Systematic screening and assessment of psychosocial well-being and care needs of people with cancer

Background : Receiving a diagnosis of cancer and the subsequent related treatments can have a significant impact on an individual's physical and psychosocial well-being. To ensure that cancer care addresses all aspects of well-being, systematic screening for distress and supportive care needs is recommended. Appropriate screening could help support the integration of psychosocial approaches in daily routines in order to achieve holistic cancer care and ensure that the specific care needs of people with cancer are met and that the organisation of such care is optimised. Objectives : To examine the effectiveness and safety of screening of psychosocial well-being and care needs of people with cancer. To explore the intervention characteristics that contribute to the effectiveness of these screening interventions. Search methods : We searched five electronic databases in January 2018: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, and CINAHL. We also searched five trial registers and screened the contents of relevant journals, citations, and references to find published and unpublished trials. Selection criteria : We included randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) that studied the effect of screening interventions addressing the psychosocial well-being and care needs of people with cancer compared to usual care. These screening interventions could involve self-reporting of people with a patient-reported outcome measures (PROMs) or a semi-structured interview with a screening interventionist, and comprise a solitary screening intervention or screening with guided actions. We excluded studies that evaluated screening integrated as an element in more complex interventions (e.g. therapy, coaching, full care pathways, or care programmes). Data collection and analysis : Two review authors independently extracted the data and assessed methodological quality for each included study using the Cochrane tool for RCTs and the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool for NRCTs. Due to the high level of heterogeneity in the included studies, only three were included in meta-analysis. Results of the remaining 23 studies were analysed narratively. Main results : We included 26 studies (18 RCTs and 8 NRCTs) with sample sizes of 41 to 1012 participants, involving a total of 7654 adults with cancer. Two studies included only men or women; all other studies included both sexes. For most studies people with breast, lung, head and neck, colorectal, prostate cancer, or several of these diagnoses were included; some studies included people with a broader range of cancer diagnosis. Ten studies focused on a solitary screening intervention, while the remaining 16 studies evaluated a screening intervention combined with guided actions. A broad range of intervention instruments was used, and were described by study authors as a screening of health-related quality of life (HRQoL), distress screening, needs assessment, or assessment of biopsychosocial symptoms or overall well-being. In 13 studies, the screening was a self-reported questionnaire, while in the remaining 13 studies an interventionist conducted the screening by interview or paper-pencil assessment. The interventional screenings in the studies were applied 1 to 12 times, without follow-up or from 4 weeks to 18 months after the first interventional screening. We assessed risk of bias as high for eight RCTs, low for five RCTs, and unclear for the five remaining RCTs. There were further concerns about the NRCTs (1 = critical risk study; 6 = serious risk studies; 1 = risk unclear). Due to considerable heterogeneity in several intervention and study characteristics, we have reported the results narratively for the majority of the evidence. In the narrative synthesis of all included studies, we found very low-certainty evidence for the effect of screening on HRQoL (20 studies). Of these studies, eight found beneficial effects of screening for several subdomains of HRQoL, and 10 found no effects of screening. One study found adverse effects, and the last study did not report quantitative results. We found very low-certainty evidence for the effect of screening on distress (16 studies). Of these studies, two found beneficial effects of screening, and 14 found no effects of screening. We judged the overall certainty of the evidence for the effect of screening on HRQoL to be very low. We found very low-certainty evidence for the effect of screening on care needs (seven studies). Of these studies, three found beneficial effects of screening for several subdomains of care needs, and two found no effects of screening. One study found adverse effects, and the last study did not report quantitative results. We judged the overall level of evidence for the effect of screening on HRQoL to be very low. None of the studies specifically evaluated or reported adverse effects of screening. However, three studies reported unfavourable effects of screening, including lower QoL, more unmet needs, and lower satisfaction. Three studies could be included in a meta-analysis. The meta-analysis revealed no beneficial effect of the screening intervention on people with cancer HRQoL (mean difference (MD) 1.65, 95% confidence interval (CI) -4.83 to 8.12, 2 RCTs, 6 months follow-up); distress (MD 0.0, 95% CI -0.36 to 0.36, 1 RCT, 3 months follow-up); or care needs (MD 2.32, 95% CI -7.49 to 12.14, 2 RCTs, 3 months follow-up). However, these studies all evaluated one specific screening intervention (CONNECT) in people with colorectal cancer. In the studies where some effects could be identified, no recurring relationships were found between intervention characteristics and the effectiveness of screening interventions. Authors' conclusions : We found low-certainty evidence that does not support the effectiveness of screening of psychosocial well-being and care needs in people with cancer. Studies were heterogeneous in population, intervention, and outcome assessment. The results of this review suggest a need for more uniformity in outcomes and reporting; for the use of intervention description guidelines; for further improvement of methodological certainty in studies and for combining subjective patient-reported outcomes with objective outcomes

