The effect of cancer stage and treatment modality on quality of life in oropharyngeal cancer

Objectives/Hypothesis To examine changes in health-related quality of life among oropharyngeal cancer patients by stages and across treatment types among advanced cancer patients. Study Design Individual prospective cohort study. Methods All newly diagnosed patients with oropharyngeal cancer treated with curative intent were routinely assessed. The European Organization for Research and Treatment of Cancer (EORTC) both the Main Module quality-of-life questionnaire (QLQ-C30) and the Head and Neck Cancer (HNC) Module (QLQ-H&N35) were administered at diagnosis and 3, 6, and 12 months thereafter. Complete case analysis was used following assessment of missing data. The proportion of patients with clinically significant deterioration (changes of ≥10 points) from baseline were calculated for each follow-up time point and compared by stage (I/II vs. III/IV) and then treatment type (chemotherapy and radiotherapy [CRT] vs. surgery and postoperative radiotherapy [S&PORT]). Results Deterioration in most domains was most frequent for stage III/IV patients at 3 months (both modules), whereas stage I/II patients experienced this at 6 months (QLQ-C30) and 12 months (H&N35). Among stage III/IV patients, this happened at all time points for S&PORT patients (QLQ-C30) versus 12 months for CRT patients (H&N35). The number of patients reporting deterioration was lower for most domains at 12 months compared to earlier periods, although dry mouth remained a problem for most patients (60%-85% across treatment/stage groups). Conclusions Our preliminary findings suggest that general and disease-specific deterioration is of most concern for stage I/II patients at 6 and 12 months and at 3 months for advanced cancer patients. For stage III/IV patients receiving S&PORT, general deterioration remains a problem after diagnosis, whereas for CRT patients, disease-specific deterioration is of most concern at 12 months. Level of Evidence 4. Laryngoscope, 124:151-158, 201

Screening for hazardous alcohol use and dependence in psychiatric in-patients using the AUDIT questionnaire

The Alcohol Use Disorders Identification Test (AUDIT) has been used to screen for hazardous and harmful alcohol consumption among general hospital populations but not in psychiatric patients. Using the AUDIT, we assessed alcohol use in patients with four major types of psychiatric disorder, namely mood, adjustment, anxiety and psychotic disorders. Nine hundred and ninety consecutive admissions to the psychiatric units of two hospitals during a 12-month period underwent assessment. In each diagnostic group a high proportion of patients was alcohol-dependent. Among those with mood disorders 25.4% of men were alcohol-dependent, compared with 16.3% of women, while 34.5% of men with anxiety disorder were alcohol-dependent compared with 25.0% of women. Both gender differences were statistically significant. The differences were even greater for adjustment disorder (44.4% vs. 14.5%) and psychosis (29.2% and 4.2%, respectively). More men than women with anxiety disorder were classified as hazardous (24.1% vs. 11.7%) or harmful drinkers (13.8% vs. 3.3%), but for the other diagnostic groupings the percentages in these drinking categories were more nearly similar. Thus, there is a high rate of excessive alcohol consumption in people with psychiatric disorders, especially males. Such individuals may be particularly vulnerable to complications of alcohol misuse such as suicide and exacerbation of their disorder. The potential for decreased severity of psychiatric symptoms and a reduction in the number of hospital admissions following cessation or reduction in alcohol consumption is considerable. The AUDIT is a simple screening device for investigating alcohol use and dependence, and offers a means of initiating intervention in this population

2010-2011 Best Practice Sampler: The Theory and Practice of Teaching at Philadelphia University

