bluuebunny/crossref_metadata_2025 huggingface dataset:
Skeletal tuberculosis in children in the Western world: 18 new cases with a review of the literature
Authors: Hosalkar Harish S. , Agrawal Nina , Reddy Swapna , Sehgal Kriti , Fox Edward J. , Hill Robert A.
Published: June 2009

Purpose

The occurrence of pediatric skeletal (extra-spinal) tuberculosis in the developed world is extremely rare. The purpose of this study was to review the cases at our institutions.

Methods

We performed a retrospective review of all pediatric biopsy-proven skeletal (extra-spinal) cases of tuberculosis over a five-year period.

Results

Eighteen patients of biopsy-proven tuberculosis were identified. The mean age was 12 years (range 7–20). Lesion locations included: distal humerus, ulna, scapula, acetabulum, proximal femur, proximal tibia, distal tibia, and calcaneus. All had symptoms of pain, swelling, and stiffness. Five cases had multi-focal involvement. Twenty-four lesions were noted in 18 patients. Nineteen lesions were cystic in nature at presentation. The sedimentation rate was normal in six and purified protein derivative (PPD) was negative in five patients. All received chemotherapy. Six patients underwent surgery.

Conclusions

The diagnosis of pediatric skeletal tuberculosis can be made with good correlation of clinical, radiographic, and laboratory findings. Biopsy and culture are the gold standards in diagnosis. Prognosis is good with chemotherapy and non-operative management. Surgical intervention may be needed in select cases.
Periostin localizes to cells in normal skin, but is associated with the extracellular matrix during wound repair
Authors: Jackson‐Boeters Linda , Wen Weiyan , Hamilton Douglas W.
Published: June 2009

Epidermal tissue repair represents a complex series of temporal and dynamic events resulting in wound closure. Matricellular proteins, not normally expressed in quiescent adult tissues, play a pivotal role in wound repair and associated extracellular matrix remodeling by modulating the adhesion, migration, intracellular signaling, and gene expression of inflammatory cells, pericytes, fibroblasts and keratinocytes. Several matricellular proteins show temporal expression during dermal wound repair, but the expression pattern of the recently identified matricellular protein, periostin, has not yet been characterized. The primary aim of this study was to assess whether periostin protein is present in healthy human skin or in pathological remodeling (Nevus). The second aim was to determine if periostin is expressed during dermal wound repair. Using immunohistochemistry, periostin reactivity was detected in the keratinocytes, basal lamina, and dermal fibroblasts in healthy human skin. In pathological nevus samples, periostin was present in the extracellular matrix. In excisional wounds in mice, periostin protein was first detected in the granulation tissue at day 3, with levels peaking at day 7. Periostin protein co‐localized with α‐smooth muscle actin‐positive cells and keratinocytes, but not CD68 positive inflammatory cells. We conclude that periostin is normally expressed at the cellular level in human and murine skin, but additionally becomes extracellular during tissue remodeling. Periostin may represent a new therapeutic target for modulating the wound repair process.
Prevalence and predictors of dysmenorrhea among students at a university in Turkey
Authors: Ozerdogan Nebahat , Sayiner Deniz , Ayranci Unal , Unsal Alaettin , Giray Sevgi
Published: June 2009

Objective

To determine the prevalence of dysmenorrhea among Turkish university students and to evaluate the effects of sociodemographic characteristics on the condition.

Method

A cross‐sectional survey of 857 students conducted by questionnaire in April 2007 at a university in Turkey. A visual analogue scale was used to assess the severity of dysmenorrhea. Data were analyzed using the χ2 test and logistic regression analysis.

Results

The prevalence of dysmenorrhea was 55.5% (444 out of 800 women). Risk of dysmenorrhea was approximately 1.5‐times higher in women with a satisfactory spending allowance (OR 1.49; 95% CI, 1.05–2.13); 3.5‐times higher in women with a family history of dysmenorrhea (OR 3.48; 95% CI, 2.54–4.78); 1.5‐times higher in women who were underweight compared with overweight/obese women (OR 1.52; 95% CI 0.99–2.33); 1.6‐times higher in women who reported a history of smoking (OR 1.57; 95% CI, 1.10–2.25); and 1.8‐times higher in women with an excessive sugar intake (OR 1.77; 95% CI, 1.15–2.72).