Promoting Handwashing and Sanitation Behaviour Change in Low- and Middle-Income Countries: A Mixed-Method Systematic Review

This systematic review shows which promotional approaches are effective in changing handwashing and sanitation behaviour and which implementation factors affect the success or failure of such interventions. The authors find that promotional approaches can be effective in terms of handwashing with soap, latrine use, safe faeces disposal and open defecation. No one specific approach is most effective. However, several promotional elements do induce behaviour change. Different barriers and facilitators that influence implementing promotional approaches should be carefully considered when developing new policy, programming, practice, or research in this area

European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain–Barré syndrome

Guillain–Barré syndrome (GBS) is an acute polyradiculoneuropathy. Symptoms may vary greatly in presentation and severity. Besides weakness and sensory disturbances, patients may have cranial nerve involvement, respiratory insufficiency, autonomic dysfunction and pain. To develop an evidence-based guideline for the diagnosis and treatment of GBS, using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a Task Force (TF) of the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) constructed 14 Population/Intervention/Comparison/Outcome questions (PICOs) covering diagnosis, treatment and prognosis of GBS, which guided the literature search. Data were extracted and summarised in GRADE Summaries of Findings (for treatment PICOs) or Evidence Tables (for diagnostic and prognostic PICOs). Statements were prepared according to GRADE Evidence-to-Decision (EtD) frameworks. For the six intervention PICOs, evidence-based recommendations are made. For other PICOs, good practice points (GPPs) are formulated. For diagnosis, the principal GPPs are: GBS is more likely if there is a history of recent diarrhoea or respiratory infection; CSF examination is valuable, particularly when the diagnosis is less certain; electrodiagnostic testing is advised to support the diagnosis; testing for anti-ganglioside antibodies is of limited clinical value in most patients with typical motor-sensory GBS, but anti-GQ1b antibody testing should be considered when Miller Fisher syndrome (MFS) is suspected; nodal–paranodal antibodies should be tested when autoimmune nodopathy is suspected; MRI or ultrasound imaging should be considered in atypical cases; and changing the diagnosis to acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP) should be considered if progression continues after 8 weeks from onset, which occurs in around 5% of patients initially diagnosed with GBS. For treatment, the TF recommends intravenous immunoglobulin (IVIg) 0.4 g/kg for 5 days, in patients within 2 weeks (GPP also within 2–4 weeks) after onset of weakness if unable to walk unaided, or a course of plasma exchange (PE) 12–15 L in four to five exchanges over 1–2 weeks, in patients within 4 weeks after onset of weakness if unable to walk unaided. The TF recommends against a second IVIg course in GBS patients with a poor prognosis; recommends against using oral corticosteroids, and weakly recommends against using IV corticosteroids; does not recommend PE followed immediately by IVIg; weakly recommends gabapentinoids, tricyclic antidepressants or carbamazepine for treatment of pain; does not recommend a specific treatment for fatigue. To estimate the prognosis of individual patients, the TF advises using the modified Erasmus GBS outcome score (mEGOS) to assess outcome, and the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) to assess the risk of requiring artificial ventilation. Based on the PICOs, available literature and additional discussions, we provide flow charts to assist making clinical decisions on diagnosis, treatment and the need for intensive care unit admission.</p

