OS09.5.A The experience of interval scans for adults living with primary malignant brain tumours

Background

People living with primary malignant brain tumours (PMBT) face a complex and unpredictable illness. Throughout the disease course they undergo various treatments and follow-up with regular interval scanning. There are potential costs and benefits to interval scanning, however there is no high-quality evidence to suggest interval scanning is beneficial or whether scans alter outcomes of importance for people living with PMBTs. Yet, interval scanning may exacerbate issues such as uncertainty and anxiety - which impacts on patient quality of life. The aim of this study was to gain an in-depth understanding of how adults living with PMBTs experience and cope with interval scanning.

Material and Methods

Twelve patients with a diagnosis of PMBT (glioblastoma n=10; astrocytoma grade 3 n=1; solitary fibrous tumour of the dura grade 3 n=1) under the neuro-oncology teams at Leeds Teaching Hospital NHS Trust and King's College Hospital NHS Foundation Trust took part in the study. They were interviewed remotely about their experiences of interval scans, following a semi-structured interview guide. An abbreviated version of a constructionist grounded theory approach was used to analyse data.

Results

Five main themes were generated from the data: ‘Living with a PMBT’, ‘Interval scanning: the difficult times’, ‘MRI scan: accepting the discomfort’, ‘Waiting for results: coping with the uncertainty’ and ‘Results: providing some certainty in uncertainty’. Although most participants found interval scans uncomfortable, they accepted that they were something that they had to do and were using various coping methods to get through the MRI scan. All participants said that the wait between their scan and results was the most difficult part. Despite the difficulties they experienced, all participants said that they would prefer to have interval scans than wait for a change in their symptoms. Most of the time, scans provided relief, gave participants some certainty in an uncertain situation, and a short-term sense of control over their lives.

Conclusion

The present study shows that interval scanning is important and highly valued by patients living with PMBT. Although interval scans are anxiety provoking, they appear to help people living with PMBT cope with the uncertainty of their diagnosis.

Randomized controlled feasibility trial of supported self-management in adults with Type 2 diabetes mellitus and an intellectual disability: OK Diabetes

AIMS

To undertake a feasibility randomized controlled trial of supported self-management vs treatment as usual in a population of adults with obesity, Type 2 diabetes and an intellectual disability.

METHODS

We conducted an individually randomized feasibility trial. Participants were adults aged >18 years with a mild or moderate intellectual disability, living in the community with Type 2 diabetes, on any therapy other than insulin. Participants had mental capacity to consent to research and the intervention. Inclusion criteria included HbA_1c > 48 mmol/mol (6.5%), BMI >25 kg/m² , or self-reported physical activity below national guideline levels. The experimental intervention was standardized supported self-management delivered by diabetes specialist nurses plus treatment as usual, compared with treatment as usual alone. Feasibility outcomes included: recruitment and retention; intervention acceptability and feasibility; data collection and completeness for physiological state and values for candidate primary outcomes (HbA_1c and BMI).

RESULTS

A total of 82 participants (89% of those contacted and eligible) were randomized. All supported self-management sessions were completed by 35/41 participants (85%); only four completed no sessions. Data on the follow-up candidate primary outcomes HbA_1c and BMI were obtained for 75/82 (91%) and 77/82 participants (94%), respectively. The mean baseline HbA_1c was 56±16.5 mmol/mol (7.3±1.5%) and the mean BMI was 34±7.6 kg/m² .

CONCLUSIONS

Adherence to supported self-management and willingness to have blood taken for outcome measurement was good. A definitive randomized controlled trial is feasible in this population. (Trial registration: Current Controlled Trials ISRCTN41897033).

Elective orthognathic treatment decision making: a survey of patient reasons and experiences

OBJECTIVE

Few studies have explored decisions about orthognathic treatment (OGT) from the patient's perspective. This study describes the factors associated with the patient's decision to have or not have orthognathic treatment, and assesses whether the process can be considered to be informed decision making.

DESIGN

A cross-sectional survey employing both interview and questionnaire methods, conducted in four OGT services in Yorkshire.

SAMPLE

Participants were patients aged over 16 years, either making an OGT decision over a 6-month period or had made their treatment choice 18-42 months prior to the study start date in 2003.

