Exploring patients' views on colonisation with meticillin-resistant Staphylococcus aureus

his qualitative study follows previous research on how meticillin-resistant Staphylococcus aureus (MRSA) affects patients as reported by healthcare workers. The aim of this study was to research the phenomenon of being colonised with MRSA from the patient's perspective. A total of 14 patients were interviewed following discharge from hospital, transcripts were then analysed using an interpretive phenomenological approach. The key findings are reported under the four themes of information provision, patient understanding, lived experience and information needs. Poor information provision was a key theme, experienced by many patients. This resulted in some patients feeling confused and often anxious, and for some affected their lives both in and out of hospital. Providing good quality and reassuring information appropriate to the patient and their current condition is key to improving understanding, deflecting the impact of the media and reducing significance of this symptom-free state. Recommendations for practice include enhanced training for healthcare workers on how to address sensitively the patient's information needs and reduce unnecessary confusion and distress.

Short term health-related quality of life improvement during opioid agonist treatment

BACKGROUND

Opioid dependence is associated with high levels of morbidity, yet sparse data exists regarding the health-related quality of life (HRQoL) of individuals with opioid dependence, particularly following treatment initiation. To inform cost-effectiveness analyses of treatment modalities, this study investigates short-term changes in HRQoL following enrollment into opioid agonist treatment (OAT), across treatment modalities and patient subgroups.

METHODS

Data was analyzed from the Starting Treatment with Agonist Replacement Therapies (START) and Prescription Opioid Addiction Treatment Studies (POATS) randomized controlled trials. Participants included individuals dependent on prescription opioids (POs) or heroin, receiving limited-term or time-unlimited treatment. PO- or heroin-users in START received buprenorphine/naloxone (BUP/NX) or methadone (MET) over 24 weeks. PO-users in POATS received psychosocial care and short-term (4-week) taper with BUP/NX, with non-responders offered subsequent extended (12-week) stabilization and taper. HRQoL was assessed using the short-form SF-6D while in and out of OAT, with distinction between MMT and BUP/NX in START. Linear mixed effects regression models were fitted to determine the independent effects of OAT on HRQoL and characterize HRQoL trajectories.

RESULTS

Treatment had a similar immediate and modest positive association with HRQoL in each patient subgroup. The association of OAT on HRQoL was statistically significant in each model, with effect sizes between 0.039 (heroin-users receiving BUP/NX) and 0.071 (PO-users receiving MET). After initial improvement, HRQoL decreased slightly, or increased at a diminished rate.

CONCLUSIONS

OAT, whether delivered in time-limited or unlimited form, using BUP/NX or MET, is associated with modest immediate HRQoL improvements, with diminishing benefits thereafter.

The effectiveness of chocolate milk as a post-climbing recovery aid

AIM

Recovery is essential to effective performance in climbing competitions which often involve repeated bouts, and sport climbing where climbers may work a route over a number of days prior to a complete ascent.

METHODS

This study employed a cross-over design to compare water with chocolate milk as recovery aids following an exhaustive bout of high intensity endurance climbing. Ten male climbers (age: 22±1 years; height: 178.5±7.9 cm; mass: 74.7±11.3 kg) climbed a Tredwall (Brewer Ledge M6) until volitional exhaustion. The participants consumed either water or chocolate milk 20 minutes after the climb and then again with their evening meal. The exercise protocol was repeated 24 hours after the original climb. The second condition was completed 7 days later. Workload indicators of heart rate, rate of perceived exertion (RPE), blood lactate and muscle soreness scores were recorded alongside climbing performance measures of duration and distance of the climb. A improved performance was found after the consumption of chocolate milk, with both a greater distance climbed (F(1,9)=11.704, P=0.008) and duration (F(1,9) =10.922, P=0.009), there were no differences in end of climb heart rate or RPE.

RESULTS

Muscle soreness scores were lower three days after exercise following chocolate milk (t(8)=3.773, P=0.005). Chocolate milk as a recovery drink resulted in further sustained climbing, a decrease in muscle soreness, compared to water. It may be pertinent for climbers to consider its use as a recovery aid during repeated climbing bouts. Chocolate milk is a relatively unexplored recovery aid and warrants further attention.

Comparison of two passive warming devices for prevention of perioperative hypothermia in dogs

OBJECTIVE

To compare effects of two passive warming methods combined with a resistive heating mat on perioperative hypothermia in dogs.

MATERIALS AND METHODS

Fifty-two dogs were enrolled and randomly allocated to receive a reflective blanket (Blizzard Blanket) or a fabric blanket (VetBed). In addition, in the operating room all dogs were placed onto a table with a resistive heating mat covered with a fabric blanket. Rectal temperature measurements were taken at defined points. Statistical analysis was performed comparing all Blizzard Blanket-treated to all VetBed-treated dogs, and VetBed versus Blizzard Blanket dogs within spay and castrate groups, spay versus castrate groups and within groups less than 10 kg or more than 10 kg bodyweight.

RESULTS

Data from 39 dogs were used for analysis. All dogs showed a reduction in perioperative rectal temperature. There were no detected statistical differences between treatments or between the different groups.

CLINICAL SIGNIFICANCE

This study supports previous data on prevalence of hypothermia during surgery. The combination of active and passive warming methods used in this study prevented the development of severe hypothermia, but there were no differences between treatment groups.