European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain–Barré syndrome

Guillain–Barré syndrome (GBS) is an acute polyradiculoneuropathy. Symptoms may vary greatly in presentation and severity. Besides weakness and sensory disturbances, patients may have cranial nerve involvement, respiratory insufficiency, autonomic dysfunction and pain. To develop an evidence-based guideline for the diagnosis and treatment of GBS, using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology a Task Force (TF) of the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) constructed 14 Population/Intervention/Comparison/Outcome questions (PICOs) covering diagnosis, treatment and prognosis of GBS, which guided the literature search. Data were extracted and summarised in GRADE Summaries of Findings (for treatment PICOs) or Evidence Tables (for diagnostic and prognostic PICOs). Statements were prepared according to GRADE Evidence-to-Decision (EtD) frameworks. For the six intervention PICOs, evidence-based recommendations are made. For other PICOs, good practice points (GPPs) are formulated. For diagnosis, the principal GPPs are: GBS is more likely if there is a history of recent diarrhoea or respiratory infection; CSF examination is valuable, particularly when the diagnosis is less certain; electrodiagnostic testing is advised to support the diagnosis; testing for anti-ganglioside antibodies is of limited clinical value in most patients with typical motor-sensory GBS, but anti-GQ1b antibody testing should be considered when Miller Fisher syndrome (MFS) is suspected; nodal–paranodal antibodies should be tested when autoimmune nodopathy is suspected; MRI or ultrasound imaging should be considered in atypical cases; and changing the diagnosis to acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP) should be considered if progression continues after 8 weeks from onset, which occurs in around 5% of patients initially diagnosed with GBS. For treatment, the TF recommends intravenous immunoglobulin (IVIg) 0.4 g/kg for 5 days, in patients within 2 weeks (GPP also within 2–4 weeks) after onset of weakness if unable to walk unaided, or a course of plasma exchange (PE) 12–15 L in four to five exchanges over 1–2 weeks, in patients within 4 weeks after onset of weakness if unable to walk unaided. The TF recommends against a second IVIg course in GBS patients with a poor prognosis; recommends against using oral corticosteroids, and weakly recommends against using IV corticosteroids; does not recommend PE followed immediately by IVIg; weakly recommends gabapentinoids, tricyclic antidepressants or carbamazepine for treatment of pain; does not recommend a specific treatment for fatigue. To estimate the prognosis of individual patients, the TF advises using the modified Erasmus GBS outcome score (mEGOS) to assess outcome, and the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) to assess the risk of requiring artificial ventilation. Based on the PICOs, available literature and additional discussions, we provide flow charts to assist making clinical decisions on diagnosis, treatment and the need for intensive care unit admission.</p

Bitter, not just a matter of bad taste: Extra-oral bitter taste receptors as targets for the treatment of obesity

