Morphological and geochemical variations of Cyprideis (Ostracoda) from modern waters of the northern Neotropics

The variability of modern Cyprideis salebrosa and Cyprideis americana (Ostracoda) from the northern Neotropics were investigated in order to understand site specific influences on the isotopic composition of their valves (δ¹⁸O, δ¹³C) in comparison to their host water and to connect this to morphological features of their valves (valve size, nodosity). C. salebrosa was found in a stream (Shell Creek, Florida) and a slightly brackish lake (Laguna del Rincon, Dominican Republic; salinity <0.7 psu) while C. americana occurred in a coastal lake with polyhaline waters (Parrotee Pond, Jamaica; salinity: >20 psu). Valve size and position of nodes differed between the two species. A reverse temperature dependency have been considered to influence Shell length (seasonally in Shell Creek, summer: 1076 µm; winter: 1092 µm, supposedly permanently in Laguna del Rincon, 1035 µm). But, regarding the small dataset other factors could not be excluded to influence ostracod valve size. A decline of node frequency of C. salebrosa is mainly related to an increase in salinity. Isotopic values of ostracod valves reflect the trend in stable isotopes of their host water. Variations in Cyprideis salebrosa δ¹⁸O and δ¹³C values signify differences in their host water. Offsets of ostracod valves to a theoretical calcite precipitated in their host water with an uncertain time lag (+0.015 to +2.63 ‰) needs to be clarified. This study presents a contribution to the understanding of environmental influences on modern ostracod shell characters as basis for paleontological applications.

Toll-like receptor 8 signaling facilitates West Nile virus infection in mice (VIR9P.1161)

West Nile virus (WNV) is a neurotropic virus that can cause encephalitis, meningitis or possible death in humans. Human and mouse Toll-like receptor 7 (h/mTLR7) and human Toll-like receptor 8 (hTLR8) detect viral single-stranded (ss)RNA motifs. Importantly, mTLR7 recognizes WNV, as TLR7-/- mice are susceptible to lethal WNV infection. However, the role of TLR8 in WNV pathogenesis is not clear. In this study, we found that mice deficient in TLR8 (TLR8-/-) infected with WNV (2,000 plaque forming units) had improved percentage survival (65%) compared to wild-type (WT) controls (25%), which was coupled to reduced viral burden in the brains of TLR8-/- mice. These data suggest that TLR8 signaling facilities WNV infection in mice. Further mechanistic studies showed that expression of TLR7 and the interferon-induced anti-viral gene Isg-56 (IFIT-1) were significantly increased in TLR8-/- mice whole-brain samples and mixed neuronal cultures following WNV infection, compared to WT controls. These results indicate that TLR8 signaling may down-regulate TLR7 and Isg-56 expression, thus promoting WNV-induced neuroinvasive disease.

Should noncurative resection of the primary tumour be performed in patients with stage iv colorectal cancer? A systematic review and meta-analysis

PURPOSE

Surgical resection of the primary tumour in patients with advanced colorectal cancer (crc) remains controversial. This review compares survival in patients with advanced crc who underwent surgical resection of the primary tumour with that in patients not undergoing resection, and determines rates of post-operative mortality and nonfatal complications, the primary tumour complication rate, the non-resection surgical procedures rate, and quality of life (qol).

METHODS

Reports in the central, medline, and embase databases were searched for relevant studies, which were selected using pre-specified eligibility criteria. The search was also restricted to publication dates from 1980 onward, the English language, and studies involving human subjects. Screening, evaluation of relevant articles, and data abstraction were performed in duplicate, and agreement between the abstractors was assessed. Articles that met the inclusion criteria were assessed for quality using the Newcastle-Ottawa Scale. Data were collected and synthesized per protocol.

