bluuebunny/crossref_metadata_2025 huggingface dataset:
How movement direction shapes the spatial representation of its effects: About the consequence of the ideomotor bidirectional association
Authors: Lestage Hélène , Camus Thomas , Dru Vincent , Brouillet Thibaut
Published: September 2018

Ideomotor theories assume that action and perception share a common representational system in which a movement and its effect are equally represented and integrated by a bidirectional association. However, there is no mention of how this association leads to influence the representational content of each part. In this article, we investigated the influence of movement properties on the spatial representation of auditory effects. In line with the Action Constrains Theory of space perception, we suggest that changes in the movement direction leads to correlative changes in the spatial representation of the effect. In a pre-experiment, we replicated traditional ideomotor results with a response-effect (R-E) compatibility procedure. In two experiments, we used one condition of this procedure (i.e., the corresponding R-E mapping) to manipulate the movement properties associated to a non-spatialised effect. In the first experiment, the effect was associated with horizontal outward movements or with forward–backward movements. In the second experiment, we tested some alternative explanations for the results obtained in the first experiment. Globally, we showed that rightward movements led to localised auditory effect more on the right space than leftward movements and that backward movements led to localisation of the effect closer from the subjects than forward movements. In accordance with the Action Constrains Theory of space perception, these data suggest that movement shapes the spatial organisation of the effect representation.
Historical framing of the Ukraine Crisis through the Great Patriotic War: Performativity, cultural consciousness and shared remembering
Authors: McGlynn Jade
Published: September 2018

Remembering in Russia is increasingly performative and actualised, as shown by the Russian government and media’s conflation of the Ukraine Crisis with the Great Patriotic War. By presenting the Great Patriotic War as a frame though which to understand events in Ukraine, the media and government guided domestic political perceptions of the contemporary crisis and encouraged participative shared remembering as a bulwark against threats to Russian national identity and historical legacies. Across several media sources, similarities in the frame’s thematic content, sequencing, and presentation demonstrated a concerted and sophisticated effort to exploit the Ukraine Crisis for identity construction. As part of these attempts, the media and government presented patriotic models for emulation, appropriating cultural memory in order to merge respect for the past with allegiance to government policy.
Rifaximin has the potential to prevent complications of cirrhosis
Authors: Flamm Steven L. , Mullen Kevin D. , Heimanson Zeev , Sanyal Arun J.
Published: September 2018

Background:

Cirrhosis-related complications are associated with poor prognosis. With our analyses, we examined the potential benefit of rifaximin in reducing the risk of developing cirrhosis-related complications.

Methods:

Adults with cirrhosis and hepatic encephalopathy (HE) in remission were randomly assigned to receive rifaximin 550 mg twice daily or placebo for 6 months with concomitant lactulose permitted. Post hoc analyses examined time to cirrhosis-related complications (HE, spontaneous bacterial peritonitis (SBP), variceal bleeding, acute kidney injury/hepatorenal syndrome). Subgroup analyses evaluated efficacy for select baseline disease characteristics.

Results:

Of patients receiving rifaximin ( n = 140) and placebo ( n = 159), 53.6% and 49.1%, respectively, had baseline Model for End-Stage Liver Disease (MELD) score ⩾ 12 and international normalized ratio (INR) ⩾ 1.2. Baseline ascites was observed in 36.4% (rifaximin) and 34.6% (placebo) of patients. In patients with MELD score ⩾ 12 and INR ⩾ 1.2, rifaximin reduced the relative risk (RR) of any first complication experienced during trial by 59% [hazard ratio (HR) = 0.41, 95% confidence interval (CI): 0.25–0.67; p < 0.001] versus placebo. For patients with baseline ascites, rifaximin reduced the RR of any first complication experienced during trial by 42% versus placebo (HR = 0.58, 95% CI: 0.34–1.0; p = 0.045). For some subgroups, there was a decrease in RR of complications of SBP, variceal bleeding, and acute kidney injury/hepatorenal syndrome with rifaximin versus placebo, although there were few events reported in the study.

Conclusion:

Rifaximin may reduce the incidence of cirrhosis-related complications and the recurrence of overt HE. [ ClinicalTrials.gov identifier: NCT00298038.]
Normal Ultrasonographic Parameters of the Posterior Tibial, Peroneal, and Achilles Tendons
Authors: Jackson J. Benjamin , Chu Christopher H. , Williams Kevin A. , Bornemann Paul H.
Published: September 2018

