The Development of a Bereavement Support Group Curriculum for Bereaved Parents of Young Adult Children: Bridging the Gap

Purpose: There is limited research addressing the bereavement needs of parents whose young adult (YA) children have died from cancer. Research within oncology about the impact of child loss has tended to focus on parents of pediatric aged children. We adapted a general bereavement support group curriculum used with adults to address the unique needs of bereaved parents of YAs. Methods: Using a quality improvement framework, 25 bereaved parents of YA children participated in one of three 6-session bereavement support group programs during 2020 and 2021. Due to the coronavirus disease 2019 (COVID-19) pandemic, the programs were offered virtually. The participants provided feedback and completed an evaluation. Results: Nineteen mothers and six fathers participated with 20 (80%) completing the evaluation. The median time since the death of their child was 6 months. The participants evaluated the program highly, reporting that they felt less isolated (4.25/5 on a 5-point Likert scale); that their concerns were similar to others (4.45/5); and the discussion topics were relevant (4.20/5). Other topics that were identified included the impact on the family of losing a YA child, and how other relationships change. Forty-five percent of participants expressed a preference for a hybrid delivery model, incorporating in-person and virtual sessions. The majority also wished to continue meeting monthly, given they had little contact with other bereaved parents of YAs. Conclusion: The general bereavement support group curriculum was readily adapted for use with bereaved parents of YA children who died from cancer. A hybrid delivery model was the preferred method for future groups.

Adolescent and Young Adult Initiated Discussions of Advance Care Planning: Family Member, Friend and Health Care Provider Perspectives

Background and Aims

End-of-life (EoL) discussions can be difficult for seriously ill adolescents and young adults (AYAs). Researchers aimed to determine whether completing Voicing My CHOiCES (VMC)-a research-informed advance care planning (ACP) guide-increased communication with family, friends, or health care providers (HCPs), and to evaluate the experience of those with whom VMC was shared.

Methods

Family, friends, or HCPs who the AYAs had shared their completed VMC with were administered structured interviews to assess their perception of the ACP discussion, changes in their relationship, conversation quality, and whether the discussion prompted changes in care. Open-ended responses underwent thematic analysis.

Results

One-month post-completion, 65.1% of AYA had shared VMC completion with a family member, 22.6% with a friend, and 8.9% with an HCP. Among a sample of respondents, family (47%) and friends (33%) reported a positive change in their relationship with the AYA. Participant descriptions of the experience fell into five themes: positive experience (47%), difficult experience (44%), appreciated a guide to facilitate discussion (35%), provided relief (21%), and created worry/anxiety (9%). Only 1 HCP noted a treatment change. Family (76%), friends (67%), and HCP (50%) did not think the AYA would have discussed EoL preferences without completing VMC.

Conclusions

VMC has potential to enhance communication about ACP between AYA and their family and friends, though less frequently with HCPs. Participants reported a positive change in their relationship with the AYA after discussing VMC, and described experiencing the conversation as favorable, even when also emotionally difficult.

Feasibility and Acceptability of a Mobile Phone App Intervention for Coping With Cancer as a Young Adult: Pilot Trial and Thematic Analysis

BACKGROUND

Many young adult patients do not receive adequate psychosocial services to help them cope with cancer.

OBJECTIVE

This study aims to assess the feasibility and acceptability of a smartphone app (iaya) intervention that was designed to create an engaged community of young adult patients and help them learn emotional coping skills.

METHODS

For this single-group pilot trial, 25 young adult patients aged 18-39 years who were receiving active cancer treatment were asked to use the iaya app for 12 weeks. To collect app use data, we used Mixpanel, an analytics platform for apps. Feasibility was assessed through rates of app sessions and the number of coping exercises engaged, and intervention acceptability was evaluated by using an app usability questionnaire and through qualitative interviews at study completion. We collected patient-reported outcome data at baseline and at week 12 to explore self-efficacy for coping with cancer, self-efficacy for managing emotions, perceived emotional support, and quality of life.

RESULTS

Baseline patient-reported outcome data indicated that participants scored relatively low on perceived emotional support but reasonably high on self-efficacy for coping with cancer and managing emotions as well as quality of life. Participants had a mean of 13 app sessions (SD 14) and 2 coping exercises (SD 3.83) in 12 weeks. Only 9% (2/23) of participants met our combined feasibility definition of ≥10 app sessions and ≥3 coping skills from different categories. The participants' mean usability score was 73.7% (SD 10.84), which exceeded our predefined threshold of ≥70%, and qualitative feedback was generally positive.