RESULTS

From among the 3379 reports located, fifteen retrospective observational studies were selected. Of the 12,416 patients in the selected studies, 8620 (69%) underwent surgery. Median survival was 15.2 months (range: 10-30.7 months) in the resection group and 11.4 months (range: 3-22 months) in the non-resection group. Hazard ratio for survival was 0.69 [95% confidence interval (ci): 0.61 to 0.79] favouring surgical resection. Mean rates of postoperative mortality and nonfatal complications were 4.9% (95% ci: 0% to 9.7%) and 25.9% (95%ci: 20.1% to 31.6%) respectively. The mean primary tumour complication rate was 29.7% (95% ci: 18.5% to 41.0%), and the non-resection surgical procedures rate in the non-resection group was 27.6% (95 ci: 15.4% to 39.9%). No study provided qol data.

CONCLUSIONS

Although this review supports primary tumour resection in advanced crc, the results have significant biases. Randomized trials are warranted to confirm the findings.

Canadian integrative oncology research priorities: results of a consensus-building process

BACKGROUND

In Canada, many diverse models of integrative oncology care have emerged in response to the growing number of cancer patients who combine complementary therapies with their conventional medical treatments. The increasing interest in integrative oncology emphasizes the need to engage stakeholders and to work toward consensus on research priorities and a collaborative research agenda. The Integrative Canadian Oncology Research Initiative initiated a consensus-building process to meet that need and to develop an action plan that will implement a Canadian research agenda.

METHODS

A two-day consensus workshop was held after completion of a Delphi survey and stakeholder interviews.

RESULTS

FIVE INTERRELATED PRIORITY RESEARCH AREAS WERE IDENTIFIED AS THE FOUNDATION FOR A CANADIAN RESEARCH AGENDA: EffectivenessSafetyResource and health services utilizationKnowledge translationDeveloping integrative oncology models Research is needed within each priority area from a range of different perspectives (for example, patient, practitioner, health system) and in a way that reflects a continuum of integration from the addition of a single complementary intervention within conventional cancer care to systemic change. Strategies to implement a Canadian integrative oncology research agenda were identified, and working groups are actively developing projects in line with those strategic areas. Of note is the intention to develop a national network for integrative oncology research and knowledge translation.

CONCLUSIONS

The identified research priorities reflect the needs and perspectives of a spectrum of integrative oncology stakeholders. Ongoing stakeholder consultation, including engagement from new stakeholders, is needed to ensure appropriate uptake and implementation of a Canadian research agenda.

Use of a stable carbon isotope to assess the efficiency of a drinking water treatment method with CO₂

CO₂ gas with a special isotopic signature (δ¹³C = -35.2‰ vs. VPDB) was used as a marker to evaluate the efficiency of a drinking water treatment method and the effect of an ultrasonic (US) stirrer. This treatment was developed to prevent precipitation and corrosion effects in water-supply systems. The research work was performed using a laboratory-scale pilot plant that was filled with tap water. The stable isotope analyses of δ¹³C-DIC (Dissolved Inorganic Carbon) in the water samples indicated that the maximum content of added CO₂ gas in DIC was in the range of 35 to 45%. The use of the US stirrer during the entire experiment decreased the method's overall efficiency by 10%, due to degassing at a late stage of the experiment but accelerated the dissolution process in the early experimental stage.

Impact and outcomes of an Iyengar yoga program in a cancer centre

Background

Individuals have increasingly sought complementary therapies to enhance health and well-being during cancer, although little evidence of their effect is available.

Objectives

We investigated

how an Iyengar yoga program affects the self-identified worst symptom in a group of participants.

whether quality of life, spiritual well-being, and mood disturbance change over the Iyengar yoga program and at 6 weeks after the program.

how, from a participant’s perspective, the Iyengar yoga program complements conventional cancer treatment.

Patients and Methods

This pre–post instrumental collective case study used a mixed methods design and was conducted at a private Iyengar yoga studio. The sample consisted of 24 volunteers (23 women, 1 man; 88% Caucasian; mean age: 49 years) who were currently on treatment or who had been treated for cancer within the previous 6 months, and who participated in ten 90-minute weekly Iyengar yoga classes.