Tendinopathy of the foot and ankle is common and can lead to pain or functional limitations. The most frequently affected tendons in the foot and ankle are the posterior tibial, peroneal, and Achilles. We used ultrasound to determine normal values for these tendons. From 2015 to 2016, a prospective, standardized bilateral lower extremity ultrasound examination protocol was performed by a musculoskeletal ultrasonographer of the 4 tendons and above and below the malleoli as appropriate. A total of 199 patients with 398 extremities were identified, consented, and participated in the study. Most tendons were normally distributed. The average size of the tendons was as follows: Achilles 5.0 mm (range 2.8-11.2 mm); peroneus long above the malleolus 2.1 mm (range 0.7-3.6 mm), below the malleolus 2.9 mm (range 0.8-6.3 mm); peroneus brevis above the malleolus 1.2 cm (range 0.3-4.0 mm), below the malleolus 1.3 mm (range 0.5-4.8 mm); posterior tibial tendon above the malleoli 3.7 mm (range 1.9-8.1 mm), below the malleolus 4.6 cm (range 1.8-11.8 mm). Standard deviations and distribution curves were similarly calculated for each tendon. This baseline data can assist clinicians in their diagnostic ability with ultrasound. Given its low cost, lack of ionizing radiation and dynamic ability along with an improved understanding of normative data it may become an increasingly used diagnostic modality.

Levels of Evidence: Level II: Diagnostic
Hepatitis C virus Infection is Frequently Associated with High Titers of Anti-thyroid Antibodies
Authors: Ploix C. , Veber S. , Chevallier-Queyron P. , Ritter J. , Bousset G. , Monier J.C. , Fabien N.
Published: September 2018

Objective

To assess the implication of hepatitis C virus (HCV) infection in the development of autoimmune thyroid response, thyroid autoantibodies were studied in serum of HCV positive patients.

Methods

Anti-microsomal, anti-thyroperoxidase (anti-TPO) and anti-thyroglobulin antibodies were evaluated in the sera of 100 patients with chronic hepatitis C (53 women and 47 men; mean age = 55±5 years). In parallel, thyroid autoantibodies were investigated in blood samples obtained from two separated control groups: age-matched HCV negative-HBV positive patients (25 women, 25 men; mean age= 47±6 years) and healthy blood donors (29 women and 21 men; mean age= 54±8 years).

Results

Anti-thyroid antibodies were found more frequently in HCV positive women when compared to the men (8/53= 15.1 % vs 0/47= 0%,.p<0.01). The prevalence of these autoantibodies was not statistically different between HCV positive and healthy female blood donors. However the investigation of thyroid autoantibody titers showed significantly higher levels of anti-TPO and anti-microsomal antibodies in HCV positive women in comparison with healthy women controls (respectively 1: 83200 vs 1: 1900 and 834 vs 23, p<0,01).

Conclusions

This strong association between HCV infection and high levels of anti-thyroid autoantibodies in women outlines the interest of systematic detection of anti-microsomal and/or anti-TPO antibodies in this population.
A Comparison of the Effects of Short-term Singing, Exercise, and Discussion Group Activities on the Emotional State and Social Connectedness of Older Australians
Authors: Maury Susan , Rickard Nikki
Published: September 2018

Choir membership has been shown to improve emotional states and facilitate social connectedness. It is, however, less clear whether these benefits are unique to group singing or are shared by other social group activities that include some of the characteristics of choirs other than singing, such as music listening and social interaction. This research compares older Australians who are members of either a choir that both produces and listens to music in a social context, an exercise group that incorporates music listening and movement with social interaction, or a current events discussion group with social interaction but no music content. Participants were administered emotional state and cohesion questionnaires at two test times, just prior to and immediately after the session, to determine the short-term (60–90 minutes) effects on emotional state and social cohesion as result of different social activities containing varying levels of music engagement. A two-way Analysis of Variance (ANOVA) revealed significant improvements in positive affect and cohesion scores, and a decrease in negative affect and tiredness scores, over time for all groups. The choir and exercise groups were also observed by two raters who recorded observable behaviors categorized using the circumplex model of emotion. Findings revealed that both groups demonstrated significant increases in Activated Pleasant (high positive affect, high arousal) behaviors over time, but with no differences between the two groups. Taken together, these studies suggest that well-being benefits are shared by self-selected leisure social group activities, and that the effects can be observed within a very short time frame using both self-report and behavioral measures. The authors suggest that future research incorporates suitable control groups into research designs to better articulate any unique benefits that group singing may confer.
Embolizing Massive Right Atrial Thrombus in a HIV-Infected Patient
Authors: Natarajan Piruthiviraj , Joolhar Fowrooz , Thangarasu Sudhagar , Aboeed Ayham , Win Theingi Tiffany , Cobos Everardo
Published: September 2018

The risk of thromboembolism is increased when associated with the human immunodeficiency viral (HIV) infection. Various factors are involved in promoting thrombosis, and the presence of a patent foramen ovale augments the potential for a paradoxical embolism. We describe the case of a 56-year-old man receiving antiretroviral therapy with features of right heart failure and pulmonary embolism. Due to the high incidence of life-threatening thromboembolism in the HIV-infected group, the need for long-term anticoagulation has to be evaluated.
A systematic review of the comparative pragmatic differences in conversational skills of individuals with autism
Authors: Ying Sng Cheong , Carter Mark , Stephenson Jennifer
Published: September 2018

Background and aims: Given that problems with social interaction and communication are defining features of autism spectrum disorder, it stands to reason that individuals with autism spectrum disorder have difficulties in conversation. There is a growing body of research on the conversation skills of individuals with autism spectrum disorder, including research conducted to compare these skills to those of typically developing individuals and those with other disabilities. Such comparisons may offer insight into the extent to which conversational skills may be deficient and whether deficits are unique to a particular diagnostic group.

