To understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer: a systematic review of qualitative studies

PURPOSE

This study aimed to understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer.

METHODS

A qualitative systematic review has been reported according to PRISMA guidelines. A comprehensive search was conducted across multiple databases (APA PsycINFO, CINAHL, and Medline) and citation searches. Studies were screened according to pre-determined inclusion and exclusion criteria. Methodological quality was evaluated. Findings were extracted in relation to the context of interest of experiences, needs, and preferences of supportive care. Each finding was accompanied by a qualitative verbatim illustration representing the participant's voice.

RESULTS

4449 publications were screened, and 44 studies were included. Cancer populations represented in the included studies included lymphoma, leukaemia, brain cancer, sarcomas, and neuroblastoma. Two overarching synthesised findings were identified as (1) coping, caring relationships, communication, and impact of the clinical environment, and (2) experiences of isolation, fear of the unknown, restricted information, and changing self. Children and adolescents articulated that cancer care would be enhanced by developing a sense of control over their body and healthcare, being involved in communication and shared decision-making, and ensuring the clinical environment is age-appropriate. Many experienced a sense of disconnection from the rest of the world (including peers, school, and experiences of prejudice and bullying), and a lack of tailored support and information were identified as key unmet care needs that require further intervention.

CONCLUSIONS

Children and adolescent who are diagnosed with cancer are a unique and understudied group in oncological survivorship research, with the slowest progress in improvement of care over time. This review will facilitate the development of future interventions and promote the importance of tailored support for children and adolescents at all stages of the cancer journey.

IMPLICATIONS FOR CANCER SURVIVORS

Children and adolescents continue to experience a range of difficulties despite routine contact with cancer healthcare professionals. Children and adolescents should be carefully assessed about their individual circumstances and preferences for support given the clear implications from this review that "one size" does not fit all.

Problem-based learning in medical radiation science education: A scoping review

INTRODUCTION

The current educational and technological environment in medical radiation science is dynamic. Educators must seek both proven and contemporary methods to ensure graduates are equipped for the clinical environment. This scoping review sought to assess the evidence regarding the value of problem-based learning (PBL) as part of medical radiation undergraduate curricula.

METHODS

A systematic search of Medline, Emcare, and CINAHL was undertaken. Studies using both quantitative and qualitative methodologies were eligible if they reported the outcomes relating to PBL intervention for medical radiation science students in undergraduate education (diagnostic radiography, radiation therapy, or nuclear medicine). Outcomes included self-perceived benefits, disadvantages, and skills. Screening and data extraction was conducted independently by two reviewers.

RESULTS

Eleven studies were included. Data regarding perceived benefits, perceived disadvantages, and skills were gathered. Pre-post studies demonstrated statistically significant findings suggesting better preparedness and improved attitudes for PBL students. Across institutions globally, there is evidence suggesting PBL is positively received by medical radiation students. High satisfaction was experienced amongst participants. Negative feedback included lack of resources, limitations in realism, and issues associated with groupwork.

CONCLUSION

PBL may positively impact student satisfaction, knowledge acquisition, and skills, though this necessitates further research.

IMPLICATIONS FOR PRACTICE

Medical radiation is an evolving discipline, and problem-based learning poses an educational tool to equip graduates with adaptive qualities.

A110 INCIDENCE AND PREDICTORS OF ASYMPTOMATIC ABNORMALITIES IN BIOCHEMICAL AND RADIOLOGIC PANCREATIC MARKERS FOLLOWING UNCOMPLICATED ERCP

Background

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is common. Its diagnosis relies on characteristic abdominal pain in addition to biochemical and/or radiographic evidence of pancreatic inflammation.

Purpose

Little is known regarding the frequency with which asymptomatic alterations in biochemical and/or imaging parameters occur following uncomplicated ERCP. We sought to assess the incidence and predictors of such alterations following uncomplicated ERCP.

Method

This study was an analysis of a prospectively maintained ERCP registry. All inpatients ³ 18 years old who underwent ERCP between 2018/09/01 and 2022/02/28 were identified. Patients with acute pancreatitis or abdominal pain following ERCP were excluded, as were patients with lipase levels ≥3x the upper limit of normal (ULN) within 7 days preceding ERCP. Primary outcomes were (1) asymptomatic lipase elevation within 48 hours of uncomplicated ERCP or (2) asymptomatic cross-sectional imaging findings of pancreatic inflammation within 14 days of ERCP.Descriptive statistics were presented as means with accompanying standard deviations (SD) and percentages by lipase categories and PEP, or by imaging categories. Multiple logistic regression was used to examine the associations of exposure variables with PEP or imaging findings.

