Assessing the Need for Standardized Pre-Chemotherapy Education: An Outpatient Oncology Clinic Initiative

Abstract Purpose: In a diverse southern California outpatient oncology clinic, assess the need for standardized pre-chemotherapy education for newly diagnosed cancer patients to aid in the improvement of health literacy, self-management of side effects, satisfaction, and reduction of anxiety. Background: Cancer patients often feel anxious, overwhelmed, and confused by the abundance of information and medical jargon that they must digest. One southern California outpatient oncology clinic identified the need for consistent, standardized procedure in providing chemotherapy education and assessing treatment knowledge in newly-diagnosed cancer patients as evidenced by: inconsistent attendance in educational classes and or appointments, inability to articulate treatment after presentation of written material, numerous follow-up telephone calls, and uncertainty about techniques to self-manage symptoms and side effects. Evidence shows that when done appropriately, providing multiple methods of pre-chemotherapy education is effective in preventing and reducing anxiety, improvement in health literacy recall, and ability to self-mange side effects in patients receiving chemotherapy for the first time. Process: This evidence-based practice project was built on the foundation of the Ace Star Model of Knowledge Transformation framework and the gate control pain theory. An integrated literature review was piloted to examine the best methods of providing chemotherapy education in the effort to improve patient’s health literacy, self-management of treatment side effects, patient satisfaction, and the reduction of anxiety. Outcomes: The implementation of standardized procedure in methods of pre-chemotherapy education are pending. Conclusion: Standardizing the process of chemotherapy education can provide measurable improvement in quality of care, productivity, adherence to treatment, and morale for chemotherapy patients by enhancing their level of health care literacy and sills for self-management of chemotherapy-related side effects

Institutionalized Delinquent and Maladjusted Juveniles: A Psycholegal Systems Analysis

I. Introduction II. The Criminal Justice and Mental Health Systems ... A. Angles A1 and A2 ... B. A1→B1, or A2→B2 … C. Angles B1 and B2 ... D. The Shuffle: A1→C1→A1 or A2; or A2→C2→A2 or A1; or A1→B2 or C1→B2 ... E. The Merger ... F. Prospects for Change ... G. Summary III. The Juvenile Justice System ... A. Legal Rights at Intake in the Juvenile Justice System (Angle A3 ) ... B. Legal Rights during Juvenile Incarceration (A3 to B3) ... C. Controversy over the Goal of Juvenile Justice (Angle B3) ... D. Dumping (Angle C3) and Shuffling (A3→C3→A3 or A1 or A2; or A3→A1 or A2) in the Juvenile Justice System ... E. Merger with the Criminal Justice System ... F. Summary IV. Juveniles in the Mental Health System ... A. Commitment of Juveniles to Mental Health Facilities (Angle A4) ... B. Incipient Legalization at Angle A4 ... C. Prospects for Further Legalization at Angle A4 ... D. Prospects for Treatment Rights (A4→B4) ... E. The Future of the Juvenile Mental Health System ... F. Summary V. Conclusio

Institutionalized Delinquent and Maladjusted Juveniles: A Psycholegal Systems Analysis

I. Introduction II. The Criminal Justice and Mental Health Systems ... A. Angles A1 and A2 ... B. A1→B1, or A2→B2 … C. Angles B1 and B2 ... D. The Shuffle: A1→C1→A1 or A2; or A2→C2→A2 or A1; or A1→B2 or C1→B2 ... E. The Merger ... F. Prospects for Change ... G. Summary III. The Juvenile Justice System ... A. Legal Rights at Intake in the Juvenile Justice System (Angle A3 ) ... B. Legal Rights during Juvenile Incarceration (A3 to B3) ... C. Controversy over the Goal of Juvenile Justice (Angle B3) ... D. Dumping (Angle C3) and Shuffling (A3→C3→A3 or A1 or A2; or A3→A1 or A2) in the Juvenile Justice System ... E. Merger with the Criminal Justice System ... F. Summary IV. Juveniles in the Mental Health System ... A. Commitment of Juveniles to Mental Health Facilities (Angle A4) ... B. Incipient Legalization at Angle A4 ... C. Prospects for Further Legalization at Angle A4 ... D. Prospects for Treatment Rights (A4→B4) ... E. The Future of the Juvenile Mental Health System ... F. Summary V. Conclusio

