bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequency of Jackhammer Esophagus as the Extreme Phenotypes of Esophageal Hypercontractility Based on the New Chicago Classification
Authors: Jia Yi , Arenas Juan , Hejazi Reza A. , Elhanafi Sherif , Saadi Mohammed , McCallum Richard W.
Published: February 2016

Background:

Jackhammer Esophagus is defined as intact esophageal peristaltic contractions with extremely elevated amplitudes. We conducted a retrospective study to identify the frequency of esophageal hypercontractility and the clinical characteristics of Jackhammer Esophagus.

Methods:

Charts for the patients referred for manometric study at a tertiary-care motility center were reviewed. Data were collected utilizing the new Chicago classification criteria for Jackhammer Esophagus. Concomitant clinical variables were also explored.

Results:

Eight patients were identified with Jackhammer Esophagus from a total of 205 (127 female/77 male) patients referred for high-resolution esophageal manometry. Jackhammer patients had an average distal contractile integral (DCI) of 9061 mmHg/ sec/ cm and median maximal DCI of 16,433 mmHg/ sec/ cm. The greatest DCI from 15 swallows was 28,875 mmHg/ sec/ cm. Hypercontractility was associated with multipeaked contractions in every Jackhammer patient. The mean lower esophageal sphincter (LES) pressure was 41 mm Hg with 4 patients having a hypertensive pressure of >40 mm Hg. Three of the 8 (37.5%) Jackhammer group had incomplete LES relaxation by integrated relaxation pressure criteria (>15 mm Hg residual pressure). Dysphagia (8/8) was the dominant indication for the manometric study, whereas the clinical background setting was gastroesophageal reflux disease (4/8) and hiatal hernia (1/8). Treatments included smooth muscle relaxation, antireflux regimens, and pneumatic dilation of the LES.

Conclusions:

Jackhammer Esophagus, an extreme manometric phenotype, was identified in 4.0% of patients referred to a University Motility Center. The patients with these esophageal hypercontractility states present mainly with dysphagia. A subgroup of Jackhammer did have accompanying incomplete LES relaxation and responded to targeted therapy with pneumatic dilatation.
Clinical Implications of Histologic Abnormalities in Ileocolonic Biopsies of Patients With Crohn’s Disease in Remission
Authors: Brennan Gregory T. , Melton Shelby D. , Spechler Stuart J. , Feagins Linda A.
Published: February 2016

Background:

For patients with Crohn’s disease (CD) who have colonoscopy during periods of clinical remission, the utility of taking ileocolonic biopsy specimens to assess disease activity is disputed.

Goals:

We explored the clinical implications of histologic disease activity in such patients.

Study:

We reviewed medical records of CD patients who underwent elective colonoscopy while in clinical remission at our VA Medical Center from 2000 to 2013, and who had at least 6 months of follow-up. We correlated endoscopic and histologic disease activity with the subsequent development of flares.

Results:

We identified 62 CD patients who had a total of 103 colonoscopies during clinical remission; 55 colonoscopies revealed complete endoscopic healing and 48 showed active disease. Flares within 6, 12, and 24 months of colonoscopy were not more common in patients with endoscopic activity than those with complete endoscopic healing. In contrast, patients with any of 5 histologic features of active inflammation (erosions, cryptitis, crypt abscess, increased neutrophils, or increased eosinophils in the lamina propria) had more flares than patients without those changes (P<0.05). Among the individual histologic features, an increase in eosinophils or neutrophils in the lamina propria and cryptitis were associated with higher flare rates (P<0.05).

Conclusions:

For CD patients who have a colonoscopy while in clinical remission, biopsy seems to provide important prognostic information beyond that provided by endoscopic assessment of disease activity alone. In particular, increased eosinophils or neutrophils in the lamina propria and cryptitis are strongly associated with an increased risk of clinical flares within 1 to 2 years.
Factors associated with anxiety and depressive symptoms in colorectal cancer survivors
Authors: Braamse Annemarie M.J. , van Turenhout Sietze T. , Terhaar sive Droste Jochim S. , de Groot Gerrit H. , van der Hulst René W.M. , Klemt-Kropp Michael , Kuiken Sjoerd D. , Loffeld Ruud J.L.F. , Uiterwaal M. Tessa , Mulder Chris J.J. , Dekker Joost
Published: February 2016

Background

Up to 37% of colorectal cancer (CRC) survivors report depressive and anxiety symptoms. The identification of risk factors for depressive or anxiety symptoms might help focus supportive care resources on those patients most in need. The present study aims to explore which factors are associated with heightened anxiety or depression symptom severity.

Methods

In this cross-sectional study, individuals diagnosed with CRC 3.5 to 6 years ago completed questionnaires on sociodemographic information, medical comorbidities, anxiety symptoms (Beck Anxiety Inventory), and depressive symptoms (Inventory of Depressive Symptomatology). The general linear model analysis of covariance was used to identify factors associated with heightened anxiety or depressive symptom severity.

Results

The sample included 91 CRC survivors, 40.7% women, mean age 69.1 years. A minority of CRC survivors had moderate (3.4%) or severe (2.3%) anxiety symptoms, and moderate (7.7%) or severe (0%) depressive symptoms. Shorter time since diagnosis and higher number of comorbid diseases were associated with higher anxiety symptom severity. Female sex and higher number of comorbid diseases were associated with higher depressive symptom severity.

