Perceptions and Practices of Key Worker Stakeholder Groups in Hospital Animal- Assisted Intervention Programs on Occupational Benefits and Perceived Risks

Background: Animal-assisted intervention (AAI) programs, used widely for patient benefit, have increasingly been used for healthcare workers (HCW) to reduce occupational stress. However, there are barriers to these programs which limit their utilization, for both patients and HCW, specifically infectious disease concerns. The aim of the research project is to identify barriers and facilitators to AAI program use for healthcare worker benefit, and determine knowledge, beliefs, and practices regarding infectious disease risk and control policies, in order to understand the contextual parameters of program implementation. Methods: We collected perceptions of key stakeholders involved with hospital AAI programs (HCW and AAI workers) through semi-structured in-depth interviews. We used framework analysis to guide thematic coding, completed independently by three researchers. Results: We interviewed 37 participants in this study. We divided our themes into two topic areas: program use for HCW and perceived infectious disease risk. Use for healthcare workers included perspectives on the benefits for HCW and program barriers and facilitators (specifically collaboration and leadership). Perceived risk included opinions on infection concerns with AAI, thoughts on control measures to reduce this risk, and responsibility for safety during these programs. Conclusions: While significant benefits were reported for HCW, they were limited by administrative barriers and hazard concerns. Facilitators to surmount these barriers are best implemented with collaboration across the hospital and appropriate leadership roles to direct safe program implementation. By addressing these barriers through targeted facilitators in the form of evidence-backed guidelines, AAI programs can be used to benefit both patients and HCW

Microbial sharing between pediatric patients and therapy dogs during hospital animal-assisted intervention programs

Microbial sharing between humans and animals has been demonstrated in a variety of settings. However, the extent of microbial sharing that occurs within the healthcare setting during animal-assisted intervention programs is unknown. Understanding microbial transmission between patients and therapy dogs can provide important insights into potential health benefits for patients, in addition to addressing concerns regarding potential pathogen transmission that limits program utilization. This study evaluated for potential microbial sharing between pediatric patients and therapy dogs and tested whether patient-dog contact level and a dog decolonization protocol modified this sharing. Patients, therapy dogs, and the hospital environment were sampled before and after every group therapy session and samples underwent 16S rRNA sequencing to characterize microbial communities. Both patients and dogs experienced changes in the relative abundance and overall diversity of their nasal microbiome, suggesting that the exchange of microorganisms had occurred. Increased contact was associated with greater sharing between patients and therapy dogs, as well as between patients. A topical chlorhexidine-based dog decolonization was associated with decreased microbial sharing between therapy dogs and patients but did not significantly affect sharing between patients. These data suggest that the therapy dog is both a potential source of and a vehicle for the transfer of microorganisms to patients but not necessarily the only source. The relative contribution of other potential sources (e.g., other patients, the hospital environment) should be further explored to determine their relative importance

Bone Mineral Density after Bone Marrow Transplantation in Childhood: Measurement and Associations

This study examined the bone mineral density (BMD) of 46 (median age 16.3, 8-29) survivors of autologous and allogeneic bone marrow transplantation (BMT). Areal (g/m2) BMD was acquired with dual energy x-ray absorptiometry and volumetric (g/cm3) BMD values were calculated. Abnormal BMD was identified in 24% (11/46) of survivors with areal measures and 22% (10/46) with volumetric measures. Comparison of areal and volumetric BMD revealed the measures were highly correlated (r = 0.73, p<0.001) but clinical diagnosis of osteopenia/osteoporosis were not consistent. Volumetric z-scores were higher for 7/8 of the survivors who were < 3rd percentile for height. Associations of BMD and body composition and disease and treatment factors were assessed with multiple linear regression. When controlling for other significant associations and cumulative steroid dose, the body composition measure of fat mass index (FMI) was associated with higher volumetric BMD z-scores (CI: 0.006, 0.193; p = 0.037). CNS irradiation (CI: -1.710,-0.200; p = 0.015), age at time of testing (CI: -0.116, -0.024; p = 0.004) and female sex (CI: -1.375, -0.155; p = 0.015) were associated with lower volumetric BMD z-scores. Conclusions: Childhood BMT survivors are at risk for diminished BMD. Areal and volumetric DEXA derived measures of BMD are highly correlated and volumetric measures may correct for underestimation of BMD in BMT survivors who are small for age. Survivors who received CNS irradiation, are older and female may be at greater risk for diminished BMD while fat mass is associated with higher BMD in childhood BMT survivors

