An exploratory randomised controlled trial comparing telephone and hospital follow-up after treatment for colorectal cancer

Aim:  Following treatment for colorectal cancer it is common practice for patients to attend hospital clinics at regular intervals for routine monitoring, although debate persists on the benefits of this approach. Nurse-led telephone follow-up is effective in meeting information and psycho-social needs in other patient groups. We explored the potential benefits of nurse-led telephone follow-up for colorectal cancer patients. Method:  Sixty-five patients were randomised to either telephone or hospital follow-up in an exploratory randomised trial. Results:  The telephone intervention was deliverable in clinical practice and acceptable to patients and health professionals. Seventy-five percent of eligible patients agreed to randomization. High levels of satisfaction were evident in both study groups. Appointments in the hospital group were shorter (median 14.0 minutes) than appointments in the telephone group (median 28.9 minutes). Patients in the telephone arm were more likely to raise concerns during consultations. Conclusion:  Historical approaches to follow-up unsupported by evidence of effectiveness and efficiency are not sustainable. Telephone follow-up by specialist nurses may be a feasible option. A main trial comparing hospital and telephone follow-up is justified although consideration needs to be given to trial design and practical issues related to the availability of specialist nurses at study locations

Comparing hospital and telephone follow-up after treatment for breast cancer: randomised equivalence trial

Objective To compare traditional hospital follow-up with telephone follow-up by specialist nurses after treatment for breast cancer. Design A two centre randomised equivalence trial in which women remained in the study for a mean of 24 months. Setting Outpatient clinics in two NHS hospital trusts in the north west of England Participants 374 women treated for breast cancer who were at low to moderate risk of recurrence. Interventions Participants were randomised to traditional hospital follow-up (consultation, clinical examination, and mammography as per hospital policy) or telephone follow-up by specialist nurses (consultation with structured intervention and mammography according to hospital policy). Main outcome measures Psychological morbidity (state-trait anxiety inventory, general health questionnaire (GHQ-12)), participants’ needs for information, participants’ satisfaction, clinical investigations ordered, and time to detection of recurrent disease. Results The 95% confidence interval for difference in mean state-trait scores adjusted for treatment received (−3.33 to 2.07) was within the predefined equivalence region (−3.5 to 3.5). The women in the telephone group were no more anxious as a result of foregoing clinic examinations and face-to-face consultations and reported higher levels of satisfaction than those attending hospital clinics (intention to treat P<0.001). The numbers of clinical investigations ordered did not differ between groups. Recurrences were few (4.5%), with no differences between groups for time to detection (median 60.5 (range 37-131) days in hospital group v 39.0 (10-152) days in telephone group; P=0.228). Conclusions Telephone follow-up was well received by participants, with no physical or psychological disadvantage. It is suitable for women at low to moderate risk of recurrence and those with long travelling distances or mobility problems and decreases the burden on busy hospital clinics

Being Healthy: a Grounded Theory Study of Help Seeking Behaviour among Chinese Elders living in the UK

The health of older people is a priority in many countries as the world’s population ages. Attitudes towards help seeking behaviours in older people remain a largely unexplored field of research. This is particularly true for older minority groups where the place that they have migrated to presents both cultural and structural challenges. The UK, like other countries,has an increasingly aging Chinese population about who relatively little is known. This study used a qualitative grounded theory design following the approach of Glaser (1978). Qualitative data were collected using semi-structured interviews with 33 Chinese elders who were aged between 60 and 84, using purposive and theoretical sampling approaches. Data were analysed using the constant comparative method until data saturation occurred and a substantive theory was generated. ‘Being healthy’ (the core category) with four interrelated categories: self-management, normalizing/minimizing, access to health services, and being cured form the theory. The theory was generated around the core explanations provided by participants and Chinese elders’ concerns about health issues they face in their daily life. We also present data about how they direct their health-related activities towards meeting their physical and psychological goals of being healthy. Their differential understanding of diseases and a lack of information about health services were potent predictors of non�help seeking and ‘self’ rather than medical management of their illnesses. This study highlights the need for intervention and health support for Chinese elders

What do measures of patient satisfaction with the doctor tell us?