Conclusion

From this explorative study, it follows that survivors with multiple comorbid diseases, shorter time since diagnosis, and female survivors might be at risk for higher anxiety and/or depressive symptom severity. Survivors with these characteristics might need extra monitoring.
Usefulness of a multiplying factor in predicting the final number of victims during a mass casualty incident
Authors: Maurin Olga , Bignand Michel , Jost Daniel , Travers Stéphane , Raclot Stéphane , Trichereau Julie , Bon Olivier , Frattini Benoit , Loeb Thomas , Lecarpentier Eric , Noto René , Poncelin de Raucourt Gaëtan , Tourtier Jean-Pierre
Published: February 2016

Objective

Whenever a mass casualty incident (MCI) occurs, it is essential to anticipate the final number of victims to dispatch the adequate number of ambulances. In France, the custom is to multiply the initial number of prehospital victims by 2–4 to predict the final number. However, no one has yet validated this multiplying factor (MF) as a predictive tool. We aimed to build a statistical model to predict the final number of victims from their initial count.

Methods

We observed retrospectively over 30 years of MCIs triggered in a large urban area. We considered three types of events: explosions, fires, and road traffic accidents. We collected the initial and final numbers of victims, with distinction between deaths, critical victims (T1), and delayed or minimal victims (T2–T3). The MF was calculated for each category of victims according to each type of event. Using a Poisson multivariate regression, we calculated the incidence risk ratio (IRR) of the final number of T1 as a function of the initial deaths and the initial T2–T3 counts, while controlling for potential confounding variables.

Results

Sixty-eight MCIs were included. The final number of T1 increased with the initial incidence of deaths [IRR: 1.8 (1.4–2.2)], the initial number of T2–T3 being greater than 12 [IRR: 1.6 (1.3–2.1)], and the presence of one or more explosion [IRR: 1.4 (1.1–1.8)].

Conclusion

The MF seems to be an appealing decision-making tool to anticipate the need for ambulance resources. In explosive MCIs, we recommend multiplying T1 by 1.4 to estimate final count and the need for supplementary advanced life support teams.
TIER competency-based training course for the first receivers of CBRN casualties: a European perspective
Authors: Djalali Ahmadreza , Della Corte Francesco , Segond Frederique , Metzger Marie-Helene , Gabilly Laurent , Grieger Fiene , Larrucea Xabier , Violi Christian , Lopez Cédric , Arnod-Prin Philippe , Ingrassia Pier L.
Published: February 2016

Introduction

Education and training are key elements of health system preparedness vis-à-vis chemical, biological, radiological and nuclear (CBRN) emergencies. Medical respondents need sufficient knowledge and skills to manage the human impact of CBRN events.

Objective

The current study was designed to determine which competencies are needed by hospital staff when responding to CBRN emergencies, define educational needs to develop these competencies, and implement a suitable delivery method.

Methods

This study was carried out from September 2014 to February 2015, using a three-step modified Delphi method. On the basis of international experiences, publications, and experts’ consensus, core competencies for hospital staff – as CBRN casualty receivers – were determined, and training curricula and delivery methods were defined.

Results

The course consists of 10 domains. These are as follows: threat identification; health effects of CBRN agents; planning; hospital incident command system; information management; safety, personal protective equipment and decontamination; medical management; essential resources; psychological support; and ethical considerations. Expected competencies for each domain were defined. A blended approach was chosen.

Conclusion

By identifying a set of core competencies, this study aimed to provide the specific knowledge and skills required by medical staff to respond to CRBN emergencies. A blended approach may be a suitable delivery method, allowing medical staff to attend the same training sessions despite different time zones and locations. The study output provides a CBRN training scheme that may be adapted and used at the European Union level.
Meta-analysis of the Correlation Between Interleukin-6 Promoter Polymorphism -174G/C and Interferon Regulatory Factor 4 rs12203592 Polymorphism With Skin Cancer Susceptibility
Authors: Wu Miao , Cao Yi , Liu Yong-lin , Ma Li-li , Yang Xiao-hong
Published: February 2016

Inflammation is a process whereby the immune system responds to a disease or injury. Chronic inflammation, however, has been linked to several types of cancers such as skin cancer. Molecular epidemiological studies were carried out in recent years evaluating interferon regulatory factor 4 (IRF4) rs12203592 and interleukin-6 (IL-6) gene -174G/C polymorphism associated with skin cancer risk for different groups of people. However, the results are still conflicting, not conclusive. We performed a meta-analysis to investigate the association between cancer susceptibility and IL-6 -174G/C (1130 cases and 1260 controls from 7 studies) and IRF4 rs12203592 polymorphisms (3879 cases and 6759 controls from 9 studies) in different inheritance models. We assess the strength of association of odds ratio (ORs), 95% confidence interval (CI). Overall, significantly elevated skin cancer risk was found when all studies were pooled into the meta-analysis of IL-6 -174G/C (For GC vs. GG: OR = 1.28, 95% CI, 1.06–1.54, I
2 = 0, P
heterogeneity = 0.816; for CC/GC vs. GG: OR = 1.26, 95% CI, 1.05–1.50, I
2 = 0, P
heterogeneity = 0.618). However, for IRF4 rs12203592 polymorphism, significantly increased risk of skin cancer was observed in TT versus CC (OR = 1.99, 95% CI, 1.30–3.07, I
2 = 76.7%, P
heterogeneity < 0.001) and in recessive model (OR = 1.91, 95% CI, 1.31–2.77, I
2 = 69.9%, P
heterogeneity < 0.001). This meta-analysis indicates that the IL-6 gene -174G/C and IRF4 rs12203592 polymorphisms may be associated with an increased skin cancer risk.
Undifferentiated Embryonal Sarcoma of the Liver (UESL): A Single-Center Experience and Review of the Literature
Authors: Techavichit Piti , Masand Prakash M. , Himes Ryan W. , Abbas Rana , Goss John A. , Vasudevan Sanjeev A. , Finegold Milton J. , Heczey Andras
Published: February 2016

