Depression is associated with some patient-perceived cosmetic changes, but not with radiotherapy-induced late toxicity, in long-term breast cancer survivors.: Depression-associated factors in long-term breast cancer survivors

International audienceOBJECTIVE: Although depression is prevalent in long-term breast cancer survivors (LTBCS; ≥5 years since diagnosis), it is underdiagnosed and undertreated. A better understanding of factors associated with depression could improve depression screening, treatment, and prevention in this population. Our study aimed to assess the link between patient and doctor ratings of breast cosmetic outcomes, late radiotherapy toxicity, and depression in LTBCS. METHODS: In all, 214 patients recruited from the ARCOSEIN study were assessed for late radiotherapy toxicity (by using the LENT-SOMA scale) and patient and doctor ratings of breast cosmetic outcomes (mean = 6.7 years since the end of treatment). We reassessed 120 of these patients for depression (HAD) during a second wave of long-term assessment (mean = 8.1 years since the end of treatment). We used univariate analyses and polytomous logistic regression analyses to predict the HAD depression, which was defined as follows: normal, 0-7 points; and significant depression, ≥8 points (8-10 points, possible depression; ≥11 points, probable depression). RESULTS: The mean HAD depression score was 4.5 ± 3.6. 19. 2% of our population had significant depression, 6.7% with probable depression, and 12.5% with possible depression. Significant depression was not associated with late radiotherapy toxicity or initial cancer-related variables. Patients with probable depression reported worse cosmetic outcomes than nondepressed patients in terms of perceived breast largeness (p = 0.04), breast deformation (p = 0.02), and changes in skin pigmentation (p = 0.03). CONCLUSIONS: In LTBCS, depression seems to be more strongly associated with changes in some patients' perceived breast cosmetic outcome than late treatment toxicity or initial cancer-related variables. Copyright © 2012 John Wiley & Sons, Ltd

Evaluation of the impact of interdisciplinarity in cancer care

<p>Abstract</p> <p>Background</p> <p>Teamwork is a key component of the health care renewal strategy emphasized in Quebec, elsewhere in Canada and in other countries to enhance the quality of oncology services. While this innovation would appear beneficial in theory, empirical evidences of its impact are limited. Current efforts in Quebec to encourage the development of local interdisciplinary teams in all hospitals offer a unique opportunity to assess the anticipated benefits. These teams working in hospital outpatient clinics are responsible for treatment, follow-up and patient support. The study objective is to assess the impact of interdisciplinarity on cancer patients and health professionals.</p> <p>Methods/Design</p> <p>This is a quasi-experimental study with three comparison groups distinguished by intensity of interdisciplinarity: strong, moderate and weak. The study will use a random sample of 12 local teams in Quebec, stratified by intensity of interdisciplinarity. The instrument to measure the intensity of the interdisciplinarity, developed in collaboration with experts, encompasses five dimensions referring to aspects of team structure and process. Self-administered questionnaires will be used to measure the impact of interdisciplinarity on patients (health care utilization, continuity of care and cancer services responsiveness) and on professionals (professional well-being, assessment of teamwork and perception of teamwork climate). Approximately 100 health professionals working on the selected teams and 2000 patients will be recruited. Statistical analyses will include descriptive statistics and comparative analysis of the impact observed according to the strata of interdisciplinarity. Fixed and random multivariate statistical models (multilevel analyses) will also be used.</p> <p>Discussion</p> <p>This study will pinpoint to what extent interdisciplinarity is linked to quality of care and meets the complex and varied needs of cancer patients. It will ascertain to what extent interdisciplinary teamwork facilitated the work of professionals. Such findings are important given the growing prevalence of cancer and the importance of attracting and retaining health professionals to work with cancer patients.</p

Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure

Background and aimsHeart failure (HF) programs successfully reduce 30-day readmissions. However, conflicting data exist about its sustained effects afterwards and its impact on mortality. We evaluated whether the impact of a new nurse-led coordinated transitional HF program extends to longer periods of time, including 90 and 180 days after discharge. Methods and resultsWe designed a natural experiment to undertake a pragmatical evaluation of the implementation of the program. We compared outcomes between patients discharged with HF as primary diagnosis in Period #1 (pre-program; Jan 2017-Aug 2017) and those discharged during Period #2 (HF program; Sept 2017-Jan 2019). Primary endpoint was the composite of all-cause death or all-cause hospitalization 90 and 180 days after discharge. 440 patients were enrolled: 123 in Period #1 and 317 in Period #2. Mean age was 75 +/- 9 years. There were more females in Period #2 (p = 0.025), with no other significant differences between periods. The primary endpoint was significantly reduced in the HF program group, at 90 [adjusted OR 0.31 (0.18-0.53), p <0.001] and at 180 days [adjusted OR 0.18 (CI 0.11-0.32), p <0.001]. Such a decrease was due to a reduction in cardiovascular (CV) and HF hospitalization. All-cause death was reduced when a double check discharge planning was implanted compared to usual care [0 (0%) vs. 7 (3.8%), p = 0.022]. ConclusionA new nurse-led coordinated transitional bundle of interventions model reduces the composite endpoint of all-cause death and all-cause hospitalization both at 90 and 180 days after a discharge for HF, also in high-risk populations. Such a decrease is driven by a reduction of CV and HF hospitalization. Reduction of all-cause mortality was also observed when the full model including a more exhaustive discharge planning process was implemented

Child and adolescent psychiatric patients and later criminality

<p>Abstract</p> <p>Background</p> <p>Sweden has an extensive child and adolescent psychiatric (CAP) research tradition in which longitudinal methods are used to study juvenile delinquency. Up to the 1980s, results from descriptions and follow-ups of cohorts of CAP patients showed that children's behavioural disturbances or disorders and school problems, together with dysfunctional family situations, were the main reasons for families, children, and youth to seek help from CAP units. Such factors were also related to registered criminality and registered alcohol and drug abuse in former CAP patients as adults. This study investigated the risk for patients treated 1975–1990 to be registered as criminals until the end of 2003.</p> <p>Methods</p> <p>A regional sample of 1,400 former CAP patients, whose treatment occurred between 1975 and 1990, was followed to 2003, using database-record links to the Register of Persons Convicted of Offences at the National Council for Crime Prevention (NCCP).</p> <p>Results</p> <p>Every third CAP patient treated between 1975 and 1990 (every second man and every fifth woman) had entered the Register of Persons Convicted of Offences during the observation period, which is a significantly higher rate than the general population.</p> <p>Conclusion</p> <p>Results were compared to published results for CAP patients who were treated between 1953 and 1955 and followed over 20 years. Compared to the group of CAP patients from the 1950s, the results indicate that the risk for boys to enter the register for criminality has doubled and for girls, the risk seems to have increased sevenfold. The reasons for this change are discussed. Although hypothetical and perhaps speculative this higher risk of later criminality may be the result of lack of social control due to (1) rising consumption of alcohol, (2) changes in organisation of child social welfare work, (3) the school system, and (4) CAP methods that were implemented since 1970.</p

Occlusion and Slice-Based Volume Rendering Augmentation for PET-CT

Dual-modality positron emission tomography and computed tomography (PET-CT) depicts pathophysiological function with PET in an anatomical context provided by CT. Three-dimensional volume rendering approaches enable visualization of a two-dimensional slice of interest (SOI) from PET combined with direct volume rendering (DVR) from CT. However, because DVR depicts the whole volume, it may occlude a region of interest, such as a tumor in the SOI. Volume clipping can eliminate this occlusion by cutting away parts of the volume, but it requires intensive user involvement in deciding on the appropriate depth to clip. Transfer functions that are currently available can make the regions of interest visible, but this often requires complex parameter tuning and coupled pre-processing of the data to define the regions. Hence, we propose a new visualization algorithm where a SOI from PET is augmented by volumetric contextual information from a DVR of the counterpart CT so that the obtrusiveness from the CT in the SOI is minimized. Our approach automatically calculates an augmentation depth parameter by considering the occlusion information derived from the voxels of the CT in front of the PET SOI. The depth parameter is then used to generate an opacity weight function that controls the amount of contextual information visible from the DVR. We outline the improvements with our visualization approach compared to other slice-based and our previous approaches. We present the preliminary clinical evaluation of our visualization in a series of PET-CT studies from patients with non-small cell lung cancer

