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Hundert AS, Birnie KA, Abla O, Positano K, Cassiani C, Lloyd S, Tiessen PH, Lalloo C, Jibb LA, Stinson J. A Pilot Randomized Controlled Trial of Virtual Reality Distraction to Reduce Procedural Pain During Subcutaneous Port Access in Children and Adolescents With Cancer. Clin J Pain 2021; 38:189-196. [PMID: 34974512 PMCID: PMC8823907 DOI: 10.1097/ajp.0000000000001017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 10/04/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to determine the feasibility of virtual reality (VR) distraction for children with cancer undergoing subcutaneous port (SCP) access. We also aimed to estimate preliminary treatment effects of VR compared with an active distraction control (iPad). MATERIALS AND METHODS A single-site pilot randomized controlled trial comparing VR to iPad distraction was conducted. Eligible children and adolescents were aged 8 to 18 years undergoing treatment for cancer with upcoming SCP needle insertions. Intervention acceptability was evaluated by child, parent, and nurse self-report. Preliminary effectiveness outcomes included child-reported pain intensity, distress, and fear. Preliminary effectiveness was determined using logistic regression models with outcomes compared between groups using preprocedure scores as covariates. RESULTS Twenty participants (mean age 12 y) were randomized to each group. The most common diagnosis was acute lymphocytic leukemia (n=23, 58%). Most eligible children and adolescents (62%) participated, and 1 withdrew after randomization to the iPad group. Nurses, parents, and children reported the interventions in both groups to be acceptable, with the VR participants reporting significantly higher immersion in the distraction environment (P=0.0318). Although not statistically significant, more VR group participants indicated no pain (65% vs. 45%) and no distress (80% vs. 47%) during the procedure compared with the iPad group. Fear was similar across groups, with ~60% of the sample indicating no fear. DISCUSSION VR was feasible and acceptable to implement as an intervention during SCP access. Preliminary effectiveness results indicate that VR may reduce distress and distress compared with iPad distraction. These data will inform design of a future full-scale randomized controlled trial.
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Affiliation(s)
| | - Kathryn A. Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
| | - Oussama Abla
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children
- Department of Paediatrics
| | - Karyn Positano
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children
| | | | | | | | - Chitra Lalloo
- Child Health Evaluative Sciences
- Institute of Health Policy, Management & Evaluation
| | - Lindsay A. Jibb
- Child Health Evaluative Sciences
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences
- Institute of Health Policy, Management & Evaluation
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Jibb L, Nathan PC, Breakey V, Fernandez C, Johnston D, Lewis V, McKillop S, Patel S, Sabapathy C, Strahlendorf C, Victor JC, Moretti ME, Nguyen C, Hundert A, Cassiani C, El-Khechen Richandi G, Insull H, Hamilton R, Fang G, Kuczynski S, Stinson J. Pain Squad+ smartphone app to support real-time pain treatment for adolescents with cancer: protocol for a randomised controlled trial. BMJ Open 2020; 10:e037251. [PMID: 32184315 PMCID: PMC7076249 DOI: 10.1136/bmjopen-2020-037251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Pain negatively affects the health-related quality of life (HRQL) of adolescents with cancer. The Pain Squad+ smartphone-based application (app), has been developed to provide adolescents with real-time pain self-management support. The app uses a validated pain assessment and personalised pain treatment advice with centralised decision support via a registered nurse to enable real-time pain treatment in all settings. The algorithm informing pain treatment advice is evidence-based and expert-vetted. This trial will longitudinally evaluate the impact of Pain Squad+, with or without the addition of nurse support, on adolescent health and cost outcomes. METHODS AND ANALYSIS This will be a pragmatic, multicentre, waitlist controlled, 3-arm parallel-group superiority randomised trial with 1:1:1 allocation enrolling 74 adolescents with cancer per arm from nine cancer centres. Participants will be 12 to 18 years, English-speaking and with ≥3/10 pain. Exclusion criteria are significant comorbidities, end-of-life status or enrolment in a concurrent pain study. The primary aim is to determine the effect of Pain Squad+, with and without nurse support, on pain intensity in adolescents with cancer, when compared with a waitlist control group. The secondary aims are to determine the immediate and sustained effect over time of using Pain Squad+, with and without nurse support, as per prospective outcome measurements of pain interference, HRQL, pain self-efficacy and cost. Linear mixed models with baseline scores as a covariate will be used. Qualitative interviews with adolescents from all trial arms will be conducted and analysed. ETHICS AND DISSEMINATION This trial is approved by the Hospital for Sick Children Research Ethics Board. Results will provide data to guide adolescents with cancer and healthcare teams in treating pain. Dissemination will occur through partnerships with stakeholder groups, scientific meetings, publications, mass media releases and consumer detailing. TRIAL REGISTRATION NUMBER NCT03632343 (ClinicalTrials.gov).
