Psychosocial health care needs assessment of adult cancer patients: a consensus-based guideline

PURPOSE

Although recommended as an essential part of cancer care, there is limited evidence regarding the optimum approach to psychosocial health care needs assessment in this setting. To address this gap, the Cancer Journey Action Group of the Canadian Partnership Against Cancer (CPAC) and the Canadian Association of Psychosocial Oncology (CAPO) partnered to develop consensus-based recommendations regarding the routine assessment of psychosocial and supportive care needs. The purpose of this paper is to summarize the evidence that informed the guideline and disseminate the recommendations developed by the expert panel.

METHODS

Clinical practice recommendations were developed by a panel comprised of psychosocial and interdisciplinary experts. Recommendations were informed by a review of oncology clinical practice guidelines, systematic reviews, and primary research, through to May 2008. Following expert consensus on the recommendations, the clinical practice guideline was externally reviewed by a purposively selected sample of national and international interdisciplinary experts.

RESULTS

A total of nine clinical practice guidelines, three systematic reviews, and 14 primary studies were included in the review. Overall, this body of literature suggested that routine collection of psychosocial health care data has an influence on communication with oncologists and other study specific outcomes, but the evidence was limited by heterogeneity and methodological limitations. Based on the interpretation of this body of evidence by clinical experts, research methodologists, and external reviewers, 12 substantive recommendations were developed regarding the process and parameters of psychosocial needs assessment in adult cancer patients.

CONCLUSION

Given the limitations in the current body of evidence, there remains a need for rigorous empirical research regarding the optimal approach to psychosocial needs assessment, including the specific characteristics that influence effectiveness on patient outcomes. This guideline fills an important gap in psychosocial care, regarding the routine assessment of psychosocial health care needs.

Randomized clinical trial comparing the cost and effectiveness of bipolar vessel sealers versus clips and vascular staplers for laparoscopic colorectal resection

BACKGROUND

The widespread use of laparoscopy has resulted in a variety of instruments being used routinely for vascular control. This randomized controlled trial evaluated the cost-effectiveness of bipolar vessel sealer (BVS) compared with clips and vascular stapler (CVS) in straight laparoscopic colorectal resection.

METHODS

Patients scheduled for elective colorectal resection, including benign and malignant diseases, were randomized to either BVS or CVS for vascular control. Patients whose operation was converted to an open approach before pedicle ligation were excluded. The primary endpoints were duration of operation, including time taken to control vascular pedicles, and cost of disposable instruments for vascular control.

RESULTS

Of 114 patients randomized to BVS (60 patients) or CVS (54), 14 did not receive the allocated vascular control device, leaving 55 and 45 respectively for analysis. The BVS reduced the time spent for vascular control by a mean of 6·9 min (P = 0·031) and reduced the cost of disposable instruments for vascular control by US $ 80·7 per patient (P = 0·043). For total colectomy, the BVS reduced the operating time by 103·6 min (P = 0·023) and the time taken for vascular control by 16·8 min (P = 0·022). For left colectomy, it decreased the time to vascular control by 9·3 min (P = 0·021). In multivariable analysis, the cost of disposable instruments for vascular control was independently reduced by randomization to BVS, type of procedure, female sex and estimated blood loss. The mean cost reduction was $ 88·2 for left colectomy (P = 0·037), $ 377·7 (P = 0·005) for total colectomy and $ 366·9 (P = 0·012) for proctectomy. Conversely, use of the BVS increased the cost of instruments used for vascular control in right colectomy by $ 92·6 (P = 0·012).

CONCLUSION

BVS devices are expedient and cost-efficient in proctectomy, left and total colectomy procedures.

Effects of isoflurane, pentobarbital, and urethane on apoptosis and apoptotic signal transduction in rat kidney

BACKGROUND

Renal cell apoptosis contributes significantly to the pathogenesis of acute renal failure. Anesthetic agents have been shown to modulate apoptotic signal transduction in various tissues. We examined the effects of 6 h of different general anesthetic techniques on renal cell apoptosis in rat kidneys.

METHODS

Twenty-one male Sprague-Dawley rats were randomly allocated into four groups: (i) control, non-anesthetized rats (n= 3) and rats anesthetized with (ii) inhaled isoflurane (n= 6), (iii) intraperitoneal pentobarbital (n= 6), and (iv) intraperitoneal urethane (n= 6). Animals were sacrificed 6 h after the induction of anesthesia.

