Family burden and expressed emotion in the parents of adults with schizophrenia, a critique and empirical test of an integrated model

grantor: University of TorontoThis study critiqued the dominant theoretical models of families and schizophrenia and empirically tested relationships between subjective family burden and expressed emotion (EE) of parents of adults with schizophrenia. Integration of the models is theoretically plausible, consistent with empirical evidence, congruent with dominant social work practice models, and has the potential to advance clinical practice. An integrated EE/family burden model was proposed and formed the basis of research questions. Exploratory secondary data analyses were conducted. The research tested whether the EE components, EOI and criticism, mediate relationships between parent subjective burden and each of patient social functioning, patient symptoms, parent knowledge about schizophrenia, and parent experience with schizophrenia. The results were indefinite. The findings that neither EOI nor criticism act as statistical mediators were inconclusive because of low statistical power for the tests. There were trends for associations between the EE components, subjective burden, and patient social functioning. Relationships between EE change and subjective burden change were tested. The results indicate that EE may explain, at most, a small part of subjective burden change. There was a trend for a relationship between EE change and subjective burden change. Among parents who were initially high EE, lower subjective burden was associated with subsequent change to low EE. EE was more likely to be stable than to change. Change from high to low EE was more common than change from low to high EE. The major limitations of the research design were the: (1) non probability sample; (2) small sample size and the associated low statistical power for many of the tests; and (3) the large number of univariate tests which increased the chance of Type I error. Thus, the findings must be interpreted with caution. Design features which compensate for weaknesses in the published research include: (1) use of a theoretical framework; (2) avoiding confounding in measurement; (3) preservation of sample size through the use of multiple imputation for ignorable missing data; (4) analysis of potential sample bias; and (5) use of multivariate statistical techniques.Ph.D

Awakening Canadians to ageism: a study protocol

Abstract Background Making fun of growing older is considered socially acceptable, yet ageist humour reinforces negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Such stereotypes and discrimination affect the wellbeing of older people, the largest demographic of Canadians. While ageism extends throughout professions and social institutions, we expect nurses—the largest and most trusted group of healthcare professionals—to provide non-ageist care to older people. Unfortunately, nurses working with older people often embrace ageist beliefs and nursing education programs do not address sufficient anti-ageism content despite gerontological nursing standards and competencies. Methods To raise awareness of ageism in Canada, this quasi-experimental study will be supported by partnerships between older Canadians, advocacy organizations, and academic gerontological experts which will serve as an advisory group. The study, guided by social learning theory, will unfold in two parts. In Phase 1, we will use student nurses as a test case to determine if negative stereotypes and ageist perceptions can be addressed through three innovative e-learning activities. The activities employ gamification, videos, and simulations to: (1) provide accurate general information about older people, (2) model management of responsive behaviours in older people with cognitive impairment, and (3) dispel negative stereotypes about older people as dependent and incontinent. In Phase 2, the test case findings will be shared with the advisory group to develop a range of knowledge mobilization strategies to dispel ageism among healthcare professionals and the public. We will implement key short term strategies. Discussion Findings will generate knowledge on the effectiveness of the e-learning activities in improving student nurses’ perceptions about older people. The e-learning learning activities will help student nurses acquire much-needed gerontological knowledge and skills. The strength of this project is in its plan to engage a wide array of stakeholders who will mobilize the phase I findings and advocate for positive perspectives and accurate knowledge about aging—older Canadians, partner organizations (Canadian Gerontological Nurses Association, CanAge, AgeWell), and gerontological experts

Adjuvant Sirolimus Does Not Improve Outcome in Pet Dogs Receiving Standard-of-Care Therapy for Appendicular Osteosarcoma: A Prospective, Randomized Trial of 324 Dogs

PurposeThe mTOR pathway has been identified as a key nutrient signaling hub that participates in metastatic progression of high-grade osteosarcoma. Inhibition of mTOR signaling is biologically achievable with sirolimus, and might slow the outgrowth of distant metastases. In this study, pet dogs with appendicular osteosarcoma were leveraged as high-value biologic models for pediatric osteosarcoma, to assess mTOR inhibition as a therapeutic strategy for attenuating metastatic disease progression.Patients and methodsA total of 324 pet dogs diagnosed with treatment-naïve appendicular osteosarcoma were randomized into a two-arm, multicenter, parallel superiority trial whereby dogs received amputation of the affected limb, followed by adjuvant carboplatin chemotherapy ± oral sirolimus therapy. The primary outcome measure was disease-free interval (DFI), as assessed by serial physical and radiologic detection of emergent macroscopic metastases; secondary outcomes included overall 1- and 2-year survival rates, and sirolimus pharmacokinetic variables and their correlative relationship to adverse events and clinical outcomes.ResultsThere was no significant difference in the median DFI or overall survival between the two arms of this trial; the median DFI and survival for standard-of-care (SOC; defined as amputation and carboplatin therapy) dogs was 180 days [95% confidence interval (CI), 144-237] and 282 days (95% CI, 224-383) and for SOC + sirolimus dogs, it was 204 days (95% CI, 157-217) and 280 days (95% CI, 252-332), respectively.ConclusionsIn a population of pet dogs nongenomically segmented for predicted mTOR inhibition response, sequentially administered adjuvant sirolimus, although well tolerated when added to a backbone of therapy, did not extend DFI or survival in dogs with appendicular osteosarcoma