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Our aim was to examine the accuracy of the German version of the Distress Thermometer (DT) compared with the Hospital Anxiety and Depression Scale (HADS) in patients with palliative care needs living at home.
Ours was a 15-month cross-sectional study beginning in September of 2013 in Germany with consecutive patients cared for by a palliative home care service. The survey was implemented during the initial visit by a home care team. Patients were excluded if they were under 18 years of age, mentally or physically unable to complete the assessment questionnaires as judged by their healthcare worker, or unable to understand the German language. During the first encounter, the DT and HADS were applied, and sociodemographic and medical data were collected.
A total of 89 persons completed both the HADS and DT questionnaires (response rate = 59.7%; mean age = 67 years; female = 55.1%; married = 65.2%; living home with relatives = 73.0%; oncological condition = 92.1%; Karnofsky Performance Scale [KPS] score: 0–40 = 30.3%, 50–70 = 57.3%, >80 = 6.7%). The mean DT score was 6.3 (±2.3), with 84.3% of participants scoring above the DT cutoff (≥4). The mean HADStotal score was 17.9 (±7.8), where 64% of participants had a total HADS score (HADStotal) ≥15, 51.7% reported anxiety (HADSanxiety ≥ 8), and 73% reported depression (HADSdepression ≥ 8). Using the HADS as a gold standard, a DT cutoff score ≥5 was optimal for identifying severe distress in patients with palliative care needs, with a sensitivity of 93.0%, a specificity of 34.4%, a positive predictive value (PPV) of 73.3%, and likelihood ratios LR+ = 1.42 (<3) and –LR = 0.203 (<0.3).
Significance of results:
The DT performed satisfactorily compared to the HADS in screening for distress in our study and can be employed as an instrument for identification of patients with distress. Consequent to the high prevalence of distress, we recommend its routine use for screening distressed persons at home with palliative care needs in order to offer adequate support.
At issue in a short survey of republican art is the lack of many longer ones, as if there were no art to be discussed. The opposite is true: for nearly half a millennium, the Latin cities, Rome preeminent among them, expressed themselves both intensely and fluently, with art, architecture, and landscape architecture, private and public, in coins and engraved gems, metal and stone images, mosaic and painting, in the brilliantly modeled terracottas of houses and public buildings. Later Roman ages cherished, recorded, and imitated that patrimony and held in respect the memory of the leaders who put art into their cities - even the memory of those who created it, including that interesting generation of early republican nobles who made monumental paintings. But how was that art “Roman”? This chapter offers one concise but nuanced partial response to this question. What follows is an attempt to explore some of the distinctive variety and characteristics of republican art, stressing its public functions for Roman society. (For help in understanding the discussion of Rome's monuments and architecture, consult Fig. 19, which consists of a map of the entire city and a detailed view of the center of the city.)