Preface Every faculty member at one time or another has known the sinking sensation that he or she is just not reaching students. Since we entered the profession because we love learning and love to facilitate learning, blank stares and dull eyes lead not only to frustration, but also to disappointment. Paraphrasing Lee Shulman, past President of the Carnegie Foundation for the Advancement of Teaching, and a leader in professional education, it is one thing to be competent in subject knowledge and another thing to be competent in subject knowledge pedagogy. The examples and ideas expressed in these pages come from our own faculty, teaching our own students and were developed to expand the tools they use to impact learning. Too often, good techniques and activities often are not shared, missing the opportunity to build on one another’s ideas and experiment with new pedagogy. There seems to be little time and no forum for practice exchange and even less opportunity for researching new pedagogical approaches. John Lewis comments, “The choice of innovative teaching strategies largely depends on the willingness of an instructor to continually test both effectiveness and acceptance of a particular technique. Learning has taken place since the dawn of civilization and some teaching methods have existed just as long. The innovative instructor often recognizes that ‘tried’ is but a rearrangement of ‘tired.’ However, some teaching practices have survived solely because of their effectiveness and their demonstrated evidence of strength. Therefore, instructors who regard time-honored practices as co-ingredients with sparkling innovation usually see marked growth among learners who have joined them in discovery. Techniques that reward creativity often yield subject mastery at the highest level of application and experimentation toward the establishment of new theory.” In addition, there can appear to be disincentives for sharing practice. As one faculty member noted, we can come to a university teaching with a desire that our sections succeed better than others. Consequently, if we have a technique that works well, we may keep it to ourselves. That same faculty member expressed great satisfaction when, in time, she learned that sharing collaboratively results in even more powerful ideas, as well as significant collegial support. Another faculty member, Jesse Coale, has found the same support by sharing his ideas, “We continue to try to find the balance between experiential learning and boring lectures. Often this happens as an organic process — sitting around the lunch table when someone presents an idea and it gets discussed, finessed and implemented. Having a faculty group that is open to new ideas and methods is essential to try these different ideas.” The Best Practice Sampler, composed of just some of the approaches evident in our classes every day, offers a way both to share techniques and activities and also to celebrate the dedication and creativity of the Philadelphia University faculty and staff. In each section, loosely organized around our Nexus Learning strategies of active, collaborative, engaged, real-world learning, employing the methods and knowledge learned in a study of the liberal arts and sciences, the authors have responded to the question,“What do you do that makes for effective student learning?” The short pieces chronicle many of our best pedagogical practices. They show how teachers implement their ideas and beliefs about teaching and learning, in a concrete and practical way

T-Bar clasp-retained removable partial denture as an alternative to implant-based prosthetic treatment

This article reports the case of a 55-year-old female patient who presented with unsatisfactory temporary crowns in the right mandibular premolars and molars, and a premolar-to-molar fixed partial denture in the left side. The clinical and radiographic examinations revealed a fracture of the left first premolar that was a retainer of the fixed partial denture and required extraction. Initially, the acrylic resin crowns were replaced by new ones, and a provisional RPD was made using acrylic resin and orthodontic wire clasps to resolve the problem arising from the loss of the fixed partial denture. Considering the patient's high esthetic demands, the treatment options for the definitive prosthetic treatment were discussed with her and rehabilitation with implant-supported dentures was proposed because the clinical conditions of the residual alveolar ridge were suitable for implant installation, and the patient's general health was excellent. However, the patient did not agree because she knew of a failed case of implant-retained denture in a diabetic individual and was concerned. The patient was fully informed that implant installation was the best indication for her case, but the arguments were not sufficient to change her decision. The treatment possibilities were presented and the patient opted for a clasp-retained removable partial denture (RPD) associated with the placement of crowns in the pillar teeth. The temporary RPD was replaced by the definitive RPD constructed subsequently. Although RPD was not the first choice, satisfactory esthetic and functional outcomes were achieved, overcaming the patient's expectations. This case report illustrates that the dentist must be prepared to deal with situations where, for reasons that cannot be managed, the patient does not accept the treatment considered as the most indicated for his/her case. Alternatives must be proposed and the functional and esthetic requirements must be fulfilled in the best possible manner.Este artigo relata o caso de uma paciente de 55 anos que apresentava no arco mandibular coroas provisórias insatisfatórias nos pré-molares do lado direito e uma prótese parcial fixa de molar a pré-molar no lado esquerdo. Os exames clínico e radiográfico revelaram uma fratura do primeiro pré-molar esquerdo que era um retentor da prótese parcial fixa e teve a extração indicada. Inicialmente, as coroas provisórias foram substituídas por novas e uma prótese parcial removível provisória foi confeccionada com resina acrílica e grampos de fio ortodôntico a fim resolver os problemas relacionados à perda da prótese parcial fixa. Considerando a forte demanda estética da paciente, foram discutidas as opções de tratamento protético definitivo. Foi proposta a reabilitação com prótese implanto-suportada uma vez que as condições clínicas do rebordo alveolar se apresentavam adequadas para instalação de implantes e a saúde geral da paciente era excelente. Entretanto, a paciente não concordou com o tratamento proposto, alegando saber de um caso clínico em que houve insucesso na reabilitação por prótese implanto-suportada em um paciente diabético. Ela foi inteiramente informada de que a colocação de implantes era a melhor indicação para seu caso, mas os argumentos não foram suficientes para mudar sua decisão. As possibilidades de tratamento foram apresentadas e a paciente optou por uma prótese parcial removível (PPR) retida a grampos associada com coroas nos dentes pilares. Na seqüência, a PPR provisória foi substituída por uma PPR definitiva. Embora a PPR não tivesse sido a primeira escolha, foram obtidos resultados estéticos e funcionais satisfatórios, superando as expectativas da paciente. Este relato de caso ilustra que o dentista deve estar preparado para enfrentar situações em que, por razões que não possam ser administradas, o paciente não aceite o tratamento considerado mais indicado para seu caso. Alternativas devem ser propostas e as exigências estéticas e funcionais devem ser contempladas da melhor maneira possível

