2,126 research outputs found
Patient preferences for adjuvant radiotherapy in early breast cancer are strongly influenced by treatment received through random assignment
Objective: TARGITâA randomised women with early breast cancer to receive external beam radiotherapy (EBRT) or intraoperative radiotherapy (TARGITâIORT). This study aimed to identify what extra risk of recurrence patients would accept for perâ ceived benefits and risks of different radiotherapy treatments.
Methods: Patient preferences were determined by selfârated tradeâoff questionâ naires in two studies: Stage (1) 209 TARGITâA participants (TARGITâIORT n = 108, EBRT n = 101); Stage (2) 123 nonâtrial patients yet to receive radiotherapy (preâtreatâ ment group), with 85 also surveyed postâradiotherapy. Patients tradedâoff risks of local recurrence in preference selection between TARGITâIORT and EBRT.
Results: TARGITâIORT patients were more accepting of IORT than EBRT patients with 60% accepting the highest increased risk presented (4%â6%) compared to 12% of EBRT patients, and 2% not accepting IORT at all compared to 43% of EBRT paâ tients. Preâtreatment patients were more accepting of IORT than postâtreatment paâ tients with 23% accepting the highest increased risk presented compared to 15% of postâtreatment patients, and 15% not accepting IORT at all compared to 41% of preâ treatment patients.
Conclusions: Breast cancer patients yet to receive radiotherapy accept a higher recurrence risk than the actual risk found in TARGITâA. Measured patient preferences are highly influenced by experience of treatment received. This finding challenges the validity of postâtreatment preference studies
âWeâre all wounded healersâ:A qualitative study to explore the wellbeing and needs of helpline workers supporting survivors of domestic violence and abuse
An exploration of the experiences and utility of functional electrical stimulation for foot drop in people with multiple sclerosis
Purpose: Functional electrical stimulation (FES) is effective in improving walking in people with multiple sclerosis (MS) with foot drop. There is limited research exploring peopleâs experiences of using this device. This study aims to explore the utility, efficacy, acceptability, and impact on daily life of the device in people with MS.
Methods: An interpretative phenomenological approach was employed. Ten participants who had used FES for 12 months were interviewed. Transcripts were analysed, and emergent themes identified.
Results: Nine participants continued to use the device. Three relevant super-ordinate themes were identified; impact of functional electrical stimulation, sticking with functional electrical stimulation, and autonomy and control. Participants reported challenges using the device; however, all reported positive physical and psychological benefits. Intrinsic and external influences such as; access to professional help, the influence of others, an individualâs ability to adapt, and experiences using the device, influenced their decisions to continue with the device. A thematic model of these factors was developed.
Conclusions: This study has contributed to our understanding of people with MS experiences of using the device and will help inform prescribing decisions and support the continued, appropriate use of FES over the longer term
Safety of dietary camelina oil supplementation in healthy, adult dogs
This study aimed to determine whether camelina oil is safe for use in canine diets, using canola oil and flax oil as controls, as they are similar and generally regarded as safe (GRAS) for canine diets. A total of thirty privately-owned adult dogs of various breeds (17 females; 13 males), with an average age of 7.2 ± 3.1 years (mean ± SD) and a body weight (BW) of 27.4 ± 14.0 kg were used. After a 4-week wash-in period using sunflower oil and kibble, the dogs were blocked by breed, age, and size and were randomly allocated to one of three treatment oils (camelina (CAM), flax (FLX), or canola (OLA)) at a level of 8.2 g oil/100 g total dietary intake. Body condition score (BCS), BW, food intake (FI), and hematological and select biochemical parameters were measured at various timepoints over a 16-week feeding period. All of the data were analyzed with ANOVA using the PROC GLIMMIX of SAS. No biologically significant differences were seen between the treatment groups in terms of BW, BCS, FI, and hematological and biochemical results. Statistically significant differences noted among some serum biochemical results were considered small and were due to normal biological variation. These results support the conclusion that camelina oil is safe for use in canine nutrition
Increased Psychological Distress during COVID-19 and Quarantine in Ireland: A national survey.