Main contribution: This review provides an examination of comparative studies of pragmatic aspects of conversation that included individuals with autism spectrum disorder. Only a small number of consistent findings emerged from the analysis. Groups with autism spectrum disorder find it difficult to stay on topic and provide novel, relevant information. They also tend to perseverate more and initiate and respond less during conversation but, contrary to expectation, similar numbers of turns were offered to partners, and there was little difference in the way communication breakdowns were repaired or clarified. There was a contradictory finding on the use of eye gaze.

Conclusions and implications: Some consistent findings were reported but overall, fewer than expected between group differences were found. The fragmented nature of the research and inconsistent operational definitions of variables measured made analysis problematic. Further research and replication of studies is recommended before definitive conclusions can be drawn.
Five-year PFS from the AETHERA trial of brentuximab vedotin for Hodgkin lymphoma at high risk of progression or relapse
Authors: Moskowitz Craig H. , Walewski Jan , Nademanee Auayporn , Masszi Tamas , Agura Edward , Holowiecki Jerzy , Abidi Muneer H. , Chen Andy I. , Stiff Patrick , Viviani Simonetta , Bachanova Veronika , Sureda Anna , McClendon Teresa , Lee Connie , Lisano Julie , Sweetenham John
Published: September 2018

Key Points

Early consolidation with BV improves 5-year PFS vs best supportive care and reduces the need for subsequent therapy. At 5-year follow-up, BV shows long-term tolerability, with peripheral neuropathy continuing to improve and/or resolve.
Impact on readmission rates and mortality of a chronic obstructive pulmonary disease inpatient management guideline
Authors: Smith B J , Cheok F , Heard A R , Esterman A J , Southcott A M , Antic R , Frith P A , Hender K , Ruffin R E
Published: September 2018

Aims: Chronic obstructive pulmonary disease (COPD) is a common condition associated with considerable morbidity, mortality and hospital admissions. However, published COPD management guidelines have major limitations and lack practical summaries. We aimed to optimally develop, implement, and evaluate a multidisciplinary COPD inpatient management ‘ACCORD’ guideline, including prompts for comprehensive day one assessments through to a discharge criteria checklist. Method: Two intervention and two control public teaching hospitals in Adelaide, South Australia, took part, with pre-intervention (721 COPD admissions over 7 months) and intervention phases (509 COPD admissions over 7 months). During the intervention stage the ACCORD guideline was placed in the case notes on the day of admission or soon after. Readmissions were categorized as either emergency or elective and compared between the study arms, as were mortality and potential confoundeis (age, gender, number of comorbidities), with Poisson regression analysis. Results: Of case notes of eligible COPD patients, 60% had the ACCORD guideline placed, of which 76% had evidence of use as judged by completion of guideline entry and tick boxes. The ACCORD guideline was associated with an increase in elective admissions and a reduction in emergency admissions in the intervention group in relation to the control group (P < 0.01), with no difference in overall admissions or death rates. Conclusions: The ACCORD guideline was associated with a shift from emergency admissions to more planned elective care, suggesting more proactive care of health problems, but without overall reduction in admissions.
Psychiatry trainee stressors in a postgraduate psychiatry training centre in India
Authors: Sathur Raghuraman Bharathram , Nataraj Manamohan , Shiva Lakshmi
Published: September 2018

Stress and burnout are major issues affecting medical trainees, especially psychiatry trainees, throughout the world. Stress and burnout were studied using an online survey among psychiatry trainees of the National Institute of Mental Health and Neurosciences (NIMHANS) which is one of the oldest and largest training centers in India. Postgraduate training in academic institutions like NIMHANS, while offering excellent teaching experience, may impact the mental and physical health of trainees due to complex clinical challenges and academic pressure. Measures need to be taken to enhance trainee well-being by ensuring support from colleagues and seniors, allowing for an adequate work–life balance, introducing departmental level committees to address grievances and providing therapy and mentorship. Providing safe and non-stigmatizing spaces to seek help in workplace promotes whole-person growth and well being.
Anxiety as a risk factor of Alzheimer's disease and vascular dementia
Authors: Becker Eva , Orellana Rios Claudia Lorena , Lahmann Claas , Rücker Gerta , Bauer Joachim , Boeker Martin
Published: September 2018

Background

The aetiology of dementia is not yet fully understood. Stress can have a damaging effect on brain health. The prognostic effect of anxiety is still unclear regarding Alzheimer's disease as well as vascular dementia.

Aims

To explore the association between anxiety and future dementia.

Method

Medline, PsycINFO, CINAHL, Web of Science and ALOIS were searched for publications up to 12 January 2018. Longitudinal studies with a follow-up of at least 2 years were included, if the trait or state anxiety had been assessed at baseline. Studies with cognitive impairment at baseline were not included. We used a random effects model to calculate the pooled time to Alzheimer's disease and incidence of vascular dementia.