Conclusion

The high prevalence of dysmenorrhea among Turkish university students is a significant health problem that requires attention.
Lumbosacral transitional vertebrae in cats and their effects on morphology of adjacent joints
Authors: Newitt Anna L.M. , German Alexander J. , Barr Frances J.
Published: June 2009

The present study aimed to describe the radiographic appearance of lumbosacral transitional vertebrae in the cat and compare prevalence of hip dysplasia and lumbosacral spondylosis with a population of cats without transitional vertebrae. Pelvic radiographs of cats were reviewed retrospectively, providing a population of 100 cats without transitional vertebrae and 14 examples of lumbosacral transitional vertebrae. All cats were assessed for hip dysplasia and lumbosacral spondylosis; the lumbosacral transitional vertebrae identified were also assessed for asymmetry or rotation of sacro-iliac (SI) attachment. The transitional vertebrae demonstrated a wide variety of morphology; six cats had asymmetry or rotation of SI attachment in a dorsal plane; four of those six cats had lumbosacral spondylosis and two of these had hip dysplasia. No further examples of degenerative changes were identified in the remaining eight cats with lumbosacral transitional vertebrae. The frequency of lumbosacral spondylosis was higher in the population with lumbosacral transitional vertebrae, but this was not statistically significant. There was a marked trend towards lumbosacral spondylosis in cats with pelvic rotation or asymmetry. The frequency of hip dysplasia in cats with lumbosacral transitional vertebrae was very similar to those without.
Comparison of parametric and non-parametric methods for analysing genotype×environment interactions in safflower (Carthamus tinctoriusL.)
Authors: MOGHADDAM M. J. , POURDAD S. S.
Published: June 2009

Genotype×environment interaction (GEI) is a major factor in the development of stable and high-yielding safflower cultivars under rain-fed conditions. In order to quantify GEI effects on the seed yield of 17 safflower genotypes and to identify stable genotypes, multi-environment yield trials (multi-environment trials (MET)) were conducted for four consecutive years in 33 different environments (year–location combinations) during 2003–06. The results indicated that GEI was significant using the Hildebrand (1980) procedure for non-crossover interaction (no change in genotypic rank) and by the Azzalini & Cox (1984) and the De Kroon & Van Der Laan (1981) tests for crossover interaction (change in genotypic rank). The rank-interaction was not significant when assessed using the Bredenkamp (1974) method. Fifteen univariate stability methods measuring different aspects of stability were used to determine stable genotypes. A principal component analysis based on rank correlation matrix separated those methods based on a dynamic concept of yield stability (change in genotypic performance corresponds to the predicted level for each environment) from those which are based on a static one (the lowest changes in genotypic performance across environments). The methods could be grouped into three distinct classes: (i) those which were associated with yield level and the dynamic concept of stability; (ii) those which were associated with environmental variance, which represents static stability; and (iii) those which were grouped with non-parametric stability statistics, which also represent static stability. The superiority index of cultivar performance, coefficient of regression, Rank-Sum (sum of ranks of yield and stability variance) and TOP (number of environments at which the cultivar occurred in the top third of the ranks) defined the dynamic stability.

In this MET, the genotype PI-537598 was identified as the genotype with the highest yield and high stability of yield.
WIFE ABUSE IN RURAL BANGLADESH
Authors: DALAL KOUSTUV , RAHMAN FAZLUR , JANSSON BJARNE
Published: June 2009

Intimate partner violence (IPV) is a global public health and gender problem, especially in low-income countries. The study focused on verbal abuse, physical abuse and abuse by restricting food provision to wives by their husbands by victim and perpetrator characteristics, emphasizing the socioeconomic context of rural Bangladesh. Using a cross-sectional household survey of 4411 randomly selected married women of reproductive age, the study found that a majority of the respondents are exposed to verbal abuse (79%), while 41% are exposed to physical abuse. A small proportion (5%) of the women had suffered food-related abuse. Risk factors observed were age of the wife, illiteracy (of both victims and perpetrators), alcohol misuse, dowry management, husband's monetary greed involving parents-in-law, and wife's suspicions concerning husband's extramarital affairs. Well-established risk factors for wife abuse, along with dowry and husband's monetary greed, have a relatively high prevalence in rural Bangladesh.
Socio-economic inequalities in physical functioning: a comparative study of English and Greek elderly men
Authors: TABASSUM FAIZA , VERROPOULOU GEORGIA , TSIMBOS CLEON , GJONCA EDLIRA , BREEZE ELIZABETH
Published: June 2009