Pro-resolving and anti-arthritic properties of the MC1 selective agonist PL8177

BACKGROUND: Melanocortins are peptides endowed with anti-inflammatory and pro-resolving activities. Many of these effects are mediated by the Melanocortin receptor 1 (MC(1)) as reported in several experimental settings. As such, MC(1) can be a viable target for the development of new therapies that mimic endogenous pro-resolving mediators. The aim of this study was to assess the immunopharmacology of a selective MC(1) agonist (PL8177) in vitro and in a mouse model of inflammatory arthritis. METHODS: PL8177 and the natural agonist αMSH were tested for activation of mouse and human Melanocortin receptors (MC(1,3,4,5)), monitoring cAMP accumulation and ERK1/2 phosphorylation, using transiently transfected HEK293A cells. The anti-inflammatory and pro-resolving effects of PL8177 and αMSH were evaluated using mouse peritoneal Macrophages. Finally, a model of K/BxN serum transfer induced arthritis was used to determine the in vivo potential of PL8177. RESULTS: PL8177 activates mouse and human MC(1) with apparent EC(50) values of 0.01 and 1.49 nM, respectively, using the cAMP accumulation assay. Similar profiles were observed for the induction of ERK phosphorylation (EC(50): 0.05 and 1.39 nM). PL8177 displays pro-resolving activity (enhanced Macrophage efferocytosis) and counteracts the inflammatory profile of zymosan-stimulated macrophages, reducing the release of IL-1β, IL-6, TNF-α and CCL-2. In the context of joint inflammation, PL8177 (3mg/kg i.p.) reduces clinical score, paw swelling and incidence of severe disease as well as the recruitment of immune cells into the arthritic joint. CONCLUSION: These results demonstrate that the MC(1) agonism with PL8177 affords therapeutic effects in inflammatory conditions including arthritis. SIGNIFICANCE: Drugs targeting the Melanocortin system have emerged as promising therapeutics for several conditions including inflammation or obesity. Multiple candidates are under clinical development, and some have already reached approval. Here we present the characterization of a novel drug candidate, PL8177, selective for the Melanocortin 1 receptor (MC(1)), demonstrating its selectivity profile on cAMP and ERK1/2 phosphorylation signaling pathways, of relevance as selective drugs will translate into lesser off-target effect. PL8177 also demonstrated, not only anti-inflammatory activity, but pro-resolving actions due to its ability to enhance efferocytosis (i.e. the phagocytosis of apoptotic cells), endowing this molecule with therapeutic advantages compared to classical anti-inflammatory drugs. Using a mouse model of inflammatory arthritis, the compound demonstrated in vivo efficacy by reducing clinical score, paw swelling and overall disease severity. Taken together, these results present Melanocortin-based therapies, and specifically targeting MC(1) receptor, as a promising strategy to manage chronic inflammatory diseases

Combining neuroprotectants in a model of retinal degeneration: no additive benefit

The central nervous system undergoing degeneration can be stabilized, and in some models can be restored to function, by neuroprotective treatments. Photobiomodulation (PBM) and dietary saffron are distinctive as neuroprotectants in that they upregulate protective mechanisms, without causing measurable tissue damage. This study reports a first attempt to combine the actions of PBM and saffron. Our working hypothesis was that the actions of PBM and saffron in protecting retinal photoreceptors, in a rat light damage model, would be additive. Results confirmed the neuroprotective potential of each used separately, but gave no evidence that their effects are additive. Detailed analysis suggests that there is actually a negative interaction between PBM and saffron when given simultaneously, with a consequent reduction of the neuroprotection. Specific testing will be required to understand the mechanisms involved and to establish whether there is clinical potential in combining neuroprotectants, to improve the quality of life of people affected by retinal pathology, such as age-related macular degeneration, the major cause of blindness and visual impairment in older adults.This work was supported by the Australian Research Council Centre of Excellence in Vision Science, by the Sir Zelman Cowen Universities Fund and the Lord Mayor’s Charitable Foundation, by Australian Travel Awards for L’Aquila Researchers (ARIA) to FDM and SR and by a Ministero dell’Istruzione, dell’Universita` e della Ricerca dedicato ai PRIN, Progetti di Ricerca di Interesse Nazionale (MIUR-PRIN) (2010-2011) research grant to SB

