Do radiation therapists feel able to routinely screen for symptoms and distress in people with cancer: barriers impacting practice

Introduction: This study aimed to evaluate radiation therapists’ (RTs) perceptions regarding the perceived barriers, knowledge, attitudes, confidence and role in administering an electronic screening tool to routinely screen for cancer patients’ symptoms and distress. Methods: RTs at two radiation therapy departments completed a cross-sectional paper/pen survey to assess their demographic and workplace characteristics, perceptions of barriers, knowledge, attitudes, confidence and opinion of their role in symptom and distress screening. Responses were evaluated using simple frequencies and free-text responses using thematic analysis. Results: Of 39 RTs approached, 37 (95%) participated. The majority had not previously attended any emotional cues (77%) or psychosocial training (86%); 68% reported confidence discussing psychosocial concerns and recognising signs of anxiety and depression in patients, and 65% felt discussing patients’ psychosocial concerns was part of their role. Administering the tool to patients was agreed to be the role of RTs by 38% of participants. Lack of education about psychosocial issues was the highest-ranked barrier to delivering the patient screening tool, with 74% of RTs responding ‘it has made it difficult’. Conclusion: Whilst RTs are willing to play a role in patients’ psychosocial support, they do not feel able to fulfil this role adequately because they lacked knowledge and confidence to administer symptom and distress screening. This research has highlighted the need for RT education on psychosocial concerns and recognising and responding to emotional cues. Understanding the impact education may have on the knowledge, attitude, confidence and role of RTs performing routine symptom and distress screening is required

Physical, psychosocial, relationship, and economic burden of caring for people with cancer: A review

The aim of this article is to provide an overview of the issues faced by caregivers of people diagnosed with cancer, with a particular emphasis on the physical, psychosocial, and economic impact of caring. A review of the literature identified cancer as one of the most common health conditions in receipt of informal caregiving, with the majority of caregivers reporting taking on the role of caring because of family responsibility and there being little choice or no one else to provide the care. For some, caregiving can extend for several years and become equivalent to a full-time job, with significant consequent health, psychosocial, and financial burdens. Having a better understanding of the critical and broad roles that caregivers play in the oncology setting and the impact of these on their health and well-being may assist health care professionals in supporting caregivers with these tasks and targeting services and interventions toward those most in need. Copyright © 2012 by American Society of Clinical Oncology

ENHANCING OF THE PERFORMANCE EFFICIENCY OF OILS BLEACHING EARTH

Various percentages of citric acid [0.05, 0.1, 0.15 and 0.2%] were blended with the oil (w/v) before the bleaching of either soybean oil (SOO) or sunflower oil (SUO) to rise the performance efficiency of bleaching earth. Afterwards, activated bleaching earth was added to these oils for bleaching them at 1% level. Also, the same clay was used at 2% level for bleaching the above mentioned oils without us-ing citric acid as a reference. The study revealed that better result for raising the bleaching efficiency of SOO was obtained with 0.15% citric acid. Whilst, 0.1% cit-ric acid gave the best result pertaining the bleaching efficiency of SUO. Also, the data showed high reductions in the values of peroxide number, soap, conjugated dienes and trienes for the bleached oils with the increasing percent content of citric acid. While, the acidity values of the bleached oils (SOO and SUO) slightly in-creased with increasing citric acid percentages. On the other hand, using of citric ac-id at the ratios of 0.15 and 0.2% gave almost the same values in the bleaching effi-ciency of SOO. While, using of citric acid at the ratios of 0.1 and 0.15% gave nearly the same results of bleaching efficiency of SUO. Also, the data indicated that using of citric acid caused somewhat no changes in the fatty acid composition or their oxi-dative stabilities in the bleached oils. Therefore, it can be concluded that the reduc-tion in the color of sunflower and / or soybean oils up to a levels of 33.3 and 36.7% is attainable by using either 0.1 or 0.15% citric acid prior to the bleaching step to de-crease the imported content from bleaching earth to Egyp

Porcine Bioprosthetic Aortic Valve Endocarditis with Ring Abscess and Aortic Stenosis

Porcine bioprosthetic valve endocarditis is an infrequent but serious complication of valve replacement surgery. Ring (or annular) abscess is a frequent finding in mechanical valve endocarditis. In contrast, porcine valve endocarditis most often involves the cusps, and annular infection is uncommon. Porcine valvular dysfunction secondary to endocarditis usually takes the form of incompetence, whereas stenosis is less frequent. We report a case of a 76-year-old female who developed endocarditis wilh Staphylococcus epidermidis nine months after placement of a Carpenter-Edwards porcine aortic valve. Her initial presentation included complete heart block and moderate aortic stenosis. Transesophageal echocardiography aided the diagnosis by demonstrating large vegetations, while transthoracic echocardiography showed only slight thickening of the valve leaflets. At operation, there was a circumferential abscess around the sewing ring causing valve dehiscence and virtual discontinuity of the aorta from the left ventricle. Valve degeneration and organisms within the cusps were observed on microscopy. This case illustrates two infrequent complications of porcine aortic valve endocarditis, namely massive annular abscess with invasion of the conducting system and aortic stenosis. It also demonstrates the utility and limitations of transesophageal echocardiography in the diagnosis of this disorder

