Publications by authors named "Elaine Cachia"

6 Publications

  • Page 1 of 1

The contributors of emotional distress in painful diabetic neuropathy.

Diab Vasc Dis Res 2014 Jul 12;11(4):218-225. Epub 2014 May 12.

Diabetes Research Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Aims: To examine the contribution of demographic, social, clinical and psychological factors to emotional distress in patients with painful diabetic neuropathy (DN).

Methods: In total, 142 patients with confirmed painful DN underwent detailed clinical and self-assessment measures (Neuropathic Pain Scale, Hospital Anxiety and Depression Scale, Pain Acceptance Questionnaire and Pain Catastrophizing Scale).

Results: The prevalence of emotional distress was 51.4% in this cohort. Age, sex, marital status, employment history, pain intensity, duration of diabetes and the presence of diabetic and non-diabetic complications were significantly correlated to anxiety and depressive symptom scores. Multiple regression analysis confirmed that the presence of catastrophic thinking was an independent contributor to greater symptoms of anxiety and depression. Being young, single and unemployed significantly contributed to greater anxiety symptoms. Pain-related restriction of quality of life was associated with greater depression symptom scores.

Conclusions: This study found a high prevalence of emotional distress in patients with painful DN. It highlights that the differing independent contributors to anxiety and depressive symptoms are based on an individual's circumstances and experience. We conclude by highlighting the importance of adopting a holistic approach to pain management, incorporating interventions to increase psychological flexibility alongside conventional pharmacological treatments to improve emotional distress in painful DN.
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http://dx.doi.org/10.1177/1479164114522135DOI Listing
July 2014

Transdermal opioids for cancer pain.

Curr Opin Support Palliat Care 2011 Mar;5(1):15-9

Academic Unit of Supportive Care, Department of Oncology, School of Medicine and Biomedical Science, Royal Hallamshire Hospital, Sheffield, UK.

Purpose Of Review: Cancer patients with moderate-to-severe pain require opioids for analgesia. Whereas early guidelines recommend oral morphine as the 'drug of choice', newer synthetic opioids can be given by a reliable and effective nonoral transdermal route. We examine the mode of action of transdermal patches and we review the evidence on two drugs, which are currently available in this formulation - buprenorphine and fentanyl - covering physicochemical characteristics and pharmacokinetics of the patches, clinical efficacy data and adverse effects.

Recent Findings: Both buprenorphine and fentanyl possess ideal characteristics for transdermal delivery, being small molecules with high lipophilicity. Studies of buprenorphine patches show benefits but there is poor randomized controlled trial evidence comparing them with oral opioids. Fentanyl patches have been used for longer and have a larger body of evidence supporting their use, with data to suggest improved pain relief and reduced opioid side effects compared with sustained release oral morphine. Patients who have used both oral morphine and transdermal fentanyl express a preference for the patch drug.

Summary: Transdermal buprenorphine and fentanyl are now established for moderate-to-severe cancer pain. There is still a need for further comparative studies with other opioids, especially for buprenorphine.
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http://dx.doi.org/10.1097/SPC.0b013e3283437a39DOI Listing
March 2011

Breathlessness in cancer patients.

Eur J Cancer 2008 May;44(8):1116-23

Palliative Medicine, Sheffield Teaching Hospitals Foundation NHS Trust.

Breathlessness (or dyspnoea) is a common symptom experienced by cancer patients. It may be iatrogenic and is often caused or aggravated by co-morbidity. Recent studies have elucidated the neural and chemical controls of breathing which may be involved in the production of dyspnoea. A rational approach involves making a diagnosis of aetiology and treating reversible causes wherever possible. The main approaches for palliation of dyspnoea include anti-cancer treatments; drugs; oxygen and airflow; non-medical approaches. Further research is needed to clarify the best pharmacological regimens and the place of more invasive interventions.
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http://dx.doi.org/10.1016/j.ejca.2008.03.004DOI Listing
May 2008

Incidence of inflammatory bowel disease in Malta between 1993 and 2005: a retrospective study.

