Cancer Carepartners: Improving patients' symptom management by engaging informal caregivers

<p>Abstract</p> <p>Background</p> <p>Previous studies have found that cancer patients undergoing chemotherapy can effectively manage their own symptoms when given tailored advice. This approach, however, may challenge patients with poor performance status and/or emotional distress. Our goal is to test an automated intervention that engages a friend or family member to support a patient through chemotherapy.</p> <p>Methods/Design</p> <p>We describe the design and rationale of a randomized, controlled trial to assess the efficacy of 10 weeks of web-based caregiver alerts and tailored advice for helping a patient manage symptoms related to chemotherapy. The study aims to test the primary hypothesis that patients whose caregivers receive alerts and tailored advice will report less frequent and less severe symptoms at 10 and 14 weeks when compared to patients in the control arm; similarly, they will report better physical function, fewer outpatient visits and hospitalizations related to symptoms, and greater adherence to chemotherapy. 300 patients with solid tumors undergoing chemotherapy at two Veteran Administration oncology clinics reporting any symptom at a severity of ≥4 and a willing informal caregiver will be assigned to either 10 weeks of automated telephonic symptom assessment (ATSA) alone, or 10 weeks of ATSA plus web-based notification of symptom severity and problem solving advice to their chosen caregiver. Patients and caregivers will be surveyed at intake, 10 weeks and 14 weeks. Both groups will receive standard oncology, hospice, and palliative care.</p> <p>Discussion</p> <p>Patients undergoing chemotherapy experience many symptoms that they may be able to manage with the support of an activated caregiver. This intervention uses readily available technology to improve patient caregiver communication about symptoms and caregiver knowledge of symptom management. If successful, it could substantially improve the quality of life of veterans and their families during the stresses of chemotherapy without substantially increasing the cost of care.</p> <p>Trial Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00983892">NCT00983892</a></p

Steps to improve gender diversity in the fields of coastal geosciences and engineering

Robust data are the base of effective gender diversity policy. Evidence shows that gender inequality is still pervasive in science, technology, engineering and mathematics (STEM). Coastal geoscience and engineering (CGE) encompasses professionals working on coastal processes, integrating expertise across physics, geomorphology, engineering, planning and management. The article presents novel results of gender inequality and experiences of gender bias in CGE, and proposes practical steps to address it. It analyses the gender representation in 9 societies, 25 journals, and 10 conferences in CGE and establishes that women represent 30% of the international CGE community, yet there is under-representation in prestige roles such as journal editorial board members (15% women) and conference organisers (18% women). The data show that female underrepresentation is less prominent when the path to prestige roles is clearly outlined and candidates can self-nominate or volunteer instead of the traditional invitation-only pathway. By analysing the views of 314 survey respondents (34% male, 65% female, and 1% ‘‘other’’), we show that 81% perceive the lack of female role models as a key hurdle for gender equity, and a significantly larger proportion of females (47%) felt held back in their careers due to their gender in comparison with males (9%). The lack of women in prestige roles and senior positions contributes to 81% of survey respondents perceiving the lack of female role models in CGE as a key hurdle for gender equality. While it is clear that having more women as role models is important, this is not enough to effect change. Here seven practical steps towards achieving gender equity in CGE are presented: (1) Advocate for more women in prestige roles; (2) Promote high-achieving females; (3) Create awareness of gender bias; (4) Speak up; (5) Get better support for return to work; (6) Redefine success; and, (7) Encourage more women to enter the discipline at a young age. Some of these steps can be successfully implemented immediately (steps 1–4), while others need institutional engagement and represent major societal overhauls. In any case, these seven practical steps require actions that can start immediately

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Mycobacterial and nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus infection: A prospective, cohort study

<p>Abstract</p> <p>Background</p> <p>A prospective observational study was done to describe nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus (HIV) infection.</p> <p>Methods</p> <p>The study included 1,225 consecutive hospital admissions of 599 HIV-infected patients treated from April 1995 through March 1998. Data included demographics, risk factors for HIV infection, Acute Physiology and Chronic Health Evaluation (APACHE) II score, pulmonary complications, CD4⁺ lymphocyte count, hospital stay and case-fatality rate.</p> <p>Results</p> <p>Patient age (mean ± SD) was 38.2 ± 8.9 years, 62% were men, and 84% were African American. The median APACHE II score was 14, and median CD4⁺ lymphocyte count was 60/μL. Pulmonary complications were <it>Pneumocystis carinii</it> pneumonia (85) in 78 patients, <it>Mycobacterium avium</it> complex (51) in 38, <it>Mycobacterium tuberculosis</it> (40) in 35, <it>Mycobacterium gordonae</it> (11) in 11, <it>Mycobacterium kansasii</it> (10) in 9, <it>Cytomegalovirus</it> (10) in 10, <it>Nocardia asteroides</it> (3) in 3, fungus ball (2) in 2, respiratory syncytial virus (1), herpes simplex virus (1), <it>Histoplasma capsulatum</it> (1), lymphoma (3) in 3, bronchogenic carcinoma (2) in 2, and Kaposi sarcoma (1). The case-fatality rate of patients was 11% with <it>Pneumocystis carinii</it> pneumonia; 5%, <it>Mycobacterium tuberculosis</it>; 6%, <it>Mycobacterium avium</it> complex; and 7%, noninfectious pulmonary complications.</p> <p>Conclusion</p> <p>Most pulmonary complications in hospitalized patients with HIV are from <it>Pneumocystis</it> and mycobacterial infection.</p