CONCLUSIONS

Although perceived acceptable by patients, the iaya smartphone app did not meet the a priori feasibility criteria as a stand-alone app intervention. Future studies should screen participants for unmet coping needs and consider integrating the app as part of psychosocial care for young adult patients.

The role of mindfulness in physical activity: a systematic review

Despite continued public health campaigns to promote physical activity, a majority of the population is inactive. In recent years, mindfulness-based approaches have been used in health and lifestyle interventions for physical activity promotion. We conducted a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to investigate the evidence for the potential of mindfulness-based approaches for physical activity. We searched electronic databases for papers that met eligibility criteria and identified 40 studies for inclusion. Evidence from cross-sectional studies (n = 20) indicated a positive relationship between dispositional mindfulness and physical activity, particularly with psychological factors related to physical activity. Five studies found that the mindfulness-physical activity relationship was mediated by stress, psychological flexibility, negative affect and shame, satisfaction and state mindfulness. Evidence from mindfulness-based interventions (n = 20) suggested positive between-subjects effects on physical activity, but interventions varied in duration, session length, group size, delivery, content and follow-up. Mindfulness-based interventions were more likely to be successful if they were physical activity-specific and targeted psychological factors related to physical activity. The body of research shows a need for more methodologically rigorous studies to establish the effect of mindfulness on physical activity and to identify potential mechanisms involved in the mindfulness-physical activity relationship reliably.

Pazopanib and depot octreotide in advanced, well-differentiated neuroendocrine tumours: a multicentre, single-group, phase 2 study

BACKGROUND

Treatment options for advanced, well-differentiated neuroendocrine tumours (NETs) remain scarce. Pazopanib is an orally bioavailable, small molecule, multitargeted kinase inhibitor that inhibits VEGF receptors 1, 2, and 3. We did a study of the efficacy of pazopanib with depot octreotide in patients with advanced NETs.

METHODS

We did a parallel cohort study of patients with metastatic or locally advanced grade 1-2 carcinoid tumours or pancreatic NETs, by use of a single-group, two-stage design. Patients received pazopanib 800 mg orally once per day and octreotide at their preprotocol dosage. The primary endpoint was the proportion of patients achieving an objective response, as assessed by investigators, by intention-to-treat analysis. This study is registered with ClinicalTrials.gov, identifier NCT00454363, and was completed in March, 2014.

FINDINGS

Between April 12, 2007, and July 2, 2009, we enrolled 52 patients, including 32 individuals with pancreatic NETs and 20 individuals with carcinoid tumours. Seven (21·9%, 95% CI 11·0-38·8) of 32 patients with pancreatic NETs achieved an objective response. We detected no responses in the first stage of the cohort with carcinoid tumours, and we terminated accrual at 20 patients. Toxic effects included one patient with grade 4 hypertriglyceridaemia and one with grade 4 thrombosis, with the most common grade three events being aminotransferase increases and neutropenia, each of which happened in 3 patients. In all 52 patients, the most frequently observed toxic effects were fatigue (39 [75%]), nausea (33 [63%]), diarrhoea (33 [63%]), and hypertension (28 [54%]).

INTERPRETATION

Treatment with pazopanib is associated with tumour response for patients with pancreatic NETs, but not for carcinoid tumours; a randomised controlled phase 3 study to assess pazopanib in advanced pancreatic NETs is warranted.

FUNDING

US National Cancer Institute of the National Institutes of Health.

Dobutamine stress echocardiography in the diagnosis of asymptomatic ischemic heart disease in patients with chronic kidney disease--review of literature and single-center experience

BACKGROUND

Coronary artery disease (CAD) may be present in kidney transplant (KT) candidates without the presence of CAD clinical symptoms. This study joins an ongoing discussion about appropriate noninvasive diagnostic approaches for ischemic heart disease (IHD) assessment and patient selection for revascularization procedures. The aim of this study was to evaluate the role of dobutamine stress echocardiography (DSE) in IHD diagnosis in initially asymptomatic maintenance hemodialysis (HD) patients.