RESULTS

Apoptosis was assessed by terminal deoxynucleotidyl transferase-fluorescein end-labeling analysis. RNA was extracted from the left kidney to probe cDNA microarrays. Gene expression was measured as a percentage of glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and subsequently confirmed using reverse transcriptase-polymerase chain reaction (RT-PCR). Compared with the control (no anesthesia), urethane significantly (P < 0.001) induced apoptosis in both the renal cortex and medulla. Isoflurane significantly (P < 0.001) inhibited apoptosis in the medulla. Microarray analysis revealed that urethane up-regulated more (74) genes than pentobarbital (16) and isoflurane (10). Isoflurane down-regulated more genes (85) than pentobarbital (74) and urethane (12). These anesthetic-induced modulations were significant (P < 0.05) for 60 isoflurane-, 30 pentobarbital- and 4 urethane-modulated genes.

CONCLUSION

Our results suggest that general anesthetic drugs have an effect on renal cell apoptosis and apoptotic signal transduction, and thus may potentially affect the risk of subsequent acute renal failure.

Characterization of two new zebrafish members of the hedgehog family: atypical expression of a zebrafish indian hedgehog gene in skeletal elements of both endochondral and dermal origins

We have characterized two new members of the Hedgehog (Hh) family in zebrafish, ihha and dhh, encoding for orthologues of the tetrapod Indian Hedgehog (Ihh) and Desert Hedgehog (Dhh) genes, respectively. Comparison of ihha and Type X collagen (col10a1) expression during skeletal development show that ihha transcripts are located in hypertrophic chondrocytes of cartilaginous elements of the craniofacial and fin endoskeleton. Surprisingly, col10a1 expression was also detected in cells forming intramembranous bones of the head and in flat cells surrounding cartilaginous structures. The expression of col10a1 in both endochondral and intramembranous bones reflects an atypical composition of the extracellular matrix of the zebrafish craniofacial skeleton. In addition, during fin ray regeneration, both ihha and col10a1 are detected in scleroblasts, osteoblast-like cells secreting the matrix of the dermal bone fin ray. The presence of cartilage markers suggests that the dermal fin ray possesses an intermediate phenotype between cartilage and bone.

Conceptualizing and measuring family quality of life

BACKGROUND

Increasing emphasis on family-centred approaches to services and supports for families of children with disabilities has surfaced the issue of accountability for family outcomes. We present a review of literature about the impacts of children with disabilities on families as a backdrop to proposing family quality of life as a concept that encompasses impacts of disability and one that can be used to assess the impact of supports and services on families.

METHOD

We briefly introduce the Beach Center Family Quality of Life Scale, providing information about its factor structure, reliability and convergent validity.

RESULTS

The Beach Center Family Quality of Life Scale contains 25 items assessing family ratings of importance and satisfaction with five domains: Family interaction, Parenting, Emotional well-being, Physical/material well-being and Disability-related supports.

CONCLUSION

We present a framework for utilizing a measure of family quality of life as a long-term outcome in concert with other short-term measures of service outcomes for families.

Effect of Hospitalization on the Antibiotic Resistance of FecalEnterococcus faecalisof Surgical Patients Over Time

The prevalence of antibiotic resistant Enterococcus faecalis was determined in fecal samples of 263 patients admitted to the surgical wards of three university-affiliated hospitals on admission, at discharge, and at 1 and 6 months after discharge. A slight increase in the prevalence of antibiotic resistance of E. faecalis was found at discharge for the antibiotics tested compared to those on admission, vancomycin excepted. At 6 months after discharge, the prevalence of resistance for amoxicillin (0%), ciprofloxacin (3%), erythromycin (47%), and oxytetracycline (60%) decreased to the level on admission (respectively 0%, 8%, 45%, and 64%). Gentamicin resistance was the same at discharge (10%) as 1 month later (12%), but decreased 6 months after discharge (8%) to the level on admission (7%). In conclusion, hospitalization resulted in the study population in a slight increase in the prevalence of resistant fecal E. faecalis isolates at discharge, which decreased again (slowly) to the level on admission 6 months after discharge. Thus, the influence of hospitalization on the prevalence of antibiotic resistance in the extramural situation disappears between 1 and 6 months after discharge in this population.