Action and coping plans related to the behavior of adherence to drug therapy among coronary heart disease outpatients

OBJETIVO: analisar os planos de ação e de enfrentamento de obstáculos, relacionados ao comportamento de adesão à terapia medicamentosa, elaborados por pacientes coronariopatas, em seguimento ambulatorial, e identificar as barreiras percebidas para adoção desse comportamento. MÉTODO: os participantes (n=59) foram convidados a elaborar planos de ação (action planning) e de enfrentamento de obstáculos (coping planning) para o comportamento de adesão aos medicamentos cardioprotetores e de alívio dos sintomas. RESULTADOS: foram evidenciados planos de ação específicos para a tomada dos medicamentos que associaram o comportamento a marcadores temporais e ao ciclo vigília/sono. Os obstáculos mais frequentemente relatados foram o esquecimento e a ausência de rotina nas atividades de vida diária. Os planos de enfrentamento, elaborados para superar o esquecimento, foram os mais específicos. CONCLUSÃO: os achados deste estudo subsidiam a aplicação da implementação da intenção para otimizar a adesão de coronariopatas à terapia medicamentosa.OBJETIVO: analizar los planes de acción y de enfrentamiento de obstáculos relacionados al comportamiento de adhesión a la terapia medicamentosa, elaborados por pacientes con coronariopatía en seguimiento de ambulatorio e identificar las barreras percibidas para adopción de este comportamiento. MÉTODO: los participantes (n=59) fueron invitados a elaborar planes de acción (action planning) y de enfrentamiento de obstáculos (coping planning) para el comportamiento de adhesión a los medicamentos cardio-protectores y de alivio de los síntomas. RESULTADOS: fueron evidenciados planes de acción específicos para la tomada de los medicamentos que asociaron el comportamiento a marcadores temporales y al ciclo vigilia sueño. Los obstáculos más frecuentemente relatados fueron el olvido y la ausencia de rutina en las actividades de vida diaria. Los planes de enfrentamiento elaborados para superar el olvido fueron los más específicos. CONCLUSIÓN: los hallazgos de este estudio subvencionan la aplicación de la implementación de la intención para optimizar la adhesión de pacientes con coronariopatía a la terapia medicamentosa.OBJECTIVE: to analyze the action and coping plans related to the behavior of adhering to drug therapy, developed by coronary heart disease (CHD) outpatients, and to identify the barriers perceived to adopting this behavior. METHODS: the participants (n=59) were invited to formulate action plans and coping plans for the behavior of adhering to the cardio-protective medications and the symptom-relief medications. RESULTS: specific action plans for taking the medications associated with temporal markers and the sleep-wake cycle were shown. The most frequently reported obstacles were forgetfulness and absence of routine in daily living activities. The coping plans for overcoming forgetfulness were the most specific. CONCLUSION: this study's findings support the application of implementation intentions aimed at optimizing adherence to drug therapy among patients with CHD

Integrative review: behavioral interventions for physical activity practice

This study aimed to carry out an integrative literature review on the effectiveness of interventions in physical activity (PA) practice in the general population. The search was carried out in articles indexed in online databases: Scopus, CINAHL and Medline. Studies in English or Brazilian Portuguese were included, with evidence levels 2 or 3, published between 2004 and 2008. The final sample consisted of 14 studies. In 57.1% of the studies, interventions were effective for behavior change to practice PA. The diversity of target populations, assessment instruments and intervention designs makes it difficult to compare results and build evidence on the effectiveness of interventions for PA promotion.Este estudio tuvo como objetivo realizar una revisión integrativa de la literatura sobre la efectividad de intervenciones en la realización de Actividad Física (AF) en la población general. La búsqueda fue realizada en los artículos on line indexados en las bases de datos Scopus, Medline y Cinahl. Fueron incluidos estudios en lengua inglesa o portuguesa de Brasil, con nivel de evidencia 2 o 3, publicados entre 2004 y 2008. La muestra final fue compuesta por 14 estudios. En 57,1% de los estudios las intervenciones fueron efectivas para realizar cambios de comportamiento relacionados a la AF, sin embargo, pocas fueron basadas en teorías. La diversidad de las poblaciones objetivo, de los instrumentos de evaluación y de las intervenciones, dificulta la comparación de los resultados y la construcción de evidencias sobre la efectividad de intervenciones para la promoción de AF.Este estudo teve como objetivo realizar revisão integrativa da literatura sobre a efetividade de intervenções na realização de Atividade Física (AF) na população geral. A busca foi realizada nos artigos on line indexados nas bases de dados Scopus, Medline e Cinahl. Foram incluídos estudos em língua inglesa ou portuguesa do Brasil, com nível de evidência 2 ou 3, publicados entre 2004 e 2008. A amostra final foi composta por 14 estudos. Em 57,1% dos estudos, as intervenções foram efetivas para a mudança do comportamento para realizar AF, porém, poucas foram baseadas em teoria. A diversidade das populações alvo, dos instrumentos de avaliação e das intervenções dificulta a comparação dos resultados e a construção de evidências sobre a efetividade de intervenções para a promoção de AF