The main outcome measures were most-bothersome symptom (Measure Your Medical Outcome Profile 2 instrument), quality of life and spiritual well-being (Functional Assessment of Chronic Illness Therapy–General subscale and Spiritual subscale), and mood disturbance (Profile of Mood States–Short Form). Participant perspectives were obtained in qualitative interviews.

Results

Statistically significant improvements were reported in most-bothersome symptom (t₍₂₃₎ = 5.242; p < 0.001), quality of life (F_(2,46) = 14.5; p < 0.001), spiritual well-being (F_(2,46) = 14.4; p < 0.001), and mood disturbance (F_(2,46) = 10.8; p < 0.001) during the program. At follow-up, quality of life (t₍₂₁₎ = −3.7; p = 0.001) and mood disturbance (t₍₂₁₎ = 2.4; p = 0.025) significantly improved over time. Categorical aggregation of the interview data showed that participants felt the program provided them with various benefits not included on the outcomes questionnaires.

Conclusions

Over the course of the Iyengar Yoga for Cancer program, participants reported an improvement in overall well-being. The program was also found to present participants with a holistic approach to care and to provide tools to effectively manage the demands of living with cancer and its treatment.

[Realization and implementation of a trauma network of the German Association of Trauma Surgery (DGU) exemplified by the Trauma Network of eastern Bavaria]

The quality of care of seriously injured persons in Germany is nationally and internationally recognized to be at a high level. However, there are local discrepancies. In 2006 the German Association of Trauma Surgery published the White Paper for the Management of the Seriously Injured. The goal of the paper is a further increase in the quality of care of seriously injured persons. A crucial point of the publication is the call to establish regional trauma networks in Germany. Work on this project has been carried out in eastern Bavaria since spring 2007. The first meeting of the Trauma Network of eastern Bavaria took place in July 2007. On 3rd September 2008 the university hospital of Regensburg was the first clinic audited in Germany. To date nearly 75% of all hospitals in the trauma network of eastern Bavaria have been audited. The establishment of a regional trauma network is a multifactorial event. Essential factors in the development of the trauma network were found to be the communication between the head physicians and the nomination of an appointee of the regional trauma network. For the head physicians the 9 meetings of the trauma network since July 2007 functioned as the communication platform. These exchanges of the head physicians are necessary to animate a trauma network. The appointee of the regional trauma network--most suitably a member of staff of the speaker of the trauma network--is essential to guarantee communication between meetings and to manage prompt responses to questions from the network. This article describes the experiences gained during the implementation of the trauma network in eastern Bavaria.

[Metered-dose inhaler with spacer vs nebulization for severe and potentially severe acute asthma treatment in the pediatric emergency department]

OBJECTIVE

To compare treatment with beta 2 agonist delivered either by a spacer device or a nebulizer in children with severe or potentially severe acute asthma.

METHODS

In this randomized trial, children 4 to 15 years, cared for in the emergency department for severe or potentially severe acute asthma, received 6 times either nebulizations of salbutamol (0.15mg/kg) or puffs of a beta 2 agonist (salbutamol 50 microg/kg or terbutaline 125 microg/kg). The primary outcome was the hospitalization rate. Secondary outcomes included percentage improvement in Bishop score, in PEF, SaO(2), respiratory and heart rates, side effects, length of stay and relapses 10 and 30 days later.

RESULTS

Groups did not differ for baseline data. There were no significant differences between the 2 groups (nebulizer N=40, spacer N=39) for baseline characteristics before emergency department consultation except for length of acute asthma in the spacer group. Clinical evolution after treatment, hospitalization rate, relapse were similar including the more severe subgroup. In the spacer group, tachycardia was less frequent (P<0.02). The overall length of stay in the emergency department was significantly shorter (148+/-20 vs 108+/-13 min, P<10(-9)).

CONCLUSIONS

The administration of beta 2 agonist using a metered-dose inhaler with spacer is an effective alternative to nebulizers for the treatment of children with severe or potentially severe acute asthma in the emergency department. Time gained can be used for asthma education.