The prevalence of obesity is reaching epidemic proportions and is one of the major healthcare problems worldwide. Bariatric surgery is the only treatment option with a satisfying efficacy, but is, given its invasiveness, only suitable for morbidly obese patients. Therefore, there is an unmet need for new therapies for the treatment of obesity. Food intake is mainly regulated in the central nervous system, but relies on input from the periphery, including neural and hormonal signals from the gut in response to the nutritional state. Gut peptide hormone plasma levels fluctuate in response to luminal nutrient availability and are crucial in gut-brain communication. In addition, changes in secretion and motor patterns further contribute to appetite signaling. Bariatric surgery results in an efficacious body weight loss and is accompanied by restoration of postprandial plasma gut peptide hormone levels (ghrelin, GLP-1, PYY), known to be dysregulated in obesity. These changes are thought to be involved in the beneficial effects of bariatric surgery on body weight and food intake. Targeting the release of gut peptides to influence food intake might be a valuable, non-invasive alternative for bariatric surgery. Bitter taste receptors (TAS2Rs) on the tongue detect potentially toxic substances and prevent ingestion by eliciting aversive reactions. Recently, these receptors have been found in tissues other than the oral cavity, suggesting additional functions besides the judgment of food quality. Previous work from our group has described the expression of the bitter taste receptor associated G-protein subunit α-gustducin in ghrelin producing cells of the mouse stomach. Intra-gastric delivery of bitter compounds resulted in rises in plasma ghrelin levels, accompanied by a short lasting increase in food intake. This was however followed by a longer lasting decrease in food intake, correlating with a decrease in gastric emptying rate. The latter was shown to be independent of anorexigenic gut peptide release, and was suggested to involve a direct effect on smooth muscle. These results suggest a possible role of intestinal TAS2Rs in the regulation of appetite. This PhD-project consisted of two major aims. The first aim was to verify whether smooth muscle of the gut also expresses TAS2Rs, and whether bitter agonists affect intestinal motility in vitro and in vivo. The second aim was to study the involvement of the gustatory signaling pathway in the development of obesity, and to verify whether prolonged treatment with bitter agonists would influence body weight gain and food intake in obese mice. In the first part, mRNA expression of TAS2Rs and the full canonical taste signaling pathway was demonstrated in smooth muscle tissue of the mouse gut and in cultured human gastric smooth muscle cells. Some bitter agonists induced concentration- and region-dependent contractility changes in intestinal smooth muscle strips. These were further characterized for denatonium benzoate (DB) in mouse fundic smooth muscle strips. DB induced contractions at lower concentrations and relaxations at higher concentrations. The contractions were mediated via a taste-signaling dependent pathway, involving increases in intracellular Ca2+ originating from both intracellular and extracellular sources. The contraction was partially masked through activation of a hyperpolarizing K+-efflux. The relaxation at higher concentrations was most likely TAS2R-independent. In human gastric smooth muscle cells, DB or chloroquine induced concentration-dependent rises in intracellular Ca2+-levels and ERK-phosphorylation. Intra-gastric administration of DB in mice delayed gastric emptying via a TAS2R-mediated pathway. Finally, healthy volunteers receiving an intra-gastric infusion of DB had an impaired gastric accommodation reflex and showed a decreased nutrient volume intake and early satiation. Our results demonstrate that bitter tastants can directly influence contractility of smooth muscle, and also have in vivo effects on intestinal motility. It remains however to be demonstrated whether the effects seen in vivo are directly mediated through effects on smooth muscle or also involve endocrine effects. Nevertheless, these results suggest that targeting extra-oral TAS2Rs may be of therapeutic value for the treatment of gastrointestinal motility disorders or obesity. In the second part of this PhD-project we aimed to elucidate whether targeting the gustatory signaling pathway and more specifically TAS2Rs may interfere with the development of obesity. α-gustducin-/- (α-gust-/-) mice gained less weight on a high-fat diet than wild type mice, despite an increased food intake. Correspondingly, these mice had a decreased mass of white adipose tissue and decreased plasma levels of leptin. In addition mRNA expression of uncoupling protein 1, the thermogenic gene that is the hallmark of brown adipocytes, was increased in white adipose tissue of α-gust-/- mice and resulted in an increased heat production in these mice. Our findings therefore suggest that the gustatory signaling pathway is involved in the regulation of browning of white adipose tissue resulting in an increased heat production and decreased body weight gain in α-gust-/- mice. Daily intra-gastric treatment of high-fat diet induced obese mice with bitter agonists (DB or quinine) for 4 weeks resulted in an α-gustducin-dependent decrease in body weight gain, with minor changes in food intake for DB but not quinine. Postprandial plasma levels of the gut peptides only changed modestly and are unlikely to explain the bitter agonist induced changes in body weight. The presence of mTas2Rs and α-gustducin was demonstrated in white adipose tissue and in a pre-adipocyte cell line, 3T3-F442A. Treatment of pre-adipocytes with DB or quinine resulted in an inhibition of differentiation, demonstrating a direct effect of bitter agonists on adipocyte metabolism. In conclusion, the gustatory signalling pathway seems involved in the induction of diet-induced obesity, through its involvement in the regulation of WAT browning. Intra-gastric bitter treatment inhibits weight gain, possibly by directly affecting adipocyte metabolism. To conclude, this thesis has contributed to our knowledge regarding the expression and function of extra-oral bitter taste receptors. TAS2Rs seem to be omnipresent in the human body and appear to fulfill a wide range of functions, of which not all have been uncovered. Some of the proposed functions of TAS2Rs, e.g. the activation of the innate immune system in the airways, serve to protect the body from toxic substances or invading pathogens and are thus analogue to the function of TAS2Rs on the tongue. In other tissues, e.g. the testis, the function of TAS2Rs remains speculative. Notwithstanding their sometimes unclear role, TAS2Rs might emerge as therapeutic targets in a wide range of disorders, including, as shown by us, obesity and gastrointestinal motility disorders.status: publishe

Ghrelin signaling in the gut, its physiological properties, and therapeutic potential