Objective: To gain an understanding of how patient satisfaction (PS) with the doctor (PSD) is conceptualized through an empirical review of how it is currently being measured. The content of PS questionnaire items was examined to (a) determine the primary domains underlying PSD, and (b) summarize the specific doctor-related characteristics and behaviors, and patient-related perceptions, composing each domain. Methods: A scoping review of empirical articles that assessed PSD published from 2000 to November 2013. MEDLINE and PsycINFO databases were searched. Results: The literature search yielded 1726 articles, 316 of which fulfilled study inclusion criteria. PSD was realized in one of four health contexts, with questions being embedded in a larger questionnaire that assessed PS with either: (1) overall healthcare, (2) a specific medical encounter, or (3) the healthcare team. In the fourth context, PSD was the questionnaire's sole focus. Five broad domains underlying PSD were revealed: (1) Communication Attributes; (2) Relational Conduct; (3) Technical Skill/Knowledge; (4) Personal Qualities; and (5) Availability/Accessibility. Conclusions: Careful consideration of measurement goals and purposes is necessary when selecting a PSD measure. Practice implications: The five emergent domains underlying PSD point to potential key areas of physician training and foci for quality assessment

Assessing B Cell Differentiation Following Asbestos Fiber Exposure

B cells are the main pathogenesis drivers in autoimmune diseases. Subtypes of B cells, known as B regulatory (Breg) or B10 cells contain a suppressive function, which down regulates the immune response. This is primarily conducted by IL-10, which is an inhibitory cytokine that is produced by the B10 subset. Recent evidence indicates that exposure to different asbestos fiber cause the activation of the immune system, however there is a difference in the response created by each fiber type. The Libby amphibole (LA) fiber leads to autoimmune response, whereas Chrysotile (Chry) fiber exposure does not. We hypothesize that this difference occurs because Chry exposure increases the production of B10 cell to keep the immune system suppressed. To test this, we will collect mouse splenocytes and expose the cells to the different asbestos fibers for 48 or 96 hours. As a control, the splenocytes will be exposed to the proteins, BAFF or IL-21. These proteins have been shown to stimulate proliferation of B10 cells. Next, we will use antibodies against cell surface markers and flow cytometry in order to identify B cell subtypes. Thus, we can investigate B cell differentiation, with the hypothesis that LA will decrease Breg differentiation, whereas Chry will increase Breg differentiation. This investigation will increase our understanding of how different asbestos fibers induce Breg production

Assessing the Free Radical Scavenging Ability and Antioxidant Efficiency of a Synthetic Flaxseed Lignan in an Asbestos Exposure Model

Asbestos exposure is known to cause pleural fibrosis, asbestosis, and other respiratory conditions, as well as systemic autoimmune disease (SAID). In order to help treat/prevent such illnesses, we are investigating the therapeutic potential of LGM2605, a synthetic derivative of the flaxseed lignan secoisolariciresinol diglucoside (SDG). This drug is an antioxidant and free radical scavenger which may block early immune responses (i.e. inflammation) observed with asbestos exposure. Studies have shown that mesothelial cells act as key regulators of inflammation through activation of the NLRP-3 inflammasome and the production of pro-inflammatory cytokines. Thus, we predicted that LGM2605 may help reduce these activities. We performed several DCFDA ROS assays comparing the production of reactive oxygen species (ROS) in mesothelial cells exposed to various asbestos fiber types. We found that Libby Amphibole (LA) fibers yield the highest level of ROS activity, suggesting higher levels of inflammasome activation and pathogenicity. Next, we performed additional ROS assays to determine the effects of LGM2605 treatment. We found that LGM2605 reduces ROS production in mesothelial cells exposed to asbestos fibers, which we suspect may also reduce inflammasome activation. Subsequent investigation will determine the effects of LGM2605 treatment in mice that have been exposed to LA through intraperitoneal injection