Communicating quality of life information to cancer patients: a study of six presentation formats

PURPOSE

To determine which formats for presenting health-related quality of life (HRQL) data are interpreted most accurately and are most preferred by cancer patients. Patients often want a great deal of information about cancer treatments, including information relevant to HRQL. Clinical trials provide methodologically sound HRQL data that may be useful to patients.

PATIENTS AND METHODS

In a multicenter study, 198 patients with previously treated cancer participated in a structured interview. Participants judged HRQL information presented in one textual and five graphical formats. Outcome measures included the accuracy of patients' interpretations and ease-of-use and helpfulness ratings for each format.

RESULTS

Correct interpretations ranged from 85% to 98% across formats (F = 10.3, P < .0001) with line graphs of mean HRQL scores over time being interpreted correctly most often. Older patients and less-educated patients were less likely to interpret graphs accurately (F = 7.3, P = .008; and F = 10.6, P = .001, respectively), but all groups were most accurate on simple line graphs. Multivariate analysis revealed that format type, participant age and education were independent predictors of accuracy rates. Patients' ratings also varied across formats both for ease of understanding scores (F = 12.1, P < .0001) and for helpfulness scores (F = 13.2, P < .0001), with line graphs being rated highest on both outcomes.

CONCLUSION

Patients generally prefer a simple linear representation of group mean HRQL scores, and can accurately interpret data presented in this format more than 98% of the time irrespective of their age group and educational level. The findings have important implications for the communication of clinical trial HRQL results.

[Oral morphine administration for children's traumatic pain]

OBJECTIVES

To study the compliance of prescription, the efficacity and the adverse events of oral morphine used in the pediatric emergency department (ED) in traumatic pains.

METHOD

This prospective study was conducted in the ED from october 2002 to september 2003. Children aged six months to 16 years with a visual analogic scale (VAS) score higher than 70 or with a traumatic member deformation received oral morphine (0,5 mg/kg). Pain was assessed every 30 minutes using two scales: behavioral observation by the faces scale and objective pain scale (OPS) for children less than five years, behavioral observation by the faces scale and self-report by VAS for children older than five years. The compliance of prescription, the pain scores and the adverse events were studied.

RESULTS

Ninety-one children received oral morphine and seventy-four children were studied. Seventy per cent of prescriptions were in accordance with the recommendations. For patients younger than five years a rapid decrease of pain was observed in thirty minutes. The pain's reduction was respectively 79 and 84% with faces scale and OPS when they left ED. For children older than five years, pain's reduction was more important and more rapid when pain assessment was made by nurses than when it was self-reported in the first hour (pain reduction 58,2 and 36,1%). When leaving, pain reduction was the same with the two different assessments. No major adverse event was noted.

CONCLUSION

Use of oral morphine in ED is simple, with a few numbers of adverse events. None was severe. Efficiency is correct after 30 to 60 minutes.

Quality of Life Evaluations of Caregivers of Ovarian Cancer Patients During Chemotherapy Treatment

OBJECTIVES

(1) To examine the quality of life (QOL) of caregivers of women undergoing chemotherapy for advanced ovarian cancers, and (2) to correlate the QOL measures of caregivers to those of the women undergoing chemotherapy.

METHODS

Over a 9-month period, all women undergoing chemotherapy for ovarian cancer at the Saskatoon Cancer Centre, and their caregivers, were offered participation. Two well-validated instruments were used to measure the "quality of life" concept. Women with ovarian cancer completed the Functional Assessment of Cancer Therapy--Ovarian (FACT-O) questionnaire in the clinic prior to each course of chemotherapy. Each caregiver completed a Caregiver Quality of Life Index--Cancer (CQOL-C) questionnaire at home at the start and conclusion of each chemotherapy regimen (cycle 1 and after the last chemotherapy treatment). The demographics of the caregivers were described. A paired t test was used to detect changes to caregivers' QOL scores before and after chemotherapy treatment. Correlation analysis was carried out to examine the relationship between the caregivers' total QOL scores and the various subscale and total scores of the FACT-O questionnaires completed by the women with ovarian cancer. Multivariate regression models were constructed to examine the relative importance of each of the QOL domain measures of the woman with cancer in predicting the effect on her caregiver's QOL.