METHODS

Forty HD patients aged 52.4 ± 2.0 years, were studied for 2.5 years. At inclusion, they were free of both symptoms and history of IHD. Standard electrocardiography (ECG), chest X-ray, standard echocardiography, DSE, 24-hour Holter ECG, and Doppler ultrasonography (carotids and lower extremities) were performed. Results were analyzed according to a predefined diagnostic algorithm.

RESULTS

DSE yielded negative results in all patients. Left ventricular (LV) ejection fraction ≤ 60%, LV hypertrophy, and Holter ECG silent ischemia features were noticed in 15%, 70%, and 10% of patients, respectively. Atherosclerotic lesions in lower extremities and carotid arteries were present in 50% and 37.5% of patients, respectively. During the follow-up, 9/40 patients died, including 6 cardiovascular (CV) deaths: 2 with intermediate and 4 with high CV risk according to the proposed algorithm.

CONCLUSIONS

In asymptomatic KT candidates, not only DSE, but also other noninvasive tests (eg, echocardiography and Doppler ultrasonography of the carotid and peripheral arteries) along with a detailed profile of the remaining CV risk factors should be performed and analyzed. Defined composition of risk factors and particular changes in noninvasive tests may be an indication for coronary angiography.

Two-dimensional EPR imaging with the rapid scan and rotated magnetic field gradient

A new method for fast 2D Electron Paramagnetic Resonance Imaging (EPRI) is presented. To reduce the time of projections acquisition we propose to combine rapid scan of Zeeman magnetic field using high frequency sinusoidal modulation with simultaneously applied magnetic field gradient, whose orientation is changed at low frequency. The correctness of the method is confirmed by studies carried out on a phantom consisting of two LiPc samples. The images from the acquired data are reconstructed using iterative algorithms. The proposed method allows to reduce the image acquisition time up to 10 ms for 2D EPRI, and to detect the sinogram with infinitesimal angular step between projections.

Two-dimensional spectral-spatial EPR imaging with the rapid scan and modulated magnetic field gradient

A new method for fast spectral-spatial electron paramagnetic resonance imaging (EPRI) is presented. To reduce the time of projections acquisition we propose to combine rapid scan of Zeeman magnetic field using high frequency sinusoidal modulation with simultaneously applied magnetic field gradients, whose amplitude is modulated at low frequency. The correctness of the method is confirmed by studies carried out on a phantom consisting of two LiPc samples. The spectral-spatial images from the acquired data are reconstructed using iterative algorithms. The proposed method allows to acquire the spectral-spatial image with 800 projections at 200ms.

Phase I study of sorafenib in combination with everolimus (RAD001) in patients with advanced neuroendocrine tumors

PURPOSE

Sorafenib and everolimus are both active against neuroendocrine tumors (NET). Because of potential synergy between VEGF pathway and mTOR inhibitors, we performed a phase I study to evaluate the safety and feasibility of combining sorafenib and everolimus in patients with advanced NET.

METHODS

Patients were treated with everolimus 10 mg daily in combination with sorafenib (dose level 1: 200 mg twice daily; dose level 2: 200 mg per morning, 400 mg per evening) using standard phase I dose escalation design. Dose-limiting toxicity (DLT) was defined within the first cycle (28 days) of therapy. Treatment was continued until tumor progression, unacceptable toxicity, or withdrawal of consent. Twelve additional patients were treated at the maximum tolerated dose (MTD) level to further characterize safety and a preliminary assessment of activity.

RESULTS

One patient in Cohort 1 experienced DLT (grade 3 skin rash); the cohort was expanded to 6 patients with no further DLTs. All 3 patients in Cohort 2 experienced DLT, consisting of thrombocytopenia, hand-foot skin reaction, and rash/allergic reaction. Sorafenib 200 mg twice daily in combination with everolimus 10 mg daily was established as the MTD. Independently reviewed best objective responses revealed that 62 % of patients had some degree of tumor shrinkage. By RECIST, we observed partial response in 1 patient, stable disease in 13 patients, and progressive disease in 3 patients.

CONCLUSION

Sorafenib 200 mg twice daily with everolimus 10 mg daily represents the MTD of this combination in patients with advanced NET. While the combination is active, toxicity concerns may preclude more widespread use.