Orthostatic intolerance in survivors of childhood cancer

Purpose: To compare the prevalence and severity of orthostatic intolerance in survivors of childhood cancer and in healthy controls, and to correlate results of self-reported measures of health status with orthostatic testing in survivors of childhood cancer. Patient and methods: Thirty-nine survivors of childhood cancer and 56 controls were recruited for this study Each cancer survivor completed standardised self-report measures and all participants underwent a standing test (5 min supine, 10 min of motionless standing leaning against a wall, followed by another 2 min supine). The main outcomes of the standing test were orthostatic tachycardia (OT), defined as a heart rate increase of at least 30 beats per minute (bpm) during standing, and neurally mediated hypotension (NMH), defined as a drop in systolic blood pressure of at least 25 mm Hg. Results: OT developed in 22/39 (56%) cancer survivors versus 17/56 (30%) controls (P = .01). Cancer survivors had a higher baseline and maximum standing heart rate (both P <.001) and a more rapid onset of significant OT (P = .005). No significant difference in scores on self-report measures was found between cancer survivors with or without OT. Conclusion: This study provides preliminary evidence of a higher rate of orthostatic intolerance in childhood cancer survivors. Further study is warranted to better define whether this is a modifiable risk factor for fatigue in this population, and how orthostatic intolerance interacts with other known risk factors for lowered quality of life. (c) 2007 Elsevier Ltd. All rights reserved

Late hepatic toxicity surveillance for survivors of childhood, adolescent and young adult cancer: Recommendations from the international late effects of childhood cancer guideline harmonization group

Background: Survivors of childhood, adolescent and young adult (CAYA) cancer may develop treatment-induced chronic liver disease. Surveillance guidelines can improve survivors’ health outcomes. However, current recommendations vary, leading to uncertainty about optimal screening. The International Late Effects of Childhood Cancer Guideline Harmonization Group has developed recommendations for the surveillance of late hepatotoxicity after CAYA cancer. Methods: Evidence-based methods based on the GRADE framework were used in guideline development. A multidisciplinary guideline panel performed systematic literature reviews, developed evidence summaries, appraised the evidence, and formulated recommendations on the basis of evidence, clinical judgement, and consideration of benefits versus the harms of the surveillance while allowing for flexibility in implementation across different health care systems. Results: The guideline strongly recommends a physical examination and measurement of serum liver enzyme concentrations (ALT, AST, gGT, ALP) once at entry into long-term follow-up for survivors treated with radiotherapy potentially exposing the liver (moderate- to high-quality evidence). For survivors treated with busulfan, thioguanine, mercaptopurine, methotrexate, dactinomycin, hematopoietic stem cell transplantation (HSCT), or hepatic surgery, or with a history of chronic viral hepatitis or sinusoidal obstruction syndrome, similar surveillance for late hepatotoxicity once at entry into LTFU is reasonable (low-quality evidence/expert opinion, moderate recommendation). For survivors who have undergone HSCT and/or received multiple red blood cell transfusions, surveillance for iron overload with serum ferritin is strongly recommended once at long-term follow-up entry. Conclusions: These evidence-based, internationally-harmonized recommendations for the surveillance of late hepatic toxicity in cancer survivors can inform clinical care and guide future research of health outcomes for CAYA cancer survivors