Result(s)

A total of 646 patients were analyzed in the biochemical cohort, and 187 patients were analyzed in the radiologic cohort. In the biochemical cohort, 478 patients (74.0%) had no elevations in pancreatic enzymes, while 81 (12.5%) had elevations up to 2x ULN, 26 (4.0%) had elevations between 2-3x ULN, and 61 (9.4%) had elevations >3x ULN. In the radiologic cohort, 148 (79.1%) had no abnormalities on cross-sectional imaging within 14 days of ERCP, while 39 (20.9%) had one or more imaging finding typically associated with acute pancreatitis. Among these, 22 (11.8%) had peri-pancreatic fluid collections and 2.1-9.6% of patients had pancreatic findings that included edema, enlargement, inflammation, or fat-stranding. On multivariable analysis, predictors of lipasemia >3x ULN included balloon sphincteroplasty (odds ratio, OR, 2.29, 95% confidence intervals, CI, 1.08 to 4.85) and the placement of a common bile duct stent (OR 4.19, 95% CI 1.37 to 12.77), whereas cannulation of the pancreatic duct or performance of a pancreatogram were not significantly associated (OR 0.75, 95% CI 0.24 to 2.35 and OR 1.07, 95% CI 0.18 to 6.26, respectively).

Conclusion(s)

Over 25% of patients will have asymptomatic elevations in pancreatic enzymes following ERCP, while over 20% will have asymptomatic cross-sectional imaging findings suggestive of pancreatic inflammation. Clinical symptoms should guide post-ERCP care rather than biochemical or imaging parameters.

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Disclosure of Interest

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Interprofessional education (IPE) in medical radiation science: A scoping review

INTRODUCTION

Interprofessional education (IPE) in medical radiation education is designed to enhance both student and longer-term patient outcomes. This scoping review aims to provide an overview of the available evidence and examine the effectiveness of IPE strategies used to enhance the development of medical radiation science (MRS) students.

METHODS

Medline, CINAHL, Cochrane Library and Emcare were searched for articles which employed an experimental study design to quantitatively assess the effectiveness of IPE for MRS students. Two reviewers screened and extracted relevant data independently. Critical appraisal was conducted using the JBI critical appraisal tool.

RESULTS

Eighteen studies were included in this review. Diverse approaches to IPE were discovered, particularly in terms of the method of delivery, setting and duration of interventions. MRS students interact with many professions, particularly medical doctors and nurses. All studies which employed a control arm demonstrated statistically positive findings favoring IPE intervention(s). In pre-post studies, most IPE interventions reported significant positive differences after IPE was implemented. This entailed an enhanced perceived knowledge and understanding of other professions, and ability to undertake their role in the team.

CONCLUSION

IPE was shown to be effective in enhancing students' perceptions and attitudes and to a limited extent, improve knowledge acquisition. Future research should assess long-term effects and patient-related outcomes.

IMPLICATIONS FOR PRACTICE

IPE in a variety of formats demonstrates positive results for MRS students; however, interventions which are longer-term, conducted in small groups, and performed earlier in the educational pathway, may demonstrate greater effectiveness.

Preoperative anaemia management in patients undergoing vascular surgery

CAVIAR is a multicentre prospective stepped observational study encompassing 160 patients undergoing vascular intervention. The aim was to identify whether it was feasible to establish a preoperative anaemia pathway and, if so, the efficacy of intravenous iron for treatment of preoperative anaemia. Large barriers prevented implementation of an intravenous iron pathway, with only ten patients receiving intravenous iron and a small increase in haemoglobin level (mean 5·7 (95 per cent c.i. 4·5 to 6·9) g/l). Preoperative anaemia was associated with a longer hospital stay and greater transfusion requirement. Anaemia common and dedicated pathway difficult to instigate.

P1-07-02: Discordance between Central and Local Laboratory HER2 Testing from a Large HER2−Negative Population in VIRGO, a Metastatic Breast Cancer Registry

Background: HER2 overexpression is associated with unfavorable prognosis and is reported in 18–25% of breast cancers (BC). HER2 testing is often performed using immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH). Because of the significant benefit of HER2−directed therapies, it is critical to accurately identify women whose tumors are HER2+. Reports have noted discordance between HER2+ test results from local vs. large reference labs in patients with HER2+ BC evaluated for trastuzumab-based clinical studies. There are little published data on central testing of BC found to be negative locally.