Adolescent contraception: review and guidance for pediatric clinicians

The majority of adolescents initiate sexual activity during their teenage years, making contraception an important aspect of routine adolescent health care. Despite common misperceptions, all available methods of reversible contraception are appropriate for adolescent use. Contraceptive side effects profiles and barriers to use of certain methods should be considered when providing contraceptives to adolescents. In particular, ease of use, confidentiality, and menstrual effects are main concerns of adolescents. Contraceptive counseling with adolescents should describe method efficacy, discuss user preferences, explore barriers to use, counsel regarding sexually transmitted infection prevention, and consider what to do if contraception fails. Emergency contraception should be widely discussed with adolescents, as it is appropriate for use during gaps in other contraceptive use, method failure, and adolescents who are not using another form of contraception. Dual method use (condom plus a highly effective method of contraception) is the gold standard for prevention of both pregnancy and sexually transmitted infections.

Using a predictive model of clinician intention to improve continuing health professional education on cancer survivorship

INTRODUCTION

Cancer survivorship is a chronic disease that places patients in limbo between oncologists and primary care clinicians. Strategies have been proposed to ease the shift in coordination of care, including broad-based educational outreach to primary care providers.

METHODS

Guided by the theory of planned behavior (TPB), predictors of intention to provide survivorship care, including credentials, experience, perception of barriers, and personal survivorship status, were evaluated using logistic regression with a cohort of physicians, nurse practitioners, and registered nurses participating in an unprecedented online continuing medical education/continuing education survivorship care course.

RESULTS

Results showed that physicians were significantly less likely to express intent to provide survivorship care (odds ratio [OR] = .237, p = .0001) compared to the other groups. Overall, clinicians with 6-10 years of experience were 3 times more likely to express intent to provide survivorship care (OR = 2.86, p = .045) than those with less or more experience. When clinicians perceived the presence of a barrier, they were nearly twice as likely to have diminished intent (OR = 1.89, p = .035). Most participants (66%; n = 1185) selected two barriers: lack of survivorship care plans and treatment summaries (45.4%; n = 821) and lack of education (20.1%; n = 364).

DISCUSSION

Barriers to the delivery of survivorship care can influence clinicians' intention to provide survivorship care, which varied by years of experience in this study. Interdisciplinary educational strategies featuring midcareer provider champions who have successfully incorporated survivorship care and can offer specific solutions to these barriers are recommended for future interventions.

Abstract P6-05-10: Association between BRCA1/2 status and DNA-based assays for homologous recombination deficiency in breast cancer

Homologous recombination (HR) repair defects are of potential therapeutic relevance in a variety of different cancers. Numerous studies have investigated the rate of BRCA1/2 mutations in triple negative breast cancer, and current clinical studies are investigating the efficacy of agents targeting HR deficiency in this breast cancer subtype. A more comprehensive assay for HR defects might expand the number of patients likely to benefit from these therapies, and may expand their utility to other breast cancer subtypes.

Recently three DNA-based measures of HR deficiency (HRD) have been developed based on whole genome tumor LOH profiles, telomeric allelic imbalance, or large-scale state transitions. These will be referred herein as HRD-LOH, HRD-TAI and HRD-LST respectively. All 3 scores are highly correlated with defects in BRCA1/2 and other pathway genes in breast or ovarian cancer, and are associated with sensitivity to platinum agents.

213 invasive breast tumor samples and matched normal tissue blocks were obtained from 3 commercial vendors. The samples were selected to contain approximately equal numbers of all subtypes of breast cancer as defined by IHC analysis of ER, PR, and HER2. BRCA1/2 mutation screening and BRCA1 promoter methylation analysis was performed, and genome wide SNP profiles were generated. These data were used to calculate HRD-LOH, HRD-TAI, and HRD-LST scores.

Somatic and germline BRCA1/2 mutations were detected in all subtypes of breast cancer at significant levels with the total mutation frequency ranging from 7.8 – 16.4% depending on subtype. In contrast BRCA1 promoter methylation was confined almost exclusively to triple negative tumors (19.7%). Overall BRCA1/2 deficiency ranged from approximately 10% in ER+/Her2- tumors up to approximately 36% in triple negative tumors.

HRD-LOH, HRD-TAI, and HRD- LST scores have previously been shown to be highly significantly associated with BRCA1/2 status in both breast and ovarian cancer. In this dataset all 3 scores showed significant association with BRCA1/2 status for the entire dataset, in addition significant association was observed between the scores and BRCA1/2 status in each of the individual tumor subtypes. The 3 scores were found to be highly correlated with one another, but all 3 were still significant in multivariate analysis. This dataset is not of sufficient size to determine which of these scores is best able to identify BRCA1/2 deficient tumors. It is likely that a combination of the 3 scores will prove to be the most robust predictor of HR deficiency.

This study has demonstrated significant levels of BRCA1/2 deficiency across all subtypes of breast cancer. All 3 HR deficiency assays showed significant association with BRCA1/2 deficiency regardless of breast cancer subtype. The 3 scores are highly correlated, but also additive and a combination of all 3 is likely to provide the best predictor of HR deficiency.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-10.

Low-temperature Debye–Scherrer powder diffraction on Beamline I11 at Diamond

A bespoke capillary sample holder is described that attaches to the cold head of a commercially manufactured (PheniX) closed-cycle helium cryostat originally intended for flat-plate geometry. The new holder allows high-resolution synchrotron powder diffraction data to be collected from samples in Debye–Scherrer geometry over the temperature range 11–295 K. To demonstrate that high-quality powder data can be obtained using this new sample holder, structural refinement (Rietveld) and thermal expansion results measured from reference samples (Si and Al) are presented.