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Affiliation(s)
- Lindsay Jibb
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Paul C Nathan
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Vicky Breakey
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Conrad Fernandez
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Hematology/Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Donna Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Victor Lewis
- Division of Hematology/Oncology, Alberta Children's Hospital, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah McKillop
- Division of Hematology/Oncology, Stollery Children's Hospital, Edmonton, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Serina Patel
- Division of Hematology/Oncology, London Health Sciences Centre Children's Hospital, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christine Sabapathy
- Division of Hematology/Oncology, Montreal Children's Hospital, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Caron Strahlendorf
- Division of Hematology/Oncology, BC Children's Hospital, Vancouver, BC, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - J Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Myla E Moretti
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia Nguyen
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amos Hundert
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Celia Cassiani
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Hayley Insull
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rachel Hamilton
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Geoffrey Fang
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer, Toronto, Ontario, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Cassiani C, Stinson J, Lindsay S. E-mentoring for youth with physical disabilities preparing for employment: a content analysis of support exchanged between participants of a mentored and non-mentored group. Disabil Rehabil 2019; 42:1963-1970. [PMID: 30641025 DOI: 10.1080/09638288.2018.1543360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Peer-mentoring is a method of delivering support that may ameliorate some of the challenges that youth with physical disabilities experience when preparing for future employment. This qualitative study compared and described forum content of an employment-focused peer e-mentoring intervention for youth with physical disabilities with a focus on support provided within a mentored group (an experimental group) and a non-mentored group (a control group).Methods: Using a descriptive qualitative approach, textual data from discussion forums of two groups within a peer e-mentoring intervention were analyzed through a content analysis. This qualitative study was part of a larger mixed-method pilot-randomized control trial on peer e-mentoring.Results: The mentored group consisted of nine youth with physical disabilities, aged 15-21 (mean age, 17.8) and two paid-peer mentors, and the non-mentored group included seven youth with physical disabilities, aged 15-19 (mean age = 16.1). We analyzed 151 posts. The types of support exchanged differed between the two groups. Two overarching themes emerged: (1) solution-focused support and (2) catalysts for supportConclusion: Peer e-mentoring can offer youth unique forms of support to help them prepare for employment. Clinicians may explore the opportunity for peer e-mentoring to complement current practice in preparing youth with physical disabilities for future employment.Implications for rehabilitationClinicians such as social workers, occupational therapists, and life skill coaches who are interested in preparing youth with physical disabilities for employment should consider the unique types of support provided in an online-mentored group.Peer e-mentoring has the potential to offer youth with physical disabilities distinct types of support and addresses concerns raised from face-to-face mentoring programs, such as accessibility and time.
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Affiliation(s)
- Celia Cassiani
- Rehabilitation Science Institute, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, Toronto, Canada
| | - Sally Lindsay
- Rehabilitation Science Institute, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Canada
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Guarna A, Belle C, Machetti F, Occhiato EG, Payne AH, Cassiani C, Comerci A, Danza G, De Bellis A, Dini S, Marrucci A, Serio M. 19-nor-10-azasteroids: a novel class of inhibitors for human steroid 5alpha-reductases 1 and 2. J Med Chem 1997; 40:1112-29. [PMID: 9089333 DOI: 10.1021/jm960807v] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Steroid 5alpha-reductase is a system of two isozymes (5alphaR-1 and 5alphaR-2) which catalyzes the NADPH-dependent reduction of testosterone to dihydrotestosterone in many androgen sensitive tissues and which is related to several human endocrine diseases such as benign prostatic hyperplasia (BPH), prostatic cancer, acne, alopecia, pattern baldness in men and hirsutism in women. The discovery of new potent and selective 5alphaR inhibitors is thus of great interest for pharmaceutical treatment of these diseases. The synthesis of a novel class of inhibitors for human 5alphaR-1 and 5alphaR-2, having the 19-nor-10-azasteroid skeleton, is described. The inhibitory potency of the 19-nor-10-azasteroids was determined in homogenates of human hypertrophic prostates toward 5alphaR-2 and in DU-145 human prostatic adenocarcinoma cells toward 5alphaR-1, in comparison with finasteride (IC50 = 3 nM for 5alphaR-2 and approximately 42 nM for 5alphaR-1), a drug which is currently used for BPH treatment. The inhibition potency was dependent on the type of substituent at position 17 and on the presence and position of the unsaturation in the A and C rings. delta9(11)-19-Nor-10-azaandrost-4-ene-3,17-dione (or 10-azaestra-4,9(11)-diene-3,17-dione) (4a) and 19-nor-10-azaandrost-4-ene-3,17-dione (5) were weak inhibitors of 5alphaR-2 (IC50 = 4.6 and 4.4 microM, respectively) but more potent inhibitors of 5alphaR-1 (IC50 = 263 and 299 nM, respectively), whereas 19-nor-10-aza-5alpha-androstane-3,17-dione (7) was inactive for both the isoenzymes. The best result was achieved with the 9:1 mixture of delta9(11)- and delta8(9)-17beta-(N-tert-butylcarbamoyl)-19-nor-10-aza-4- androsten-3-one (10a,b) which was a good inhibitor of 5alphaR-1 and 5alphaR-2 (IC50 = 127 and 122 nM, respectively), with a potency very close to that of finasteride. The results of ab initio calculations suggest that the inhibition potency of 19-nor-10-azasteroids could be directly related to the nucleophilicity of the carbonyl group in the 3-position.
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Affiliation(s)
- A Guarna
- Dipartimento di Chimica Organica Ugo Schiff, Università di Firenze, Italy.
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