Senescent Cells:A Potential Target for New Cancer Therapies in Older Oncologic Patients

Cellular senescence is a complex process and is one of the key elements of ageing [...]

De illusie van de maakbaarheid

Technologische ontwikkelingen waren decaden lang leidend in de samenleving in bredere zin en in de geneeskunde in het bijzonder. Mede daardoor leven we langer. In de wereld om ons heen lijkt alles maakbaar; gezondheid, schoonheid en soms ook geluk.Hoe schril is het contrast tussen die maakbare wereld en de realiteit van ziekte, ouderdom en sterfte, stelt Barbara van Leeuwen in haar oratie. Voordat een patiënt op een operatietafel terecht komt, heeft zich een selectieproces voltrokken. De patiënt is verwezen naar een chirurg, een diagnose is gesteld, een mogelijke operatie geopperd en geschikt bevonden. Daar is niet meer voor nodig dan een juiste diagnose in combinatie met een richtlijn en technische mogelijkheden.Dit ziektegedreven proces doet geen recht aan de individuele patiëntkenmerken of -voorkeuren en voldoet zeker niet voor de oudere patiënt. Dat blijkt in de praktijk door de soms teleurstellende uitkomsten na grote operaties bij patiënten op oudere leeftijd. De ziekte is genezen, maar de patiënt en diens familie worden geconfronteerd met de onbedoelde schade van de behandeling, complicaties, functieverlies en achteruitgang van de kwaliteit van leven.Als reactie op de soms teleurstellende uitkomsten van een operatie op oudere leeftijd is de laatste jaren de transitie naar waardegedreven zorg ingezet. Als we de zorg daadwerkelijk waardegedreven willen maken, dan hoort daar acceptatie bij van het feit dat - behalve genezing - ook andere uitkomsten van zorg van waarde zijn.Niet alles is maakbaar, dat is een illusie, maar waardegedreven zorg mag dat niet zijn

Ethische kwesties in de mondzorg voor kwetsbare ouderen

Voor kwetsbare ouderen is vaak intensieve preventieve en curatieve mondzorg nodig ten behoeve van de kwaliteit van leven. Door fysieke en cognitieve beperkingen van de oudere kunnen behandelingen niet altijd lege artis uitgevoerd worden, wat tot praktische problemen leidt. Hieraan gerelateerd doen zich morele vragen voor. Mondzorg voor kwetsbare ouderen kan, zelfs met beperkingen, bijdragen aan hoge kwaliteit van leven als deze ethische kwesties vaker expliciet daarin betrokken worden. Daarmee zal ook de morele druk van ethische kwesties op de zorgverlener worden verlicht. Het gaat veelal om ‘alledaagse’ ethische kwesties, waarvoor de betrokkenen met elkaar oplossingen kunnen vinden in open overleg in een zorgethische benadering. Dat laatste betekent gerichtheid op ‘de goede dingen goed doen’ met inbegrip van alle relevante aspecten van de persoon en de omgeving. Voorwaarden zijn onder andere inbedding van de mondzorg in de zorg voor ouderen en voor zorgverleners betrokkenheid bij de oudere en kennis en vaardigheden om te reflecteren

Live bedside music in daily clinical practice of a surgical hospital ward among older patients:A controlled study design of an innovative practice

OBJECTIVE: There is an increasing interest in the role of the arts, particularly music, in healthcare. Music seems an attractive non-pharmacological intervention for older patients to improve postoperative outcomes. Although live music elicits more meaningful responses from an audience than recorded music, the use of live music is still rare on hospital wards. In view of the positive effects of recorded music on older surgical patients, we designed, in collaboration with a conservatoire, an innovative practice named Meaningful Music in Health Care (MiMiC). The aim is to determine whether live bedside music implements into daily practice and allows improves patient outcomes. METHOD: This manuscript provides an overview of a trial evaluating if live bedside music can improve postoperative outcomes in older patients. The MiMiC initiative is a non randomized controlled trial study among older surgical patients on three hospital wards. Live bedside music is performed by professional musicians, once a day for six or seven consecutive days. The primary outcome is experienced pain; secondary outcomes are anxiety, relaxation and physical parameters (heart rate, heart rate variability, blood pressure, respiratory rate and oxygenation). Measurements of these variables are collected before the intervention, 30 min afterwards and again after three hours. Daily evaluations determine whether this innovative practice can be implemented in daily practice. CONCLUSION: This manuscript describes a new practice, live bedside music by professional musicians, on surgical hospital wards aiming to improve patient outcomes. It offers a new field of interprofessional collaboration for the benefit of patients. Further research must be conducted focussing on patient outcomes, including cost-effectiveness and the experiences of patients and healthcare professionals

