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Alvarez J, Shi Q, Dasari A, Garcia-Aguilar J, Sanoff H, George TJ, Hong TS, Yothers G, Philip PA, Nelson GD, Al Baghdadi T, Alese O, Zambare W, Omer DM, Verheij FS, Buckley J, Williams H, George M, Garcia R, O'Reilly EM, Meyerhardt JA, Shergill A, Horvat N, Romesser PB, Hall WA, Smith JJ. ALLIANCE A022104/NRG-GI010: The Janus Rectal Cancer Trial: a randomized phase II/III trial testing the efficacy of triplet versus doublet chemotherapy regarding clinical complete response and disease-free survival in patients with locally advanced rectal cancer. medRxiv 2024:2024.04.25.24306396. [PMID: 38712176 PMCID: PMC11071544 DOI: 10.1101/2024.04.25.24306396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background Recent data have demonstrated that in locally advanced rectal cancer (LARC), a total neoadjuvant therapy (TNT) approach improves compliance with chemotherapy and increases rates of tumor response compared to neoadjuvant chemoradiation (CRT) alone. They further indicate that the optimal sequencing of TNT involves consolidation (rather than induction) chemotherapy to optimize complete response rates. Data, largely from retrospective studies, have also shown that patients with clinical complete response (cCR) after neoadjuvant therapy may be managed safely with the watch and wait approach (WW) instead of preemptive total mesorectal resection (TME). However, the optimal consolidation chemotherapy regimen to achieve cCR has not been established, and a randomized clinical trial has not robustly evaluated cCR as a primary endpoint. Collaborating with a multidisciplinary oncology team and patient groups, we designed this NCI-sponsored study of chemotherapy intensification to address these issues and to drive up cCR rates, to provide opportunity for organ preservation, improve quality of life for patients and improve survival outcomes. Methods In this NCI-sponsored multi-group randomized, seamless phase II/III trial (1:1), up to 760 patients with LARC, T4N0, any T with node positive disease (any T, N+) or T3N0 requiring abdominoperineal resection or coloanal anastomosis and distal margin within 12 cm of anal verge will be enrolled. Stratification factors include tumor stage (T4 vs T1-3), nodal stage (N+ vs N0) and distance from anal verge (0-4; 4-8; 8-12 cm). Patients will be randomized to receive neoadjuvant long course chemoradiation (LCRT) followed by consolidation doublet (mFOLFOX6 or CAPOX) or triplet chemotherapy (mFOLFIRINOX) for 3-4 months. LCRT in both arms involves 4500 cGy in 25 fractions over 5 weeks + 900 cGy boost in 5 fractions with a fluoropyrimidine (capecitabine preferred). Patients will undergo assessment 8-12 (+/- 4) weeks post-TNT completion. The primary endpoint for the phase II portion will compare cCR between treatment arms. A total number of 296 evaluable patients (148 per arm) will provide statistical power of 90.5% to detect an 17% increase in cCR rate, at a one-sided alpha=0.048. The primary endpoint for the phase III portion will compare disease-free survival (DFS) between treatment arms. A total of 285 DFS events will provide 85% power to detect an effect size of hazard ratio 0.70 at a one-sided alpha of 0.025, requiring enrollment of 760 patients (380 per arm). Secondary objectives include time-to event outcomes (overall survival, organ preservation time and time to distant metastasis) and adverse effects. Biospecimens including archival tumor tissue, plasma and buffy coat in EDTA tubes, and serial rectal MRIs will be collected for exploratory correlative research. This study, activated in late 2022, is open across the NCTN and has a current accrual of 312. Support: U10CA180821, U10CA180882, U24 CA196171; https://acknowledgments.alliancefound.org . Discussion Building off of data from modern day rectal cancer trials and patient input from national advocacy groups, we have designed the current trial studying chemotherapy intensification via a consolidation chemotherapy approach with the intent to enhance cCR and DFS rates, increase organ preservation rates, and improve quality of life for patients with rectal cancer. Trial Registration Clinicaltrials.gov ID: NCT05610163 ; Support includes U10CA180868 (NRG) and U10CA180888 (SWOG).
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Zhang Y, Amjad A, Ding J, Sarosiek C, Zarenia M, Conlin R, Dang NP, Hall WA, Erickson BA, Paulson ES, Li A. Clinical Usability-Oriented Automatic Contour Quality Evaluation for Deep Learning Auto-Segmentation. Int J Radiat Oncol Biol Phys 2023; 117:S144-S145. [PMID: 37784368 DOI: 10.1016/j.ijrobp.2023.06.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Various auto-segmentations, including deep learning auto-segmentation (DLAS), are being increasingly adopted in radiotherapy. A common method to evaluate quality of auto-segmented contours uses thresholds of various quantitative metrics (e.g., dice similarity coefficient (DSC), mean distance to agreement (MDA), etc.) that are often averaged over all contour slices. This method fails to detect contour errors on individual slices, thus, does not reflect the current clinical practice (slice-by-slice evaluation) and the clinical usability (e.g., expected contour editing time). In addition, the use of multi-metrics is generally not easy to interpret. This work aims to develop a novel contour quality classification (CQC) model to evaluate auto-segmented contours based on their clinical applicability. MATERIALS/METHODS The CQC method was designed to classify a contour on a slice into acceptable, minor edit or major edit category, based on the expected editing effort/time. Organ-specific supervised ensemble tree classification models were trained to relate the slice-based quality category with the combination of seven commonly used calculatable quantitative metrics (i.e., DSC, MDA, Hausdorff 95% distance, surface DSC, added path length (APL), slice area and relative APL). The proposed method was demonstrated by training CQC models using DLAS contours of five abdominal organs (i.e., pancreas, duodenum, stomach, and small and large bowels) from 50 MRI sets and evaluating on 20 MRI and 9 CT testing sets. These test datasets were labelled by six individual observers and the consensus labels were generated through majority vote method. The model performance was evaluated using accuracy (acc), and risk rate (RR, the percentage of unacceptable slices mislabeled as acceptable) and compared with inter-observer variation and baseline threshold-based method. RESULTS Compared to the majority vote labels, the obtained CQC models achieved a mean accuracy of 95.8% ([94.5%-99.1%]) and 94.3% ([90.6%-96.9%]), and the mean RR of 0.8% ([0.3%-1.3%]) and 0.7% ([0%-1.1%]) for the MRI and CT testing sets, respectively. The CQC performance was comparable to the inter-observer variation and significantly higher than those from the threshold-based method with single or multiple metrics. The execution time on a typical abdominal dataset (e.g., 70 slices) took less than 3 seconds. Table 1 CQC models performance for different organs CONCLUSION: The proposed CQC model can classify the quality of a contour slice with high accuracy. This slice-based single-output evaluation method better reflects the current clinical practice and may be used to evaluate/compare performance of DLAS on any image modality, facilitating its clinical implementation and quality assurance.
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Affiliation(s)
- Y Zhang
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - A Amjad
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - J Ding
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - C Sarosiek
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Zarenia
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - R Conlin
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - N P Dang
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - B A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - E S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - A Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
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Phillips R, Proudfoot J, Davicioni E, Spratt DE, Feng FY, Simko J, Den RB, Pollack A, Rosenthal SA, Sartor O, Sweeney C, Attard G, Patel SI, Hall WA, Efstathiou JA, Shah AB, Hoffman KE, Pugh S, Sandler HM, Tran PT. Validation of a Genomic Classifier in the NRG Oncology/RTOG 0521 Phase III Trial of Docetaxel with Androgen Suppression and Radiotherapy for Localized High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S34-S35. [PMID: 37784480 DOI: 10.1016/j.ijrobp.2023.06.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Decipher is a prognostic genomic classifier (GC) validated in several prospective NRG Oncology Phase III trials. Herein, we validate the GC in pre-treatment biopsy samples for risk stratification in a cohort of high-risk men treated with definitive radiotherapy and androgen suppression with or without docetaxel chemotherapy. MATERIALS/METHODS As per a pre-specified and approved NCI analysis plan (Navigator #1061), we obtained available formalin-fixed paraffin-embedded tissue from biopsy specimens from the NRG biobank from patients enrolled on the NRG/RTOG 0521 randomized phase III trial. After central review, the highest-grade tumors were profiled on clinical-grade whole-transcriptome arrays (Veracyte, San Diego, CA) and GC scores were obtained. Pre-specified categorical GC scores, adjusted for archival tissue analysis, were used to define higher (>0.46) and lower (≤0.46) risk groups. The primary objective was to validate the independent prognostic ability of GC for metastasis-free survival (MFS) with Cox multivariable analyses (MVA). RESULTS Samples were obtained from 283 consented, evaluable patients with tissue (50% of trial) yielding 183 (65%) GC scores that passed quality metrics, 91 from control and 92 from the interventional arm. Median age was 66 years, median PSA was 19.3 ng/uL (IQR: 8.1-41.4), 81% had clinical stage ≥T2 and 80% had Gleason score ≥8 (47% ≥9). Median GC score was 0.55 (IQR: 0.38-0.78) and overall the arms were balanced for key covariates. With a median follow-up of 9.9 years (IQR: 9.3, 10.7), 67 MFS events including 34 distant metastases (DM) were observed. On MVA, only the GC (per 0.1 unit) was independently associated with MFS (HR 1.12, 95% CI 1.01-1.25) as well as DM (sHR 1.22, 95% CI 1.06-1.41), whereas the 4 pre-defined trial risk groups used for stratification (based on Gleason score, T-stage and PSA), randomization and patient age were not. For categorical GC, on MVA, higher-risk GC patients (65%) had worse DM (sHR 2.82, 95% CI 1.1-7.3) compared to those with lower GC. Cumulative incidence of DM at 10-years was 27% for higher GC vs 9% (95% CI 7-18%) for lower GC. No biomarker-by-treatment interaction with GC and the addition of docetaxel was detected. CONCLUSION In pre-treatment biopsy samples from a randomized Phase 3 trial cohort, GC demonstrated its ability to further risk stratify clinically high-risk men demonstrating an independent association of GC score with DM and MFS. High-risk prostate cancer is a heterogeneous disease state and GC can improve risk stratification to help personalize shared decision-making. NRG-GU009/PREDICT-RT (NCT04513717) aims to determine the optimal therapy based on GC score for high-risk prostate cancer.