Patients and Methods: VIRGO is an observational cohort of N=1,287 women with primarily HER2−negative metastatic BC. An optional tissue collection substudy was conducted, and 776 patient samples were received and centrally retested. Central testing was performed at 2 reference labs and tumors were deemed HER2+ if IHC 3+ and/or FISH positive (HER2:CEP17 ratio ≥2.0). Tumors with unknown/missing local HER2 status (n=68) were excluded from primary analyses. Number of patients potentially affected based on BC incidences from the American Cancer Society (ACS) 2011 estimates and the World Health Organization (WHO) 2008 report were calculated. Testing on the remainder of the HER2−negative cohort is in process.

Results: Central retesting has been performed on tumor samples from n=373 patients to date: HER2−negative locally evaluable tumors (n=301), n=4 HER2−negative locally with no evaluable tumor, and HER2 unknown (n=68). A total of 301 unique patient samples were included in the primary analysis. Of these, 15 (4.98% [95% CI (2.7%, 7.9%)] were found to be HER2+ by central testing (Table). Based on sensitivity analyses assuming all 68 tumors with unknown HER2 status to be negative locally, 4.07%(15 /369) would be centrally HER2+.

Spatio-temporal diffusion of dynamic PET images

Positron emission tomography (PET) images are corrupted by noise. This is especially true in dynamic PET imaging where short frames are required to capture the peak of activity concentration after the radiotracer injection. High noise results in a possible bias in quantification, as the compartmental models used to estimate the kinetic parameters are sensitive to noise. This paper describes a new post-reconstruction filter to increase the signal-to-noise ratio in dynamic PET imaging. It consists in a spatio-temporal robust diffusion of the 4D image based on the time activity curve (TAC) in each voxel. It reduces the noise in homogeneous areas while preserving the distinct kinetics in regions of interest corresponding to different underlying physiological processes. Neither anatomical priors nor the kinetic model are required. We propose an automatic selection of the scale parameter involved in the diffusion process based on a robust statistical analysis of the distances between TACs. The method is evaluated using Monte Carlo simulations of brain activity distributions. We demonstrate the usefulness of the method and its superior performance over two other post-reconstruction spatial and temporal filters. Our simulations suggest that the proposed method can be used to significantly increase the signal-to-noise ratio in dynamic PET imaging.

Structural and functional differences between 3-repeat and 4-repeat tau isoforms. Implications for normal tau function and the onset of neurodegenetative disease

Tau, MAP2, and MAP4 are members of a microtubule-associated protein (MAP) family that are each expressed as "3-repeat" and "4-repeat" isoforms. These isoforms arise from tightly controlled tissue-specific and/or developmentally regulated alternative splicing of a 31-amino acid long "inter-repeat:repeat module," raising the possibility that different MAP isoforms may possess some distinct functional capabilities. Consistent with this hypothesis, regulatory mutations in the human tau gene that disrupt the normal balance between 3-repeat and 4-repeat tau isoform expression lead to a collection of neurodegenerative diseases known as FTDP-17 (fronto-temporal dementias and Parkinsonism linked to chromosome 17), which are characterized by the formation of pathological tau filaments and neuronal cell death. Unfortunately, very little is known regarding structural and functional differences between the isoforms. In our previous analyses, we focused on 4-repeat tau structure and function. Here, we investigate 3-repeat tau, generating a series of truncations, amino acid substitutions, and internal deletions and examining the functional consequences. 3-Repeat tau possesses a "core microtubule binding domain" composed of its first two repeats and the intervening inter-repeat. This observation is in marked contrast to the widely held notion that tau possesses multiple independent tubulin-binding sites aligned in sequence along the length of the protein. In addition, we observed that the carboxyl-terminal sequences downstream of the repeat region make a strong but indirect contribution to microtubule binding activity in 3-repeat tau, which is in contrast to the negligible effect of these same sequences in 4-repeat tau. Taken together with previous work, these data suggest that 3-repeat and 4-repeat tau assume complex and distinct structures that are regulated differentially, which in turn suggests that they may possess isoform-specific functional capabilities. The relevance of isoform-specific structure and function to normal tau action and the onset of neurodegenerative disease are discussed.