Results

Anxiety predicts risk of Alzheimer's disease (n = 26 193 out of seven studies, hazard ratio1.53, 95% CI 1.16–2.01, P < 0.01) and vascular dementia (n = 4916 out of two studies, odds ratio1.88, 95% CI 1.05–3.36, P < 0.01). The pooled hazard ratio regarding risk of Alzheimer's disease was still significant when excluding studies with critical risk of bias (n = 14 110 out of six studies, hazard ratio 1.35, 95% CI 1.08–1.70, P < 0.01).

Conclusions

Anxiety is a risk factor for both types of dementia. The temporal and functional relation between anxiety and dementia needs investigation in future studies. The protective value of treating anxiety should be explored further.

Declaration of interest

None.
Deep brain stimulation and revising the Mental Health Act: the case for intervention-specific safeguards
Authors: Pugh Jonathan , Aziz Tipu , Herring Jonathan , Savulescu Julian
Published: September 2018

Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.

Declaration of interest

T.A. is a paid consultant for Boston Scientific, Medtronic and St. Jude Medical. He has received honoraria from Abbott, Boston and Medtronics and served as consultant to all three.
Child maltreatment and mental health problems in adulthood: birth cohort study
Authors: Kisely Steve , Abajobir Amanuel Alemu , Mills Ryan , Strathearn Lane , Clavarino Alexandra , Najman Jake Moses
Published: September 2018

Background

Retrospective studies have shown a high association between child abuse and subsequent psychiatric morbidity. Prospective studies are rarer.

Aims

To examine, using a prospective record-linkage analysis, whether substantiated child maltreatment is associated with adverse psychological outcomes in early adulthood.

Method

The participants were 3778 mother and child pairs enrolled in a population-based birth cohort study in Brisbane, Australia. Exposure to suspected child maltreatment was measured by linkage with state child protection agency data. The primary outcomes were the internalising and externalising scales of the Youth Self-Report and the Centre for Epidemiological Studies-Depression scales (CES-D) at approximately 21 years of age. A subset completed the Composite International Diagnostic Interview-Auto version (CIDI-Auto).

Results

In total, 171 (4.5%) participants had a history of substantiated child maltreatment, most commonly emotional abuse (n= 91), followed by physical abuse (n= 78), neglect (n= 73) and sexual abuse (n= 54). After adjustment for potential confounders, depressive symptoms on the CES-D, as well as internalising and externalising behaviours were strongly associated with substantiated abuse in all forms, except sexual abuse. The results for the subset of the sample who completed the CIDI-Auto were less clear. Anxiety, especially post-traumatic stress disorder, showed the strongest association whereas the findings for depressive disorder were equivocal. However, across all diagnostic categories, emotional abuse and neglect, as well as multiple forms of abuse, showed a consistent association.

Conclusions

Child maltreatment, particularly neglect and emotional abuse, has serious adverse effects on early adult mental health. These two warrant the attention given to other forms of child maltreatment. Children experiencing more than one type of maltreatment are at particular risk.

Declaration of interest

None.
Promoting Smoking Cessation Through New Media Tools Facebook, Instagram and WhatsApp
Authors: Elmeguid W. Abd , Kassem A. , Abdalla R. , Moustafa O.
Published: September 2018

Background and context: Tobacco use is a devastating problem all over the world and in the Middle East. In Egypt 20% of the adult populations are using any type of tobacco and the problem is increasing among youth especially waterpipe. Tobacco industry is targeting the youth through many ways and using indirect ways in drama and points of sale. Raising the awareness of the public about smoking hazards and benefits of quitting is one important strategy to control the epidemic. Providing support and help material is very important. Behavioral support and promoting change is very important using coaching strategies and using new tools is very helpful to reach youth. Aim: Motivating current smokers to quit through the effect of role model using new tools for behavioral support. Strategy/Tactics: Providing the message and support through new tools as WhatsApp, Instagram and Facebook where smokers who is able to quit provide information about their smoking experience and how they overcome it. Program/Policy process: Tobacco treatment specialist worked in collaboration with few young medical students to develop a Facebook page on the World No Tobacco Day 2016 and developed different posts about smoking problem and inviting viewers to add their inputs. During the early days of the campaign the team used the Facebook ads tool to promote for the page and this was sponsored by few supporters. The team who is in charge of managing the Facebook page then thought about new ideas to increase the reach and impact of the page where inviting smokers who was able to quit or take a selfie with a piece of paper writing how many days they were able to abide from smoking. The page during few months made a trend on social media. Outcomes: The reach of the page was 3 million and the reactions were 500 thousand engagement with 52 thousand members. About three thousand smokers were able to quit with following the stories sent on the page. What was learned: Using social media tools is very good way to reach out and mobilize the public to change the behavior.
Kenyan Youth Understanding of Cancer, Cancer Risk and Cancer Prevention: An Ethnographic Study
Authors: Busolo D. , Woodgate R.L. , Hack T. , Decker K.
Published: September 2018