Phase I study of pasireotide (SOM 230) and everolimus (RAD001) in advanced neuroendocrine tumors

Octreotide and everolimus have demonstrated efficacy in neuroendocrine tumors. Pasireotide is a somatostatin analog with binding affinity to a broader range of somatostatin receptor subtypes than octreotide. We performed a phase I study to evaluate the safety and feasibility of combining pasireotide with everolimus in patients with advanced neuroendocrine tumors. Cohorts of patients with advanced neuroendocrine tumors were treated with escalating doses of pasireotide (600-1200  μg s.c. b.i.d., followed by pasireotide LAR 40-60  mg i.m. monthly) and everolimus (5-10  mg daily). Twenty-one patients were treated. Dose-limiting toxicities consisting of grade 3 rash and grade 3 diarrhea were observed. Twelve patients were safely treated at the maximum protocol-defined dose level of pasireotide LAR 60  mg i.m. monthly and everolimus 10  mg daily. Hyperglycemia was common; other observed toxicities were consistent with the known toxicities of either agent alone. Partial tumor response was observed in one patient; 17 (81%) patients experienced at least some tumor regression as their best response to therapy. In conclusion, pasireotide LAR 60  mg i.m. monthly in combination with everolimus 10  mg daily is feasible and associated with preliminary evidence of antitumor activity in patients with advanced neuroendocrine tumors. Further studies evaluating this combination are warranted.

Multicenter randomized phase II trial of cisplatin, irinotecan plus bevacizumab (PCA) versus docetaxel, cisplatin, irinotecan plus bevacizumab (TPCA) in patients (pts) with metastatic esophagogastric cancer (MEGCA)

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Background: In MEGCA, PCA has a 65% response rate (RR) and 8.3 mos time to progression (Shah. JCO 2006); TPCA has a 66% RR and 8.9 mos progression-free survival (PFS) (Enzinger. ESMO 2008 updated). Methods: Chemo naive pts with MEGCA were stratified: ECOG (0/1 vs. 2) and disease site (Gastric or GEJ/esophageal) and randomized 1:1 to PCA or TPCA. PCA -- cisplatin 30mg/m2 and irinotecan 65mg/m2 on d1, 8, and bevacizumab 10 mg/kg d1 docetaxel 30mg/m2, cisplatin 25mg/m2 and irinotecan 50mg/m2 on d1, 8, and bevacizumab 10 mg/kg d1. Cycles were 3 weeks. Response assessment - q6wks (RECIST 1.1). Primary endpoint was PFS. Results: 85 patients: median age=61 (40-85); male/female= 70/15; ECOG: 0/1/2=(34/49/2); gastric/GE junction/esophageal=27/21/37; measurable/evaluable: 78/7; sites of metastatic disease (# of pts): lymph nodes (34), liver (31), lung (11), bone (5), abdomen (4), peritoneum (4), other (11). There were two treatment-related deaths: esophageal hemorrhage, sudden death (both TPCA). Conclusions: Both regimens were efficacious and reasonably well tolerated. The addition of docetaxel to the attenuated PCA combination did not significantly improve efficacy. [Table: see text]

Feature-selective attention enhances color signals in early visual areas of the human brain

We used an electrophysiological measure of selective stimulus processing (the steady-state visual evoked potential, SSVEP) to investigate feature-specific attention to color cues. Subjects viewed a display consisting of spatially intermingled red and blue dots that continually shifted their positions at random. The red and blue dots flickered at different frequencies and thereby elicited distinguishable SSVEP signals in the visual cortex. Paying attention selectively to either the red or blue dot population produced an enhanced amplitude of its frequency-tagged SSVEP, which was localized by source modeling to early levels of the visual cortex. A control experiment showed that this selection was based on color rather than flicker frequency cues. This signal amplification of attended color items provides an empirical basis for the rapid identification of feature conjunctions during visual search, as proposed by "guided search" models.