Inflamm Bowel Dis 2008 Apr;14(4):550-3

Department of Gastroenterology, St. Luke's University Hospital, Malta.

Background: The primary aim of the study was to estimate the incidence of Crohn's disease (CD) and ulcerative colitis (UC), collectively known as inflammatory bowel disease (IBD), in Malta in a well-defined population during a 13-year study period.

Methods: Diagnostic criteria for CD and UC were defined. A diagnosis of IBD was obtained from the histopathology reports at St. Luke's Hospital, Malta, between January 1993 and December 2005. The date of diagnosis was defined as the date of the first histopathology report revealing signs of IBD.

Results: Incidence rates were standardized using the direct method on the European Standard Population. The mean incidence of UC in males was 8.16 per 100,000 per year and for females was 7.59 per 100,000 per year, while that for CD in males was 0.96 per 100,000 per year and for females 1.622 per 100,000 per year. Using linear regression, in UC there is an almost significant (P = 0.069) increasing trend with time but no difference by gender (P = 0.591). On the other hand, in CD there is no significant trend with time (P = 0.555) but almost a significant difference by gender (P = 0.078).

Conclusions: This is the first Maltese study in which the incidence of IBD has been recorded. In Malta the incidence of UC is similar to the overall incidence of other European countries while the incidence of CD is lower. In fact, the incidence rates of CD are among the lowest in Europe, similar to other southern European countries.
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http://dx.doi.org/10.1002/ibd.20321DOI Listing
April 2008

The impact of diabetes on psychological well being and quality of life. The role of patient education.

Psychol Health Med 2007 Oct;12(5):545-55

Department of Diabetes and Endocrinology, Luton and Dunstable Hospital NHS Foundation Trust, Lutoh, UK.

People with diabetes live in a society that does not understand their condition. The overall perception that people with serious diabetes inject insulin and that Type 2 diabetes is relatively mild remains rife within the general population and even with some health care professionals. To make the situation worse, only few people understand that diabetes is a condition that cannot be simply controlled by medications and that the presence of diabetes markedly alters the lives of individuals and their families. Consequently, in this article we will be reviewing the scientific evidence of the effects of impaired psychological well being and poor perception of life quality on patients with diabetes. We will be enlightening the importance of patient education and self-empowerment on this aspect of management, which is crucial for the improvement in the physical, psychological and social well being of every patient suffering from this disease.
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http://dx.doi.org/10.1080/13548500701235740DOI Listing
October 2007

The impact of Cardiovascular Autonomic Neuropathy in diabetes: is it associated with left ventricular dysfunction?

Auton Neurosci 2007 Mar 2;132(1-2):1-7. Epub 2007 Jan 2.

Department of Diabetes and Endocrinology Luton and Dunstable Hospital NHS Trust Lewsey Road, Luton LU4 ODZ, United Kingdom.

Cardiovascular Autonomic Neuropathy (CAN) is one of the least understood of all serious complications of diabetes. Besides increasing mortality, CAN may have various clinical sequelae including exercise intolerance, arrhythmias and painless myocardial infarction. But does it also cause left ventricular dysfunction? Patients with diabetes have a greater risk of developing congestive heart failure. Coronary artery disease and hypertension have been notorious in causing left ventricular dysfunction in many of these patients. However, even in their absence, diabetes itself, through several studies, has been proposed to cause the controversial entity, Diabetic Cardiomyopathy (DCM). Various mechanisms have been suggested. CAN through alteration in myocardial blood flow and sympathetic denervation, and through changes in myocardial neurotransmitters, including catecholamines and neurotransmitters of the neuropeptidergic system, has been and is still being studied as one of the main mechanisms to cause left ventricular dysfunction. Earlier detection of CAN and instant initiation of upcoming treatments may be a way to help prevent DCM, and thus improve the morbidity and mortality this causes to patients with diabetes.
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http://dx.doi.org/10.1016/j.autneu.2006.11.003DOI Listing
March 2007