Background: Cancer incidence and mortality continues to rise worldwide including in Kenya. Among the groups that are likely to get cancer in future are Kenyan youth that engage in behavior that can increase their lifetime cancer risk. Despite this awareness, little is known about Kenyan youth's understanding of cancer, cancer risk, and cancer prevention. Such awareness is needed to inform germane cancer prevention and health promotion initiatives. Aim: The purpose of this ethnographic study was to explore Kenyan youth's understanding of cancer, cancer risk, and cancer prevention. Methods: Fifty-three youth (ages 12-19) took part in individual interviews and focus group discussions. Results: In their conceptualization of cancer, youth described cancer in ways that are grouped into two themes: there is no other disease like it and lay understanding through metaphors. In their conceptualization of cancer risk, youth described cancer in ways that are grouped as cancer risk as lifestyle factors and the process of risk perception. Finally, in conceptualization of cancer prevention, youth described cancer prevention in ways that are grouped into the following themes: avoiding cancer risk factors, avoiding peers who partake in risk factors, and being healthy. Conclusion: This study is the first of its kind to be conducted in Kenya and adds to the body of knowledge in this area. Despite limited cancer control plans, youth described the grim consequences of getting cancer, their chances of getting the disease, and proposed opportunities for prevention. The study results will create a platform for future cancer prevention research and health promotion programs in Kenya and other part of Africa.
Ovarian Cancer in Morocco: Diagnosis and Outcome
Authors: Haimer A. , Habib F. , Soulaymani A. , Mokhtari A. , Hami H.
Published: September 2018

Background: Ovarian cancer is the fifth most common cancer and the fourth leading cause of cancer death among women in northern Africa, with an estimated 5050 new cancer cases and 3509 deaths from cancer in 2012 ( GLOBOCAN 2012 ). Aim: This study was conducted to determine the epidemiologic characteristics of ovarian cancer in Morocco. Methods: This is a descriptive retrospective study of ovarian cancer cases, diagnosed and treated at Al Azhar Oncology Center in Rabat between 2005 and 2015. Results: There were 164 new cases of ovarian cancer diagnosed at Al Azhar Oncology Center, accounting for 3.5% of all cancers affecting women reported during 2005-2015. During this period, ovarian cancer was the third most common cancer and the third leading cause of cancer death after breast and cervical cancer among women. The average age at diagnosis of ovarian cancer was 52.5 ± 13.3 years (range 18-81 years). The risk of developing the disease is associated with age, 91.1% of cases were diagnosed in women aged 35 years and older, with 70.2% of new ovarian cancer cases occurring among those aged 35-64 years. A 43-year-old woman was diagnosed with metastatic disease. Among all detected cases, 18 (11%) died during the study period, accounting for 6.6% of all female cancer deaths. Conclusion: Ovarian cancer is a preventable disease, and a significant decrease in incidence and mortality can be expected as a result of population-based screening programs, which rely on regular preventive examinations to search for precancerous changes and to prevent the development of malignant tumors.
Childhood Cancer Early Detection Training Program for Primary Healthcare Providers
Authors: Ntacyabukura B.
Published: September 2018

Background and context: Over 250,000 new pediatric cancer cases are diagnosed yearly worldwide. Health care providers (mainly nurses) at health centers (HC) level are the children´s first opportunity for correctly recognizing and responding to early signs and symptoms of childhood cancers by appropriately referring them to district hospitals but studies show that 83% of nurses did not receive training on pediatric cancers. Insufficient knowledge about the warning signs and symptoms of pediatric cancer usually leads to improper diagnosis or delay to diagnosis and hence loss of many lives of these children. After realizing that majority in our community lack information on childhood cancers, our efforts since 2017 has been concentrated on training primary healthcare providers to recognize early signs and symptoms of childhood cancers. Aim: Improve survival of children with cancer by early detection of symptoms and signs and prompt referral by nurses at health centers. Strategy/Tactics: The program is consisted of trainings in selected regions of Rwanda. The first step is a “train the trainer workshop” where volunteering medical students and doctors are trained to train the nurses and community health workers. A two days workshop is organized subsequently in each province bringing together at least with one nurse from each selected health center. These trained nurses go back with materials to train their colleagues. They are followed up every three months with a survey to assess how much they retain the learned knowledge and the impact made. Prior to trainings, RCCR and pediatric oncologists develop training materials that include training curriculum for both the trainers and for the trainees (nurses), educational and awareness material (posters, fliers, brochures). Trained nurses are kept in RCCR database for their follow-up and track any case of a childhood cancer at their health facilities. Program/Policy process: The program is run in 4 phases, Phase 1: Develop training materials materials Phase 2: Recruitment and train the trainer phase Phase 3: Selection of health center and recruitment of healthcare providers Phase 4: The execution phase. Trainings are carried out in selected health centers. Phase 5: Post training follow-up. Outcomes: In 2017, the program was conducted in 4 health centers and around 90 health care providers were trained with more than 800 posters, 950 brochures and 300 flyers distributed. According to reports, after the training, the number of referrals from health centers increased and the posttraining showed how accurate nurses were in stating their differential diagnoses. What was learned: Childhood cancers are curable when detected and treated early, there is a need to build strong partnerships with private and public sectors to address the challenge of early detection and late presentation at the hospital because the program of training primary healthcare providers showed a good impact.
Selective Internal Radiation Therapy Using Yttrium-90 Radioembolization for Hepatocellular Carcinoma
Authors: Hanin F.K. , Yussof N.A. , Sabirin J.
Published: September 2018