Strategies for Piloting a Breast Health Promotion Program in the Chinese-Australian Population

In Australia, women from non–English-speaking backgrounds participate less frequently in breast cancer screening than English-speaking women, and Chinese immigrant women are 50% less likely to participate in breast examinations than Australian-born women. Chinese-born Australians comprise 10% of the overseas-born Australian population, and the immigrant Chinese population in Australia is rapidly increasing. We report on the strategies used in a pilot breast health promotion program, Living with Healthy Breasts, aimed at Cantonese-speaking adult immigrant women in Sydney, Australia. The program consisted of a 1-day education session and a 2-hour follow-up session. We used 5 types of strategies commonly used for cultural targeting (peripheral, evidential, sociocultural, linguistic, and constituent-involving) in a framework of traditional Chinese philosophies (Confucianism, Taoism, and Buddhism) to deliver breast health messages to Chinese-Australian immigrant women. Creating the program's content and materials required careful consideration of color (pink to indicate femininity and love), symbols (peach blossoms to imply longevity), word choice (avoidance of the word death), location and timing (held in a Chinese restaurant a few months after the Chinese New Year), communication patterns (the use of metaphors and cartoons for discussing health-related matters), and concern for modesty (emphasizing that all presenters and team members were female) to maximize cultural relevance. Using these strategies may be beneficial for designing and implementing breast cancer prevention programs in Cantonese-speaking Chinese immigrant communities

Unmet psychological and practical needs of patients with cancer in rural and remote areas of Western Australia