Plasminogen Binding and Activation at the Mesothelial Cell Surface Promotes Invasion through a Collagen Matrix

Plasminogen (Plg) activation to the serine protease plasmin (Pla) plays a key role in regulating wound healing and fibrotic responses, particularly when bound to cell surface receptors. Our previous work suggested that mesothelial cells bind Plg at the cell surface, though no Plg receptors were described for these cells. Since mesothelial cells contribute to injury responses, including cellular differentiation to a mesenchymal-like phenotype and extracellular matrix remodeling, we hypothesized that Plg binding would promote these responses. Here, we confirm that Plg binds to both pleural and peritoneal mesothelial cells via the lysine-binding domain present in Plg, and we demonstrate the presence of three Plg receptors on the mesothelial cell surface: &alpha;-Enolase, Annexin A2, and Plg-RKT. We further show that bound-Plg is activated to Pla on the cell surface and that activation is blocked by an inhibitor of urokinase plasminogen activator or by the presence of animal-derived FBS. Lastly, we demonstrate that Plg promotes mesothelial cell invasion through a type I collagen matrix but does not promote cellular differentiation or proliferation. These data demonstrate for the first time that mesothelial cells bind and activate Plg at the cell surface and that active Pla is involved in mesothelial cell invasion without cell differentiation

Autoimmunity and Asbestos Exposure

Despite a body of evidence supporting an association between asbestos exposure and autoantibodies indicative of systemic autoimmunity, such as antinuclear antibodies (ANA), a strong epidemiological link has never been made to specific autoimmune diseases. This is in contrast with another silicate dust, crystalline silica, for which there is considerable evidence linking exposure to diseases such as systemic lupus erythematosus, systemic sclerosis, and rheumatoid arthritis. Instead, the asbestos literature is heavily focused on cancer, including mesothelioma and pulmonary carcinoma. Possible contributing factors to the absence of a stronger epidemiological association between asbestos and autoimmune disease include (a) a lack of statistical power due to relatively small or diffuse exposure cohorts, (b) exposure misclassification, (c) latency of clinical disease, (d) mild or subclinical entities that remain undetected or masked by other pathologies, or (e) effects that are specific to certain fiber types, so that analyses on mixed exposures do not reach statistical significance. This review summarizes epidemiological, animal model, and in vitro data related to asbestos exposures and autoimmunity. These combined data help build toward a better understanding of the fiber-associated factors contributing to immune dysfunction that may raise the risk of autoimmunity and the possible contribution to asbestos-related pulmonary disease

Involvement in treatment decisions: what do adults with asthma want and what do they get? Results of a cross sectional survey

Background: Current healthcare policy advocates patient participation in treatment decision making. However, in asthma there is little evidence regarding patients' views on such involvement. This study explored the preferred and perceived level of involvement in treatment decisions, rationales for role preference, perceived facilitators of/barriers to involvement, and the interrelationship of role preference and demographic variables in a sample of patients with asthma. Methods: A cross sectional survey was performed of 230 adults with clinician diagnosed asthma from 10 primary care sites and one specialist respiratory centre in north-west England. Preferred role in treatment decisions was assessed using the Control Preferences Scale. Results: Fifty five (23.9%) preferred an active role, 82 (35.7%) a collaborative role, and 93 (40.4%) a passive role; 19 (8.2%) perceived their role as active compared with 45 (19.6%) collaborative and 166 (72.2%) passive. Only 33.5% (n = 77) of respondents attained their most preferred role; 55.2% (n = 127) were less involved than they preferred. Patient related, professional related, and organisational factors, especially quality and duration of consultations, facilitated or hampered involvement. Role preferences were not strongly associated with demographic variables or asthma severity. Conclusions: This study in patients with asthma highlights the fact that there is a need for professional and patient education regarding partnership working, skilful communication, and innovative approaches to service delivery