Towards benchmark second-order correlation energies for large atoms: Zn[sup 2+] revisited

To provide very accurate reference results for the second-order Møller-Plesset (MP2) energy and its various components for Zn(2+), which plays for 3d-electron systems a similar role as Ne for smaller atoms and molecules, we have performed extensive calculation by two completely different implementations of the MP2 method: the finite element method (FEM) and the variation-perturbation (VP) method. The FEM and VP calculations yield partial wave contributions up to l(max)=45 and 12, respectively. Detailed comparison of all FEM and VP energy components for l(max)=12 has disclosed an extraordinary similarity, which justifies using the present results as benchmarks. The present correlation energies are compared with other works. The dependability of an earlier version of FEM, already applied to very large closed-shell atoms, is confirmed. It has been found that for larger atoms the accuracy of the analytical Hartree-Fock results has an impact on the accuracy of the MP2 energies greater than for smaller atoms. Fields of applications of the present results in studies of various electron correlation effects in 3d-electron atoms and molecules are indicated.

Sustained division of the attentional spotlight

By voluntarily directing attention to a specific region of a visual scene, we can improve our perception of stimuli at that location. This ability to focus attention upon specific zones of the visual field has been described metaphorically as a moveable spotlight or zoom lens that facilitates the processing of stimuli within its 'beam'. A long-standing controversy has centred on the question of whether the spotlight of spatial attention has a unitary beam or whether it can be divided flexibly to disparate locations. Evidence supporting the unitary spotlight view has come from numerous behavioural and electrophysiological studies. Recent experiments, however, indicate that the spotlight of spatial attention may be divided between non-contiguous zones of the visual field for very brief stimulus exposures (&<100 ms). Here we use an electrophysiological measure of attentional allocation (the steady-state visual evoked potential) to show that the spotlight may be divided between spatially separated locations (excluding interposed locations) over more extended time periods. This spotlight division appears to be accomplished at an early stage of visual-cortical processing.

The effect of familiarity on visual-search performance: evidence for learned basic features

In this study, the effects of familiarity on visual search were investigated. To avoid any confounding between familiarity and visual-feature differences between item pairs, Ns and mirror-Ns were presented as target and as distractors to a group of German participants and to a group of Slavic participants. For the Germans only N was familiar, whereas for the Slavs both N and mirror-N were familiar. The results show that search was difficult only when the Germans had to find an N among mirror-Ns. In any other case, search was efficient. Therefore, our results demonstrate that, contrary to earlier suggestions, search for a familiar item among familiar distractors can be easy. This supports the hypothesis that familiarity improves distractor grouping. However, the data are also compatible with the idea that letters are standard or basic features, which implies that basic features can be learned.

How to produce an absent-advantage in visual search

In a series of four experiments, we investigated the conditions under which target-absent responses are faster than target-present responses in visual search. Previous experiments have shown that such an absent-advantage occurs mainly for homogeneous distractors arranged in a regular pattern. From these results, it has been concluded that the absent-advantage is due to perceptual processes, such as grouping by similarity. Our data show that such processes are not sufficient. Rather, the absent-advantage is the result of interactions between perceptual and decisional processes. Certain perceptual conditions, such as randomizing stimulus patterns, lead to specific criteria settings that produce an absent-advantage. That such an account can explain our main results is demonstrated by modeling our data with a modified version of the Guided Search 2 model.

[Treatment of external postoperative fistulas of the gastrointestinal tract]

In the years 1985-1996 82 patients with postoperative external fistulas of gastrointestinal tract (pefgt) were treated in the Department of General Surgery of Hospital in Olsztyn. The age of the patient varied from 18 to 70 years. 37 patients were women and 45 man. Volume of excreted fluid fluctuated from 100 ml to 3000 ml per day. The most frequent cause of pefgt was dehiscence of the anastomosis of jejunum in 31 patients, and operations of complications of gastric or duodenal ulcer disease in 30 patients. 54 patients underwent medical treatment. It was based on compensation of disorders in water and electrolyte balance and acid-base equilibrium, nutritional treatment, protection of the skin, suction of the excreted fluid, controlling of foci of infection, rehabilitation. 7 patients were reoperated for the purpose of closing the fistula and 21 to drain abscess or to stop bleeding. 57 (70%) out of 82 patients recovered, 25 (30%) died. In this number 14 patients among 54 treated conservatively and 11 out from 28 operated. The most frequent cause of death was sepsis (15 patients). The conservative treatment including TPN is successful in majority of patients with pefgt and indispensable in patients treated operatively. Special attention should be given for coexisting intraperitoneal abscessa, peritonitis and sepsis.