Multidimensional collaboration; reflections on action research in a clinical context

This paper reflects on the challenges and benefits of multidimensional collaboration in an action research study to evaluate and improve preoperative education for patients awaiting colorectal surgery. Three cycles of planning, acting,observing and reflecting were designed to evaluate practice and implement change in this interactive setting, calling for specific and distinct collaborations. Data collection includes: observing educational interactions; administering patient evaluation questionnaires; interviewing healthcare staff, patients and carers; patient and carer focus groups; and examining written and audiovisual educational materials. The study revolves around and depends on multi-dimensional collaborations. Reflecting on these collaborations highlights the diversity of perspectives held by all those engaged in the study and enhances the action research lessons. Successfully maintaining the collaborations recognises the need for negotiation, inclusivity, comprehension, brokerage,and problem-solving. Managing the potential tensions is crucial to the successful implementation of changes introduced to practice and thus has important implications for patients’ well-being. This paper describes the experiences from an action research project involving new and specific collaborations, focusing on a particular healthcare setting. It exemplifies the challenges of the collaborative action research process and examines how both researchers and practitioners might reflect on the translation of theory into educational practices within a hospital colorectal department. Despite its context-specific features, the reflections on the types of challenges faced and lessons learned provide implications for action researchers in diverse healthcare settings across the world

Cross sectional imaging of truncal and quadriceps muscles relates to different functional outcomes in cancer

Introduction: Following the consensus definition of cancer cachexia, more studies are using CT scan analysis of truncal muscles as a marker of muscle wasting. However, how CT-derived body composition relates to function, strength and power in patients with cancer is largely unknown. Aims: We aimed to describe the relationship between CT truncal (L3) skeletal muscle index (SMI) and MRI quadriceps cross sectional area with lower limb strength, power and measures of complex function. Methods: Patients undergoing assessment for potentially curative surgery for oesophagogastric or pancreatic cancer were recruited from the regional upper gastrointestinal (UGI) or hepatopancreaticobiliary (HPB) multi-disciplinary team meetings. Maximum Isometric Knee Extensor Strength (IKES) and Maximum Leg Extensor Power (Nottingham Power Rig) (LEP) were used as measures of lower limb performance. Both Sit to Stand (STS) and Timed Up and Go (TUG) were used as measures of global complex muscle function. Muscle SMI was measured from routine CT scans at the level of the third lumbar vertebrae (L3) and MRI scan was used for the assessment of quadriceps muscles. Linear regression analysis was performed for CT SMI or MRI quadriceps as a predictor of each measure of performance. Results: Forty-four patients underwent assessment. Height and weight were significantly related to function in terms of quadriceps power, while only weight was associated with strength (P < 0.001). CT SMI was not related to measures of quadriceps strength or power but had significant association with more complex functional measures (P = 0.006, R2 = 0.234 and 0.0019, R2 = 0.175 for STS and TUG respectively). In comparison, both gross and fat-subtracted measures of quadriceps muscle mass from MRI were significantly correlated with quadriceps strength and power (P < 0.001), but did not show any significant association with complex functional measures. Conclusion: CT SMI and MRI quadriceps have been shown to reflect different aspects of functional ability with CT SMI being a marker of global muscle function and MRI quadriceps being specific to quadriceps power and strength. This should therefore be considered when choosing outcome measures for trials or definitions of muscle mass and function

LSCluster, a large-scale sequence clustering and aligning software for use in partial identity mapping and splice-variant analysis

Many sequence analyses and multiple sequence alignment tools are widely used in biological research and are well described. However, large-scale proteome-wide analysis to identify potential splice-variants, describe the sequence differences compared to a progenitor sequence and cluster those sequences into individual groups for further analysis is a difficult task with the tools available, and a desktop-based, stand-alone search engine with the capabilities to align and cluster thousands of sequences and present the output in a deprecated format has been lacking. We have developed a novel software named LSCluster (Large-Scale CLUSTERing) which allows users to group tens of thousands of sequences based on sequence alignments or partial identity mapping, and can be used specifically for the detection of splicing variants and other pairs of sequences sharing identical fragments. One of the unique features of LSCluster is its ability to display the alignment output as a deprecated string thereby listing only differences in aligned sequences. The software (current version 2.0) is freely available through the PADB (Proteomic Analysis DataBase) initiative at www.PADB.org.<p></p> Biological significance: Large-scale proteome-wide analysis to identify potential splice-variants, describe the sequence differences compared to a progenitor sequence and cluster those sequences into individual groups for further analysis is a difficult task with the tools presently available. This work introduces a desktop-based, stand-alone search engine with the capabilities to align and cluster thousands of sequences and present the output in a deprecated format. We have developed a novel software named LSCluster (Large-Scale CLUSTERing) which allows users to group tens of thousands of sequences based on sequence alignments or partial identity mapping which can be used specifically for the detection of splicing variants and other pairs of sequences sharing identical fragments. One of the unique features of LSCluster is the ability to display the alignment output as a deprecated string listing only differences in aligned sequences. The software (current version 2.0) is freely available through the PADB (Proteomic Analysis DataBase) initiative at www.PADB.org.<p></p&gt