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Affiliation(s)
- R Phillips
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | - D E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - F Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | | | - R B Den
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - A Pollack
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - S A Rosenthal
- Sutter Medical Group and Cancer Center, Sacramento, CA
| | - O Sartor
- Tulane University, New Orleans, LA
| | - C Sweeney
- South Australian Immunogenomics Cancer Institute, Adelaide, Australia
| | - G Attard
- The Institute of Cancer Research, London, United Kingdom
| | - S I Patel
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - J A Efstathiou
- Department of Radiation Oncology, Harvard School of Medicine, Boston, MA
| | - A B Shah
- York Cancer Center, York, PA, United States
| | - K E Hoffman
- Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - H M Sandler
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - P T Tran
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
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Peltenburg J, Hosni A, Bahij R, Böke S, Braam PM, Hall WA, Intven MPW, Nicosia LD, Sonke JJ, Nowee ME, Janssen T. Interobserver Variation in Tumor Delineation of Liver Metastases using Magnetic Resonance Imaging. Int J Radiat Oncol Biol Phys 2023; 117:e145. [PMID: 37784723 DOI: 10.1016/j.ijrobp.2023.06.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Magnetic Resonance (MR-) guided stereotactic body radiotherapy enables accurate treatment of liver metastases. Despite the accuracy of treatment delivery, one of the main uncertainties is the variation in tumor delineation, which requires additional treatment margins. The aim of this study was to quantify the interobserver variation (IOV) in MRI based delineation of the gross tumor volume (GTV) of liver metastases. MATERIALS/METHODS A cohort of 20 liver metastases treated on a MR-Linac were consecutively selected per primary tumor (colorectal (6), breast (6) and lung (8)). Planning MRI scans (T1 weighted with IV-contrast) were collected and anonymized. GTV delineation guidelines and case-specific information were provided to 8 radiation oncologists from 8 institutions. All cases were quantitatively reviewed and delineations with major violations of the guidelines were marked as outliers (such as contours including a vein or excluding obvious parts of a tumor). IOV was quantified by comparing individual delineations with the median contour and calculating the standard deviation (SD) and 95th percentile Hausdorff distance (HD95). Analyses were conducted on all delineations and on a subgroup excluding outliers per case to distinguish between accuracy of delineation and individual guideline interpretation. Sphericity was calculated from the volume and surface area of all delineations. Correlation between SD and sphericity was determined using Spearman's rs. Differences in SD between primary tumors were analyzed using the Kruskal-Wallis test. RESULTS The median volume of all metastases was 6.5 cc (IQR 3.7 - 29.8 cc) and sphericity was 0.84 (IQR 0.80 - 0.87) based on all contours (Table 1). The SD was 1.6 mm and the median HD95 was 2.7 mm. In the subgroup analysis, one (in 15 cases) or two (in 5 cases) delineations were excluded. Subgroup analyses showed a SD of 1.1 mm and median HD 95 of 2.6mm. The Kruskal-Wallis test showed no difference (p = 0.59) in SD between primary tumors. There was a significant negative correlation between IOV (SD) and sphericity (rs = -0.70; p = 0.008). Table 1: Overview of SD (mm), HD95 (mm) and volume (cc) of all observers and subgroup per primary tumor and in total CONCLUSION: MRI based GTV delineation variation of liver metastases is 1.1 - 1.6 mm, which is smaller than anticipated, although significant outliers (HD95 up to 3.9 mm) were present. Use of common delineation guidelines will ensure consistency in contouring and have the potential to decrease treatment margins when taking IOV into account.
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Affiliation(s)
- J Peltenburg
- The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, Noord-Holl, The Netherlands
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - R Bahij
- Odense University Hospital (OUH), Odense, Denmark
| | - S Böke
- Tübingen University Hospital, Tübingen, Germany
| | - P M Braam
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L D Nicosia
- Advanced Radiation Oncology Department - Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - J J Sonke
- The Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands, Amsterdam, The Netherlands
| | - M E Nowee
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - T Janssen
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
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Ponce SEB, Daamen LA, Van der Voort vanZyp J, Westerhoff JM, Pos FJ, Christodouleas JP, Choudhury A, van der Heide U, Lawton CAF, Straza MW, Bedi M, Paulson ES, Nasief HG, Li A, Verkooijen H, Tree A, Hall WA. Quality of Life in Prostate Cancer Patients Undergoing Daily Adaptive Versus Non-Adaptive Radiation Therapy Utilizing A 1.5 Tesla MR-Linac. Int J Radiat Oncol Biol Phys 2023; 117:S114-S115. [PMID: 37784299 DOI: 10.1016/j.ijrobp.2023.06.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Using adaptive radiation therapy (ART) physicians can re-contour normal organs (such as bladder and rectum) before each fraction. While ART may result in more reliable dosimetry to regional organs at risk, the process is time consuming and more expensive than non-ART. We evaluated differences in patient reported quality of life (PR-QOL) between daily ART and non- ART. MATERIALS/METHODS Patients with prostate cancer from 3 centers in the Netherlands and United States were treated using a 1.5 Tesla MR Linear accelerator. Patients consented to the Multiple Outcome Evaluation of Radiation Therapy Using the MR-Linac Study (MOMENTUM, NCT04075305) between 2019 and 2022. PR-QOL was prospectively collected using the EORTC QLQ-C30 and PR-25 at baseline (before RT), and at 3 and 6 months after RT. Patients without complete QOL data were excluded. QOL differences were compared between patients undergoing daily ART vs. non-ART. A linear mixed effect model was performed to account for repeated measurements. Analyses were performed using R Studio. RESULTS One hundred thirty-six patients underwent RT with QOL were analyzed. Median follow up was 13 months (6-26 months). Patients were treated without daily ART (n = 94) or with daily ART (n = 42). The median age was 70 (range 53-83) years and 65.4% had intermediate risk disease, 35% of patients received hormonal therapy. Fractionation schedules included 36 Gy/6 (n = 16), 36.25 Gy/5 (n = 103), 60 Gy/20 (n = 6), 62 Gy/20 (n = 8), and 70 Gy/28 (n = 3). Compared to baseline scores, EORTC QLQ C30 diarrhea scores at 6 months post-treatment were significantly worse for patients treated without daily ART compared to those treated with daily ART (p < 0.05). Other QLQ PR25 bowel scores were not significantly different at 3 or 6 months. Both PR25 urinary and treatment-related symptoms were improved with daily ART compared to non-ART at the 3 (p < 0.001 and p < 0.01, respectively) and 6 (p < 0.01 and p < 0.001, respectively) month time points. Magnitude of improvements can be found in Table 1. CONCLUSION Among prostate cancer patients treated using 1.5 Tesla MRI-guided RT, daily ART was associated with improved PR-QOL in urinary and bowel domains compared to non-ART. These hypotheses generating preliminary results provide the first indications (to our knowledge) that adapting contours to daily anatomy may improve short-term urinary and bowel PR-QOL. Updated results will be presented at ASTRO 2023.
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Affiliation(s)
- S E Beltran Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - L A Daamen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - F J Pos
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - A Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom
| | - U van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C A F Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M W Straza
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - E S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - H G Nasief
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - A Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - H Verkooijen
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Tree
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
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Westley R, Peltenburg J, Aitken KL, Awan MJ, Braam PM, Daamen LA, Hosni A, Intven MPW, Janssen T, Schytte T, Sonke JJ, Straza MW, Paulson ES, Hall WA, Nowee ME. Outcomes of Tolerability, Acute Toxicity and Quality of Life from MR-Guided Radiation Therapy (1.5T MR-Linac) for Liver Metastases in the MOMENTUM Study. Int J Radiat Oncol Biol Phys 2023; 117:e156. [PMID: 37784746 DOI: 10.1016/j.ijrobp.2023.06.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiation therapy (SBRT) offers an important treatment option for metastatic liver tumors. The introduction of magnetic resonance (MR) guided SBRT has paved the way for optimal tumor visualization and daily plan adaptation. The purpose of this study is to review tolerability of MR-guided SBRT of liver metastases and to present early toxicity and quality of life outcomes. MATERIALS/METHODS All patients with liver metastases who were treated on a 1.5T MR-Linac and enrolled in the MOMENTUM study (NTC04075305) were included. Patients were treated between April 2019 and December 2022 in 5 different institutes across 3 countries. Descriptive statistics were used to present the tolerability of treatment, toxicity (CTCAE v5.0) and quality of life outcomes (QLQ C30 and EQ 5D-5L) at baseline and 3 months after treatment. RESULTS A total of 127 patients with liver metastases were included in the analysis. There were 64 females and 63 men, with a median age of 66 years (range 31 to 93). The median ECOG-score was 0 (range 0-2). The most common primary origin was colorectal cancer (66%), followed by bronchus and lung cancer (12%), with ocular melanoma, pancreatic and breast cancer being joint third (all 6-7%). Fractionation schedules ranged from 12 - 67.5 Gy in 2 - 12 fractions. The most commonly prescribed fractionation dose was 60 Gy in 3-5 fractions (53% and 13% respectively) and 50 Gy in 5 fractions (11%). Completion data was available for 116 patients. 112 patients (97%) received all fractions. 4 Patients (3%) did not complete treatment due to technical issues and 2 of the 4 receiving no treatment on the MR-Linac. Physician reported toxicity at 3 months was recorded for 82 patients (66%). No grade 4 or 5 toxicities were reported. There were 12 grade 3 toxicities reported in 6 (7%) patients with 5 deemed radiation therapy related (Table 1) and 34 grade 2 toxicities in 21 (26%) patients. CONCLUSION We have presented the largest cohort (to our knowledge) of 127 patients treated using 1.5 Tesla MR Guidance for metastatic liver tumors. 97% of treatments were completed successfully with all treatments being well tolerated. Acute grade 3 toxicity was reported in 7% of patients with no grade 4 or 5 toxicities present. These outcomes suggest radiotherapy on the MR-Linac is a safe and promising treatment for patients with liver metastases. Additional prospective follow up is ongoing for late toxicity events and long-term control data. Table 1: Grade ≥3 toxicity at 3 months related to radiation therapy (total No. of patients was 82) There was QLQ-C30 data on 89 patients at baseline and on 62 patients at 3 months. At 3 months the median score was worse for physical functioning, VAS score and pain.
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Affiliation(s)
- R Westley
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - J Peltenburg
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, Noord-Holl, The Netherlands
| | - K L Aitken
- Royal Marsden Hospital, London, United Kingdom
| | - M J Awan
- Case Western Reserve University, Cleveland, OH
| | - P M Braam
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - L A Daamen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Janssen
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - T Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - J J Sonke
- The Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands, Amsterdam, The Netherlands
| | - M W Straza
- Department of Radiation Oncology, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
| | - E S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M E Nowee
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
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Lee WR, Dignam JJ, Amin M, Bruner DW, Low D, Swanson GP, Shah AB, D'Souza DP, Michalski JM, Dayes I, Seaward SA, Hall WA, Nguyen PL, Pisansky TM, Faria SL, Chen Y, Rodgers J, Sandler HM. Long-Term Follow-Up Analysis of NRG Oncology RTOG 0415: A Randomized Phase III Non-Inferiority Study Comparing Two Fractionation Schedules in Patients with Favorable-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S3-S4. [PMID: 37784471 DOI: 10.1016/j.ijrobp.2023.06.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To assess whether the efficacy of a hypofractionated (H) schedule is no worse than a conventional (C) schedule in men with low-risk prostate cancer. MATERIALS/METHODS Accrual began April 2006 and ended in December 2009. 1115 men with favorable-risk prostate cancer were randomly assigned 1:1 to a conventional (C) schedule (73.8 Gy in 41 fractions over 8.2 weeks) or to a hypofractionated (H) schedule (70 Gy in 28 fractions over 5.6 weeks). The trial was designed to establish with 90% power and alpha = 0.05 that (H) results in 5-year disease-free survival (DFS) that is not lower than (C) by more than 7% (hazard ratio (HR) < 1.52). Protocol specified secondary endpoints evaluated for noninferiority include: biochemical recurrence (BR), local progression, disease-specific survival, and overall survival. RESULTS One thousand ninety-two protocol eligible men were analyzed: 542 to C and 550 to H. Median follow-up is 12.75 years. Baseline characteristics were not different according to treatment arm. The estimated 12-year DFS is 56.1% (95% CI 51.5, 60.5) in the C arm and 61.8% (57.2, 66.0) in the H arm. The DFS hazard ratio (H/C) is 0.85 (0.71-1.03), confirming non-inferiority (p<0.001). Twelve-year cumulative incidence of biochemical recurrence (BR) was 17.0% (CI 13.8, 20.5) in the C-RT and 9.9% (CI 7.5, 12.6) in the H-RT arm; (HR = 0.56, (0.40-0.78) suggesting improved efficacy with H. Additional pre-specified secondary endpoints were non-inferior Late Grade ≥ 3 GI toxicity is 3.2% (C) vs. 4.4% (H), Relative risk (RR) for H vs. C 1.39 (CI 0.75, 2.55) Late Grade ≥ 3 GU toxicity is 3.4% (C) vs. 4.2% (H), RR = 1.26 (CI 0.69, 2.30). CONCLUSION In men with favorable-risk prostate cancer, long-term disease-free survival is non-inferior with 70 Gy in 28 fractions compared to 73.8 Gy in 41 fractions. The risk of BR is reduced with moderate hypofractionation. No differences in late Grade ≥3 GI/GU toxicity were observed between the arms. (ClinicalTrials.gov identifier: NCT00331773).