RESULTS

Thirty different patient-caregiver pairs participated in the study, providing 50 separate assessments since not all pairs had completed the post-chemotherapy assessments. There was improvement (P <.05) in the caregiver's QOL scores at the conclusion of the chemotherapy treatment compared to the baseline assessments. The improvement was unrelated to the performance status or response to chemotherapy of the woman undergoing treatment. There was also a correlation (P <.05) between an increase in a caregiver's distress and worsening scores in the "emotional," "functional," and "concerns" QOL domain assessments of the woman undergoing treatment. Stepwise regression analysis showed the "concerns" score, measuring specific ovarian cancer-related symptoms, to be the only predictor of a caregiver's distress (P <.05).

CONCLUSIONS

Standard chemotherapy for ovarian cancer does not worsen a caregiver's QOL. There is a direct relationship between the QOL of women with cancer and that of their caregivers. Future research is required to identify how best to integrate the results of QOL assessments in cancer treatment protocols and to examine the long-term effects of ovarian cancer and its treatment on both caregivers and the women for whom they care.

Quality-of-life issues in patients with ovarian cancer and their caregivers: a review

Significant progress has been made towards the treatment of ovarian cancer resulting in longer median survival despite a persistent low cure rate. Relatively few studies have examined the impact of the cancer and its treatment on the patients and their caregivers due to the difficulty in the definition and measurement of the Quality of Life (QOL) concept. A review of the literature revealed significant alterations in the quality of life of ovarian cancer patients during treatment and long term follow ups. For the caregivers, it is important for health care providers to realize that: 1) caregivers are being asked to assume an increasing number of complex care giving tasks at home, 2) there exists a high proportion of unmet caregiver needs, 3) the care giving experience includes both positive and negative elements and, 4) perception of caregivers' burden is positively linked to negative reactions to care giving. Supportive programs for patients and caregivers should be designed with these needs in mind. Future research should study the best way to incorporate results of quality of life assessments into routine treatment decision-making.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader should be able to outline the current data on QOL issues in patients with ovarian cancer, and to describe potential working definitions of QOL.

Quality of life evaluations in patients with ovarian cancer during chemotherapy treatment

OBJECTIVES

To examine the impact of treatment- and disease-related factors on the quality of life of patients with ovarian cancers undergoing chemotherapy.

PATIENTS AND METHODS

Over 18 months period, all patients with ovarian cancer receiving chemotherapy at the Saskatoon Cancer Center were recruited. The Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaire was used to assess patients' quality of life before each chemotherapy cycle. Platinum-based chemotherapy was used initially or in patients with a platinum-free interval of more than 6 months in a recurrence setting. After progression on the platinum-based regimens, liposomal doxorubicin, topotecan, and cisplatinum/etoposide were used as salvage chemotherapy pending on drug availability and convenience of administration to patients. Regression analysis was used to identify significant disease and treatment-related factors that can significantly affect patients' quality of life measures.

RESULTS

Seventy-two patients participated in the study providing 270 separate observations. The mean age was 57.81 years with a standard deviation of 13.40. The median duration of chemotherapy-free interval for patients with recurrent disease was 7 months. All patients had stage 3 or 4 disease. About half (52.2%) of the patients had optimal surgical resection with small (<1 cm) residual cancer masses before primary adjuvant chemotherapy. Seventy percent of the patients had either a first diagnosis or a first recurrence of cancer with the other 30% previously treated with two or more chemotherapy regimens. Sixty-two percent had an initial complete response to platinum-based chemotherapy. Multivariate regression analysis showed the use of topotecan or cisplatinum/etoposide, patients' poor responses to chemotherapy, experience with two or more previous line of chemotherapy treatment, and younger ages were significant predictors of poor quality of life during chemotherapy.

