported benefits of FM system use in specific listening situations. Throughout the 2-yr study, a number of practical problems associated with FM system use outside the classroom were identified. CONCLUSIONS: Formal language measures did not yield significant differences between the FM and HA groups, but some subjects had rates of language acquisition which suggested that FM system use may be beneficial in selected cases. In addition, subjective reports of FM system benefit suggest that appropriate use of the device may facilitate effective communication in a variety of listening situations. Although recent advances in FM system design may minimize some of the factors that reportedly restricted consistent FM use in this study, the complexities associated with the modes of operation and problems with FM interference remain issues that require consistent audiologic monitoring of FM system use in nonacademic environments.

Characteristics of the NANC post-stimulus ('rebound') contraction of the urinary bladder neck muscle in sheep.

1. Strips of muscle from sheep bladder neck were set up for tension recording and subjected to electrical field stimulation (EFS) to stimulate their intramural nerves. 2. In the presence of atropine (1 microM) and guanethidine (1 microM), the response to 1 Hz EFS was biphasic, characterized by a relaxation during the stimulus period, followed by a post-stimulus contraction. A similar biphasic response was also seen following bolus application of nitric oxide (NO). 3. In the absence of atropine and guanethidine, the relaxations were masked by contractions during stimulation; however, the post-stimulus contraction were unaffected. L-NAME (100 microM) blocked the post-stimulus contractions and L-arginine (1 mM) restored them, suggesting that they were NO-mediated. 4. M&B 22948, a phosphodiesterase inhibitor, prolonged the relaxations and abolished the post-stimulus contractions. This suggests that rapid removal of cyclic GMP is required for post-stimulus contraction to occur. 5. When the number of pulses in the stimulus train was kept constant, the size of the post-stimulus contraction increased as the duration of the preceding period of stimulation increased. Maximal post-stimulus contractions were obtained following stimulation for > 40 s. 6. The L-channel antagonist, nifedipine (1 microM) and verapamil (1 microM), had little effect on the amplitude of the post-stimulus contractions. 7. In contrast, ryanodine-(8 microM) reduced the post-stimulus contractions by over 90%. Caffeine (20 mM) also abolished the post-stimulus contractions and cyclopiazonic acid (CPA, 10 microM) reduced them by 76%. However, in the presence of CPA a slower post-stimulus contraction developed. Nifedipine (1 microM) reduced this by 40%. 8. In conclusion, these results support a role for NO in the post-stimulus contraction of the sheep bladder neck muscle. The post-stimulus contraction depends more on release of intracellular Ca2+, than Ca2+ influx through L-type channels.

Concentration dependence of adenosine and the protection of rat cortical neurones during anoxia.

Aglycaemic/anoxic slices of rat olfactory cortex lose all electrical activity. On reoxygenation, 10 microM adenosine enhanced recovery from 23 +/- 7% to 53 +/- 12%; an increased tissue endurance of 5-7 min. 100 microM adenosine slightly depressed recovery to 11.5 +/- 2.1%. Dipyridamole increased whereas adenosine deaminase reduced recovery. These observations question the therapeutic effectiveness of high adenosine concentrations.

Adenosine-induced enhanced recovery of evoked responses after anoxia.

Transverse slices of rat hippocampus were used to test the effect of adenosine on recovery of synaptically-evoked potentials after anoxia. To produce conditions better resembling ischaemia, glucose was omitted during the period of anoxia. Anoxia abolished all electrical activity within 5 min. The responses recovered completely after short periods of anoxia (3 min), but the amount of recovery was progressively reduced with longer exposures. The recovery was enhanced by the presence of 100 microM adenosine: the exposure time giving a 50% recovery of the response was 17.6 +/- 1.8 min in normal solution and 29.0 +/- 4.1 min with adenosine. These results are consistent with the idea that adenosine offers some protection from anoxia.