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Affiliation(s)
- W R Lee
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
| | - J J Dignam
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - M Amin
- University of Tennessee Health Science Center, Memphis, TN
| | | | - D Low
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | | | - A B Shah
- York Cancer Center, York, PA, United States
| | - D P D'Souza
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre, Western University, London, ON, Canada
| | - J M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - I Dayes
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - P L Nguyen
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - T M Pisansky
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S L Faria
- McGill University Health Centre, Montreal, QC, Canada
| | - Y Chen
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - J Rodgers
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - H M Sandler
- Cedars-Sinai Medical Center, Los Angeles, CA
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8
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Daamen LA, Westerhoff JM, Couwenberg AM, Braam PM, Rütten H, Christodouleas JP, Hall WA, Verkooijen H, Intven MPW. Patient-Reported Outcomes of Rectal Cancer Patients Treated on a 1.5T MR-Linac within the MOMENTUM Study. Int J Radiat Oncol Biol Phys 2023; 117:e291. [PMID: 37785076 DOI: 10.1016/j.ijrobp.2023.06.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) With the 1.5 MR-Linac, planning target volume (PTV) margins for the treatment of rectal cancer can be reduced by 1/3 compared to conventional radiotherapy techniques. This allows better sparing of surrounding tissues, potentially resulting in less toxicity and greater patient comfort. Patient-reported outcomes (PROs) after rectal cancer treatment on a 1.5T MR-Linac have not yet been reported. Through international collaboration, the 'Multi-OutcoMe EvaluatioN of radiation Therapy Using the MR-Linac (MOMENTUM)' registry provides the unique opportunity to study these outcomes in a relatively large patient cohort. The aim of this study is to assess PROs of rectal cancer patients treated on a 1.5T MR-Linac within MOMENTUM. MATERIALS/METHODS An international, prospective, observational cohort study was performed, including all patients with rectal cancer who were treated with 25 Gy in five fractions on an MR-Linac in three institutions located in the Netherlands (2019-2022). Patient-reported outcomes were measured using the general EORTC QLQ-C30 and colorectal cancer-specific EORTC QLQ-CR29 questionnaires. Scores were calculated according to the EORTC QLQ-C30 scoring manual. A high score for a functional scale represents a high functioning level, while a high score for a symptom scale represents a high symptomatology level. Outcomes were measured at regular time points (i.e., at baseline and after three, 6 and 12 months follow-up). Patients who underwent tumor resection were censored at the date of surgery. RESULTS In total, 152patients were included, with a median follow-up of 17 (interquartile range [IQR] 11-27) months. Of these, six patients (4%) had American Joint Committee on Cancer (AJCC) stage I disease, 11 patients (7%) stage II, 85 patients (56%) stage III, and 12 patients (8%) stage IV. A total of 87 patients (57%) reached three months follow-up without surgery, 60 patients (39%) six months, and 40 patients (26%) twelve months. At six months follow-up, 25/132 patients (19%) had received additional chemotherapy. The median global health score was 83 (interquartile range [IQR] 67-83) at baseline, 75 (IQR 58-83) at three months, 75 (IQR 58-83) at six months and 83 (IQR 83-100) at twelve months. In most QLQ-C30 domains, functional and symptom scores deteriorated during the first six months after treatment, but returned to or exceeded baseline scores at 12 months. Overall, treatment resulted in improved QLQ-CR29 scores after 12 months follow-up. Most frequently reported symptoms were blood and mucus in stool, urinary frequency, stool frequency and anxiety. CONCLUSION This study presents patient-reported outcomes in the currently largest cohort of patients with rectal cancer who received treatment on a 1.5T MR-Linac. Overall, treatment resulted in improved symptom management, and stabilized or improved quality of life outcomes after twelve months of follow-up.
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Affiliation(s)
- L A Daamen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - A M Couwenberg
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P M Braam
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Rütten
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - H Verkooijen
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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9
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Daamen LA, Westerhoff JM, Christodouleas JP, Orrling K, Eggert D, Choudhury A, Fuller CD, van der Heide U, Sahgal A, Schultz CJ, Schytte T, Tersteeg R, Tree A, Hall WA, Verkooijen H. Evolution of the MOMENTUM Study for Evidence-Based Implementation of MR-Guided Radiotherapy Using the 1.5 Tesla MR-Linac. Int J Radiat Oncol Biol Phys 2023; 117:e576-e577. [PMID: 37785753 DOI: 10.1016/j.ijrobp.2023.06.1912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The international prospective 'Multiple Outcome Evaluation of Radiation Therapy Using the MR-Linac' (MOMENTUM) study (NCT04075305) was initiated in 2019 by seven hospitals and industry partner precision radiation medicine company, with the aim to facilitate evidence-based implementation of magnetic resonance (MR) guided radiotherapy using the 1.5 Tesla (T) MR-linear accelerator (Linac). Over the last four years, MOMENTUM has expanded to other institutions and the design and organization of MOMENTUM have evolved. Herein, we give an overview of the current status of MOMENTUM and study innovations that have been implemented to accelerate development and assessment of the 1.5T MR-Linac. MATERIALS/METHODS We summarized operational outputs of MOMENTUM, including site participation, data aggregation, academic output, and study design elements that have been introduced since 2019. RESULTS As of January 2023, 17 sites have joined and 10 sites are actively enrolling patients in MOMENTUM. The MOMENTUM infrastructure, which consists of prospectively collected clinical and technical patient data and patient reported outcomes, is increasingly being used for predicate studies, technical development studies, safety and early clinical evaluation, and hypothesis testing studies according to R-IDEAL. Over 3500 patients who received treatment for 33 different tumor sites have provided informed consent for using their data for scientific research and product development. The technical database currently includes over 190.000 items, including approximately 98,000 MRI scans and 33,800 dose plans. A total of 38 data requests have been accepted (2019: n = 1; 2020: n = 5; 2021: n = 10; 2022: n = 22), including technical studies focused on algorithmic development. The MOMENTUM infrastructure is also hosting prospective clinical studies, including the randomized HERMES trial (NCT04595019) and prospective UNITED study (NCT04726397). Recently, the 'Trials within Cohorts' (TwiCs) design has been implemented, which is well suited to perform pragmatic randomized trials. MOMENTUM has partnered with Kaiku Health, an electronic patient-reported outcomes application, to facilitate collection of patient reported toxicity. CONCLUSION Over the past four years, the MOMENTUM study has evolved into a unique platform, whose infrastructure is increasingly being used by clinicians, researchers, physicists and industry. Continuous efforts are being made to encourage the participation of new sites and the development of innovative tools to facilitate the conduct of well-designed trials that are expected to transform daily clinical practice.
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Affiliation(s)
- L A Daamen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - D Eggert
- Elekta Inc., Atlanta, GA, United States
| | - A Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom
| | - C D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - U van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - T Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - R Tersteeg
- University Medical Center Utrecht, Utrecht 3584CX, The Netherlands
| | - A Tree
- Radiotherapy and Imaging Division, Institute of Cancer Research, London, United Kingdom
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - H Verkooijen
- University Medical Center Utrecht, Utrecht, The Netherlands
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Amjad A, Chen X, Hall WA, Lawton CAF, Li A, Paulson ES. Patient-Specific Deep Learning Auto-Segmentation for MR-Guided Adaptive Radiotherapy of Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e638-e639. [PMID: 37785902 DOI: 10.1016/j.ijrobp.2023.06.2044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) MR guided conventional prostate radiotherapy requires agreement of bladder and rectum position, size, and shape with reference plan anatomy. In many instances, treatments may be delayed to allow optimal filling of these organs at risk (OARs). To account for such changes, we propose a patient specific deep learning based auto-segmentation (PS-DLAS) solution to implement pseudo (adapt-to-shape) ATS planning as a replacement for (adapt-to-position) ATP for conventionally fractionated treatments, and to generate auto-segmented contours for ATS SBRT treatments. MATERIALS/METHODS A commercially available DLAS tool that allows to customize/re-train DLAS models to an individual patient was implemented and automated in 3 iterative steps: 1) training of initial PS-DLAS model based on the first daily MRI with manual contours for the patient, 2) using the trained model to auto-segment the next daily MRI (acquired at next fraction), and 3) re-training/updating the model with newly available daily MRI sets and the verified contours. Steps 1) and 3) were performed offline while the step 2 was online. The solution was tested using daily MRI sets collected for 6 prostate cancer patients treated with MR guided adaptive radiotherapy (MRgART) either in 5-fraction SBRT or conventionally fractionated with adapt-to-shape (ATS) or adapt-to-position (ATP) workflows on a 1.5T MR-Linac. The quality of the auto-segmented OAR contours, including bladder, penile bulb, prostate, rectum, and seminal vesicles, obtained in step 2) were assessed, where the acceptable contour slices (no editing required) were identified. Additionally, ATP was simulated using a pseudo ATS workflow on patient 6, allowing the PS-DLAS to be used on daily MRI sets and the obtained contours to be used in the daily plan optimization. The time saving and the plan quality of using the PS-DLAS were compared to those from the current standard clinical workflow. RESULTS The times for the offline model training in steps 1) or 3) were < 50 minutes and the times of applying the updated PS-DLAS to auto-segment a daily MRI set in step 2) were within 1 minute using a hardware of Intel(R) Xeon(R) Gold 5222 CPU. Among the auto-segmented contour slices, 87%, 92%, 88%, 86% and 84% were found to be acceptable for bladder, penile bulb, prostate, rectum, and seminal vesicles, respectively. The time savings of using the PS-DLAS were about 7 minutes, compared to the manual contouring in the current ATS workflow. Manual editing was almost always required in 1-3 most superior slices for each organ. For the patient tested with the pseudo ATS, time saving was 10 minutes with comparable plan quality to the standard ATP workflow. CONCLUSION In this study, we demonstrated use of a PS-DLAS approach to reduce contouring time in MR-guided ATS prostate radiotherapy. In addition, these results suggest a PS-DLAS approach combined with pseudo-ATS may reduce overall treatment times in conventionally fractionated MRgRT by eliminating time required for matching of OAR filling.