CONCLUSION

There were significant differences in side effects of commonly used chemotherapy regimens on patients' quality of life. Quality of life assessments should be routinely incorporated in selecting specific chemotherapy to be used. Future research should be carried out to identify the best strategies to further integrate the results of quality of life assessments in cancer treatment protocols and to examine the long-term effects of cancer and its treatment on patients and their families.

Cancer patients' preferences for communicating clinical trial quality of life information: a qualitative study

Health-related quality of life (HRQL) is a prevalent outcome measure in clinical trials, but it is not known how best to communicate HRQL results to new patients with cancer. The purpose was to explore cancer patients' attitudes toward, and preferences for, 10 visual and written formats for communicating HRQL information. Using standardized qualitative methods, six focus groups were held (two groups in each of three cancer centres) with patients who had completed treatment for cancer at least 6 months earlier. Groups were stratified according to patients' education. To ensure consistency across centres, group moderators used the same detailed guide, training video, and props. Three investigators independently coded the resulting transcripts. Participants also rated each of the 10 presentation formats as to their perceived usefulness. Fourteen men and 19 women with a variety of cancer diagnoses participated; 13 (39%) participated in the three lower-education groups and 20 (61%) in the three higher-education groups. We found that simple formats (simple graphs or written text) were generally preferred to more complex graphical information, regardless of educational level. The same format was rated favourably by the highest proportion of participants in both the high (85%) and low (85%) education level groups. Individual patients, however, varied as to which visual format they most preferred. Patients did not wish to receive HRQL information out of context or without explanation. We conclude that cancer patients desire HRQL information, but vary in their preferences for its communication. Simple formats are generally preferred.

Impingement pressure and tension forces of the anterior cruciate ligament

This study examined the impingement behavior of the uninjured ACL and the impingement pressure and tension forces of the ACL to draw conclusions for ACL reconstructions. A miniature pressure sensor was inserted between the ACL and the intercondylar roof of 15 knees of human cadavers before and after a 3-mm notch roof resection (thickness of the sensor); tension of the ACL was measured after attaching the tibial insertion to a load cell. A long-arm goniometer was used to determine corresponding extension angles. The beginning of contact of the ACL with the notch roof was between -1 and -2 degrees of knee extension. Pressure for full passive extension was 855.6+/-279.1 and 346.4+/-287.7 kPa, and ACL tension averaged 101.9+/-38.4 N. Tension forces in passive hyperextension were higher than those detected when a 200-N Lachman test was performed (83.5+/-25.1 N). There was a significant correlation between extension capability and impingement pressure. Impingement of the ACL was detected in all knees. Full passive extension exerts biomechanical pressure and tension on the ACL. Tension forces of the ACL are higher in passive hyperextension than during a Lachman test with 200 N. The impingement behavior found for the uninjured ACL is simulated in an ACL reconstruction when the center tibial tunnel position is used.

Unconventional therapy use among children with cancer in Saskatchewan

The study aimed to estimate the prevalence of unconventional therapy use among children with cancer in Saskatchewan, including identification of the most commonly used therapies, and to describe families' expectations and experiences in doing so. Researchers used a cross-sectional survey design with semi-structured telephone interviews to suit the descriptive and exploratory inquiry and the population focus. The personal telephone interviews occurred during the fall and winter of 1996 to 1997, with the parents coming from a wide range of geographic areas in the province of Saskatchewan. Parents of all children who were aged 14 years or younger when diagnosed with cancer during 1994 and 1995 in Saskatchewan and still living at the time of the study were identified through the provincial cancer registry with the assistance of the Saskatchewan Cancer Agency. Of the 44 families participating (92% of those eligible), 36% reported using unconventional therapy for their child's cancer; another 21% considered it. Reasons included complementing medical treatment, coping with side effects; making the child stronger; and stopping the cancer. Experiences were generally positive. Reasons for not using unconventional therapies included the child doing well and parents placing confidence in the medical system. Parents identified a need for better quality information about unconventional therapies. Unconventional therapies play a substantial complementary role in cancer care for children. Families need support to identify safe and potentially helpful therapies when they choose that route. This requires: more research about therapies' effectiveness; more accessible, quality information; and more training for health professionals in understanding and discussing unconventional therapies. There is considerable research showing that use of unconventional therapies, also known as complementary or alternative therapies, is high among adult cancer patients. Although it is likely reasonable to assume this may also be true for children, there is almost no research on children's use of unconventional therapies for cancer. Knowing the extent of children's use of unconventional therapies and whether those experiences have been beneficial or harmful is essential for parents and health professionals making quality care decisions for children.

