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

Impact des contacts des sociétés complexes de l’est de la Méditerranée sur le développement de la société en Crète au cours de l’âge du Bronze

L’âge du Bronze, est une époque caractérisée par de nombreux et d’importants changements sociaux, particulièrement autour de la Méditerranée. La Crète fut l’une de ces régions où la société s’est transformée au cours de cette période. L’ampleur et la rapidité des bouleversements qui ont alors lieu s’expliquent peut-être par le rôle joué par certains facteurs externes, en particulier les contacts entre les populations de la Crète et celles de l’est de la Méditerranée. Malgré son insularité, la Crète n’est pas complètement isolée du reste de la Méditerranée puisque du matériel exogène y parvient dès le Néolithique, et peut-être même avant. Cela démontre donc que la Crète devait faire partie de certains réseaux de contacts dont l’importance a pris de l’ampleur au cours des premières périodes de l’âge du Bronze. Le matériel archéologique retrouvé en Crète, de même qu’ailleurs en Méditerranée orientale, permet de retracer ces réseaux de contacts et d’évaluer l’impact que ces échanges de biens, mais aussi de connaissances et d’idées, ont pu avoir sur les processus de transformation sociale qui ont conduit au développement des sociétés minoennes. Ces contacts ont alors pu mener à la mise en place de structures organisant les communautés, mais aussi de nombreuses innovations techniques qui auraient modifié et stimulé les productions artisanales de l’île à cette époque

Co-expression of BMPs and BMP-inhibitors in human fractures and non-unions

Bone morphogenetic proteins (BMPs) are increasingly being used clinically to enhance fracture repair and healing of non-unions. However, the potential efficacy of supraphysiological dosing for clinical results warrants further clarification of the BMP signaling pathway in human fracture healing. As BMP signaling can be fine-tuned at numerous levels, the role of BMP-inhibitors has become a major focus. The aim of the present study was to document co-expression of BMPs, pSmad 1/5/8, and BMP-inhibitors in human fracture callus and human non-unions. Using human tissue of fracture callus (n = 14) and non-unions (n = 4) we documented expression of BMPs (BMP2, BMP3 and BMP7), pSmad 1/5/8 and the BMP-inhibitors noggin, gremlin, chordin, Smad-6, Smad-7 and BAMBI. Co-expression of pSmad 1/5/8, BMPs and BMP-inhibitors was noted in the osteoblasts of fracture callus as well as of non-unions. Expression of BMP-inhibitors was generally stronger in non-unions than in fracture callus. The most pertinent differences were noted in the cartilaginous tissue components. Expression of BMP2 in chondrocytes was markedly decreased in non-unions compared to fracture callus and that of BMP7 was almost completely absent. Expression of BMP-inhibitors was almost the same in osteoblasts, chondrocytes and fibroblasts of fracture callus and well as in non-unions. Interestingly, although BMP ligands were present in the chondrocytes and fibroblasts of non-unions, they did not co-express pSmad 1/5/8 suggesting that BMP signaling may have been inhibited at some point before Smad 1/5/8 phosphorylation. These results suggest co-expression of BMP, pSmad 1/5/8 and BMP-inhibitors occurs in human fracture callus as well as non-unions but the relative expression of BMPs vs. BMP-inhibitors was different between these two tissue types. In contrast to our expectations, the expression of BMP inhibitors was comparable between fracture callus and non-unions, whereas the expression of BMPs was notably lower in the cartilaginous component of the non-unions in comparison to fracture callus. Based on these results, we believe that aberrations in the BMP-signaling pathway in the cartilaginous component of fracture healing could influence clinical fracture healing. An imbalance between the local presence of BMP and BMP-inhibitors may switch the direction towards healing or non-healing of a fracture. (C) 2012 Elsevier Inc. All rights reserve

BMP-9 expression in human traumatic heterotopic ossification: a case report

Background: Heterotopic ossification (HO) is defined as the abnormal formation of mature bone in soft tissue, notably skeletal muscle. The morbidity of HO in polytraumatized patients impacts the functional outcome, impairs rehabilitation, and increases costs due to subsequent surgical interventions. Case presentation: We present the case of a 34-year-old African male who developed severe HO around his right hip 11 days after a major trauma. Immunohistochemical analyses of resected tissue revealed that several BMPs were expressed in the HO, including highly osteogenic BMP-9. Conclusions: To the best of our knowledge, this is the first report of local BMP expression, notably BMP-9, in traumatic HO, and suggests that BMP-9, possibly through mrSCs, can contribute to HO formation in soft tissues when a suitable microenvironment is presen