Undifferentiated embryonal sarcoma of the liver (UESL) is a rare and aggressive pediatric malignancy. The purpose of this study was to review the clinical, radiologic, and pathologic features and outcome of children with UESL at our institution, in the United Network of Organ Sharing database and to review the existing literature to define the state of the art for children with UESL. Six children were diagnosed with UESL at the Texas Children’s Cancer Center between 1993 and 2014, 12 children underwent liver transplantation registered in the United Network of Organ Sharing database, and 198 children with UESL were described in 23 case series during 1978 to 2014. Patients were treated with multimodal treatment approaches including primary surgical resection, neoadjuvant and/or adjuvant chemotherapy, and liver transplantation resulting in overall survival reported between 20% and 100% with significant improvement over the recent years. We show that complete tumor removal remains the key element of treatment and our single-institutional experience and data in the published literature suggest that combination chemotherapy with ifosfamide and doxorubicin to facilitate complete surgical resection is an effective approach to cure children with UESL.
Current Practice of Pharmacological Thromboprophylaxis for Prevention of Venous Thromboembolism in Hospitalized Children: A Survey of Pediatric Hemostasis and Thrombosis Experts in North America
Authors: Badawy Sherif M. , Rychlik Karen , Sharathkumar Anjali A.
Published: February 2016

Pharmacological thromboprophylaxis (pTP) is the most effective intervention to prevent venous thromboembolism (VTE) in hospitalized adults. High-quality studies investigating the role of pTP in children are lacking. The aim of this study is to understand pediatric hematologists’ current practices of pTP prescription and to explore their opinion about universal adoption of pTP for high-risk hospitalized children. An electronic survey was sent to members of Hemostasis and Thrombosis Research Society of North America. The response rate was 47.3% (53/112). VTE was perceived as a major hospital acquired complication by all and 96% (51/53) prescribed pTP in select cases. Majority would consider prescribing pTP for personal history of thrombosis, inheritance of severe thrombophilic conditions, and teen age. The majority of respondents (55%, 29/53) were either not in support of or uncertain about the universal adoption of pTP policy for high-risk hospitalized children. In total, 62% of respondents (33/53) did not support the use of pTP for central venous lines. Respondents reported on the presence of pharmacological (32%, 17/53) and mechanical (45%, 24/53) thromboprophylaxis policies at their institutions. Pediatric hematologists considered pTP a useful intervention to prevent VTE and prescribed pTP in select cases. Universal adoption of pTP was not supported. Wide variability in clinical practice was observed.
Early Posttherapy Hospitalizations Among Survivors of Childhood Leukemia and Lymphoma
Authors: Smitherman Andrew B. , Wilkins Tania M. , Blatt Julie , Dusetzina Stacie B.
Published: February 2016

Long-term survivors of childhood cancers are at increased risk for hospitalization. To test the hypothesis that many treatment-related morbidities are identifiable in the early posttherapy period, we determined the rates and causes for hospitalization among survivors of leukemia and lymphoma during the first 3 years posttherapy. Using a health plan claims database, we identified patients aged 0 to 21 years old treated for leukemia or lymphoma from 2000 to 2010. Survivors were matched 10:1 with similar children without a history of cancer. Hospitalization rates over 3 years were compared using Cox proportional hazards regression and risks of cause-specific hospitalization were compared using log-binomial models. Nineteen percent of childhood leukemia and lymphoma survivors were hospitalized in the first 3 years off therapy. Leukemia survivors (N=529) experienced over 6 times (hazard ratio=6.3; 95% confidence interval [CI], 4.9-8.0) and lymphoma survivors (N=454) over 3 times the hospitalization rate of controls (hazard ratio=3.2; 95% CI, 2.5-4.2). Compared with children without a cancer history, survivors were at increased risk for hospitalization due to infectious causes (leukemia: relative risk [RR], 60.0; 95% CI, 23.4-154.0; lymphoma: RR, 10.0; 95% CI, 4.4-22.9). In addition, lymphoma survivors were at increased risk for cardiovascular-related (RR, 15.0; 95% CI, 5.4-42.0) and pulmonary-related (RR, 8.1; 95% CI, 3.9-16.8) hospitalizations. These findings highlight the morbidity experienced by survivors and suggest that treatment-associated complications may be emerging soon after therapy completion.
Intensive treadmill training in the acute phase after ischemic stroke
Authors: Strømmen Anna M. , Christensen Thomas , Jensen Kai
Published: February 2016