A study to test the effectiveness of placebo Reiki standardization procedures developed for a planned Reiki efficacy study

Reiki is one type of alternative therapy that is increasing in popularity. It is advocated by its practitioners as a precise method for connecting universal life energy with the body's innate process of healing through hands-on techniques. The claim of Reiki practitioners is that Reiki reduces a variety of physical problems and improves psychospiritual well-being. There are abundant anecdotal records that support the previous claim, and a few pioneer scientific studies are starting to emerge. Although the Reiki research in totality supports the anecdotal records, the absence of randomized and placebo-controlled trials precludes the interpretation of the outcomes as resulting from specific effects as opposed to placebo effects plus natural history. Authorities in the field indicate that researchers interested in placebo-controlled studies should have the placebo treatment look exactly like the real intervention in every respect. Because no studies could be found in the literature that tested standardization procedures for real and placebo Reiki, the decision was made to conduct one. The purpose of this study was to test the standardization procedures developed by our research team for placebo Reiki, before going ahead and conducting our planned full-scale randomized and placebo-controlled Reiki efficacy study. This study used a 4-round, crossover experimental design in which 20 blinded subjects (12 students, 4 breast cancer survivors, and 4 observers) were exposed to a combination of 2 interventions (Reiki plus Reiki, or placebo plus placebo, or Reiki plus placebo, or placebo plus Reiki); and were then asked to evaluate the interventions using a self-administered questionnaire. The blinded observers were used in round number 4. Two real Reiki practitioners in the Usui system were chosen first, then 2 placebo practitioners who closely resembled them were recruited. The placebo practitioners were trained in Reiki by the study Reiki Master and the principal investigator, but were not initiated. The belief in Reiki is that only practitioners that are initiated could give Reiki, thus making it possible to have a placebo arm in efficacy studies. The findings of the study indicate that the developed standardization procedures were successful because none of the final participants in round 4 (4 breast cancer patients and 4 observers) could differentiate between the identity of placebo and Reiki practitioners. The qualitative comments expressed by the participants further con-firmed the quantitative data. It was concluded based on these findings that it is safe to go ahead and conduct the planned randomized 3-arm Reiki efficacy clinical trial. It is recommended that scholars interested in Reiki research could incorporate our techniques to strengthen their designs by adding a placebo arm.

Family members' care expectations, care perceptions, and satisfaction with advanced cancer care: results of a multi-site pilot study

Psychometric properties of assessment tools designed for use with English-speaking family members of advanced cancer patients in different care settings and different geographic locations were evaluated in this study. The robustness of the theoretical framework guiding the study and the factors identified with care satisfaction were also tested. Seventy-two family members drawn equally from medical hospital units, palliative care units, and home care programs in Alberta, Saskatchewan, and Manitoba participated. Instruments used included the F-Care Expectations Scale, F-Care Perceptions Scale, FAMCARE Scale, and the General Functioning Scale of the Family Assessment Device. All four tools yielded acceptable reliability estimates. Discrepancy theory predicted family care satisfaction in a highly significant manner (p < 0.0001). Family members of patients who had been diagnosed for longer than two years had more positive perceptions of palliative care than did family members of patients diagnosed for less than two years (p = 0.05). Older family members reported better family functioning than younger family members (p < 0.001). Spouses reported less discrepancy between care expectations and perceptions than did other relatives (p < 0.05).