Assessment of the Effect of Systemic Delivery of Sclerostin Antibodies on WNT Signaling in Distraction Osteogenesis Using Immunohistochemistry

Introduction Sclerostin is a known inhibitor of the WNT signaling pathway involved in osteogenesis, therefore when inactivated bone formation is stimulated. One of the potential ways of inactivation of this molecule is the sclerostin antibody injection. This antibody has been shown to improve fracture healing in the mouse model but to our knowledge its effect has not been studied in the context of distraction osteogenesis (DO). Objective The objective of this study was to determine the immunohistochemical effect of sclerostin antibody injection at various time points during bone formation in a wild-type mouse model of DO. Materials and Methods Tibial DO was conducted on a total of 24 wild type mice, which were then divided into 2 groups; saline injection group (control) and anti-sclerostin (Scl-Ab) injection group (treatment). The mice in the treatment group received 100mg/kg intravenous injections of the antibody weekly till sacrifice. The 12 mice in each group were subdivided into four time points according to time post-osteotomy for sacrifice, these were 11 days (mid-distraction), 17 days (late distraction), 34 days (mid-consolidation) and 51 days (late consolidation) with 3 mice per subgroup. The tibia specimens post-sacrifice were then collected for immunohistochemical analysis. Results Our results showed that the group injected with anti-sclerostin had an earlier peak (day 11) in the distraction phase of the osteogenic molecules involved in the WNT signaling pathway in comparison to the placebo group. In addition to the noted downregulation of the inhibitors of this pathway in the treatment group when compared with the placebo group. Also LRP-5 should a significant increase in expression in the treatment group. Conclusion Sclerostin inhibition has a significant effect on the DO process through its effect on the WNT pathway. This effect was evident through the decreased effect of sclerostin on LRP-5 and earlier upregulation of the osteogenic molecules involved in this pathway. Clinical Relevance This is the first report of the immunohistochemical effect of sclerostin antibody injection in DO, which could be a potential treatment modality to accelerate healing of the gap created during the process of DO, thus reducing the complications associated with this

Breast reconstruction and quality of life five years after cancer diagnosis: VICAN French National cohort

Purpose: Women with breast cancer (BC) who have a mastectomy may subsequently undergo breast reconstruction (BR). This study aimed to identify (1) factors associated with having BR, (2) factors associated with immediate BR (IBR) and delayed BR (DBR), and (3) associations between no BR, IBR and DBR and physical and mental quality of life (QoL) 5 years after diagnosis.Methods: Analyses were based on data from the national French cancer cohort VICAN, which followed a representative sample of cancer survivors, including BC survivors, for 5 years after diagnosis. BR and BR type (IBR/DBR) were identified using medico-administrative databases. The SF12 scale was used to measure mental and physical QoL. Multivariate logistic regressions were used to identify factors associated with BR, and linear models to evaluate associations between BR and BR type with QoL.Results: Of the 1192 BC survivors in VICAN, 32.6% (n = 388) had a mastectomy. Among them, 60.1% (n = 233) had BR. Of these, 38.6% (n = 90) and 61.4% (n = 143) had IBR and DBR, respectively. Compared with women who had BR, women who did not were more likely to be older and to have a lower level of health literacy. Compared with women who did not have BR, those with IBR had better mental QoL, while those who had either IBR or DBR had better physical QoL.Conclusion: Older women and those with inadequate health literacy were less likely to have BR. This may reflect women's preferences, inequalities in care options offered after a mastectomy, and socioeconomic barriers to accessing BR. These issues need further exploration. Furthermore, BR was associated with a better long-term physical QoL. IBR was associated with better mental QoL and should be promoted when possible

Average bone fill scores.

<p>Data is represented as a mean of Bone-fill scores, as blindly graded by radiological assessment.</p

Biomechanical testing results.

<p>Biomechanical testing parameters to compare HS-injected bones and saline-injected (control) bones at 34 days and 51 days post-osteotomy. For statistical analysis, a two-tailed un-paired t test was performed between the HS-injected group and controls, in which * indicates p<0.05.</p

Classification of Bone Fill Scores.

<p>Classification of Bone Fill Scores.</p

Frequency of post-operative complications.

<p>The frequency of infection and early euthanasia was increased in the HS-injected group compared to controls. For statistical analysis, a two-tailed un-paired t test was performed between the HS-injected group and controls, in which * indicates p<0.05.</p