The aim of the study was to (a) assess the feasibility of intensive treadmill training in patients with acute ischemic stroke, (b) test whether physical activity of the legs during training increases with time, and (c) evaluate to what extent training sessions contribute toward the overall physical activity of these patients. Twenty hospitalized patients with acute ischemic stroke trained on a treadmill twice daily for 30 min for 5 days and on day 30. Physical activity was measured as activity counts (AC) from accelerometers. A total of 196 of 224 initiated training sessions were completed. Training started 41.5±14 h after symptom onset. Only nonserious adverse events occurred in 14.7% of the sessions. An intensity of at least 50% of the individual heart rate reserve was obtained in 31% of training sessions. There was a significant increase in AC/min in the legs during training sessions with increasing number of days, with the median AC being 133% higher on day 5 than on day 1. AC in the paretic leg during 60 min of training constituted median 53% of the daytime AC. Early intensive treadmill training in acute ischemic stroke patients is thus feasible and contributes considerably toward the patients’ overall physical activity.
Using Healthcare Failure Mode and Effect Analysis to Reduce Intravenous Chemotherapy Errors in Chinese Hospitalized Patients
Authors: Li Gui , Xu Bo , He Rui-xian , Zhang Shu-xiang
Published: February 2016

Background:

Intravenous chemotherapy administration is a high-risk process; attention must be paid to preventing errors that might occur during the administration of chemotherapy.

Objective:

The aim of this study is to investigate whether the healthcare failure mode and effect analysis (HFMEA) is a valid proactive method to apply to chemotherapy administration in the Chinese oncology inpatient setting.

Methods:

A multidisciplinary team created a flow diagram of the chemotherapy administration process and potential failure modes were identified and evaluated using a hazard-scoring matrix. Using a decision tree, failure mode recommendations were made. Chemotherapy error rates before and after the HFMEA were compared.

Results:

A total of 5 failure modes were identified with high hazard scores, and 15 recommendations were made. After the intervention, the chemotherapy error rate decreased significantly from 2.05% to 0.17%.

Conclusions:

The complexity of intravenous chemotherapy makes it vulnerable to error, and with serious consequences. Multiple errors can occur during ordering, preparing, compounding, dispensing, and administering the chemotherapy. The process of HFMEA helped reduce the chemotherapy error rate in Chinese hospitalized patients.

Implications for Practice:

Clinicians in oncology can take effective measures to avoid chemotherapy errors using the HFMEA.
Development of a Symptom Management Intervention
Authors: Mosher Catherine E. , Ott Mary A. , Hanna Nasser , Jalal Shadia I. , Champion Victoria L.
Published: February 2016

Background:

Little is known about cancer patient and family caregiver preferences for the content and format of nonpharmacologic interventions. Revising interventions based on patient and caregiver feedback before implementation may improve intervention feasibility and acceptability, especially in the context of advanced-stage cancer.

Objectives:

The aim of the study was to obtain feedback from patients with advanced-stage, symptomatic lung cancer and their family caregivers on the content and format of a nonpharmacologic symptom management intervention under development. The intervention blended evidence-based cognitive-behavioral and emotion-focused strategies to reduce physical and psychological symptoms.

Methods:

Semistructured qualitative interviews were conducted with 21 patients with advanced-stage, symptomatic lung cancer and caregivers. Participants reviewed handouts regarding intervention components and provided feedback.

Results:

Patients and caregivers desired intervention components that addressed the patient’s high symptom burden such as education regarding treatment adverse effects and the provision of various coping tools. Offering interventions with a brief or flexible length and delivering them via telephone were other suggestions for enhancing intervention acceptability. Participants also preferred an equal focus on patient and caregiver concerns and a more positive intervention framework.

Conclusions:

Intervention preferences of patients with advanced-stage lung cancer and caregivers underscore the severity of the disease and treatment process and the need to adapt interventions to patients with high symptom burden. These preferences may be incorporated into future intervention trials to improve participant recruitment and retention.

Implications for Practice:

Nurses can modify interventions to meet the needs of patients with advanced-stage, symptomatic lung cancer and caregivers. For example, flexibility regarding intervention content and length may accommodate those with significant symptoms.
Effects of Slow-Stroke Back Massage on Symptom Cluster in Adult Patients With Acute Leukemia
Authors: Miladinia Mojtaba , Baraz Shahram , Shariati Abdolali , Malehi Amal Saki
Published: February 2016

Background:

Patients with acute leukemia usually experience pain, fatigue, and sleep disorders, which affect their quality of life. Massage therapy, as a nondrug approach, can be useful in controlling such problems. However, very few studies have been conducted on the effects of massage therapy on the complications of leukemia.

Objective:

The aim of this study was to examine the effects of slow-stroke back massage (SSBM) on the symptom cluster in acute leukemia adult patients undergoing chemotherapy.

Methods:

In this randomized controlled trial, 60 patients with acute leukemia were allocated randomly to either the intervention or control group. The intervention group received SSBM 3 times a week (every other day for 10 minutes) for 4 weeks. The pain, fatigue, and sleep disorder intensities were measured using the numeric rating scale. The sleep quality was measured using the Pittsburgh Sleep Quality Index. Statistical tests ofχ2,ttest, and the repeated-measure analysis of variance were used for data analysis.

Results:

Results showed that the SSBM intervention significantly reduced the progressive sleep disorder, pain, fatigue, and improved sleep quality over time.

Conclusions:

Slow-stroke back massage, as a simple, noninvasive, and cost-effective approach, along with routine nursing care, can be used to improve the symptom cluster of pain, fatigue, and sleep disorders in leukemia patients.