The financial and psychological impacts of cancer treatment on patients can be severe. Practical issues, such as childcare, medical supplies and obtaining ‘home help’ can impose financial strain on patients and their families, and this is often exacerbated by a simultaneous loss of income if a patient is unable to continue employment during treatment, or if family members become full-time carers. These financial difficulties are often more severe for patients from rural regions because cancer services tend to be concentrated in metropolitan areas, requiring rural patients to relocate or undertake lengthy, frequent commutes to access treatment. The needs of rural cancer patients may differ from and exceed those of metropolitan cancer patients. Because of this, it is important to assess the needs of rural and metropolitan populations to develop appropriate, tailored supportive-care interventions. This article compares the unmet supportive-care needs of rural/remote with metropolitan cancer patients in Western Australia (WA), a large and sparsely populated Australian state with a substantial rural and remote population. This article is part of a larger program of research assessing the supportive-care needs of WA cancer patients.Methods: Participants were identified through the Western Australian Cancer Registry (WACR) and considered eligible if diagnosed with any type of cancer between 6 months and 2 years previously. A random sample of 2079 potential participants was generated, structured to include all cancer types and geographical areas, and with both sexes randomised within these groups. Following confirmation and exclusion of deceased patients and those patients excluded at the treating doctor’s request, 1770 patients were contacted. Participants were asked to complete a demographic questionnaire and the Supportive Care Needs Survey Long Form (SCNS-59). Data from participants who completed and returned both questionnaires were analysed using descriptive statistics and χ2 tests; and any missing data were addressed through imputation.Results: Eight hundred and twenty-nine participants (47% response) completed the SCNS-LF59 and 786 (94.8%) completed both questionnaires. Of the 786 respondents, 234 (30%) were from rural areas and 169 (22%) were from remote areas. Among the 15 items with the highest frequency for ‘some needs’ on the survey, participant needs did not vary by geographical location, with no significant differences found for any of the 15 items. The item for which the greatest, albeit non-significant (p = 0.12) difference was seen, was ‘concern about financial situation’. The differences among all other items were not significant (p-values from 0.28 to 0.96). Furthermore, the proportion of participants reporting ‘moderate to high need’ on these items also did not differ significantly across geographical populations (p-values from 0.13 to 0.91).Conclusions: The lack of discrepancy between rural, remote and metropolitan cancer patients’ unmet needs provides a positive message regarding the state of WA cancer services and the level of support provided to rural and remote WA residents. Future research should also assess the unmet needs of rural and remote carers and families in comparison with metropolitan carers and families, to ensure that services are well-equipped to meet the needs of all individuals involved in a patient’s cancer journey

Angle closure glaucoma secondary to psychotropic medications

BackgroundPsychotropic medications are commonly associated anticholinergic side-effects. In susceptible patients, this can result in angle closure induced permanent loss of visionAimsTo review the mechanism of angle closure and which psychotropics are most likely to precipitate this complication.MethodsLiterature review surrounding the mechanism of angle closure and pharmacology of various psychotropicsResultsMydriasis, forward-displacement of the lens-iris diaphragm and ciliary body swelling are the mechanisms by which angle closure occurs. Anticholinergic side effects of psychotropic medications are most implicated in causing this.ConclusionScreening patients for risk factors of angle closure and either having them formally assessed or choosing psychotropics with minimal anticholinergic effects may avoid inducing angle closure

Annual Report Fall 2014-Summer 2015: The Design, Implementation, & Assessment of Nexus Learning Hubs

Executive Summary Literature suggests that active and collaborative pedagogies, as compared to traditional lecturing, may enhance student engagement, motivation, retention, learning, and achievement. While Philadelphia University’s faculty members have embraced these Nexus Learning pedagogies that facilitate active and collaborative learning, the built environment of our traditional classrooms, and their associated technologies, have often limited the effectiveness. Philadelphia University began an initiative aiming to radically transform existing traditional learning spaces into intentionally designed learning environments that aim to minimize the physical and technological limitations of some of our traditional classrooms and maximize the beneficial evidence-based approaches of active, collaborative, real world pedagogies. This annual report summarizes the processes of design/implementation, assessment results, and lessons learned from this first year of the Active Learning Space Initiative. The planning process included key campus stake-holders under consultation with external experts in learning space design. The fall 2014 semester saw the unveiling of two Nexus Learning Hubs intentionally designed to offer more seamless transitions from different modes of active learning, enhance versatility in furniture configurations to optimize active and collaborative interactions, and couple appropriate technologies with vibrant and modern spaces to allow students to co-create and critique information in an aesthetically motivating space. The Nexus Learning Hubs have provided an experimental space offering a no-risk, highly versatile environment in which faculty members can amass evidence-based approaches to optimizing the interconnectedness of the built learning space, pedagogies, and technology. To assess the effectiveness of these spaces, and identify weaknesses or oversights (lessons learned), we used direct and indirect methods such as the Active Learning Post-Occupancy Evaluation, ethnographic data garnered from classroom observations, periodic faculty and student surveys, and summaries from two faculty feedback sessions