BACKGROUND: Ghrelin, an orexigenic hormone secreted from the stomach, was soon after its discovery hypothesized to be a prokinetic agent, due to its homology to motilin. Studies in animals and humans, using ghrelin and ghrelin receptor agonists, confirmed this hypothesis, suggesting a therapeutic potential for the ghrelin receptor in the treatment of gastrointestinal motility disorders. Precilinical studies demonstrated that ghrelin can act directly on ghrelin receptors on the enteric nervous system, but the predominant route of action under physiological circumstances is signaling via the vagus nerve in the upper gastrointestinal tract and the pelvic nerves in the colon. Different pharmaceutical companies have designed stable ghrelin mimetics that revealed promising results in trials for the treatment of diabetic gastroparesis and post-operative ileus. Nevertheless, no drug was able to reach the market so far, facing problems proving superiority over placebo treatment in larger trials. PURPOSE: This review aims to summarize the road that led to the current knowledge concerning the prokinetic properties of ghrelin with a focus on the therapeutic potential of ghrelin receptor agonists in the treatment of hypomotility disorders. In addition, we outline some of the problems that could be at the basis of the negative outcome of the trials with ghrelin agonists and question whether the right target groups were selected. It is clear that a new approach is needed to develop marketable drugs with this class of gastroprokinetic agents.status: publishe

Importance of information provision in the acceptance of blood donation criteria by the general public in Belgium

BACKGROUND: Blood transfusions save lives, but carry the risk of causing transfusion-transmitted diseases. This risk is limited by strict donor selection criteria, the most controversial being the exclusion of men who had sex with men (MSM). This cross-sectional study investigated knowledge and beliefs of the general public concerning donor exclusion criteria, with emphasis on MSM. MATERIALS AND METHODS: A representative sample of the population of Flanders, Belgium was questioned using a web-based questionnaire. The effect of additional information on people's opinions was tested. RESULTS: People were less aware of the exclusion of MSM than of other risk populations, e.g. prostitutes. Correspondingly, they were more willing to accept blood from MSM than from other risk populations. MSM were also considered appropriate donors. Interestingly, prior knowledge about the exclusion of MSM appeared to be the strongest predictor for not accepting blood from MSM or a more stringent attitude on MSM exclusion. Receiving information on reasons for exclusion shifted opinions towards more stringency. Nevertheless, most people think that exceptions for MSM should be made under certain circumstances. This study identified several demographic factors associated with opinions concerning the exclusion of MSM for blood donation and the potential to change opinions after receiving information, e.g. age or socio-economic status. DISCUSSION: Blood collecting services can gain understanding from the general public about their exclusion policies by providing clear information. Communication efforts targeting specific audiences in function of their knowledge and likeliness to change their opinion, might improve the effectiveness of information campaigns.status: publishe

Importance of information provision in the acceptance of blood donation criteria by the general public in Belgium

Background: Blood transfusions save lives, but carry the risk of causing transfusion-transmitted diseases. This risk is limited by strict donor selection criteria, the most controversial being the exclusion of men who had sex with men (MSM). This cross-sectional study investigated knowledge and beliefs of the general public concerning donor exclusion criteria, with emphasis on MSM. Materials and methods: A representative sample of the population of Flanders, Belgium was questioned using a web-based questionnaire. The effect of additional information on people's opinions was tested. Results: People were less aware of the exclusion of MSM than of other risk populations, e.g. prostitutes. Correspondingly, they were more willing to accept blood from MSM than from other risk populations. MSM were also considered appropriate donors. Interestingly, prior knowledge about the exclusion of MSM appeared to be the strongest predictor for not accepting blood from MSM or a more stringent attitude on MSM exclusion. Receiving information on reasons for exclusion shifted opinions towards more stringency. Nevertheless, most people think that exceptions for MSM should be made under certain circumstances. This study identified several demographic factors associated with opinions concerning the exclusion of MSM for blood donation and the potential to change opinions after receiving information, e.g. age or socio-economic status. Discussion: Blood collecting services can gain understanding from the general public about their exclusion policies by providing clear information. Communication efforts targeting specific audiences in function of their knowledge and likeliness to change their opinion, might improve the effectiveness of information campaigns

The Potential Efficacy of Psychological First Aid on Self-Reported Anxiety and Mood

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