MEASURES

Questionnaires assessed patient demographics, dental history and psychopathology (anxiety, satisfaction with self, body satisfaction, facial appearance); interviews explored patients' reasons for, and experiences of, orthognathic treatment.

RESULTS

Of 138 patients approached, 61 participated (mean age 25 years, 66% female). Psychopathology scores were within the normal range. The thematic content analysis of interview transcripts found: reasons given for having OGT were to improve the 'bite', as well as gaining a more normal facial appearance; most patients reported the service information was satisfactory, but about half made negative comments, with some reporting staff communications made them feel worse; knowledge of OGT risks and benefits was poor; patients had strong emotions about their facial appearance and the orthognathic treatment they received, which did not seem to be addressed by current practice.

CONCLUSIONS

Some OGT patients do not appear to be making informed decisions about their treatment. They seem to have unmet needs in relation to support for their decision making, and managing the emotional effects of undergoing and adjusting to treatment. The implications for information provision, assessment and support during treatment are discussed.

Indications of disordered eating behaviour in adolescent patients with idiopathic scoliosis

We have investigated whether patients with adolescent-onset idiopathic scoliosis (AIS) are more likely to have a low body-weight. Measurements of weight, height and body mass index (BMI) were made in 44 young women with AIS and compared with age- and gender-adjusted normative data. The body mass criteria of the International Classification of Diseases for eating disorders was used to determine how many patients were within the range considered to be ‘eating disordered’. Compared with the normative data, the AIS group did not differ significantly in terms of height, (p = 0.646), but they were significantly lighter (p < 0.001) and had significantly lower BMI scores (p < 0.001); 25% of the series had BMI scores which were within the range considered to be anorexic.

The relationship between a diagnosis of AIS and low body-weight may indicate disordered eating and is thus a cause for concern, particularly in the light of the well-established relationship between eating psychopathology and osteoporosis. Aspects of organic health may need to be considered in addition to the cosmetic deformity.

Indications of disordered eating behaviour in adolescent patients with idiopathic scoliosis

We have investigated whether patients with adolescent-onset idiopathic scoliosis (AIS) are more likely to have a low body-weight. Measurements of weight, height and body mass index (BMI) were made in 44 young women with AIS and compared with age- and gender-adjusted normative data. The body mass criteria of the International Classification of Diseases for eating disorders was used to determine how many patients were within the range considered to be 'eating disordered'. Compared with the normative data, the AIS group did not differ significantly in terms of height, (p = 0.646), but they were significantly lighter (p < 0.001) and had significantly lower BMI scores (p < 0.001); 25% of the series had BMI scores which were within the range considered to be anorexic. The relationship between a diagnosis of AIS and low body-weight may indicate disordered eating and is thus a cause for concern, particularly in the light of the well-established relationship between eating psychopathology and osteoporosis. Aspects of organic health may need to be considered in addition to the cosmetic deformity.

Implicit memory in multiple sclerosis

A number of neuropsychological studies have revealed that memory problems are relatively common in patients with multiple sclerosis (MS). It may be useful to compare MS with conditions such as Huntington's disease (HD), which have been referred to as subcortical dementia. A characteristic of these conditions may be an impairment in implicit (unconscious) memory, but not in explicit (conscious) memory. The present study examined the functioning of explicit and implicit memory in MS. Results showed that implicit memory was not significantly impaired in the MS subjects, and that they were impaired on recall but not recognition. A correlation was found between implicit memory performance and disability status in MS patients. Findings also suggest the possibility of long-term priming of implicit memory in the control subjects. The implications of these results are discussed.

Colour-contingent after-effects are really wavelength-contingent

McCollough reported that following adaptation to (say) a red and black pattern of vertical stripes, alternating every few seconds with a green and black pattern of horizontal stripes, an orientation-contingent colour after-effect is observed when black and white gratings are viewed. Vertical gratings are tinged with green and horizontal gratings with pink. We have exploited colour constancy, the tendency for objects to appear constant in hue despite large changes in the spectral composition of the illuminant, to examine whether the colours observed on the McCollough effect test gratings are determined by the wavelength composition of the adaptation patterns or by their perceived colour. The key to this approach can be illustrated by Edwin Land's elegant demonstrations of colour constancy using 'Mondrian' displays. By embedding the adapting grating that is used to induce the McCollough effect within a Mondrian we show that the effect depends upon the wavelength of light coming from the grating, rather than the perceived colour.