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Affiliation(s)
- A Amjad
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - X Chen
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - C A F Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - A Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - E S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI; Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
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Ponce SEB, Small CJ, Ahmad T, Patel K, Tsai S, Kamgar M, George B, Kharofa JR, Saeed H, Dua KS, Clarke C, Aldakkak M, Evans DB, Christians K, Paulson ES, de Choudens SO, Erickson BA, Hall WA. Patterns of Locoregional Pancreatic Cancer Recurrence after Total Neoadjuvant Therapy and Implications on Optimal Neoadjuvant Radiation Treatment Volumes. Int J Radiat Oncol Biol Phys 2023; 117:e284-e285. [PMID: 37785058 DOI: 10.1016/j.ijrobp.2023.06.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Neoadjuvant treatment for patients with localized pancreatic adenocarcinoma (PDAC) has improved survival duration. As survival increases, local disease control becomes even more important. We sought to understand the patterns of locoregional recurrence following total neoadjuvant therapy (TNT) and determine the impact of treatment volumes on recurrence. MATERIALS/METHODS Patients with PDAC managed with neoadjuvant chemotherapy and chemoradiation (TNT) followed by surgery who developed an isolated locoregional or simultaneously locoregional and distant recurrence were identified. Locoregional recurrences were individually contoured utilizing commercially available software. When available, original neoadjuvant dose distributions were registered to the scans on which the locoregional recurrences were contoured. Recurrences where then classified as in-field (> 95% of prescription dose), marginal (50-95% of prescription dose), or out of field (< 50% of prescription dose). Target volumes were created using four commonly utilized PDAC contouring guidelines to characterize the relationship of the local recurrence to the RT dose distribution. RESULTS Of 474 patients treated with TNT and surgery, 80 (17%) patients developed a locoregional recurrence with or without distant recurrence, visible on diagnostic imaging. Of the 80 patients, 56 (70%) had tumors in the pancreatic head; 46 (57.5%) were borderline resectable, 23 (28.8%) locally advanced, and 11 (13.6%) resectable. The most common initial neoadjuvant therapies were FOLFIRINOX (57.5%) and gemcitabine/nab-paclitaxel (18.8%). Chemoradiation included concurrent gemcitabine (47.5%) or 5-fluorouracil (26.3%). RT dose distributions were available for 38 patients; 22 (57.9%) had in-field failures, 9 (23.7%) marginal failures, and 7 (18.4%) out of field failures. Each published contouring atlas covered a relatively low percentage of recurrences, which are summarized in Table 1. Regions at particularly high likelihood of recurrence that were under covered on existing atlases included: aortic-diaphragmic junction, retro-pancreatic duodenal nodal basin, and the region to the right of the superior mesenteric artery (SMA). CONCLUSION We present the largest series (to our knowledge) of mapped locoregional recurrences for patients being treated with TNT in PDAC. These recurrences differ substantially from established atlases and highlight anatomical regions of highest priority for RT coverage. A novel visual contouring volume highlighting these regions will be presented which will strive to advance the use of RT in the TNT setting.
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Affiliation(s)
- S E Beltran Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - C J Small
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - T Ahmad
- Medical College of Wisconsin, Milwaukee, WI
| | - K Patel
- Medical College of Wisconsin, Milwaukee, WI
| | - S Tsai
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Kamgar
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - B George
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - J R Kharofa
- University of Cincinnati, Department of Radiation Oncology, University of Cincinnati Cancer Center, Cincinnati, OH
| | - H Saeed
- Lynn Cancer Institute, Boca Raton Regional Hospital, Baptist Health South Florida, Boca Raton, FL
| | - K S Dua
- Department of Gastroenterology, Medical College of Wisconsin, Milwaukee, WI
| | - C Clarke
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Aldakkak
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - D B Evans
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - K Christians
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - E S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - S Ortiz de Choudens
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
| | - B A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
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Hall WA, Keys E, Ou C. A call to action about nurses promoting healthy sleep. Sleep Med 2023; 108:53-54. [PMID: 37327660 DOI: 10.1016/j.sleep.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/15/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Wendy A Hall
- UBC School of Nursing, The University of British Columbia, T 201 2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada. https://twitter.com/wendyha65734663
| | - Elizabeth Keys
- School of Nursing, Okanagan Campus, ART360 (Arts Building), 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Christine Ou
- School of Nursing, University of Victoria, B, Victoria, BC, V8P 5C2, Canada.
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13
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Clark E, Vedam S, Mclean A, Stoll K, Lo W, Hall WA. USING THE DELPHI METHOD TO VALIDATE INDICATORS OF RESPECTFUL MATERNITY CARE FOR HIGH RESOURCE COUNTRIES. J Nurs Meas 2023; 31:120-144. [PMID: 35705228 DOI: 10.1891/jnm-2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/25/2022]
Abstract
Background and Purpose: Consistent measurement of respectful maternity care (RMC) is lacking. This Delphi study assessed consensus about indicators of RMC. Methods: A multidisciplinary panel assessed items (n = 201) drawn from global literature. Over two rounds, the panel rated importance, relevance, and clarity, and ranked priority within 17 domains including communication, autonomy, support, stigma, discrimination, and mistreatment. Qualitative feedback supported the analysis. Results: In Round One, 191 indicators exceeded a content validation index of 0.80. In Round Two, Kendall's W ranged from 0.081 (p = .209) to 0.425 (p < .001) across domains. Fourteen indicators received strong support. Changes in indicator assessment between rounds prevented agreement stability assessment. Conclusion: The indicators comprise a registry of items for use in perinatal care research.
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Affiliation(s)
- Esther Clark
- School of Nursing, The University of British Columbia, Vancouver, Canada
| | - Saraswathi Vedam
- Principal, Birth Place Lab, Professor, UBC Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Alison Mclean
- Community Engagement Coordinator, Birth Place Lab, Midwifery Program, Department of Family Practice, Faculty of Medicine, Vancouver, BC Canada
| | - Kathrin Stoll
- Honorary Research Associate, Birth Place Lab, Midwifery Program, Department of Family Practice, Faculty of Medicine, Vancouver, BC, Canada
| | - Winnie Lo
- NHS England and NHS Improvement, Skipton House, London, UK
| | - Wendy A Hall
- Professor Emerita, UBC School of Nursing, Vancouver, BC, Canada
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Ou CHK, Hall WA, Rodney P, Stremler R. Seeing Red: A Grounded Theory Study of Women's Anger after Childbirth. Qual Health Res 2022; 32:1780-1794. [PMID: 35969648 PMCID: PMC9511239 DOI: 10.1177/10497323221120173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Persistent intense anger is indicative of postpartum distress, yet maternal anger has been little explored after childbirth. Using grounded theory, we explained how and why mothers develop intense anger after childbirth and the actions they take to manage their anger. Twenty mothers of healthy singleton infants described their experiences of anger during the first two postpartum years. Mothers indicated they became angry when they had violated expectations, compromised needs, and felt on edge (e.g., exhausted, stressed, and resentful), particularly around infants' sleep. Mothers described suppressing and/or expressing anger with outcomes such as conflict and recruiting support. Receiving support from partners, family, and others helped mothers manage their anger, with more positive outcomes. Women should be screened for intense anger, maternal-infant sleep problems, and adequacy of social supports after childbirth. Maternal anger can be reduced by changing expectations and helping mothers meet their needs through social and structural supports.
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Affiliation(s)
- Christine H. K. Ou
- School of Nursing, University of Victoria, Victoria, BC, Canada
- Canadian Institute of Substance Use Research, University of Victoria, Victoria, BC
| | - Wendy A. Hall
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Paddy Rodney
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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15
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Ou CH, Hall WA, Rodney P, Stremler R. Correlates of Canadian mothers' anger during the postpartum period: a cross-sectional survey. BMC Pregnancy Childbirth 2022; 22:163. [PMID: 35227249 PMCID: PMC8883707 DOI: 10.1186/s12884-022-04479-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although some women experience anger as a mood problem after childbirth, postpartum anger has been neglected by researchers. Mothers' and infants' poor sleep quality during the postpartum period has been associated with mothers' depressive symptoms; however, links between mothers' sleep quality and postpartum anger are unclear. This study aimed to determine proportions of women with intense anger, depressive symptoms, and comorbid intense anger and depressive symptoms, and to examine mothers' and infants' sleep quality as correlates of postpartum anger. METHODS This cross-sectional survey study was advertised as an examination of mothers' and babies' sleep. Women, with healthy infants between 6 and 12 months of age, were recruited using community venues. The survey contained validated measures of sleep quality for mothers and infants, and fatigue, social support, anger, depressive symptoms, and cognitions about infant sleep. RESULTS 278 women participated in the study. Thirty-one percent of women (n = 85) reported intense anger (≥ 90th percentile on State Anger Scale) while 26% (n = 73) of mothers indicated probable depression (>12 on Edinburgh Postnatal Depression Scale). Over half of the participants rated their sleep as poor (n = 144, 51.8%). Using robust regression analysis, income (β = -0.11, p < 0.05), parity (β = 0.2, p < 0.01), depressive symptoms (β = 0.22, p < 0.01), and mothers' sleep quality (β = 0.10, p < 0.05), and anger about infant sleep (β = 0.25, p < 0.01) were significant predictors of mothers' anger. CONCLUSIONS Mothers' sleep quality and anger about infant sleep are associated with their state anger. Clinicians can educate families about sleep pattern changes during the perinatal time frame and assess women's mood and perceptions of their and their infants' sleep quality in the first postpartum year. They can also offer evidence-based strategies for improving parent-infant sleep. Such health promotion initiatives could reduce mothers' anger and support healthy sleep.
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Affiliation(s)
- Christine Hk Ou
- School of Nursing, University of Victoria, 3800 Finnerty Road, HSD Building, Room A402a, Victoria, British Columbia, V8P 5C2, Canada. .,Institute of Aging and Lifelong Health, University of Victoria, Victoria, Canada.
| | - Wendy A Hall
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Paddy Rodney
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
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16
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MacKenzie NE, Keys E, Hall WA, Gruber R, Smith IM, Constantin E, Godbout R, Stremler R, Reid GJ, Hanlon-Dearman A, Brown CA, Shea S, Weiss SK, Ipsiroglu O, Witmans M, Chambers CT, Andreou P, Begum E, Corkum P. Children's Sleep During COVID-19: How Sleep Influences Surviving and Thriving in Families. J Pediatr Psychol 2021; 46:1051-1062. [PMID: 34472600 PMCID: PMC8522399 DOI: 10.1093/jpepsy/jsab075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/10/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents' and children's needs to support sleep during the pandemic. METHODS Eighty-five Canadian parents with children aged 4-14 years participated in this explanatory sequential, mixed-methods study using an online survey of children's and parents' sleep, with a subset of 16 parents, selected based on changes in their children's sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. RESULTS While some parents perceived their child's sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child's sleep had worsened (40.0%, n = 34). Parents attributed children's worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children's and parents' sleep. CONCLUSIONS The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children's sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges.