Live and Recorded Music Interventions to Reduce Postoperative Pain:Protocol for a Nonrandomized Controlled Trial

BACKGROUND: Postoperative patients who were previously engaged in the live musical intervention Meaningful Music in Healthcare reported significantly reduced perception of pain than patients without the intervention. This encouraging finding indicates a potential for postsurgical musical interventions to have a place in standard care as therapeutic pain relief. However, live music is logistically complex in hospital settings, and previous studies have reported the more cost-effective recorded music to serve as a similar pain-reducing function in postsurgical patients. Moreover, little is known about the potential underlying physiological mechanisms that may be responsible for the reduced pain perceived by patients after the live music intervention.OBJECTIVE: The primary objective is to see whether a live music intervention can significantly lower perceived postoperative pain compared to a recorded music intervention and do-nothing control. The secondary objective is to explore the neuroinflammatory underpinnings of postoperative pain and the potential role of a music intervention in mitigating neuroinflammation.METHODS: This intervention study will compare subjective postsurgical pain ratings among 3 groups: live music intervention, recorded music intervention, and standard care control. The design will take the form of an on-off nonrandomized controlled trial. Adult patients undergoing elective surgery will be invited to participate. The intervention is a daily music session of up to 30 minutes for a maximum of 5 days. The live music intervention group is visited by professional musicians once a day for 15 minutes and will be asked to interact. The recorded music active control intervention group receives 15 minutes of preselected music over headphones. The do-nothing group receives typical postsurgical care that does not include music.RESULTS: At study completion, we will have an empirical indication of whether live music or recorded music has a significant impact on postoperative perceived pain. We hypothesize that the live music intervention will have more impact than recorded music but that both will reduce the perceived pain more than care-as-usual. We will moreover have the preliminary evidence of the physiological underpinnings responsible for reducing the perceived pain during a music intervention, from which hypotheses for future research may be derived.CONCLUSIONS: Live music can provide relief from pain experienced by patients recovering from surgery; however, it is not known to what degree live music improves the patients' pain experience than the logistically simpler alternative of recorded music. Upon completion, this study will be able to statistically compare live versus recorded music. This study will moreover be able to provide insight into the neurophysiological mechanisms involved in reduced pain perception as a result of postoperative music listening.TRIAL REGISTRATION: The Netherlands Central Commission on Human Research NL76900.042.21; https://www.toetsingonline.nl/to/ccmo_search.nsf/fABRpop?readform&amp;unids=F2CA4A88E6040A45C1258791001AEA44.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40034.</p

Construction and testing of a novel host-range defective myxoma virus vaccine with the M063 gene inactivated that is non-permissive for replication in rabbit cells

Deletion of the M063 gene from myxoma virus produces a virus that is unable to replicate in rabbit cells in vitro or in live rabbits but can be propagated in non-rabbit cell lines. A targeted M063 deletion mutant was constructed in the attenuated Uriarra strain of myxoma virus and the ability of this virus to act as a safe, non-transmissible vaccine against myxomatosis was tested in outbred laboratory rabbits. Immunization with the M063 deletion vaccine provided good short-term protection against lethal challenge with virulent myxoma virus. Long-term protection was similar to reported results with heterologous live virus, with some rabbits protected but others succumbing to challenge. Replication-deficient poxvirus vaccines, like the Modified Vaccinia Virus Ankara (MVA) in man and the myxoma virus vaccine described here in rabbits, are very attractive from a safety perspective. Seasonal boosting would be predicted to provide long-term protection. Targeted host-range gene deletions could have potential for rapid development of poxvirus vaccines in general.This study was funded by the Pest Animal Control Cooperative Research Centre. Grant McFadden is an International Scholar of the Howard Hughes Medical Institute

Postoperative recovery of accelerometer-based physical activity in older cancer patients