Background: Hepatocellular carcinoma (HCC) is a primary malignant tumor of the liver that accounts for an important health problem worldwide. It is the sixth most common cancer worldwide with an incidence of 626,000 new patients a year, and the third most common cause of cancer related death. Secondary or metastatic liver are more common than primary tumor. The most common sites of primary tumor are breast, lung, and colorectal cancer with the majority of secondary liver cancers are metastases from colorectal cancer. Several locoregional catheter-based therapies options are available such as transarterial chemoembolism (TACE), drug eluting bead chemo-embolism and 90Y radioembolization for treatment of choice for unresectable HCC. Aim: To assess the effectiveness, safety and cost-effectiveness of selective internal radiation therapy (SIRT) using 90Y microspheres for the treatment of hepatocellular carcinoma. Methods: Electronic databases searched through the Ovid interface using MEDLINE (R) In-Process and Other Non-Indexed Citations and Ovid MEDLINE (R) 1946 to present. Additional articles were identified from reviewing the references of retrieved articles. Last search was conducted on 25th February 2016. Results: Seventeen articles related to SIRT using 90Y microspheres for HCC were included in this report in term of safety and effectiveness. For primary HCC, limited fair level of retrievable evidence to demonstrate that yttrium-90 radioembolization increased clinical response rates, improve survival and downstaging tumor for resection or transplant in unresectable primary HCC. For liver metastatic disease in colorectal cancer, limited fair level of retrievable evidence to demonstrate improvement in clinical response rates, longer median time to liver progression and overall survival when used in combination with first, second or third line chemotherapy as well as salvage treatment of chemotherapy refractory disease. For liver metastasis in neuroendocrine tumor, limited low level of retrievable evidence to suggest the use of 90Y radioembolization improved clinical response rates and median overall survival. Sufficient fair level of retrievable to suggest that 90Y radioembolization is a safe and well-tolerated procedure with some radioembolization specific complications. No retrievable evidence on cost-effectiveness. Conclusion: SIRT using 90Y microspheres may be used for unresectable primary hepatocellular carcinoma (HCC) and liver metastasis from colorectal cancer (mCRC). Strict criteria should be applied for patient selection and treatment shall be delivered through multidisciplinary team approach. However, SIRT is not recommended for unresectable metastatic liver disease of neuroendocrine tumor (mNET).
Patient Engagement for Metastatic Breast Cancer Patients: WhatsApp Counseling
Authors: Maudgal S.
Published: September 2018

Background: Breast cancer accounts for 1/4th of all female cancers in India. Lack of awareness, poor diagnostic facilities, low priority for women's health cause late stage presentation. Younger average age, aggressive disease, incomplete or abandoned treatment, results in large numbers of metastatic breast cancer cases (MBC). Most people have smartphones and access to the Internet. We have created a WhatsApp based counseling program where patients can be active or passive while benefiting from others’ experiences. Aim: MBC patients cannot share their fears and innermost feelings with family members. It is therefore beneficial to create a secure, nonjudgmental, empathetic group having personal experiences and knowledge about MBC. Such interactions reduce social isolation, promote hope and optimism about the future. Methods: Doctors, social workers, nurses and administrators at 5 hospitals provided phone numbers of MBC patients who were invited to join. Groups of 6-10 women were created. A 14 week program was created alternating interventions for physical and psychological problems. Results: 50% patients contacted refused to participate. They had no desire to interact with others, had sufficient information, wanted to maintain secrecy. Some joined but left due to negative comments posted by a participant. Confidentiality could not be guaranteed since software can determine phone owners' identity. Participants were given rules, but there were many infractions. Positive outcomes: Information on healthy lifestyles, yoga, inspirational and spiritual messages, recipes, fashion, makeup tips, prostheses suppliers; music, books, movies, articles from newspapers, journals, information about workshops, seminars, meetings were shared. Inputs from physiotherapists, dieticians, CBT intervention from counselors was valued. Members were reminded about exercise and care of affected arm. Financial issues, sexual problems, advice on reconstruction were some beneficial topics. Patients arranged and enjoyed physical meetings. Negative outcomes: Patients posted information on unproven cures, personal comments about doctors. Patients on treatment asked questions better directed to their doctor. One patient asked for funds. Postings through the night disturbed those who had not muted the conversation. Irrelevant forward, videos and generic messages were a distraction. Much tact was required to prevent degeneration of the conversation. Loss of a group member was a setback for all members. Conclusion: The role of a counselor has changed greatly in recent times. Side effects are minimized, hair loss is less traumatic and patients find information on the Internet. Greater acceptance, lesser stigma means that support groups are not seen to be essential. The WhatsApp group replaced physical meetings. Women with MBC experience trauma due to physical symptoms, psychological and spiritual distress. The group allowed them to share problems with other women in similar situations.
Bowel Cancer Screening in Australia: Research and Tactics to Achieve an Advocacy Goal
Authors: Grogan P.
Published: September 2018