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Affiliation(s)
| | - Elizabeth Keys
- Department of Psychology and Neuroscience, Dalhousie
University, Canada
| | - Wendy A Hall
- School of Nursing, University of British
Columbia, Canada
| | - Reut Gruber
- Department of Psychiatry, Faculty of Medicine, and
Attention Behavior and Sleep Lab, Douglas Mental Health University Institute,
McGill University, Canada
| | - Isabel M Smith
- Departments of Psychology & Neuroscience and
Pediatrics, Dalhousie University, Canada
| | - Evelyn Constantin
- Department of Pediatrics, Montreal
Children’s Hospital, McGill University Health Centre,
Canada
| | - Roger Godbout
- Sleep Laboratory & Clinic, Department of
Psychiatry, Université de Montréal, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University
of Toronto, Canada
| | - Graham J Reid
- Departments of Psychology, Family Medicine &
Paediatrics, The University of Western Ontario, Canada
| | | | - Cary A Brown
- Faculty of Rehabilitation Medicine, University of
Alberta, Canada
| | - Sarah Shea
- Department of Pediatrics, Dalhousie University, IWK
Health Centre, Canada
| | - Shelly K Weiss
- Division of Neurology, Department of Pediatrics,
Hospital for Sick Children, University of Toronto, Canada
| | | | - Manisha Witmans
- Faculty of Medicine & Dentistry, University
of Alberta, Canada
| | - Christine T Chambers
- Departments of Psychology & Neuroscience and
Pediatrics, Dalhousie University, Canada
| | - Pantelis Andreou
- Department of Community Health and Epidemiology,
Faculty of Medicine, Dalhousie University, Canada
| | - Esmot Begum
- Department of Psychology and Neuroscience, Dalhousie
University, Canada
| | - Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie
University, Canada
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Hall WA, Biletchi J, Hunter DL, Lemay S, Ou C, Rempel L. Dissemination of evidence based interventions for pediatric sleep disorders - The Niagara project: process and outcomes. Sleep Med X 2019; 1:100001. [PMID: 33870160 PMCID: PMC8041121 DOI: 10.1016/j.sleepx.2019.100001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 01/30/2023] Open
Abstract
Background/objective This paper describes evidence-based strategies for the dissemination of empirically supported interventions for infant behavioral sleep problems. Methods To identify parents' needs, a survey sampled 1022 parents in the Niagara region about use of health resources, tracking occurred of public health nurses' consultations with parents about infant sleep, and nurses obtained sleep workshop evaluation data from 18 parents. A focus group with 10 participants, a survey of Niagara Region Public Health and Emergency Services (NRPH&ES) employees, and consultations with external stakeholders identified gaps in parents' and infants' care and public health nurses' training needs. We developed solutions by creating evidence-based tools and a program for parents and public health nurses. We implemented and disseminated information via sharing tools on the NRPH&ES website, and workshops for community agencies and public health nurses. Results Seventy childhood educators, support workers, and social and public health professionals attended our community workshop. Twenty-three public health nurses attended our training workshop. In guided discussion, nurses evaluated the workshop as addressing gaps in knowledge and enhancing NRPH&ES interventions to manage infants' behavioral sleep problems. Fifteen parents attended a sleep workshop pilot, with seven parents indicating a preference for follow-up telephone support. Fifty individuals attended our oral presentation at the Ontario Public Health Convention. Conclusions For next directions, community and other public health agencies want access to our tools and program components. We received a research grant to design, implement, and evaluate sharing tools and program components with community agencies (daycares and childcare centres). Behavioral sleep problems are common during infancy. Parents identify problems but have limited access to evidence-based care. Public health nurses can provide evidence-based support to families. Public health nurses can offer community agencies evidence-based resources.
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Affiliation(s)
- Wendy A Hall
- University of British Columbia School of Nursing, T. 201, 2211 Wesbrook Mall, V6T 2B5, Vancouver, British Columbia, Canada
| | - Jeff Biletchi
- Niagara College, 100 Niagara College Boulevard, Welland, Ontario, L3C 7L3, Canada
| | - Debbie L Hunter
- Niagara Region Public Health and Emergency Services, Sir Isaac Brock Way, Campbell East, Thorold, L2V 0A2, Ontario, Canada
| | - Stephanie Lemay
- Niagara Region Public Health and Emergency Services, Sir Isaac Brock Way, Campbell East, Thorold, L2V 0A2, Ontario, Canada
| | - Christine Ou
- University of British Columbia School of Nursing, T. 201, 2211 Wesbrook Mall, V6T 2B5, Vancouver, British Columbia, Canada
| | - Lynn Rempel
- Brock University, 1812 Sir Isaac Brock Way, St. Catharines, L2S 3A1, Ontario, Canada
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Abstract
BACKGROUND Contrary to social constructions of new motherhood as a joyous time, mothers may experience postnatal depression and anger. Although postnatal depression has been thoroughly studied, the expression of maternal anger in the context of postnatal depression is conceptually unclear. This integrative review investigated the framing of anger in the context of postnatal depression. METHODS After undertaking a search of CINAHL, Ovid-Medline, PsycInfo, and Web of Science, we identified qualitative (n = 7) and quantitative (n = 17) papers that addressed maternal anger and postnatal depression. We analyzed the data by developing themes. RESULTS Our review indicated that anger was a salient mood disturbance for some postnatally depressed women with themes integrated as: (i) anger accompanying depression, (ii) powerlessness as a component of depression and anger, and (iii) anger occurring as a result of expectations being violated. CONCLUSIONS Our findings indicate that anger can coexist with women's postnatal depression. Anger can be expressed toward the self and toward children and family members with negative relationship effects. We recommend that health care providers and researchers consider anger in the context of postnatal mood disturbances.
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Affiliation(s)
- Christine H Ou
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Wendy A Hall
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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19
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Corkum PV, Reid GJ, Hall WA, Godbout R, Stremler R, Weiss SK, Gruber R, Witmans M, Chambers CT, Begum EA, Andreou P, Rigney G. Evaluation of an Internet-Based Behavioral Intervention to Improve Psychosocial Health Outcomes in Children With Insomnia (Better Nights, Better Days): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e76. [PMID: 29581089 PMCID: PMC5891669 DOI: 10.2196/resprot.8348] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 01/18/2023] Open
Abstract
Background Up to 25% of 1- to 10-year-old children experience insomnia (ie, resisting bedtime, trouble falling asleep, night awakenings, and waking too early in the morning). Insomnia can be associated with excessive daytime sleepiness and negative effects on daytime functioning across multiple domains (eg, behavior, mood, attention, and learning). Despite robust evidence supporting the effectiveness of behavioral treatments for insomnia in children, very few children with insomnia receive these treatments, primarily due to a shortage of available treatment resources. Objective The Better Nights, Better Days (BNBD) internet-based program provides a readily accessible electronic health (eHealth) intervention to support parents in providing evidence-based care for insomnia in typically developing children. The purpose of the randomized controlled trial (RCT) is to evaluate the effectiveness of BNBD in treating insomnia in children aged between 1 and 10 years. Methods BNBD is a fully automated program, developed based on evidence-based interventions previously tested by the investigators, as well as on the extant literature on this topic. We describe the 2-arm RCT in which participants (500 primary caregivers of children with insomnia residing in Canada) are assigned to intervention or usual care. Results The effects of this behavioral sleep eHealth intervention will be assessed at 4 and 8 months postrandomization. Assessment includes both sleep (actigraphy, sleep diary) and daytime functioning of the children and daytime functioning of their parents. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials statement. Conclusions If the intervention is supported by the results of the RCT, we plan to commercialize this program so that it is sustainable and available at a low cost to all families with internet access. Trial Registration ClinicalTrials.gov NCT02243501; https://clinicaltrials.gov/show/NCT02243501 (Archived by WebCite at http://www.webcitation.org/6x8Z5pBui)
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Affiliation(s)
- Penny V Corkum
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada
| | - Graham J Reid
- Department of Psychology, University of Western Ontario, London, ON, Canada.,Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Children's Health Research Institute & Lawson Health Research Institute, London, ON, Canada
| | - Wendy A Hall
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, BC, Canada
| | - Roger Godbout
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Robyn Stremler
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Shelly K Weiss
- Division of Neurology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Reut Gruber
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada.,Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
| | - Manisha Witmans
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Christine T Chambers
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada.,Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Esmot Ara Begum
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Pantelis Andreou
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Gabrielle Rigney
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
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Chang SHC, Hall WA, Campbell S, Lee L. Experiences of Chinese immigrant women following "Zuo Yue Zi" in British Columbia. J Clin Nurs 2018; 27:e1385-e1394. [PMID: 29266549 DOI: 10.1111/jocn.14236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES To describe Chinese women's experiences with "zuo yue zi" in British Columbia, Canada. BACKGROUND Women born in China and Taiwan are increasingly immigrating to westernised countries. Many women choose to follow traditional Chinese postpartum practices, also called "zuo yue zi." Few studies have examined women's use of traditional practices in western countries. DESIGN The study used a qualitative descriptive design. METHODS We recruited 13 mothers who were: aged 19 or older, immigrants from mainland China, Hong Kong or Taiwan in the last 5 years, and caring for infants born in the previous 6 weeks. Semistructured interviews were conducted in Mandarin, translated into English, transcribed and analysed using inductive content analysis. RESULTS The core theme was Chinese women's novel encounters with "zuo yue zi." The women's expectations of "zuo yue zi" were acquired through birth experiences or interactions with family and friends. The participants struggled with implementing traditional practices because social support and formal institutional structures were lacking. They modified their expectations about "zuo yue zi." Factors affecting their practices were catalysts and deterrents. Catalysts included help from Chinese family members, friends and informed healthcare providers. Deterrents included unregulated paid helpers, uninformed care providers, financial constraints and structural limitations in their new environments. CONCLUSIONS Chinese immigrant women struggled to modify and implement traditional practices in their adopted country when they encountered financial constraints, unregulated paid helpers and varying support from health care providers. RELEVANCE TO CLINICAL PRACTICE Some postpartum women following "zuo yue zi" believed that the practice would prevent chronic illness and strengthen their intrafamily relationships. Immigrant mothers require nursing support to follow traditional postpartum practices. Nurses can advocate on patients' behalf to increase care providers' knowledge about "zuo yue zi" and public awareness for necessary regulated institutional structures.
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Affiliation(s)
- Sylvia Hsi-Ching Chang
- BC Women's Hospital & Health Centre, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Wendy A Hall
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Suzanne Campbell
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Lily Lee
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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21
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Hall WA, Moynihan M, Bhagat R, Wooldridge J. Erratum to: Relationships between parental sleep quality, fatigue, cognitions about infant sleep, and parental depression pre and post-intervention for infant behavioral sleep problems. BMC Pregnancy Childbirth 2017. [PMID: 28629369 PMCID: PMC5477140 DOI: 10.1186/s12884-017-1386-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hall WA, Moynihan M, Bhagat R, Wooldridge J. Relationships between parental sleep quality, fatigue, cognitions about infant sleep, and parental depression pre and post-intervention for infant behavioral sleep problems. BMC Pregnancy Childbirth 2017; 17:104. [PMID: 28376726 PMCID: PMC5379718 DOI: 10.1186/s12884-017-1284-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 03/18/2017] [Indexed: 11/24/2022] Open
Abstract
Background Maternal and paternal depression has been associated with infants’ behavioral sleep problems. Behavioral sleep interventions, which alter parental cognitions about infant sleep, have improved infant sleep problems. This study reports relationships between parental depression, fatigue, sleep quality, and cognitions about infant sleep pre and post-intervention for a behavioral sleep problem. Methods This secondary analysis of data from Canadian parents (n = 455), with healthy infants aged 6-to-8-months exposed to a behavioral sleep intervention, examined baseline data and follow-up data from 18 or 24 weeks post intervention (group teaching or printed material) exposure. Parents reported on sleep quality, fatigue, depression, and cognitions about infant sleep. Data were analyzed using Pearson’s r and stepwise regression analysis. Results Parents’ fatigue, sleep quality, sleep cognitions, and depression scores were correlated at baseline and follow-up. At baseline, sleep quality (b = .52, 95% CI .19–.85), fatigue (b = .48, 95% CI .33–.63), doubt about managing infant sleep (b = .44, 95% CI .19–.69), and anger about infant sleep (b = .69, 95% CI .44–.94) were associated with mothers’ depression. At baseline, fathers’ depression related to sleep quality (b = .42, 95% CI .01–.83), fatigue (b = .47, 95% CI .32–.63), and doubt about managing infant sleep (b = .50, 95% CI .24–.76). At follow-up, mothers’ depression was associated with sleep quality (b = .76, 95% CI .41–1.12), fatigue (b = .25, 95% CI .14–.37), doubt about managing infant sleep (b = .44, 95% CI .16–.73), sleep anger (b = .31, 95% CI .02–.59), and setting sleep limits (b = −.22, 95% CI -.41-[−.03]). At follow-up, fathers’ depression related to sleep quality (b = .84, 95% CI .46–1.22), fatigue (b = .31, 95% CI .17–.45), sleep doubt (b = .34, 95% CI .05–.62), and setting sleep limits (b = .25, 95% CI .01–.49). Conclusions Mothers’ and fathers’ cognitions about infant sleep demonstrate complex relationships with their depression scores. While mothers’ setting sleep limit scores are associated with decreased depression scores, fathers’ setting limits scores are associated with increased depression scores. Parental doubts about managing infant sleep and difficulties with setting sleep limits require attention in interventions.