A sparse matrix approach to the solubilization of overexpressed proteins

Many biophysical experiments depend on large amounts of pure, soluble protein. Indeed, the revolution in structural biology has depended on molecular biology's potential to make experiments possible by allowing the overexpression of normally rare proteins in a heterologous host. All too often, however, overexpressed proteins are poorly soluble in buffers that attempt to mimic physiological conditions. Often in such cases the overexpressed protein is assumed to be present in inclusion bodies and hopes of obtaining the desired sample from the overexpression vector are abandoned. We have developed a sparse matrix approach to the solubilization of such proteins that is often successful. This approach relies on well accepted theories of protein solubility and folding to build a sparse matrix that samples 'solubility space' effectively. The buffers of the sparse matrix are used to make crude extracts that are rapidly assayed for soluble protein using gel electrophoresis. We describe our approach and give examples of its application.

Mortality from pancreatic and lymphopoietic cancer among workers in ethylene and propylene chlorohydrin production

OBJECTIVES

A previous study reported a fivefold increase in mortality from pancreatic cancer and a threefold increase in lymphopoietic and haematopoietic cancer among 278 men who were assigned to a now dismantled Union Carbide chlorohydrin unit in the Kanawha Valley of West Virginia. There were also significant trends with duration of employment. The purpose of this study was to determine whether a comparable increased risk in mortality from pancreatic cancer and lymphopoietic and haematopoietic cancer occurred among male employees assigned to the Dow Chemical Company's ethylene and propylene chlorohydrin production processes.

METHODS

The cohort consisted of 1361 male employees who worked at the company's Freeport, Texas, Plaquemine, Louisiana or Midland, Michigan plants. Subjects were considered to have had a minimum of 30 days of workplace experience in 1940-92, in the ethylene chlorohydrin and propylene chlorohydrin process areas. These process areas were located within the ethylene oxide and propylene oxide production plants. A total of 300 deaths was observed to 31 December 1992.

RESULTS

The standardised mortality ratio (SMR) for all malignant neoplasms was 94 (95% CI 74 to 118). There was one pancreatic cancer death compared with 4.0 expected (SMR 25, 95% CI 1 to 140). There were 10 lymphopoietic and haematopoietic cancer deaths compared with 7.7 expected (SMR 129, 95% CI 62 to 238). Additional analyses, which examined location, production process, duration of employment, and a 25 year induction latency period, were not significant.

CONCLUSIONS

The results provide some assurance that the Dow Chemical cohort, to date, has not experienced increased risks of pancreatic cancer and lymphopoietic and haematopoietic cancer as previously reported in a different cohort of chlorohydrin workers. Possible reasons are discussed for the inconsistent findings between the two cohorts.

Cervical spine abnormalities in institutionalized adults with Down's syndrome

The prevalence of increased anterior atlanto-odontoid distance (AAOD), a risk factor for spinal cord compression, and degenerative disease of the cervical spine (DDCS) in a population of institutionalized adults with Down's syndrome (DS) was determined and compared with age- and sex-matched 'normals' presenting to a hospital emergency department. Radiographs of the cervical spines of 99 adults with DS and 198 'normals' were compared using a standardized rating scale. The prevalence of an AAOD of 3 mm or greater, the threshold of risk from the literature, was 8% for DS cases and 2% for controls (P < 0.01). The mean AAOD for DS cases was 2.0 +/- 1 mm and for controls 1.5 +/- 0.5 mm (P < 0.01). There was a negative correlation between AAOD and age of DS cases. The prevalence of any degree of DDCS among the DS cases was 64%, the controls 39% (P < 0.001); for moderate or severe DDCS the prevalence among DS cases was 45%, controls 12% (P < 0.001). The prevalence of DDCS increased with age in both groups, but the severity of DDCS was significantly increased with age in both groups, but the severity of DDCS was significantly greater for DS individuals in all age groups. The levels of the cervical spine affected ranged from C2 to C6; the most commonly affected level was C5-C6. While DS adults are at increased theoretical risk for spinal cord compression due to increased AAOD, its clinical significance would appear to be small and to decline with age.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of paracetamol and diflunisal for pain control following 3rd molar surgery

A double-blind randomised cross-over study to compare 2 regimes of paracetamol and diflunisal for postoperative pain relief following 3rd molar surgery was designed. 35 patients received one of the regimes at one visit and the alternative at the other visit. Both drugs, namely a single dose of 500 mg of diflunisal given preoperatively or 2 doses of 1000 mg of paracetamol, given preoperatively and 4 h postoperatively, produced adequate pain relief, without the need for supplementary analgesics during the 10-h test period. The differences in the mean overall pain scores in the 2 regimes were not statistically significant.