Background: The emergence of the coronavirus pneumonia (COVID-19) resulted in a global pandemic. The psychological impact of an epidemic is multifaceted and acute, with long-term consequences. Methods: A cross-sectional online survey-based design was employed, assessing the psychological impact of COVID-19 on members of the Irish public during the quarantine period of COVID-19 in Ireland. Participants were invited to complete the Depression, Anxiety, and Stress Scale-21 (DASS-21) retrospectively (prior to quarantine) and during the quarantine period, as well as measures of illness perceptions, well-being, and a bespoke measure (the Effects of COVID Questionnaire, ECQ), which assessed perceptions of COVID-related stresses associated with personal concerns, caring for children, caring for aging parents, as well as gratitude. Results: A total of n = 1620 entered the survey platform, with a total of n = 847 surveys completed by members of the Irish public. Entry into COVID-19 quarantine was associated with significant increases in clinically significant symptoms of depression, stress, and anxiety. The ECQ reliably assessed a range of COVID-19-related stresses and had large and significant correlations with the DASS-21. Conclusions: The COVID-19 quarantine was associated with stresses and significant increases in symptoms of depression, anxiety, and stress in a national Irish cohort. The public require increased access to mental health services to meet this increase in COVID-19-related psychological distress
Finding the 'right' GP : a qualitative study of the experiences of people with long-COVID
Background: An unknown proportion of people who had an apparently mild COVID-19 infection continue to suffer with persistent symptoms, including chest pain, shortness of breath, muscle and joint pains, headaches, cognitive impairment (âbrain fogâ), and fatigue. Post-acute COVID-19 (âlong-COVIDâ) seems to be a multisystem disease, sometimes occurring after a mild acute illness; people struggling with these persistent symptoms refer to themselves as âlong haulersâ.
Aim: To explore experiences of people with persisting symptoms following COVID-19 infection, and their views on primary care support received.
Design & setting: Qualitative methodology, with semi-structured interviews to explore perspectives of people with persisting symptoms following suspected or confirmed COVID-19 infection. Participants were recruited via social media between JulyâAugust 2020.
Method: Interviews were conducted by telephone or video call, digitally recorded, and transcribed with consent. Thematic analysis was conducted applying constant comparison techniques. People with experience of persisting symptoms contributed to study design and data analysis.
Results: This article reports analysis of 24 interviews. The main themes include: the âhard and heavy workâ of enduring and managing symptoms and accessing care; living with uncertainty, helplessness and fear, particularly over whether recovery is possible; the importance of finding the 'right' GP (understanding, empathy, and support needed); and recovery and rehabilitation: what would help?
Conclusion: This study will raise awareness among primary care professionals, and commissioners, of long-COVID and the range of symptoms people are experiencing. Patients require their GP to believe their symptoms and to demonstrate empathy and understanding. Ongoing support by primary care professionals during recovery and rehabilitation is crucial
Cross modal perception of body size in domestic dogs (Canis familiaris)
While the perception of size-related acoustic variation in animal vocalisations is well documented, little attention has been given to how this information might be integrated with corresponding visual information. Using a cross-modal design, we tested the ability of domestic dogs to match growls resynthesised to be typical of either a large or a small dog to size- matched models. Subjects looked at the size-matched model significantly more often and for a significantly longer duration than at the incorrect model, showing that they have the ability to relate information about body size from the acoustic domain to the appropriate visual category. Our study suggests that the perceptual and cognitive mechanisms at the basis of size assessment in mammals have a multisensory nature, and calls for further investigations of the multimodal processing of size information across animal species
Cosmetic outcome as rated by patients, doctors, nurses and BCCT.core software assessed over 5 years in a subset of patients in the TARGIT-A trial
Background: The purpose of this research was to assess agreement between four rating systems of cosmetic outcome measured in a subset of patients with early breast cancer participating in the randomised TARGIT-A trial. TARGIT-A compared risk-adapted single-dose intra-operative radiotherapy (TARGIT-IORT) to whole breast external beam radiotherapy (EBRT).
Methods: Patients, their Radiation Oncologist and Research Nurse completed a subjective cosmetic assessment questionnaire before radiotherapy and annually thereafter for five years. Objective data previously calculated by the validated BCCT.core software which utilizes digital photographs to score symmetry, colour and scar was also used. Agreement was assessed by the Kappa statistic and longitudinal changes were assessed by generalized estimating equations.
Results: Overall, an Excellent-Good (EG) cosmetic result was scored more often than a Fair-Poor (FP) result for both treatment groups across all time points, with patients who received TARGIT-IORT scoring EG more often than those who received EBRT however this was statistically significant at Year 5 only. There was modest agreement between the four rating systems with the highest Kappa score being moderate agreement which was between nurse and doctor scores at Year 1 with Kappa = 0.46 (p \u3c 0.001), 95% CI (0.24, 0.68).
Conclusion: Despite similar overall findings between treatment groups and rating systems, the inter-rater agreement was only modest. This suggests that the four rating systems utilized may not necessarily be used interchangeably and it is arguable that for an outcome such as cosmetic appearance, the patientâs point of view is the most important.
Trial Registration: TARGIT-A ISRCTN34086741, Registered 21 July 2004, retrospectively registered
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