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Affiliation(s)
- Wendy A Hall
- University of British Columbia School of Nursing, T. 201, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Melissa Moynihan
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Radhika Bhagat
- South Community Health Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Joanne Wooldridge
- Maternal Child Program, Vancouver Coastal Health, Vancouver, BC, Canada
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Abstract
BACKGROUND Sociocultural childbirth representations can influence the perceptions of childbirth negatively. In this paper we report on a survey study to explore the factors associated with negative impressions of childbirth in a North-West England University student sample. We also explored whether different sources and perceptions of childbirth information were linked to fear of childbirth. METHODS All students received a survey link via an online messaging board and/or direct e-mail. Female students who were 18-40 years of age and childless (but planned to have children in the future) were invited to participate. Demographics, birth preferences, a fear of birth and general anxiety measures were included as well as questions about what sources of information shaped students' attitudes toward pregnancy and birth (i.e. visual/written media, experiences of friends/family members, school-based education and other) and impressions of birth from these sources (i.e. positive, negative, both positive and negative and not applicable). RESULTS Eligible students (n = 276) completed the online questionnaire. The majority were Caucasian (87%) with a mean age of 22.6 years. Ninety-two students (33.3%) reported negative childbirth impressions through direct or vicarious sources. Students with negative birth impressions were significantly more likely to report higher fear of birth scores. Negatively perceived birth stories of friends/family members, and mixed perceptions of visual media representations of birth were associated with higher fear of birth scores. Having witnessed a birth first-hand and describing the experience as amazing was linked to lower fear scores. CONCLUSION First-hand observations of birth, especially positive experiences, had implications for salutary outcomes. Negative or conflicting perceptions of vicarious experiences were associated with increased levels of childbirth fear. While further research is needed, these insights suggest a need for positive birth stories and messages to be disseminated to mitigate any negative effects of indirect accounts.
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Affiliation(s)
- Gill Thomson
- a Maternal and Infant Nutrition and Nurture Unit (MAINN) , University of Central Lancashire , Preston , Lancashire , England
| | - Kathrin Stoll
- b Faculty of Medicine , School of Population and Public Health, University of British Columbia , Vancouver , BC , Canada
| | - Soo Downe
- c Research in Childbirth and Health Unit (ReaCH) , University of Central Lancashire , Preston , Lancashire , England
| | - Wendy A Hall
- d School of Nursing , University of British Columbia , Vancouver , BC , Canada
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Affiliation(s)
| | - Wendy A. Hall
- School of Nursing; University of British Columbia; Vancouver BC Canada
| | - Sally E. Thorne
- School of Nursing; University of British Columbia; Vancouver BC Canada
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Dahlke S, Hall WA, Baumbusch J. Constructing definitions of safety risks while nurses care for hospitalised older people: Secondary analysis of qualitative data. Int J Older People Nurs 2017; 12. [DOI: 10.1111/opn.12148] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/11/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Sherry Dahlke
- Faculty of Nursing; University of Alberta; Edmonton AB Canada
| | - Wendy A. Hall
- School of Nursing; University of British Columbia; Vancouver BC Canada
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Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Pediatric Sleep Duration Consensus Statement: A Step Forward. J Clin Sleep Med 2016; 12:1705-1706. [PMID: 27855732 DOI: 10.5664/jcsm.6368] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 11/13/2022]
Affiliation(s)
| | - Lee J Brooks
- Children's Hospital of Philadelphia, Philadelphia, PA.,Liaison for the American Academy of Pediatrics
| | | | - Wendy A Hall
- University of British Columbia School of Nursing, Vancouver, BC
| | | | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | - Merrill S Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN
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Lélis ALP, Cardoso MVL, Hall WA. Sleep disorders in children with cerebral palsy: An integrative review. Sleep Med Rev 2016; 30:63-71. [DOI: 10.1016/j.smrv.2015.11.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 11/25/2015] [Accepted: 11/26/2015] [Indexed: 11/25/2022]
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Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion. J Clin Sleep Med 2016; 12:1549-1561. [PMID: 27707447 DOI: 10.5664/jcsm.6288] [Citation(s) in RCA: 355] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/12/2016] [Indexed: 12/13/2022]
Abstract
ABSTRACT Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. After review of 864 published articles, the following sleep durations are recommended: Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health. Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health. Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression. Insufficient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts. COMMENTARY A commentary on this article apears in this issue on page 1439.
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Affiliation(s)
| | - Lee J Brooks
- Children's Hospital of Philadelphia, Philadelphia, PA.,Liaison for the American Academy of Pediatrics
| | | | - Wendy A Hall
- University of British Columbia School of Nursing, Vancouver, BC
| | | | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | - Merrill S Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN
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Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016; 12:785-6. [PMID: 27250809 DOI: 10.5664/jcsm.5866] [Citation(s) in RCA: 742] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 11/13/2022]
Abstract
ABSTRACT Sleep is essential for optimal health in children and adolescents. Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. The recommendations are summarized here. A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be published in the Journal of Clinical Sleep Medicine.
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Affiliation(s)
| | - Lee J Brooks
- Children's Hospital of Philadelphia, Philadelphia, PA.,Liaison for the American Academy of Pediatrics, Elk Grove Village, IL
| | | | - Wendy A Hall
- University of British Columbia School of Nursing, Vancouver, BC
| | | | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Carol L Rosen
- Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Matthew M Troester
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Merrill S Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN
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Stoll K, Hauck Y, Downe S, Edmonds J, Gross MM, Malott A, McNiven P, Swift E, Thomson G, Hall WA. Cross-cultural development and psychometric evaluation of a measure to assess fear of childbirth prior to pregnancy. Sexual & Reproductive Healthcare 2016; 8:49-54. [DOI: 10.1016/j.srhc.2016.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 02/13/2016] [Accepted: 02/15/2016] [Indexed: 01/04/2023]
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Hauck YL, Stoll KH, Hall WA, Downie J. Association between childbirth attitudes and fear on birth preferences of a future generation of Australian parents. Women Birth 2016; 29:511-517. [PMID: 27233945 DOI: 10.1016/j.wombi.2016.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/20/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The reality of childbirth fear is recognised for expectant parents but we lack knowledge about the childbirth attitudes of the next generation of Australian parents. AIM Examination of adults' attitudes toward childbirth including influencing contributing factors, fear scores, birth preferences and reasons for this preference. METHODS A cross-sectional online study was conducted with 654 Western Australian students attending one tertiary institution. Students (male and female) were eligible to participate if they were less than 40 years of age and did not currently have children but confirmed their intention to become parents. To assess associations or comparison of means, bi-variable analyses (Chi square test, Fisher's Exact test, Independent Student's t-test or one way ANOVA) were used. Factors associated with childbirth fear and birth preferences were assessed with binary logistic regression analysis. FINDINGS Childbirth attitudes were shaped by family members' (82.0%) and friends' experiences (64.4%) plus media (TV, YouTube, and movies) (63.5%). Furthermore, 15.6% of adults indicated a preference for a caesarean birth, even without obstetric complications. Likewise, 26.1% reported elevated fear; students with elevated fear scores had 2.6 times greater odds of wanting a caesarean birth. Only 23.4% of students felt confident about their childbirth knowledge. CONCLUSION Adults reported fear levels that warrant attention prior to a future pregnancy. Although the majority would choose a vaginal birth, they require awareness of benefits and risks for both vaginal and caesarean births to ensure their decisions reflect informed choice rather than influences of inadequate knowledge or fear.
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Affiliation(s)
- Yvonne L Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA 6845 Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Bagot Rd, Subiaco, WA 6008, Australia.
| | - Kathrin H Stoll
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, East Mall, Vancouver, BC V6T-1Z3, Canada.
| | - Wendy A Hall
- School of Nursing, University of British Columbia, Westbrook Mall, Vancouver, BC V6T 2B5, Canada.
| | - Jill Downie
- Office of the Deputy Vice-Chancellor, Academic, Curtin University, Perth, WA 6845, Australia.
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Stoll KH, Hauck YL, Hall WA. Home or hospital? Midwife or physician? Preferences for maternity care provider and place of birth among Western Australian students. Women Birth 2016; 29:e33-8. [DOI: 10.1016/j.wombi.2015.07.187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
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Hall WA, Hutton E, Brant RF, Collet JP, Gregg K, Saunders R, Ipsiroglu O, Gafni A, Triolet K, Tse L, Bhagat R, Wooldridge J. A randomized controlled trial of an intervention for infants' behavioral sleep problems. BMC Pediatr 2015; 15:181. [PMID: 26567090 PMCID: PMC4643535 DOI: 10.1186/s12887-015-0492-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022] Open
Abstract
Background Infant behavioral sleep problems are common, with potential negative consequences. We conducted a randomized controlled trial to assess effects of a sleep intervention comprising a two-hour group teaching session and four support calls over 2 weeks. Our primary outcomes were reduced numbers of nightly wakes or parent report of sleep problem severity. Secondary outcomes included improvement in parental depression, fatigue, sleep, and parent cognitions about infant sleep. Methods Two hundred thirty five families of six-to-eight month-old infants were randomly allocated to intervention (n = 117) or to control teaching sessions (n = 118) where parents received instruction on infant safety. Outcome measures were observed at baseline and at 6 weeks post intervention. Nightly observation was based on actigraphy and sleep diaries over six days. Secondary outcomes were derived from the Multidimensional Assessment of Fatigue Scale, Center for Epidemiologic Studies Depression Measure, Pittsburgh Sleep Quality Index, and Maternal (parental) Cognitions about Infant Sleep Questionnaire. Results One hundred eight intervention and 107 control families provided six-week follow-up information with complete actigraphy data for 96 in each group: 96.9 % of intervention and 97.9 % of control infants had an average of 2 or more nightly wakes, a risk difference of −0.2 % (95 % CI: −1.32, 0.91). 4 % of intervention and 14 % of control infants had parent-assessed severe sleep problems: relative risk 0.3, a risk difference of −10 % (CI: 0.11, 0.84-16.8 to −2.2). Relative to controls, intervention parents reported improved baseline-adjusted parental depression (CI: −3.7 to −0.4), fatigue (CI: −5.74 to −1.68), sleep quality (CI: −1.5 to −0.2), and sleep cognitions: doubts (CI: −2.0 to −0.6), feeding (CI: − 2.1 to - 0.7), anger (CI: − 1.8 to - 0.4) and setting limits (CI: −3.5 to −1.5). Conclusions The intervention improved caregivers' assessments of infant sleep problem severity and parental depression, fatigue, sleep, and sleep cognitions compared with controls. Trial registration ISRCTN42169337, NCT00877162
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Affiliation(s)
- Wendy A Hall
- University of British Columbia School of Nursing, T 201, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Eileen Hutton
- Midwifery Education Program, McMaster University, Michael G DeGroote Centre for Learning & Discovery, Room 2210, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
| | - Rollin F Brant
- Department of Statistics, University of British Columbia/Child and Family Research Institute, ESB 3146, 2207 Main Mall, Vancouver, BC, V6T 1Z4, Canada.
| | - Jean Paul Collet
- Child and Family Research Institute, University of British Columbia, Clinical Support Building, Room V3-320, 948 West 28th Avenue, Vancouver, BC, V6H 3N1, Canada.
| | - Kathy Gregg
- University of British Columbia School of Nursing, Vancouver, BC, Canada.
| | - Roy Saunders
- University of British Columbia Faculty of Medicine, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada.
| | - Osman Ipsiroglu
- British Columbia Children's Hospital, Division of Developmental Pediatrics, 3644 Slocan Street, Vancouver, BC, V5M 3E8, Canada.