Implications for Practice:

Oncology nurses can increase their knowledge regarding this symptom cluster and work to diminish the cluster components by using SSBM in adult leukemia patients.
The Efficacy of Couple-Based Interventions on Health-Related Quality of Life in Cancer Patients and Their Spouses: A Meta-analysis of 12 Randomized Controlled Trials
Authors: Wang FuZhi , Luo Dan , Fu Lianguo , Zhang Hao , Wu Shuyin , Zhang Min , Zhou Huan , Sun Ting , Chen Xingzhi
Published: February 2016

Background:

Couple-based interventions on health-related quality of life (HRQoL) of cancer patients and their spouses have received increasing attention in recent years, but the findings of previous studies are inconsistent.

Objective:

The aim of this study was to investigate the effects of couple-based interventions on the HRQoL of cancer patients and their spouses using a meta-analysis approach.

Method:

English- and Chinese-language publications were collected from PubMed, EBSCO, EMBASE, CMB, and CNKI. The outcome measures included physical health, depression, anxiety, hopelessness, and marital satisfaction (MS). Pooled, weighted mean differences and 95% confidence intervals were estimated using fixed- and random-effects models. Publication bias and sensitivity analyses were performed.

Results:

Twelve randomized controlled trials were included in this study. Compared with the control groups, the weighted mean differences of depression, anxiety, and MS were significantly improved in the intervention groups. However, improvements in the measures of physical health and hopelessness were nonsignificant. Psychoeducational interventions yielded a larger effect size than did skill training and blending interventions. Publication bias was not significant, and a sensitivity analysis indicated that the results were robust.

Conclusions:

Couple-based interventions can improve anxiety, depression, and MS among cancer patients and their spouses, and psychoeducational interventions may be an effective approach. Given the small number of studies utilized in this analysis, the results should be considered preliminary and interpreted with caution.

Implications for Practice:

Couple-based interventions may be an adjunctive method for cancer patients and their spouses to improve HRQoL. Further study concerning couple-based skill training and blending intervention are needed to better understand intervention effects.
Incidence and Determinants of Port Occlusions in Cancer Outpatients
Authors: Milani Alessandra , Mazzocco Ketti , Gandini Sara , Pravettoni Gabriella , Libutti Livio , Zencovich Claudia , Sbriglia Ada , Pari Chiara , Magon Giorgio , Saiani Luisa
Published: February 2016

Background:

Normal saline is considered a safe alternative for heparin as a locking solution in totally implantable venous access devices. The incidence rate of partial occlusion with the use of normal saline (easy injection, impossible aspiration) is estimated at 4%.

Objective:

The aim of this study was to investigate determinants of partial occlusions with the use of normal saline solution and the maintenance of positive pressure in the catheter.

Methods:

We enrolled 218 patients with different solid tumors who underwent pharmacologic treatment through the port with different frequencies: from once every week to at least once every month. The port was flushed with normal saline solution keeping a positive pressure in the catheter.

Results:

We performed 4111 observations and documented normal port functioning in 99% of observations (n = 4057) and partial occlusions in 1% of observations (n = 54). Partial occlusions were significantly associated with frequency of port flushing (P < .05), chemotherapy (P < .001), and blood sample collection (P < .001).

Conclusions:

The use of positive pressure in addition to normal saline reduces the incidence rate of partial occlusions. The type of treatment, blood sample collection, and treatment schedule are important determinants of partial occlusions.

Implications for Practice:

Nurses play a key role in maintaining a functioning port using positive pressure during the flushing techniques. Certain risk factors must be monitored to prevent partial occlusions, and certain patients are more likely to present with port-related problems.
Adolescents’ Perspectives of Living With a Parent’s Cancer
Authors: Bartfai Jansson Katrin , Anderzén-Carlsson Agneta
Published: February 2016

Background:

By the age of 21 years, 1 in 15 children will have had a parent with a diagnosis of cancer. A parent’s cancer affects the whole family. Adolescent children of cancer patients seek information about their parents’ condition and support in reciprocal relations.

Objective:

The aims of this study were to explore adolescents’ views on support and information when a parent has cancer and to describe the impact a parent’s illness has on adolescents’ everyday lives.

Interventions/Methods:

Interviews with 11 participants, conducted individually or in a focus group, were processed using qualitative content analysis.

Results:

Participants gained understanding about their parent’s illness mainly through their experience. They looked for support primarily in their own social circles and often found their needs met. Sometimes a fear of appearing vulnerable stood in the way of asking for support and left the adolescents feeling alone.

Conclusions:

Participants dealt with the situation in ways that reflected their adolescence. They were connected to their parents emotionally, but strived for independence. The adolescents shared an ideal of handling difficulties on their own and looking after the people who were important to them.

Implications for Practice:

Making parents feel more secure in supporting their adolescent child is important. The task of balancing respect for the adolescent’s integrity and providing them an opportunity to let their guard down requires trust. Inviting the adolescents to the hospital gives them a chance to learn what is happening there and to get to know healthcare personnel who may be able to help them.
“Cancer Put My Life on Hold”
Authors: McGrath Catherine , Mihala Gabor , Beesley Vanessa L. , Lynch Brigid M. , Graves Nicholas , Gordon Louisa G.
Published: February 2016

Background:

Colorectal cancer affects a wide range of working-age people. Little is known about the consequent work limitations.