Introduction: Recovery of physical activity is an important functional outcome measure after cancer surgery. However, objective data on physical activity for older cancer patients is scarce. The aims of this study were to quantify perioperative physical activity levels, assess recovery of physical activity three months after surgery, and characterise patients who achieved recovery. Materials and methods: This observational cohort study analysed physical activity data collected from patients aged >65 who were scheduled for cancer surgery between May 2018 and July 2019. Perioperative daily step count was measured using a Fitbit device. The primary outcome measure was the percentage of patients who returned to (>90% of) their preoperative (baseline) physical activity levels three months after surgery. Results: Fifty patients (mean age 73) were recruited, and available Fitbit data was analysed. Median daily step counts at baseline (n = 40), before hospital discharge (n = 40), and three months postoperative (n = 37) were 5,974 (IQR 4,250-7,922),1,619 (IQR 920-2,839), and 4,674 (IQR 3,047-7,592), respectively. The 15/37 (41%) patients who had reached baseline levels three months after surgery seemed to have more preoperative self-reported physical activity, better anaesthesiologists' physical status classification, and fewer in-hospital complications compared to patients who had not, although the differences were statistically non-significant. Conclusion: Perioperative physical activity was quantified for older cancer patients, and 41% returned to baseline levels within three months. Accelerometer-based physical activity provided a valuable outcome measure for postoperative physical recovery. Future studies using objective physical activity measures are needed to evaluate effects of interventional studies aimed at improving physical activity. (C) 2020 The Authors. Published by Elsevier Ltd

Strategies for involving family members in treatment decision making for older patients with cancer

Background and purpose: Many older patients with cancer have their family members, often their adult children, involved in a process of treatment decision making. Despite the growing awareness that family members can facilitate a process of shared decision making (SDM), literature about SDM pays little attention to family relations and strategies to facilitate family involvement in decision making processes. Therefor this study aimed to 1. explore surgeons' and nurses' perceptions about involvement of adult children in treatment decision-making for older patients; and 2. identify strategies surgeons' and nurses use to ensure positive family involvement. Methods: This study used a qualitative open in-depth interview design. Semi-structured interviews were conducted with 13 surgical oncologists and 13 oncology nurses in two hospitals in the Netherlands. Qualitative content analysis was conducted according to the steps of thematic analysis. Results: Surgeons and nurses indicated that adult children's involvement in decision-making increases when patients become frail. They reported beneficial and challenging characteristics of this involvement. Subsequently, six strategies to stimulate positive involvement of adult children in the decision-making process were revealed: 1. Focus on the patient; 2. Actively involve adult children; 3. Acknowledge different perspectives; 4. Get to know the family system; 5. Check that the patient and family members understand the information; and 6. Stimulate communication and deliberation with adult children.Conclusions and implications: Surgeons and nurses perceive involvement of adult children in treatment decision making for older patients with cancer as beneficial. Adult children can help these patients reach well-informed treatment decisions. Therefor surgeons and nurses stimulate the communication and deliberation between these patients and their adult children. However, involving family in treatment decision making also triggers specific complexities and challenges in treatment decision conversations that seem to call for the development and implementation of practical patient and family-centered strategies

Strategies for involving family members in treatment decision making for older patients with cancer

Background and purpose: Many older patients with cancer have their family members, often their adult children, involved in a process of treatment decision making. Despite the growing awareness that family members can facilitate a process of shared decision making (SDM), literature about SDM pays little attention to family relations and strategies to facilitate family involvement in decision making processes. Therefor this study aimed to 1. explore surgeons' and nurses' perceptions about involvement of adult children in treatment decision-making for older patients; and 2. identify strategies surgeons' and nurses use to ensure positive family involvement. Methods: This study used a qualitative open in-depth interview design. Semi-structured interviews were conducted with 13 surgical oncologists and 13 oncology nurses in two hospitals in the Netherlands. Qualitative content analysis was conducted according to the steps of thematic analysis. Results: Surgeons and nurses indicated that adult children's involvement in decision-making increases when patients become frail. They reported beneficial and challenging characteristics of this involvement. Subsequently, six strategies to stimulate positive involvement of adult children in the decision-making process were revealed: 1. Focus on the patient; 2. Actively involve adult children; 3. Acknowledge different perspectives; 4. Get to know the family system; 5. Check that the patient and family members understand the information; and 6. Stimulate communication and deliberation with adult children.Conclusions and implications: Surgeons and nurses perceive involvement of adult children in treatment decision making for older patients with cancer as beneficial. Adult children can help these patients reach well-informed treatment decisions. Therefor surgeons and nurses stimulate the communication and deliberation between these patients and their adult children. However, involving family in treatment decision making also triggers specific complexities and challenges in treatment decision conversations that seem to call for the development and implementation of practical patient and family-centered strategies