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, CRL-208, Hamilton, ON, L8S 4K1, Canada.
| | - Kathy Triolet
- Pacific Spirit Community Health Centre, Vancouver Coastal Health, 2110 43rd Avenue West, Vancouver, BC, V6M 2E1, Canada.
| | - Lillian Tse
- South Community Health Centre, Vancouver Coastal Health, 6405 Knight Street, Vancouver, BC, V5P 2V9, Canada.
| | - Radhika Bhagat
- South Community Health Centre, Vancouver Community, Vancouver Coastal Health, 6405 Knight Street, Vancouver, BC, V5P 2V9, Canada.
| | - Joanne Wooldridge
- Early Childhood Development at Vancouver Coastal Health, Vancouver Coastal Health, 11th floor, 601 West Broadway, Vancouver, BC, V5Z 4C2, Canada.
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Stoll K, Edmonds JK, Hall WA. Fear of Childbirth and Preference for Cesarean Delivery Among Young American Women Before Childbirth: A Survey Study. Birth 2015; 42:270-6. [PMID: 26104997 DOI: 10.1111/birt.12178] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fear of birth and mode of delivery preferences are similar among pregnant and nonpregnant women, suggesting that attitudes toward birth are formed in young adulthood or earlier. Understanding why some young women fear birth and prefer obstetric interventions can inform public health initiatives aimed at reducing fear and promoting birth as a normal life event. METHODS We conducted an online survey with 752 American nulliparous young women to assess their preferences and attitudes toward childbirth. We identified explanatory variables associated with reported fear of childbirth and cesarean delivery (CD) preferences. RESULTS A preference for CD was reported by 14 percent of young women and 27 percent had scores indicating elevated fear of birth. Fear of birth increased the likelihood of cesarean preference (adjusted relative risk (ARR) 3.84 [95% CI 2.49-5.95]) as did a family history of CD (ARR 1.65 [95% CI 1.13-2.42]). The likelihood of reporting elevated childbirth fear was increased among young women who reported concerns about the physical changes pregnancy and birth have on women's bodies (ARR 2.04 [95% CI 1.50-2.78]). Young women who reported a high degree of confidence in their knowledge about childbirth were significantly less likely to report childbirth fear (ARR 0.61 [95% CI 0.42-0.87]). Access to childbirth information was also associated with a decreased likelihood of fear of birth (ARR 0.75 [95% CI 0.59-0.95]). CONCLUSIONS Young women reporting high levels of childbirth fear are nearly four times more likely to prefer a CD. Specific fears, such as worries over the influence of pregnancy and birth on the female body, need to be addressed before pregnancy.
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Affiliation(s)
- Kathrin Stoll
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Wendy A Hall
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Zaidman-Zait A, Hall WA. Children's night waking among toddlers: relationships with mothers' and fathers' parenting approaches and children's behavioural difficulties. J Adv Nurs 2015; 71:1639-49. [DOI: 10.1111/jan.12636] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Anat Zaidman-Zait
- Department of School Counseling and Special Education; Constantiner School of Education; Tel-Aviv University; Israel
- Department of Human Early Learning Partnership (HELP); University of British Columbia; Vancouver British Columbia Canada
| | - Wendy A. Hall
- University of British Columbia School of Nursing; Vancouver British Columbia Canada
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Abstract
In this grounded theory study, informed by symbolic interactionism, we explain how nurses, patients, and family members construct relationships in acute care settings, including managing effects of work environments. We recruited participants from 10 acute care units across four community hospitals in a Western Canadian city. From 33 hr of participant observation and 40 interviews with 13 nurses, 17 patients, and 10 family members, we constructed the basic social-psychological process of progressively engaging. Nurses, patients, and family members approached constructing relationships through levels of engagement, ranging from perspectives about "just doing the job" to "doing the job with heart." Progressively engaging involved three stages: focusing on tasks, getting acquainted, and building rapport. Workplace conditions and personal factors contributed or detracted from participants' movement through the stages of the process; with higher levels of engagement, participants experienced greater satisfaction and cooperation. Progressively engaging provides direction for how all participants in care can invest in relationships.
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Affiliation(s)
| | - Wendy A Hall
- University of British Columbia, Vancouver, Canada
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Abstract
Detecting the effectiveness of behavioral interventions to reduce infant night-waking requires valid sleep measures. Although viewed as an objective measure, actigraphy has overestimated night-waking. Sleep diaries are criticized for only documenting night-waking with infant crying. To support potential outcome measure validity, we examined differences between sleep diaries and actigraphy in detecting night-waking and sleep duration. We recruited 5.5 to 8-month-old infants for a behavioral sleep intervention trial conducted from 2009 to 2011. Intervention (sleep education and support) and control groups (safety education and support) collected infant diary and actigraphy data for 5 days. We compared night-time sleep actigraphy with diary data at baseline (194 cases), and 6 weeks (166 cases) and 24 weeks post-education (118 cases). We hypothesized numbers of wakes and wakes of ≥20 min would be higher and longest sleep time and total sleep time shorter by actigraphy compared with diaries. Using paired t-tests, there were significantly more actigraphy night wakes than diary wakes at baseline (t = 29.14, df = 193, p < 0.001), 6 weeks (t = 23.99, df = 165, p < 0.001), and 24 weeks (t = 22.01, df = 117, p < 0.001); and significantly more night wakes of ≥20 min by actigraphy than diary at baseline (t = 5.03, df = 183, p < 0.001), and 24 weeks (t = 2.19, df = 107, p < 0.05), but not 6 weeks (t = 1.37, df = 156, n.s.). Longest sleep duration was significantly higher by diary than actigraphy at baseline (t = 14.71, df = 186, p < 0.001), 6 weeks (t = 7.94, df = 158, p < 0.001), and 24 weeks (t = 17.18, df = 114, p < 0.001). Night sleep duration was significantly higher by diary than actigraphy at baseline (t = 9.46, df = 185, p < 0.001), 6 weeks (t = 13.34, df = 158, p < 0.001), and 24 weeks (t = 13.48, df = 114, p < 0.001). Discrepancies in actigraphy and diary data may indicate accurate actigraphy recording of movement but not sleep given active infant sleep and self-soothing.
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Affiliation(s)
- Wendy A Hall
- School of Nursing, University of British Columbia , Vancouver, BC , Canada
| | - Sarah Liva
- School of Nursing, University of British Columbia , Vancouver, BC , Canada
| | - Melissa Moynihan
- School of Nursing, University of British Columbia , Vancouver, BC , Canada
| | - Roy Saunders
- University of British Columbia Faculty of Medicine , Vancouver, BC , Canada
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Speth TA, Coulombe JA, Markovich AN, Chambers CT, Godbout R, Gruber R, Hall WA, Reid GJ, Stremler R, Weiss SK, Witmans M, Corkum PV. Barriers, facilitators, and usability of an Internet intervention for children aged 1 to 10 years with insomnia. Translational Issues in Psychological Science 2015. [DOI: 10.1037/tps0000016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
In this article we describe a grounded theory study of how caregivers of school-aged children with fetal alcohol spectrum disorder (FASD) managed their children's schooling. We completed 30 interviews with 17 caregivers residing in a western Canadian province, as well as document analysis and 25 hours of participant observation. We used constant comparative analysis to construct our substantive theory: intertwining to fit in. The core variable is an iterative cycle caregivers used to resolve their main concerns: preventing their children from failing academically and in social interactions and preventing themselves from being regarded as unacceptable parents. To intertwine to fit in, caregivers used two strategies: orchestrating schooling and keeping up appearances. They also regulated their relationships with their children. "Intertwining to fit in" contributes to the literature on attachment and parenting and extends explanations about caregivers' advocacy for their children with FASD. The theory has implications for school personnel and practitioners, as well as researchers.
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Affiliation(s)
- Suretha Swart
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy A Hall
- University of British Columbia, Vancouver, British Columbia, Canada
| | - William T McKee
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie Ford
- University of British Columbia, Vancouver, British Columbia, Canada
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Lam CH, Hansen EA, Hall WA, Hubel A. Application of transport phenomena analysis technique to cerebrospinal fluid. J Neurosurg Sci 2013; 57:317-326. [PMID: 24091435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The study of hydrocephalus and the modeling of cerebrospinal fluid flow have proceeded in the past using mathematical analysis that was very capable of prediction phenomenonologically but not well in physiologic parameters. In this paper, the basis of fluid dynamics at the physiologic state is explained using first established equations of transport phenomenon. Then, microscopic and molecular level techniques of modeling are described using porous media theory and chemical kinetic theory and then applied to cerebrospinal fluid (CSF) dynamics. Using techniques of transport analysis allows the field of cerebrospinal fluid dynamics to approach the level of sophistication of urine and blood transport. Concepts such as intracellular and intercellular pathways, compartmentalization, and tortuosity are associated with quantifiable parameters that are relevant to the anatomy and physiology of cerebrospinal fluid transport. The engineering field of transport phenomenon is rich and steeped in architectural, aeronautical, nautical, and more recently biological history. This paper summarizes and reviews the approaches that have been taken in the field of engineering and applies it to CSF flow.
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Affiliation(s)
- C H Lam
- Departments of Neurosurgery University of Minnesota, Minneapolis, MN, USA -
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Hall WA, Petrova AV, Colbert LE, Hardy CW, Fisher SB, Saka B, Shelton JW, Warren MD, Pantazides BG, Gandhi K, Kowalski J, Kooby DA, El-Rayes BF, Staley CA, Volkan Adsay N, Curran WJ, Landry JC, Maithel SK, Yu DS. Low CHD5 expression activates the DNA damage response and predicts poor outcome in patients undergoing adjuvant therapy for resected pancreatic cancer. Oncogene 2013; 33:5450-6. [PMID: 24276239 DOI: 10.1038/onc.2013.488] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/17/2013] [Accepted: 10/04/2013] [Indexed: 01/01/2023]
Abstract
The DNA damage response (DDR) promotes genome integrity and serves as a cancer barrier in precancerous lesions but paradoxically may promote cancer survival. Genes that activate the DDR when dysregulated could function as useful biomarkers for outcome in cancer patients. Using a siRNA screen in human pancreatic cancer cells, we identified the CHD5 tumor suppressor as a gene, which, when silenced, activates the DDR. We evaluated the relationship of CHD5 expression with DDR activation in human pancreatic cancer cells and the association of CHD5 expression in 80 patients with resected pancreatic adenocarcinoma (PAC) by immunohistochemical analysis with clinical outcome. CHD5 depletion and low CHD5 expression in human pancreatic cancer cells lead to increased H2AX-Ser139 and CHK2-Thr68 phosphorylation and accumulation into nuclear foci. On Kaplan-Meier log-rank survival analysis, patients with low CHD5 expression had a median recurrence-free survival (RFS) of 5.3 vs 15.4 months for patients with high CHD5 expression (P=0.03). In 59 patients receiving adjuvant chemotherapy, low CHD5 expression was associated with decreased RFS (4.5 vs 16.3 months; P=0.001) and overall survival (OS) (7.2 vs 21.6 months; P=0.003). On multivariate Cox regression analysis, low CHD5 expression remained associated with worse OS (HR: 3.187 (95% CI: 1.49-6.81); P=0.003) in patients undergoing adjuvant chemotherapy. Thus, low CHD5 expression activates the DDR and predicts for worse OS in patients with resected PAC receiving adjuvant chemotherapy. Our findings support a model in which dysregulated expression of tumor suppressor genes that induce DDR activation can be utilized as biomarkers for poor outcome.