The value of saline salpingosonography as a surrogate test of tubal patency in low-resource settings

BACKGROUND

Tubal factor, which accounts for 15-30% of infertility in all women, is common in developing countries with high rates of pelvic inflammatory disease but limited resources. It is possible to outline the fallopian tubes by injecting isotonic saline transcervically during transvaginal ultrasound scanning of the pelvis, and both color flow Doppler and 3-dimensional scanning modes have been employed to improve visualization of the tubes, with varying success.

METHOD

We investigated the value of saline salpingosonography (SSG), using 2-dimensional transvaginal ultrasound scanning, as a screening test of tubal patency in 113 women by comparing SSG findings to those at HSG or laparoscopy.

RESULTS

The findings at SSG correlated well with the results of HSG or laparoscopy, with an overall concordance of 82.5%. SSG was more accurate at diagnosing patent tubes than blocked tubes and was well tolerated. The results are, however, unreliable when it is difficult to inject the saline and when the patient experiences severe pain during the procedure.

CONCLUSION

SSG is a useful screening tool for investigating infertility, particularly in low-resource settings.

Toward assessing family outcomes of service delivery: validation of a family quality of life survey

BACKGROUND

The concept of family quality of life (QoL) has emerged as an important outcome of service delivery for individuals with disabilities and their families. The present study describes the process of developing a tool to measure family QoL.

METHODS AND RESULTS

A total of 1197 respondents participated in a national field test. Through factor analysis, the survey was refined in several ways: (1) the preliminary 10-domain structure was reduced to a five-domain structure; (2) a total of 41 items were selected for the revised survey; and (3) wordings were clarified.

CONCLUSIONS

The implications for future research and practice are discussed.

Improving safer sex measures through the inclusion of relationship and partner characteristics

This article describes the development of a safer sex algorithm, which considers the characteristics of a woman's relationship and the HIV risk profile of herself and her primary partner. A sample of 306 low-income, predominantly African American women was recruited to participate in a study of the effectiveness of a sexual health seminar. These women were interviewed three times, at one month prior to seminar administration, three months after the seminar and again nine months after the seminar. Data from these women indicate that using an algorithm that considers the probability of HIV transmission between partners decreases the measured prevalence of unsafe sex in this population by about 17% and lowers the estimate of the average number of unsafe incidents by about four incidents in three months. The algorithm results in measures with adequate levels of temporal stability, which are similar to the more commonly used measure, vaginal or anal intercourse without a condom.

Genomic regions controlling vernalization and photoperiod responses in oat

Oat genotypes vary for photoperiod and vernalization responses. Vernalization often promotes earlier flowering in fall-sown but not spring-sown cultivars. Longer photoperiods also promote earlier flowering, and the response to longer photoperiods tends to be greater in cultivars from higher latitudes. To investigate the genetic basis of photoperiod and vernalization responses in oat, we mapped QTLs for flowering time under four combinations of photoperiod and vernalization treatments in the Ogle x TAM O-301 mapping population in growth chambers. We also mapped QTLs for flowering time in early spring and late-spring field plantings to determine the genetic basis of response to early spring planting in oat. Three major flowering-time QTLs (on linkage groups OT8, OT31 and OT32) were detected in most conditions. QTLs with smaller effects on flowering were less-consistently observed among treatments. Both vernalization-sensitive and insensitive QTLs were discovered. Longer photoperiod or vernalization alone tended to decrease the effects of flowering-time QTLs. Applied together, longer photoperiod and vernalization interacted synergistically, often on the same genomic regions. Earlier spring planting conferred an attenuated vernalization treatment on seeds. The major flowering-time QTLs mapped in this study matched those mapped previously in the Kanota x Ogle oat mapping population. Between these two studies, we found a concordance of flowering-time QTLs, segregation distortion, and complex genetic linkages. These effects may all be related to chromosomal rearrangements in hexaploid oat. Comparative mapping between oat and other grasses will facilitate molecular analysis of vernalization response in oat.