Acute hospital-based services used by adults during the last year of life in New South Wales, Australia: A population-based retrospective cohort study

© 2015 Goldsbury et al. Background: There is limited information about health care utilisation at the end of life for people in Australia. We describe acute hospital-based services utilisation during the last year of life for all adults (aged 18+ years) who died in a 12-month period in Australia's most populous state, New South Wales (NSW). Methods: Linked administrative health data were analysed for all adults who died in NSW in 2007 (the most recent year for which cause of death information was available for linkage for this study). The data comprised linked death records (2007), hospital admissions and emergency department (ED) presentations (2006-2007) and cancer registrations (1994-2007). Measures of hospital-based service utilisation during the last year of life included: number and length of hospital episodes, ED presentations, admission to an intensive care unit (ICU), palliative-related admissions and place of death. Factors associated with these measures were examined using multivariable logistic regression. Results: Of the 45,749 adult decedents, 82 % were admitted to hospital during their last year of life: 24 % had >3 care episodes (median 2); 35 % stayed a total of >30 days in hospital (median 17); 42 % were admitted to 2 or more different hospitals. Twelve percent of decedents spent time in an ICU with median 3 days. In the metropolitan area, 80 % of decedents presented to an ED and 18 % had >3 presentations. Overall 55 % died in a hospital or inpatient hospice. Although we could not quantify the extent and type of palliative care, 24 % had mention of "palliative care" in their records. The very elderly and those dying from diseases of the circulatory system or living in the least disadvantaged areas generally had lower hospital service use. Conclusions: These population-wide health data collections give a highly informative description of NSWhospital-based end-of-life service utilisation. Use of hospital-based services during the last year of life was common, with substantial variation across sociodemographic groups, especially defined by age, cause of death and socioeconomic classification of the decedents' place of residence. Further research is now needed to identify the contributors to these findings. Gaps in data collection were identified - particularly for palliative care and patient-reported outcomes. Addressing these gaps should facilitate improved monitoring and assessment of service use and care

Myogenic specification of side population cells in skeletal muscle

Skeletal muscle contains myogenic progenitors called satellite cells and muscle-derived stem cells that have been suggested to be pluripotent. We further investigated the differentiation potential of muscle-derived stem cells and satellite cells to elucidate relationships between these two populations of cells. FACS® analysis of muscle side population (SP) cells, a fraction of muscle-derived stem cells, revealed expression of hematopoietic stem cell marker Sca-1 but did not reveal expression of any satellite cell markers. Muscle SP cells were greatly enriched for cells competent to form hematopoietic colonies. Moreover, muscle SP cells with hematopoietic potential were CD45 positive. However, muscle SP cells did not differentiate into myocytes in vitro. By contrast, satellite cells gave rise to myocytes but did not express Sca-1 or CD45 and never formed hematopoietic colonies. Importantly, muscle SP cells exhibited the potential to give rise to both myocytes and satellite cells after intramuscular transplantation. In addition, muscle SP cells underwent myogenic specification after co-culture with myoblasts. Co-culture with myoblasts or forced expression of MyoD also induced muscle differentiation of muscle SP cells prepared from mice lacking Pax7 gene, an essential gene for satellite cell development. Therefore, these data document that satellite cells and muscle-derived stem cells represent distinct populations and demonstrate that muscle-derived stem cells have the potential to give rise to myogenic cells via a myocyte-mediated inductive interaction

Acceptability and effectiveness of opportunistic referral of smokers to telephone cessation advice from a nurse: a randomised trial in Australian general practice

<p>Abstract</p> <p>Background</p> <p>GPs often lack time to provide intensive cessation advice for patients who smoke. This study aimed to determine the effectiveness of opportunistic referral of smokers by their GP for telephone cessation counselling by a trained nurse.</p> <p>Methods</p> <p>Adult smokers (n = 318) attending 30 GPs in South Western Sydney, Australia were randomly allocated to usual care or referral to a telephone-based program comprising assessment and stage-based behavioural advice, written information and follow-up delivered by a nurse. Self-reported point prevalence abstinence at six and 12 months was compared between groups. Characteristics of patients who accepted and completed the intervention were investigated.</p> <p>Results</p> <p>Of 169 smokers randomised to the intervention, 76 (45%) consented to referral. Compared with smokers in 'pre-contemplation', those further along the stage-of-change continuum were significantly more likely to consent (p = 0.003). Those further along the continuum also were significantly more likely to complete all four calls of the intervention (OR 2.6, 95% CI: 0.8–8.1 and OR 8.6, 95% CI: 1.7–44.4 for 'contemplation' and 'preparation' respectively). At six months, there was no significant difference between groups in point prevalence abstinence (intention to treat) (9% versus 8%, p = 0.7). There was no evidence of differential intervention effectiveness by baseline stage-of-change (p = 0.6) or patient sex (p = 0.5). At 12 months, point prevalence abstinence in the intervention and control groups was 8% and 6% respectively (p = 0.6).</p> <p>Conclusion</p> <p>Acceptance of opportunistic referral for nurse delivered telephone cessation advice was low. This trial did not demonstrate improved quit rates following the intervention. Future research efforts might better focus support for those patients who are motivated to quit.</p> <p>Australian Clinical Trials Registry number</p> <p>ACTRN012607000091404</p