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Affiliation(s)
- W A Hall
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - A V Petrova
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - L E Colbert
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - C W Hardy
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - S B Fisher
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - B Saka
- Department of Pathology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - J W Shelton
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - M D Warren
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - B G Pantazides
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - K Gandhi
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Atlanta, GA, USA
| | - J Kowalski
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Atlanta, GA, USA
| | - D A Kooby
- 1] Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA [2] Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - B F El-Rayes
- Department of Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - C A Staley
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - N Volkan Adsay
- Department of Pathology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - W J Curran
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - J C Landry
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - S K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - D S Yu
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Abstract
We examined constructions of labor and birth for 461 Canadian women who attended the University of British Columbia (Canada) and participated in an online survey about pregnancy and birth, using a combination of Likert items and open-ended questions. We performed a content analysis of women's open-ended responses about their feelings toward birth and analyzed comments of women with high and low fear of childbirth separately. Students with high fear of birth described childbirth as a frightening and painful ordeal and viewed obstetric interventions as a means to make labor and birth more manageable. Students with low fear constructed birth as a natural event and regarded interventions more critically. Students in both groups supported women's autonomous maternity care decisions. Our findings contribute to care providers' and educators' knowledge about preferences and fears expressed by the next generation of maternity care consumers and potential strategies to reduce their fear of childbirth.
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Affiliation(s)
- Kathrin Stoll
- 1University of British Columbia, Vancouver, British Columbia, Canada
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Hall WA. Consumerism and consumer complexity: implications for university teaching and teaching evaluation. Nurse Educ Today 2013; 33:720-723. [PMID: 23582877 DOI: 10.1016/j.nedt.2013.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/24/2013] [Accepted: 03/07/2013] [Indexed: 06/02/2023]
Abstract
A contemporary issue is the effects of a corporate production metaphor and consumerism on university education. Efforts by universities to attract students and teaching strategies aimed at 'adult learners' tend to treat student consumers as a homogeneous group with similar expectations. In this paper, I argue that consumer groups are not uniform. I use Dagevos' theoretical approach to categorize consumers as calculating, traditional, unique, and responsible. Based on the characteristics of consumers occupying these categories, I describe the implications of the varying consumer expectations for teaching. I also consider the implications for evaluation of teaching and call for research taking consumer types into account when evaluating teaching.
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Affiliation(s)
- Wendy A Hall
- School of Nursing, and Associate Dean, Faculty of Graduate Studies, University of British Columbia, T. 201 2211 Wesbrook Mall, Vancouver, BC Canada V6T 2B5.
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Hall WA, Bandsmer JC, Gregg K, Ebbehoj C. Translating knowledge directly to childbearing women: a study of Canadian women's preferences. Health Care Women Int 2013; 34:363-79. [PMID: 23550948 DOI: 10.1080/07399332.2012.740109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Knowledge translation has relied on research products that take years to disseminate, losing relevance for intended users. We used a mixed-methods approach to determine women's preferences for research results and format, intention to share results, and potential benefits. We sampled healthy, pregnant women who completed survey data during their third trimesters and wanted access to results. Mothers preferred results about sleep, fears, and anxieties during later pregnancy to benefit from reassurance that their experiences were shared. Women mostly intended to share results with their social networks. Organizational contacts increased dissemination of the women's preferred information to nonstudy participants.
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Affiliation(s)
- Wendy A Hall
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
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Liva SJ, Hall WA, Klein MC, Wong ST. Factors Associated with Differences in Canadian Perinatal Nurses’ Attitudes Toward Birth Practices. J Obstet Gynecol Neonatal Nurs 2012; 41:761-73. [DOI: 10.1111/j.1552-6909.2012.01412.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hall WA, Stoll K, Hutton EK, Brown H. A prospective study of effects of psychological factors and sleep on obstetric interventions, mode of birth, and neonatal outcomes among low-risk British Columbian women. BMC Pregnancy Childbirth 2012; 12:78. [PMID: 22862846 PMCID: PMC3449197 DOI: 10.1186/1471-2393-12-78] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 07/24/2012] [Indexed: 11/24/2022] Open
Abstract
Background Obstetrical interventions, including caesarean sections, are increasing in Canada. Canadian women’s psychological states, fatigue, and sleep have not been examined prospectively for contributions to obstetric interventions and adverse neonatal outcomes. Context and purpose of the study: The prospective study was conducted in British Columbia (BC), Canada with 650 low-risk pregnant women. Of those women, 624 were included in this study. Women were recruited through providers’ offices, media, posters, and pregnancy fairs. We examined associations between pregnant women’s fatigue, sleep deprivation, and psychological states (anxiety and childbirth fear) and women’s exposure to obstetrical interventions and adverse neonatal outcomes (preterm, admission to NICU, low APGARS, and low birth weight). Methods Data from our cross-sectional survey were linked, using women’s personal health numbers, to birth outcomes from the Perinatal Services BC database. After stratifying for parity, we used Pearson’s Chi-square to examine associations between psychological states, fatigue, sleep deprivation and maternal characteristics. We used hierarchical logistic regression modeling to test 9 hypotheses comparing women with high and low childbirth fear and anxiety on likelihood of having epidural anaesthetic, a caesarean section (stratified for parity), assisted vaginal delivery, and adverse neonatal outcomes and women with and without sleep deprivation and high levels of fatigue on likelihood of giving birth by caesarean section, while controlling for maternal, obstetrical (e.g., infant macrosomia), and psychological variables. Results Significantly higher proportions of multiparas, reporting difficult and upsetting labours and births, expectations of childbirth interventions, and health stressors, reported high levels of childbirth fear. Women who reported antenatal relationship, housing, financial, and health stressors and multiparas reporting low family incomes were significantly more likely to report high anxiety levels. The hypothesis that high childbirth fear significantly increased the risk of using epidural anaesthesia was supported. Conclusions Controlling for some psychological states and sleep quality while examining other contributors to outcomes decreases the likelihood of linking childbirth fear anxiety, sleep deprivation, and fatigue to increased odds of caesarean section. Ameliorating women’s childbirth fear to reduce their exposure to epidural anaesthesia can occur through developing effective interventions. These include helping multiparous women process previous experiences of difficult and upsetting labour and birth.
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Affiliation(s)
- Wendy A Hall
- University of British Columbia School of Nursing, T201, 2211 Westbrook Mall, Vancouver, British Columbia, Canada V6T 2B5.
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Hall WA, Tomkinson J, Klein MC. Canadian care providers' and pregnant women's approaches to managing birth: minimizing risk while maximizing integrity. Qual Health Res 2012; 22:575-586. [PMID: 21940939 DOI: 10.1177/1049732311424292] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We employed grounded theory to explain how Canadian pregnant women and care providers manage birth. The sample comprised 9 pregnant women and 56 intrapartum care providers (family doctors, midwives, nurses, obstetricians, and doulas [individuals providing labor support]). We collected data from 2008 to 2009, using focus groups that included care providers and pregnant women. Using concurrent data collection and analysis, we generated the core category: minimizing risk while maximizing integrity. Women and providers used strategies to minimize risk and maximize integrity, which included accepting or resisting recommendations for surveillance and recommendations for interventions, and plotting courses vs. letting events unfold. Strategies were influenced by evidence, relationships, and local health cultures, and led to feelings of weakness or strength, confidence or uncertainty, and differing power- and responsibility-sharing arrangements. The findings highlight difficulties resisting surveillance and interventions in a risk-adverse culture, and the need for attention to processes of giving birth.
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Affiliation(s)
- Wendy A Hall
- University of British Columbia, Vancouver, Canada.
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Abstract
BACKGROUND While evidence suggests sleep problems are common in young children and linked to behavioural problems, studies of toddlers are rare. This community-based cross-sectional study examined associations between sleep problems and daytime behaviour among 58 children aged 1 to 3 years who attended daycare centres. METHODS Mothers and daycare providers completed four and three questionnaires, respectively, about children's sleep patterns and behaviour. Two hypotheses were tested: (1) children with higher sleep problem scores would have more behavioural problems by parental and daycare provider report; (2) problematic napping behaviours would be associated with night sleep problems. RESULTS Mothers' reports of sleep problems were positively associated with children's behavioural problems at home and daycare providers' reports of nap problems were positively correlated with children's behavioural problems at daycare. Daycare providers' reports of children's behavioural problems at daycare were associated with maternal reports of behavioural problems. Older children in the sleep problem group had maternal reports of more behavioural problems. Daycare providers reported that children with sleep problems were less happy at daycare. Children who were happier following naps had less reported night settling difficulties. Children with difficulty settling for naps at daycare had maternal reports of more behavioural problems. CONCLUSIONS Napping in daycare settings is an important component of toddlers' sleep. Crossover effects between children's sleep and behaviour at daycare and home indicate similarities in mothers' and daycare providers' perceptions. Findings suggest parent and daycare provider interactions include discussions about sleep problems and settling at home and in daycares. Parents and daycare providers would benefit from education about relationships between sleep and behavioural problems.
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Affiliation(s)
- W A Hall
- School of Nursing, University of British Columbia Human Early Learning Partnership, University of British Columbia, Vancouver, BC, Canada.
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Hall WA. Cohort study: travel time from home to hospital and adverse perinatal outcomes in women at term in The Netherlands. Evid Based Nurs 2011; 14:119-120. [PMID: 21742648 DOI: 10.1136/ebn.2011.100045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Wendy A Hall
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
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Hauck YL, Hall WA, Dhaliwal SS, Bennett E, Wells G. The effectiveness of an early parenting intervention for mothers with infants with sleep and settling concerns: a prospective non-equivalent before-after design. J Clin Nurs 2011; 21:52-62. [PMID: 21649763 DOI: 10.1111/j.1365-2702.2011.03734.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The study aim was to compare changes in maternal confidence, competence, depression, anxiety and settling behaviours and children's sleep and settling behaviours for mothers and infants (4-6 months of age) attending a Day Stay intervention at an early parenting centre in Western Australia and a community group. BACKGROUND Infant difficulties in getting to sleep and frequent night waking are concerns for parents. Techniques are available to assist parents with infants exhibiting behavioural sleep problems; however, parents often lack confidence to consistently initiate sleep interventions. DESIGN The study incorporated a prospective non-equivalent before-after design. METHOD The conceptual framework guiding this intervention emphasised the development of parental confidence and competence through connection with practitioners to promote change. Both groups provided baseline data (time 1) and four weeks postbaseline (time 2). Recruitment occurred between July 2007-July 2009. RESULTS The Ngala group (n = 93) and community group (n = 85) were not equivalent for infant age and maternal parity; there were more multiparous mothers in the community group, with infants on average one week older. The Ngala group, the majority of which were primiparous women, had significantly higher levels of competence and confidence four weeks following their Day Stay visit. There were no significant differences between groups at time 2 for time to settle the infant at night, infant night waking and maternal depression and anxiety scores. CONCLUSIONS Although both groups demonstrated an improvement in depression and anxiety scores, with decreased sleep and settling concerns, the results indicate parental inconsistency in settling approaches. Given links between inconsistent infant settling approaches and infants' difficulty with sleep self-initiation, further exploration is warranted. RELEVANCE TO CLINICAL PRACTICE The conceptual framework guiding the Ngala practitioners was effective in developing confidence and competence for the sample.
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Affiliation(s)
- Yvonne L Hauck
- School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University and King Edward Memorial Hospital for Women, Perth, WA, Australia.
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