Objective:

The aim of this study was to understand the extent and changing nature of work-related limitations of middle-aged (45-64 years) people over the first 12 months of colorectal cancer.

Methods:

Surveys were administered to participants recruited via the Queensland Cancer Registry, at 6 and 12 months after diagnosis. Among those who returned to work, the Work Limitations Questionnaire measured 4 job performance domains (time management, physical, mental-interpersonal, and output demands) and an overall productivity score. Open-ended questions supplemented the Work Limitations Questionnaire, and responses were thematically analyzed.

Results:

Of 239 participants, 8% did not continue in the study, and 20% left employment by 12 months, leaving 171 participants eligible for this analysis. Open-ended responses for why participants stopped work included bowel problems and stoma, loss of strength, and medication adverse effects. At 12 months, 22% to 39% of participants reported work limitations, but there was no overall significant change in work limitations between 6 and 12 months. Qualitative data highlighted the key work-related issues were changes in work functioning, attitudes of employers and colleagues, financial pressures, and emotional responses.

Conclusions:

While a significant proportion left work because of treatment-related problems, and the majority of participants did not experience workplace limitations, some reported considerable work-related challenges.

Implications for Practice:

Discussions with health professionals about the possible impact of treatment adverse effects on employment, good communication with employers, and workplace flexibility may facilitate return to work for this population.
A Systematic Review of Emergency Department Use Among Cancer Patients
Authors: Lash Rebecca S. , Bell Janice F. , Reed Sarah C. , Poghosyan Hermine , Rodgers James , Kim Katherine K. , Bold Richard J. , Joseph Jill G.
Published: February 2016

Background:

Recent reports call for reductions in costly and potentially avoidable services such as emergency department (ED) visits. Providing high-quality and safe care for oncology patients remains challenging for ED providers given the diversity of patients seeking care and the unpredictable clinical environment. While ED use by oncology patients is appropriate for acute health concerns, some ED visits may be preventable with well-coordinated care and adequate symptom management.

Objective:

The aim of this study was to summarize available evidence regarding the incidence, predictors of, and reasons for ED visits among oncology patients.

Methods:

Keyword/MeSH term searches were conducted using 4 online databases. Inclusion criteria were publication date between April 1, 2003, and December 5, 2014; sample size of 50 or more; and report of the incidence or predictors of ED use among oncology patients.

Results:

The 15 studies that met criteria varied in study aim, design, and time frames for calculating ED utilization rates. The incidence of ED visits among oncology patients ranged from 1% to 83%. The 30-day standardized visit rate incidence ranged from 1% to 12%. Collectively, the studies lack population-based estimates for all cancers combined.

Conclusions:

The studies included in this review suggest that rates of ED use among cancer patients exceed those of the general population. However, the extent of ED use by oncology patients and the reasons for ED visits remain understudied.

Implications for Practice:

Nurses are involved in the treatment of cancer, patient education, and symptom management. Nurses are well positioned to develop patient-centered treatment and care coordination plans to improve quality of care and reduce ED visits.
Diagnostic Utility of Orthopedia Homeobox (OTP) in Pulmonary Carcinoid Tumors
Authors: Nonaka Daisuke , Papaxoinis George , Mansoor Wasat
Published: February 2016

Recently, Orthopedia Homeobox (OTP) was described as a prognostic marker for pulmonary carcinoid tumors; however, little is known about the function and distribution pattern of this transcription factor in normal organs/tissues and in tumors. Consequently, OTP expression was investigated in a variety of tumors, with special interest in pulmonary and nonpulmonary neuroendocrine tumors (NETs) and high-grade neuroendocrine carcinomas. OTP immunohistochemical analysis was performed on a total of 162 pulmonary carcinoid tumors, 31 pulmonary neuroendocrine hyperplasias, 104 pulmonary high-grade neuroendocrine carcinomas (large cell neuroendocrine and small cell neuroendocrine), 102 nonpulmonary NETs (G1/G2 NETs, small cell and large cell neuroendocrine carcinomas, and Merkel cell carcinomas), 150 endocrine tumors (thyroid, parathyroid, adrenocortical, and pheochromocytomas/paragangliomas), 279 adenocarcinomas, and 88 squamous cell carcinomas of various organs, including those of the lungs and others. In addition, normal tissues from various organs were studied. OTP nuclear expression was seen in 80% of lung carcinoid tumors. Among other tumors, 4 small-cell carcinomas showed focal expression (2 pulmonary and 2 bladder), but all other tumors were completely negative. Overall, the sensitivity and specificity of OTP were 80.2% and 99.4%, respectively. All TTF1-positive lung carcinoid tumors were diffusely positive for OTP, but none of the OTP-negative carcinoid tumors was positive for TTF1. OTP expression was not seen in any normal tissues/organs. OTP was also negative in neuroendocrine cells of the normal bronchus/bronchiole. However, OTP was strongly expressed in neuroendocrine hyperplasia, including reactive and preneoplastic hyperplasia. Our results suggest that OTP may serve as a useful diagnostic marker for lung carcinoid tumors.
Immunostains Used to Subtype Hepatic Adenomas Do Not Distinguish Hepatic Adenomas From Hepatocellular Carcinomas
Authors: Liu Liping , Shah Sejal S. , Naini Bita V. , French Samuel , Wu Tsung-Teh , Torbenson Michael S. , Chandan Vishal S.
Published: February 2016