Desempenho psicométrico da versão brasileira do Mini-cuestionario de calidad de vida en la hipertensión arterial (MINICHAL)

This study aimed to evaluate the feasibility, acceptability, ceiling and floor effects, reliability, and convergent construct validity of the Brazilian version of the Mini Cuestionario de Calidad de Vida en la Hipertensión Arterial (MINICHAL). The study included 200 hypertensive outpatients in a university hospital and a primary healthcare unit. The MINICHAL was applied in 3.0 (± 1.0) minutes with 100% of the items answered. A "ceiling effect" was observed in both dimensions and in the total score, as well as evidence of measurement stability (ICC=0.74). The convergent validity was confirmed by significant positive correlations between similar dimensions of the MINICHAL and the SF-36, and significant negative correlations with the Minnesota Living with Heart Failure Questionnaire - MLHFQ, however, correlations between dissimilar constructs were also observed. It was concluded that the Brazilian version of the MINICHAL presents evidence of reliability and validity when applied to hypertensive outpatientsEste estudio tuvo como objetivo evaluar la practicidad, la aceptabilidad, los efectos techo y suelo, la confiabilidad y la validez de constructo convergente de la versión brasileña del Minicuestionario de Calidad de Vida de la Hipertensión Arterial - MINICHAL. Participaron del estudio 200 pacientes hipertensos en seguimiento en ambulatorio, en hospital universitario y en Unidad Básica de Salud. El MINICHAL fue aplicado en 3,0 (±1,0) minutos, con 100% de los ítems respondidos. Fue observado "efecto techo" en ambas dimensiones y puntaje total, así como evidencias de estabilidad de la medida (CCI=0,74). La validez convergente fue confirmada por correlaciones significativas positivas entre dimensiones similares del MINICHAL y del SF-36, y por correlaciones significativas negativas con el Minnesota Living with Heart Failure Questionnaire - MLHFQ, a pesar de que correlaciones entre constructos no similares hubiesen sido observadas. Se concluye que la versión brasileña del MINICHAL presenta evidencia de confiabilidad y validez cuando aplicada en hipertensos en seguimiento en ambulatorio.Este estudo teve como objetivo avaliar a praticabilidade, a aceitabilidade, os efeitos teto e chão, a confiabilidade e a validade de constructo convergente da versão brasileira do mini - cuestionario de calidad de vida en la hipertensión arterial - Minichal. Participaram do estudo 200 pacientes hipertensos, em seguimento ambulatorial, em hospital universitário e unidade básica de saúde. O Minichal foi aplicado em 3,0 (±1,0) minutos, com 100% dos itens respondidos. Foi observado efeito teto em ambas as dimensões e escore total, bem como evidências de estabilidade da medida (ICC=0,74). A validade convergente foi confirmada por correlações significativas positivas entre dimensões similares do Minichal e do SF-36, e por correlações significativas negativas com o Minnesota Living with Heart Failure Questionnaire - MLHFQ, embora correlações entre constructos dissimilares tenham sido observadas. Conclui-se que a versão brasileira do Minichal apresenta evidência de confiabilidade e validade, quando aplicada em hipertensos, em seguimento ambulatorial