Localization of a susceptibility gene for familial nonmedullary thyroid carcinoma to chromosome 2q21

The familial form of nonmedullary thyroid carcinoma (NMTC) is a complex genetic disorder characterized by multifocal neoplasia and a higher degree of aggressiveness than its sporadic counterpart. In a large Tasmanian pedigree (Tas1) with recurrence of papillary thyroid carcinoma (PTC), the most common form of NMTC, an extensive genomewide scan revealed a common haplotype on chromosome 2q21 in seven of the eight patients with PTC. To verify the significance of the 2q21 locus, we performed linkage analysis in an independent sample set of 80 pedigrees, yielding a multipoint heterogeneity LOD score (HLOD) of 3.07 (alpha=0.42), nonparametric linkage (NPL) 3.19, (P=.001) at marker D2S2271. Stratification based on the presence of at least one case of the follicular variant of PTC, the phenotype observed in the Tas1 family, identified 17 such pedigrees, yielding a maximal HLOD score of 4.17 (alpha=0.80) and NPL=4.99 (P=.00002) at markers AFMa272zg9 and D2S2271, respectively. These results indicate the existence of a susceptibility locus for familial NMTC on chromosome 2q21.

Second trimester termination of pregnancy for fetal anomaly or death: comparing mifepristone/misoprostol to gemeprost

OBJECTIVE

To assess the effect of changing the regimen for second trimester induction of labour from gemeprost to mifepristone/misoprostol.

DESIGN AND SETTING

A retrospective study at a university teaching hospital over the 5-year period 1993-1997. SUBJECTS, METHODS and REGIMENS: 68 patients, 34 in the gemeprost group and 34 in the mifepristone/misoprostol group. The gemeprost group received 1mg vaginally every 3h to a maximum of five doses. The mifepristone/misoprostol group were pre-treated with 600 mg mifepristone orally followed by 800 microg misoprostol vaginally and then 400 microg orally every 3h to a maximum of four oral doses.

MAIN OUTCOME MEASURES

Induction to abortion interval; delivery within 24h.

RESULTS

The mifepristone/misoprostol group had a lower induction to abortion interval compared to the gemeprost group (median 8.9h versus 19.8h, respectively, p<0.01). The mifepristone/misoprostol regimen was more successful than the gemeprost regimen; 94% versus 68%, respectively, aborted without extra medical or surgical intervention, p=0.02. There were no significant differences in side effects, analgesia requirements or complications between the two groups. Three patients with previous Caesarean sections had a ruptured uterus; two from the gemeprost group and one from the mifepristone/misoprostol group.

CONCLUSIONS

The new mifepristone/misoprostol regimen was more effective in second trimester induction of labour. Induction of labour with misoprostol or gemeprost should be used with care in patients with a previous Caesarean section.

Expression of heat shock protein 47(Hsp47) mRNA levels in rabbit connective tissues during the response to injury and in pregnancy

Hsp47 (also termed "colligin") is a 47 kDa protein that is localized in the ER and cis-Golgi vesicles of fibrocytes, chondrocytes, and other collagen-secreting cells. Under stress conditions, Hsp47 expression is upregulated as part of the heat shock/stress response that mitigates cell damage from noxious stimuli such as elevated temperature, heavy metals, and oxidative stress. Under non-stress conditions, Hsp47 functions as a collagen-specific molecular chaperone that facilitates intracellular procollagen polypeptide synthesis, and triple helix assembly in connective tissues. Previously it has been shown that levels of collagen-specific gene expression are significantly altered in ligaments, menisci, and other connective tissues of the rabbit following surgically induced injuries (increased), and during pregnancy (decreased). The present study was undertaken to determine whether expression of mRNA for the Hsp47 collagen-binding stress protein was also influenced in these experimental models. Since no sequence information was available on the rabbit Hsp47 gene, a partial cDNA for rabbit Hsp47 was first isolated and cloned using reverse transcriptase PCR (RT-PCR) with degenerate oligonucleotide primers. Rabbit Hsp47 sequence-specific primers then designed enabled analysis of Hsp47 mRNA expression in rabbit connective tissues using semiquantitative RT-PCR. It was found that Hsp47 expression is affected in a complex, tissue-specific manner by injury and pregnancy. Hsp47 transcript levels were elevated in the medial collateral ligament (MCL) of the rabbit knee following surgical induction of a gap injury. Transection of the anterior cruciate ligament (ACL), which leads to chronic progressive damage to menisci of the rabbit knee joint, was accompanied by an upregulation of Hsp47 expression in the medial and lateral menisci. Hsp47 mRNA levels were depressed during pregnancy in the kidney and ACL of primigravid adolescent rabbits, but were not altered in corneal tissue during pregnancy or in the ACL of skeletally mature multiparous females. The changes in Hsp47 transcript levels within these connective tissues following injury/pregnancy often, but not always, paralleled changes in collagen-specific gene expression.