Background and context: Bowel cancer is the second leading cause of cancer death in Australia, yet survival is above 90% if it is detected at stage one. Cancer Council Australia has advocated since 1997 (when RCT evidence was published) for a national government-run screening program—a challenge to any government, given the costs and changes across the health system, irrespective of the health benefits. Cancer Council Australia has advocated at every step in the program’s development, from pilot studies to securing bipartisan political support for the program´s introduction to funding allocations linked to our budget submissions. Yet cost pressures restricted the Australian Government in 2013 to implementation by 2034 - an unacceptable timeframe in view of preventable deaths over that period. To find a peer-reviewed “big number” to convince candidates in Australia´s 2013 federal election to support full implementation by 2020, Cancer Council commissioned a study of multiple screening scenarios submitted to a leading medical journal, showing our implementation plan would prevent 35,000 bowel cancer deaths by 2040. The incoming government, despite campaigning on national debt-reduction, allocated almost $100 million dollars—the centrepiece of its first health budget—to Cancer Council Australia´s plan, attributing the decision to our advice. Subsequent Cancer Council Australia research has shown the program´s life-saving benefits to be even greater if participation can be increased, and that it would achieve net savings. We continue to push for program promotion, with our peer-reviewed research showing 60% participation would prevent 84,000 bowel cancer deaths by 2040. Aim: To highlight how political advocacy and scientific research can work together by ensuring the advocacy is based on the best available evidence, with that evidence collected through a peer-reviewed study designed to deliver major policy reform. Strategy/Tactics: The key strategy/tactics were basic but often overlooked: collect the most compelling evidence of benefit, thereby making it difficult for politicians to dismiss the advocacy. The example of bowel cancer screening advocacy in Australia since 2012-13 has been presented in Australian research institutes to highlight how studies can be designed expressly to translate to a major policy outcome. Program/Policy process: Cancer Council Australia adhered to all government processes within its advocacy remit (budget submissions, being appointed to government committees, producing clinical practice guidelines) while working independently to drive the research and public policy agenda. Outcomes: The accelerated implementation of a landmark national screening program. What was learned: That even politicians obsessed with budget cuts can´t always argue with the best evidence—and that researchers can design studies that change policy and practice, if guided by political pragmatists.
EGFR Mutation Testing of Nonsquamous NSCLC in New Zealand: Trends, Selectivity and Effects on the Prevalence of EGFR Mutation
Authors: Tin S. Tin , McKeage M. , Khwaounjoo P. , Thi A.M. , Elwood M.
Published: September 2018

Background: Given the benefits in using epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI), clinical practice guidelines recommend EGFR mutation testing of nonsquamous non–small cell lung cancer (NSCLC). However, not all patients get tested, which may have an impact on the prevalence of EGFR mutation previously estimated. Aim: To determine the trends of EGFR mutation testing in patients with nonsquamous NSCLC in New Zealand, and to explore the possible associations between the proportions tested, selectivity and the prevalence of EGFR mutation. Methods: This population-based study involves all patients who were diagnosed with nonsquamous NSCLC in the four health regions of New Zealand between January 2010 and July 2016. We identified eligible patients from the New Zealand Cancer Registry and obtained information on EGFR testing from TestSafe, a clinical information sharing service. We then calculated the proportions of patients tested for EGFR mutation and computed selectivity indices for eleven periods. We used a log-linear model to assess the associations between the proportions tested, selectivity and the prevalence of EGFR mutation. Results: Of the 2986 patients involved in this analysis, 1280 (42.9%) were tested for EGFR mutation. The proportion tested increased from 3.7% in 2010 to 74.0% in 2016. Testing was more prevalent in younger age group, female, Asian and patients with adenocarcinoma, and when specimens for testing was available. Such selectivity, however, decreased from 2010 to 2016. The prevalence of EGFR mutation varied widely across the periods, ranging from 16.8% in January-June 2014 to 43.8% in 2010. It was negatively associated with the proportion tested ( P = 0.02), and positively associated with the selectivity of testing ( P = 0.03). The log linear models estimated that the prevalence of EGFR mutation would be at most 16.1% (95% CI: 9.5%–27.1%) if 100% of patients were tested. Conclusion: In New Zealand, the uptake of EGFR mutation testing has improved over time but there is still room for improvement. Incomplete and selective testing may result in an overestimation of the prevalence of EGFR mutation in patients with nonsquamous NSCLC.
The Needs and Practices of Fertility Preservation for Patients With Hematological Malignancies: A Medical Center Experience in Taiwan
Authors: Lin H.J. , Cheng Y. , Tang J.L.
Published: September 2018