Metabolic response to feeding in weight-losing pancreatic cancer patients and its modulation by a fish-oil-enriched nutritional supplement

Weight-losing patients with advanced cancer often fail to gain weight with conventional nutritional support. This suboptimal response might be explained, in part, by an increased metabolic response to feeding. It has been suggested that eicosapentaenoic acid (EPA) can modify beneficially the metabolic response to cancer. The aim of the present study was to examine the metabolic response to feeding in cancer and the effects of an EPA-enriched oral food supplement on this response. A total of 16 weight-losing, non-diabetic patients with un resectable pancreatic adenocarcinoma and six healthy, weight-stable controls were studied by indirect calorimetry in the fasting and fed states. Body composition was estimated by bioimpedence analysis. Cancer patients were then given a fish- oil-enriched nutritional supplement providing 2 g of EPA and 2550 kJ daily, and underwent repeat metabolic study after 3 weeks of such supplementation. At baseline, resting energy expenditure whether expressed per kg body weight, lean body mass or body cell mass was significantly greater in the cancer patients compared with controls. Fat oxidation was significantly higher in the fasting state in cancer patients [median 1.26 g.kg(-1).min(-1) (interquartile range 0.95-1.38)] than in controls [0.76 g.kg(-1).min(-1) (0.62-0.92); P lt 0.05]. Over the 4 h feeding period, changes in insulin and glucose concentrations in cancer patients suggested relative glucose intolerance. In response to oral meal feeding, the percentage change in the area under the curve of energy expenditure was significantly lower in the cancer patients [median 7.9% (interquartile range 3.4-9.0)] than in controls [12.6% (9.9- 15.1); P lt 0.01]. After 3 weeks of the EPA-enriched supplement, the body weight of the cancer patients had increased and the energy expenditure in response to feeding had risen significantly [9.6% (6.3-12.4)], such that it was no different from baseline healthy control values. Similarly, fasting fat oxidation fell to 1.02 g.kg(-1).min(-1) (0.8-1.18), again no longer significantly different from baseline healthy control values. While weight-losing patients with advanced pancreatic cancer have an increased resting energy expenditure and increased fat oxidation, the energy cost of feeding is, in fact, reduced. Provision of a fish-oil-enriched nutritional supplement results in some normalization of the metabolic response in both the fasted and fed states, in association with an improvement in nutritional status

Simultaneous measurement of albumin and fibrinogen synthetic rates in normal fasted subjects

Albumin and fibrinogen synthesis appear to account for the majority of protein exported by the liver and therefore make a substantial contribution to that of whole-body protein synthesis. However, data on the protein syntheticrates of albumin and fibrinogen in normalsubjects are limited. Albumin and fibrinogensyntheticrates were measured simultaneously over a 120-min period in normalsubjects (n = 6) by using a flooding dose of <sup>2</sup>H<sub>5</sub>-phenylalanine. Tracer incorporation into proteins was measured by gas chromatography/mass spectrometry. Body mass index, circulating concentrations of insulin, albumin, fibrinogen, C-reactive protein, and plasma volumes of the subjects were all within the normal reference range. There was a small and transient rise in circulating insulin concentrations following the flooding dose of phenylalanine. The median fractional syntheticrate and absolute syntheticrate for albumin was 10.3%/d and 208 mg · kg<sup>−1</sup> · d<sup>−1</sup>, respectively. The median fractional syntheticrate and absolute syntheticrate for fibrinogen was 19.5%/d and 28 mg · kg<sup>−1</sup> · d<sup>−1</sup>. In the context of the current interest in manipulating the inflammatory response of patients with various disease states, we introduce the concept of an acute phase protein quotient (APPQ). The APPQ is defined as the absolute rate of fibrinogen synthesis divided by that of albumin. In this group of normalsubjects, the median APPQ was 0.14