Workplace productivity. A review of the impact of migraine and its treatment

Migraine is a common disorder characterised by recurrent episodes of disability. Despite the high prevalence of migraine, data have been lacking on its impact in a working population. The advent of new therapies has stimulated interest in this area, and evidence is now available that documents the substantial impact of migraine on workplace productivity and the likelihood of untreated migraine leading to unemployment or underemployment for the patient. This paper reviews current findings of both observational and interventional studies about the impact of migraine on productivity and employment. When considered in the light of migraine demographics, the high prevalence of migraine, and its low consultation and treatment rates, this evidence indicates that improved screening and treatment for this common condition could have a substantial impact on worker productivity and on patient well-being.

Psychoanalysts in the public eye: internal resistances

An attitude against public presentations has been part of the inward looking stance of organized psychoanalysis and has contributed to the often-heard comment that psychoanalysis is a dying profession. Because of the very private nature of clinical psychoanalytic work, this ambivalence to public appearances continues to exist in all psychoanalysts. We have to realize that it is crucial for psychoanalysts to educate the public about psychoanalytic ideas while being aware of possible unintended negative consequences, such as interference in transference issues with patients, ethical and privacy violations, distortion in the press coverage, unfairly biased antipsychoanalytic coverage, and concern about disapproval from prominent and influential members of psychoanalytic organizations about the nature of the press coverage (or even of press coverage at all) leading to criticism of an individual psychoanalyst and interference with his or her progression. Our public information efforts have to include using misfired efforts as teaching tools and insure that presentation of clinical material is limited and sufficiently disguised.

Auditory threshold and inner ear pressure: measurements in experimental endolymphatic hydrops

HYPOTHESIS

Experimental endolymphatic hydrops leads to an endolymph-perilymph pressure imbalance that is responsible for the loss of auditory sensitivity in the ear.

BACKGROUND

This study investigates whether intralabyrinthine pressure is a factor in the auditory dysfunction of experimental endolymphatic hydrops.

METHODS

Auditory function was investigated in 10 guinea pigs 90 to 120 days after endolymphatic sac ablation by measuring compound action potentials in response to acoustic stimuli including alternating clicks and tone bursts of 0.5, 1, 2, 4, and 8 kHz. After auditory thresholds to the various stimuli were established, endolymphatic and perilymphatic pressures were measured with a no-flow micropressure measuring system. The cause of the hearing loss in Meniere's disease, especially in the early phases of this condition, remains an enigma. Histologic temporal bone preparations show a disproportion in the volume of endolymph to perilymph with an expanded and distorted membranous labyrinth. Speculation as to whether an endolymph-perilymph fluid pressure imbalance is responsible for these morphologic changes were raised by Hallpike and Cairns (1) in their initial report of the histopathology of Meniere's disease. Further speculation has questioned whether this pressure imbalance may be responsible for the symptoms and physical finding of this condition, including hearing loss. The ability to produce experimental endolymphatic hydrops in the guinea pig secondary to surgical occlusion of the endolymphatic sac and duct has been useful in studying various aspects of Meniere's disease (2). Investigators have been able to demonstrate auditory threshold shifts with hydrops. Elevated endolymph-perilymph pressure gradients have also been demonstrated (3). This

RESULTS

Increased auditory thresholds were noted in the hydrops ears at all tested parameters (p < 0.03). A relative increase in endolymph over perilymph pressure was found in hydrops ears as previously reported. The increase in endolymph-perilymph pressure of hydrops could not be correlated directly to the elevated auditory threshold shift.

CONCLUSION

Endolymphatic hydrops is a complex pathologic state with multiple inner ear alterations including abnormal intralabyrinthine pressure. Factors other than or in addition to pressure contribute to the auditory threshold shift of hydrops.