Background: The incidence of hematologic malignancies has increased steadily in Taiwan. Along with the improvement of medical treatment, the survival of patients with hematologic malignancies has greatly improved. Cancer treatment may cause temporary or permanently infertility, which may lead to psychological distress and reduced quality of life. As patients live longer, the consequences of cancer treatments and fertility preservation are of increasing importance. Aim: The aims of this study was to understand the knowledge, needs and experiences of fertility preservation (FP) of patients with hematologic malignancies, and the perceptions and practices of healthcare providers concerning FP for patients with hematologic malignancies. This study also aimed to identify the challenges of FP in health care settings. Methods: In-depth interviews with 13 patients and 13 health care providers along with on-site observation were conducted. Results: Research findings were presented in three parts, respectively addressing patients' needs and attitudes, health care providers' perspective, and problems of current treatment procedures. In the first part, findings showed that among all the 13 interviewed patients, 10 had received counseling, and among them 4 had successfully completed FP. Most patients were unaware of infertility risk of cancer treatment and uninformed with FP information. At the time of cancer diagnosis, most patients were preoccupied with cancer treatment and own survival, but once informed, most of them expressed an aspiration to preserve fertility. In the second part, healthcare providers were found to encounter multiple barriers in initiating discussions about FP with patients, which included the health conditions of patients, the urgent need for treatment, and their perceived insufficiency in knowledge concerning FP procedures and in awareness of experiences of other cases. In the third part, the findings indicated that patients faced several challenges, including the passive attitudes of their physicians, the lack of the counselors or coordinators about FP, and the lack of collaborative guidelines or practices among different subspecialties. Conclusion: The fertility issues of patients with hematologic malignancies deserve attention, as their survival rate has been improved. To ensure the provisions of more friendly medical care resources and to improve life quality of patients with hematologic malignancies, the researcher proposed the following suggestions to the health care team: to provide patients the information concerning the infertility risks caused by cancer treatment and consultation services, establish and implement treatment procedures that incorporate FP, strengthen collaboration across subspecialties, communicate with patients about FP before the initiation of cancer treatment, and provide medical assistance to patients in needs.
Survivourship Issues As Determinants of Quality of Life After Breast Cancer Treatment: Report From a Limited Resource Setting
Authors: Kaur N. , Gupta A. , Sharma A.K.
Published: September 2018

Background: Cancer survivorship is an unremitting struggle for breast cancer patients, as the consequence of complex treatment processes and its multitude of residual and late emerging side effects, have a significant impact on their quality of life (QOL). Unique issues of survivorship include those related to physical, psychological, social, and spiritual well-being of women. Amid a growing population of breast cancer survivors (BCs) worldwide, supportive care research is assuming greater importance in breast cancer care. Focus of survivorship research is to identify issues impacting QOL of the cancer survivors so that supportive care services can be tailored to their specific needs. Role of individual survivor's issues have been widely reported but a comprehensive picture is lacking. Aim: This study was conducted with the aim to identify important survivorship issues adversely affecting QOL of women after breast cancer treatment. Main objectives were to (1) estimate prevalence of various survivorship issues (2) assess QOL of survivors by using FACT-B and SF-36 questionnaires (3) study impact of time elapsed since treatment on survivorship issues and QOL scores (4) identify most important issues from the perspective of impact on QOL. Methods: This descriptive, hospital based, cross sectional study was conducted in 230 breast cancer survivors and a group of 112 healthy age-matched-controls, in an academic healthcare setting in northern India. A checklist of 14 commonly reported survivorship issues, and questionnaires for QOL assessment were administered to participants. Main outcome measures were (1) frequencies of survivorship issues and QOL scores among three groups divided on the basis of time elapsed since treatment (< 2 year follow-up, 2-5 year follow-up and > 5 year follow-up) (2) association of survivorship issues with QOL scores (3) stepwise regression analysis to identify issues with most significant impact on QOL of survivors. Results: Breast cancer survivors showed an improvement in their QOL over time which was sustained in long term survivors. However their quality of life remains poorer, compared with healthy women, irrespective of the duration of follow-up. The most prevalent survivorship issues were fatigue (60%), restriction of shoulder movement (59.6%), body and joint pain (63.5%), chemotherapy induced cessation of menstruation (73.3%) and loss of sexual desire (60%). However the issues which had maximum adverse effect on QOL scores were emotional distress, fatigue, postmastectomy chronic pain, cessation of menstruation, body and joint pain, vaginal dryness and sleep disturbances. Conclusion: Thus in this study, emotional distress and cancer related fatigue were found to be the chief determinants of poor QOL. Further premature menopause, with its attendant systemic symptoms, vulvo-vaginal atrophy and sexual dysfunction emerged as a key contributor to poor QOL in BCs.