Immunostains are used to subtype hepatic adenomas to stratify for the risk of malignant transformation. The most common panel of immunostains used for this purpose includes liver fatty acid–binding protein (LFABP), serum amyloid A (SAA) protein, C-reactive protein (CRP), and glutamine synthetase (GS). Importantly, some pathologists use these stains in an attempt to distinguish hepatocellular carcinomas (HCC) from hepatic adenomas. However, there are limited data on the performance of these stains in HCCs. To investigate the staining characteristics of HCCs, we studied 159 HCCs (92 well-differentiated, 67 moderately differentiated, and 7 poorly differentiated) and 7 fibrolamellar carcinomas for the expression of LFABP, SAA, CRP, and GS. All of the stains were positive in at least a subset of HCCs: SAA was positive in 27 of 159 (17%), CRP in 86 of 159 (54%), and GS in 23 of 47 (49%) cases; LFABP showed loss of staining in 36 of 159 (23%) cases. Fibrolamellar carcinomas were consistently CRP positive (7 of 7 cases) and frequently showed loss of LFABP (4 of 7 cases). There was no association between expression of SAA, CRP, and GS as well as loss of LFABP expression and other clinicopathologic features. HCCs with loss of LFABP were more frequently associated with negative GS expression (11 of 14 cases, P=0.02). These data show that immunostains used to subtype hepatic adenomas are not useful for distinguishing HCCs from hepatic adenomas and should be used only after a diagnosis of hepatic adenoma has been made using other criteria.
Risk Factors for Longer Hospital Stay Following the Fontan Operation
Authors: Sasaki Jun , Dykes John C. , Sosa Lisa J. , Salvaggio Jane L. , Tablante Milagros D. , Ojito Jorge , Khan Danyal M. , Hannan Robert L. , Rossi Anthony F. , Burke Redmond P. , Wernovsky Gil
Published: February 2016

Objectives:

Children with functional single ventricle undergoing the Fontan operation consume considerable resources. The purpose of this study is to evaluate pre- and intraoperative risk factors for longer hospital stay and to describe the perioperative course at a single institution over a 15-year period.

Design:

Retrospective cohort study.

Setting:

A single pediatric cardiac ICU.

Patients:

All consecutive patients undergoing a first-time Fontan operation from 2000 to 2014.

Interventions:

None.

Measurements and Main Results:

Prolonged length of stay was defined as hospital stay greater than 75 percentile at our institution after surgery. Of 218 patients who met inclusion criteria, median length of stay was 10 days (interquartile range, 8–14 d); prolonged length of stay was defined greater than or equal to 15 days. Independent pre- and intraoperative risk factors for prolonged length of stay included higher hemoglobin (odds ratio, 1.29; p = 0.003), higher mean pulmonary artery pressure (odds ratio, 1.14; p = 0.037), and lower aortic saturation (odds ratio, 0.92; p = 0.008) in the entire group. When patients with hepatic vein inclusion (following previous Kawashima) were excluded, higher hemoglobin (odds ratio, 1.24; p = 0.027), lower aortic saturation (odds ratio, 0.92; p = 0.017), and placement of a fenestration (odds ratio, 2.438; p = 0.021) were associated with prolonged length of stay. Fifty-eight patients (26.6%) had major complications defined by Pediatric Cardiac Critical Care Consortium. Placement of a fenestration (odds ratio, 2.297; p = 0.014) and longer aortic cross-clamp time (odds ratio, 1.015; p = 0.003) were independently associated with Pediatric Cardiac Critical Care Consortium major complications.

Conclusions:

In this series, 75% of patients had a postoperative length of stay less than or equal to 2 weeks. Preoperative factors suggesting worse hypoxemia/decreased pulmonary blood flow (higher hemoglobin and lower oxygen saturation) and increased pulmonary artery pressure were associated with prolonged length of stay. These findings may help risk stratify this complex patient population, provide more accurate family counseling, and provide preliminary data for changes in preoperative timing of the Fontan and/or changes to postoperative management strategies for those at high risk for increased ICU morbidity.
VcfR: a package to manipulate and visualize VCF format data in R
Authors: Knaus Brian J. , Grünwald Niklaus J.
Published: February 2016

Software to call single nucleotide polymorphisms or related genetic variants has converged on the variant call format (VCF) as the output format of choice. This has created a need for tools to work with VCF files. While an increasing number of software exists to read VCF data, many only extract the genotypes without including the data associated with each genotype that describes its quality. We created the R package vcfR to address this issue. We developed a VCF file exploration tool implemented in the R language because R provides an interactive experience and an environment that is commonly used for genetic data analysis. Functions to read and write VCF files into R as well as functions to extract portions of the data and to plot summary statistics of the data are implemented. VcfR further provides the ability to visualize how various parameterizations of the data affect the results. Additional tools are included to integrate sequence (FASTA) and annotation data (GFF) for visualization of genomic regions such as chromosomes. Conversion functions translate data from the vcfR data structure to formats used by other R genetics packages. Computationally intensive functions are implemented in C++ to improve performance. Use of these tools is intended to facilitate VCF data exploration, including intuitive methods for data quality control and easy export to other R packages for further analysis. VcfR thus provides essential, novel tools currently not available in R.
Learning In Spike Trains: Estimating Within-Session Changes In Firing Rate Using Weighted Interpolation
Authors: Jensen Greg , Muñoz Fabian , Ferrera Vincent P.
Published: February 2016