Record keeping : self-reported attitudes, knowledge and practice behaviours of nurses in selected Cape Town hospitals

Background: South African law holds nurses accountable for their acts and omissions and all documentation pertaining to patient care may serve as evidence in a court of law or at South African Nursing Council (SANC) hearings. Documentation can confirm or refute negligence and therefore should be an accurate and current reflection of what happened to the patient, particularly as litigation often arises long after care was rendered. Objective: To describe the self-reported attitudes towards, knowledge of and practice behaviours of nurses, and the association between these factors and selected variables (category of nurse, gender, hospital sector, years of experience after registration/enrolment, day/night shift and practice discipline) relative to record keeping. Methods: A quantitative, non-experimental study design, using a cross-sectional survey method to describe attitudes, knowledge and practice behaviour against predetermined measurement scales. Stratified random sampling and a questionnaire was used, with a 52.54% (186/354) response rate. Logistic regression models were fitted to determine factors associated with attitudes, knowledge and practice behaviour, fitted as binary dependent variables, each in a separate model. Strength of association was expressed as an odds ratio (OR), and a p-value of 0.05% was considered significant. Setting: Three tertiary Government hospitals and three Private hospitals in the Cape Town Metropole, South Africa. Findings: Demographically, the sample consisted of 92 Registered Nurses (RNs), 42 Enrolled Nurses (ENs) and 50 Enrolled Nursing Auxiliaries (ENAs) of which 94.62% (n=176) were female and 4.30% (n=8) male. The mean age of all respondents were 42.26 years (range 23 to 64) while 48.92% (n=91) of the respondents had more than 15 years of experience after registration/enrolment. Of the 186 respondents, 54.85% (n=102) worked in Government Hospitals, comprising 53 (51.96%) RNs, 25 (24.51%) ENs and 22 (21.57%) ENAs. The 45.16% (n=84) Private Hospital respondents consisted of 39 (46.43%) RNs, 17 (20.24%) ENs and 28 (33.33%) ENAs. Most respondents (18.82%, n=35) worked in Surgical Units and on day duty (70.43%, n=131). A predominantly positive self-reported attitude towards record keeping was evident (71.74%, n=132/184). The negative attitude ratio in the Private sector (58.49%, n=31/53) was larger than in the Government sector (41.51%, n=22/53) (OR=2.049, 95% CI=1.043-4.025, p=0.037). A larger ratio of respondents working day duty reported a negative attitude (60.00%, n=30/50), compared to those working night duty (40.00%, n=20/50) (OR=2.171, 95% CI=1.066-4.423, p=0.033). Although adequate knowledge levels relative to record keeping were reported by the majority of respondents (74.86%, n=137/183), there were some knowledge deficits. Inadequate knowledge level ratios were more evident amongst ENAs (45.65%, n=21/46) when compared to RNs (30.43%, n=14/46) (OR=4.179, 95% CI=1.873- 9.321, p=0.000). Similarly, acceptable levels of self-reported record keeping practice behaviour were evident amongst the majority of respondents (68.31%, n=125/183). A higher ratio of unacceptable practice behaviour was reported by RNs (39.66%, n=23/58) when compared to ENs (34.48%, n=20/58) (OR=2.727, 95% CI=1.266-5.877, p=0.010). The most prominent practice behaviours reported by respondents included making use of a combination of record keeping approaches when keeping records, having regular record keeping audits, having sufficient supervision relative to record keeping, reading what other nurses have written and nurses writing in the progress notes themselves. The three top ranked barriers to effective record keeping were interruptions while keeping records, insufficient time to effectively keep records and a lack of confidence in the ability to keep accurate records. Conclusion: Although respondents, particularly RNs, reported predominantly positive attitudes towards, adequate knowledge of and acceptable practice behaviour relative to record keeping, there are concerns that the deficiencies amongst ENs and ENAs may have serious implications for patient safety for both the Government and Private Health sectors. Significance to clinical practice: Deficiencies relative to record keeping attitudes, knowledge and practice behaviours were identified. The identified deficiencies could be used to implement record keeping improvement strategies