Symptom diaries

Diet records and symptom diaries are helpful but rarely diagnostic. Table 3.3.4 shows the examples of nonimmunological adverse reactions to food and masquerades of food allergy (Sicherer, 2002) (Table 3.3.4). 

There are no specific laboratory tests that are diagnostic for PMS or PMDD. A prospective self-rated symptom diary with severity ratings is most helpful in diagnosing and monitoring menstruation-related disorders. 

Bloom, in 1995, gathered economic data in a single, blind, randomized controlled trial comparing omeprazole, 20 mg each day, to ranitidine, 150 mg each day, plus metoclopramide, 10 mg four times daily, in 184 patients with erosive esophagitis. Esophagitis was verified by endoscopy before entry into the trial. Healing was confirmed by endoscopy at the end of 4 weeks and, if necessary, at the end of 8 weeks of treatment. Patients kept a daily symptom diary and also recorded the numbers and types of medical services used outside those required by the protocol and direct nonmedical costs, such as meals... 

Monitor effect, e.g. symptom diary, rating scale, number of ED presentations... 

Dietary manipulation may give diagnostic information about all types of food sensitivity. For example, a patient may keep a diet diary together with a symptom diary, although this is subject to bias. An elimination diet involves the elimination for two or three weeks of all foods that are thought to provoke sensitivity. Foods are then reintroduced slowly one by one to identify the allergen. Elimination diets do carry the risk of nutritional deficiency (21a). 

Evaluate therapy on a regular basis. Assess the patient s control of asthma by evaluating symptoms, PEF diary entries, and rescue medication use. Step long-term control therapy up or down based on these parameters. Before stepping up therapy, reassess the patient s inhaler technique to assure appropriate drug delivery. 

Evaluate the clinical outcomes of treatment by using the UPDRS. In addition, periodically ask patients to record the amount of on and off time they have with and without dyskinesias in a diary. There are a variety of scales that can be used to assess QOL, depression, anxiety, and sleep disorders. Patients with PD cannot be cured but treatment can delay the progression of symptoms and improve QOL. Delaying the patient s admission into a nursing home is a good outcome. 

Pharmacotherapy of SAD should lead to improvement in physiologic symptoms of anxiety and fear, functionality, and overall well-being.26 Many patients may not achieve full remission of symptoms but should have significant improvement. Monitor patients weekly during acute treatment (e.g., initiation and titration of pharmacotherapy). Once patients are stabilized, monitor monthly. Inquire about adverse effects and SAD symptoms at each visit. To aid in assessing improvement, ask patients to keep a diary to record fears, anxiety levels, and behaviors in social situations.26 You may administer the Leibowitz Social Anxiety Scale (LSAS) to rate SAD severity and change, and the Social Phobia Inventory can be used as a self-assessment tool for SAD patients. 

Review the sleep diaries and timing of RLS symptoms to watch for possible symptom augmentation. 

Monitor the patient for symptom relief. Have the desired outcomes jointly developed by the health care team and the patient/caregiver been achieved and to what degree Inspect the daily diary completed by the patient/caregiver since the last clinic visit and quantitate the clinical response (e.g., number of micturitions, number of incontinence episodes, and pad use). If a diary has not been used, ask the patient how many incontinence pads have been used and how they have been doing in terms of accidents since the last visit. If appropriate, administer a short-form instrument used to measure symptom impact and condition-specific quality of life and compare previous result(s). 

For variant angina, reduction in symptoms and nitroglycerin consumption as documented by a patient diary can assist the interpretation of objective data obtained from ambulatory ECG recordings. Evidence of efficacy includes the reduction of ischemic events, both ST-segment depression and elevation. Additional evidence is a reduced number of attacks of angina requiring hospitalization, and the absence of MI and sudden death. 

Patients with SAD should be monitored for symptom response, adverse effects, and overall functionality and quality of life. Patients should be seen weekly during dosage titration and monthly once stabilized. Patients should be asked to keep a diary to record symptoms and their severity. The clinician-related Liebowitz Social Anxiety Scale and the patient-rated Social Phobia Inventory can be used to monitor severity of symptoms and symptom change. 

This study involved 75 patients, 36 in the active group and 36 in the placebo group 3 patients were excluded because of insufficient data. The mean age of patients was 25 years. The study was conducted double-blind versus placebo for 2 years. The criterion for inclusion was rhinitis with or without asthma. The efficacy criteria were skin tests, a diary kept daily of symptoms and treatments, the assessment of nasal symptoms only, assessment of rhinitis using a visual analog scale by the patient and by the doctor, and assay of specific IgE and specific IgG4 versus mites. 

During the treatment no patient had reported bronchospastic or systemic reactions. All patients completed their scheduled immunotherapy diaries and their signs and symptoms were classified into three categories improvement, cured and no change. 

The pharmacist should therefore look to reinforce the information already provided to Mrs RP by outlining those parameters being monitored (i.e. tumour marker, symptoms and a CT scan after the third or fourth cycle). It will also be necessary to inform Mrs RP of the need to monitor carefully for side-effects. Often it is useful for patients to be asked to record the side-effects that they suffer from during treatment in a patient diary booklet or similar. 

Fig. 1. Diary Card intoxication scores. BL, baseline. DB, double-blind. Patients self-titrated active medication (THCCBD) or placebo against symptom relief or intolerable unwanted effects. Doses reached a plateau after 4 weeks. Open patients from both arms re-titrated onto active medication. (Reproduced with kind permission from Arnold Publishers)...

During the acute phase of treatment, patients should be seen weekly while the drug dosage is titrated. Once the patient responds and the dosage is stabilized, the patient can be seen monthly. At each visit, the patient should be asked about adverse effects and improvement in symptoms. The patient should be instructed to keep a diary to record fear levels, physical symptoms, cognitions, and anxious behaviors in actual exposures to social situations. The Liebowitz Social Anxiety Scale is a clinician-rated scale that rates clinical severity and change in SAD that can be used to monitor response. Patients can use the Social Phobia Inventory for self-assessment of SAD symptoms. Full remission is a complete resolution of symptoms across the three... 

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