The electrophysiological study of learning is hampered by modern procedures for estimating firing rates: Such procedures usually require large datasets, and also require that included trials be functionally identical. Unless a method can track the real-time dynamics of how firing rates evolve, learning can only be examined in the past tense. We propose a quantitative procedure, called ARRIS, that can uncover trial-by-trial firing dynamics. ARRIS provides reliable estimates of firing rates based on small samples using the reversible-jump Markov chain Monte Carlo algorithm. Using weighted interpolation, ARRIS can also provide estimates that evolve over time. As a result, both real-time estimates of changing activity, and of task-dependent tuning, can be obtained during the initial stages of learning.
The architecture of the human RNA-binding protein regulatory network
Authors: Quattrone Alessandro , Dassi Erik
Published: February 2016

RNA-binding proteins (RBPs) are key players of post-transcriptional regulation of gene expression. These proteins influence both cellular physiology and pathology by regulating processes ranging from splicing and polyadenylation to mRNA localization, stability, and translation. To fine-tune the outcome of their regulatory action, RBPs rely on an intricate web of competitive and cooperative interactions. Several studies have described individual interactions of RBPs with RBP mRNAs, suggestive of a RBP-RBP regulatory structure. Here we present the first systematic investigation of this structure, based on a network including almost fifty thousand experimentally determined interactions between RBPs and bound RBP mRNAs.

Our analysis identified two features defining the structure of the RBP-RBP regulatory network. What we call “RBP clusters” are groups of densely interconnected RBPs which co-regulate their targets, suggesting a tight control of cooperative and competitive behaviors. “RBP chains”, instead, are hierarchical structures driven by evolutionarily ancient RBPs, which connect the RBP clusters and could in this way provide the flexibility to coordinate the tuning of a broad set of biological processes.

The combination of these two features suggests that RBP chains may use the modulation of their RBP targets to coordinately control the different cell programs controlled by the RBP clusters. Under thisisland-hoppingmodel, the regulatory signal flowing through the chains hops from one RBP cluster to another, implementing elaborate regulatory plans to impact cellular phenotypes. This work thus establishes RBP-RBP interactions as a backbone driving post-transcriptional regulation of gene expression to allow the fine-grained control of RBPs and their targets.
The Genetic Architecture of Quantitative Traits Cannot Be Inferred From Variance Component Analysis
Authors: Huang Wen , Mackay Trudy F.C.
Published: February 2016

Classical quantitative genetic analyses estimate additive and non-additive genetic and environmental components of variance from phenotypes of related individuals. The genetic variance components are defined in terms of genotypic values reflecting underlying genetic architecture (additive, dominance and epistatic genotypic effects) and allele frequencies. However, the dependency of the definition of genetic variance components on the underlying genetic models is not often appreciated. Here, we show how the partitioning of additive and non-additive genetic variation is affected by the genetic models and parameterization of allelic effects. We show that arbitrarily defined variance components often capture a substantial fraction of total genetic variation regardless of the underlying genetic architecture in simulated and real data. Therefore, variance component analysis cannot be used to infer genetic architecture of quantitative traits. The genetic basis of quantitative trait variation in a natural population can only be defined empirically using high resolution mapping methods followed by detailed characterization of QTL effects.
Copy number variants in the sheep genome detected using multiple approaches
Authors: Jenkins Gemma M , Goddard Michael E , Black Michael A , Brauning Rudiger , Auvray Benoit , Dodds Ken G , Kijas James W , Cockett Noelle , McEwan John C
Published: February 2016

Background.

Copy number variants (CNVs) are a type of polymorphism found to underlie phenotypic variation, both in humans and livestock. Most surveys of CNV in livestock have been conducted in the cattle genome, and often utilise only a single approach for the detection of copy number differences. Here we performed a study of CNV in sheep, using multiple methods to identify and characterise copy number changes. Comprehensive information from small pedigrees (trios) was collected using multiple platforms (array CGH, SNP chip and whole genome sequence data), with these data then analysed via multiple approaches to identify and verify CNVs.

Results.

In total, 3,488 autosomal CNV regions (CNVRs) were identified in this study, which substantially builds on an initial survey of the sheep genome that identified 135 CNVRs. The average length of the identified CNVRs was 19kb (range of 1kb to 3.6Mb), with shorter CNVRs being more frequent than longer CNVRs. The total length of all CNVRs was 67.6Mbps, which equates to 2.7% of the sheep autosomes. For individuals this value ranged from 0.24 to 0.55%, and the majority of CNVRs were identified in single animals. Rather than being uniformly distributed throughout the genome, CNVRs tended to be clustered. Application of three independent approaches for CNVR detection facilitated a comparison of validation rates. CNVs identified on the Roche-NimbleGen 2.1M CGH array generally had low validation rates with lower density arrays, while whole genome sequence data had the highest validation rate (>60%).

Conclusions.

This study represents the first comprehensive survey of the distribution, prevalence and characteristics of CNVR in sheep. Multiple approaches were used to detect CNV regions and it appears that the best method for verifying CNVR on a large scale involves using a combination of detection methodologies. The characteristics of the 3,488 autosomal CNV regions identified in this study are comparable to other CNV regions reported in the literature and provide a valuable and sizeable addition to the small subset of published sheep CNVs.