The associations between socio-economic position (SEP) and physical functioning have frequently been investigated but little is known about which measures of SEP are the best to use for older people. This study examined how different SEP indicators related to the physical functioning of men aged 50 or more years in England and Greece. The data derived from Wave 1 of the English Longitudinal Study of Ageing (ELSA) and from the Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported physical functioning limitations and mobility difficulties were combined and categorised into ‘no disability’, ‘mild disability’ and ‘severe disability’. The SEP indicators studied were: wealth, educational level and occupational class. The findings indicate that respondents with less wealth, fewer educational qualifications and lower occupational class were more likely to experience mild or severe physical disability than those of high SEP. When all three measures of SEP were adjusted for each other, in both samples wealth maintained a strong association with mild and severe disability, while education was associated with severe disability but only among English men. Occupational class was not strongly associated with physical disability in either case. Hence, among English and Greek older men, wealth was a more important predictor of physical functioning difficulties than either occupational class or education.
Altruistic behaviour and social capital as predictors of well-being among older Canadians
Authors: THEURER KRISTINE , WISTER ANDREW
Published: June 2009

Self-reported altruistic activity and social capital were examined as predictors of perceived happiness and life satisfaction among a sample of 4,486 Canadians aged 65 or more years from the 2003Canadian General Social Services Survey, Cycle 17. Altruistic behaviour was measured by number of volunteer hours per month and helping others (not including family and friends). Social capital was measured using dimensions of belonging to one's community, community and neighbour trust, and group activities. Drawing on generativity and role-identity theories, it was hypothesised that altruistic behaviour and social capital are positively associated with well-being (using perceived happiness and life satisfaction), and that social capital mediates the relationship. For both perceived happiness and life satisfaction, after controlling for demographic, health status, and social support variables, measures of altruistic behaviour demonstrated statistically significant associations. Once measures of social capital were entered into the analysis in the final block, however, the altruistic behaviour variables were no longer statistically significant. Robust associations were found for social capital and the two measures of well-being, particularly between sense of belonging, trust in neighbours, and perceived happiness and life satisfaction. The findings suggest that altruistic behaviour is mediated by social capital. The implications of these findings are discussed with respect to understanding the well-being of older Canadians.
Records that play: the present past in sampling practice
Authors: CHANG VANESSA
Published: June 2009

Much of the discourse surrounding sampling practice has been couched in an archaic rhetoric of originality and creativity, predicated on the reproductive mode of creation rather than the practice's own creative logic. These notions have emerged from a metaphysics which privileges the origin as the centre of semantic production. However, this discursive preoccupation with the past is not entirely irrelevant in sampling practice. Rather, the historically inscribed aura of the original holds a redefined, but necessary, place in the practice.

This essay examines the theoretical underpinnings of the discussion so far, then reconciling these with the specific culture of sample-based hip-hop production. Through close readings of some musical examples, it posits a theoretical framework for sampling practice which takes its unique properties into account. By mapping the trajectory of several samples from source to new incarnation, the sample is revealed as the space of simultaneous play and rupture, where the past both defines the present and is effaced by it. As such, sampling creates a tradition that involves the past without deferring to its structures and limitations, restoring a revised mode of agency to the practice.
Beyond the Stars and Stripes: charting Van Dyke Parks' new world musical voyage
Authors: CARTER DALE
Published: June 2009

During the early 1970s the American songwriter, musician and producer Van Dyke Parks completed work on a series of albums exploring the musical contours of the circum-Caribbean region and, through them, broader patterns and issues in twentieth-century US–Caribbean relations. Focusing on the connections between the United States and the (former) British colony of Trinidad and Tobago as articulated via the latter's calypso and steel band traditions, these recordings (two solo albums and two productions) not only explore the grammar, vocabulary and subject matter of a new world music before the phrase ‘world music’ was conceived; they also invite a range of scholarly interpretations. Drawing on a selection of theoretical concepts – notably cultural imperialism, the Black Atlantic, minstrelsy, and world music itself – this article offers a set of formalist and contextualist readings intended to rehearse Parks' Caribbean work as both a case study in (and a challenge to aspects of) the inter-disciplinary analysis of popular music.
Tom Zé and the performance of citizenship in Brazil
Authors: DUNN CHRISTOPHER
Published: June 2009

This paper examines the recent historical trajectory of the idea of citizenship in Brazil through the perspective of Tom Zé, a composer and musician noted for his juxtaposition of avant-garde poetics and popular music. My study begins with his participation in the watershed Tropicália movement of the 1960s, focusing on his critique of consumer society and its implications for popular citizenship. In the early 1970s, the figure of the bourgeois citizen, or senhor cidadão, appears in his work as a caustic critique of those who benefited most from the expansion of capitalism during the period of authoritarian rule. With the re-emergence of civil society and redemocratisation in the 1980s, Tom Zé's work reveals a more affirmative notion of citizenship premised on the discourse of self-represenation among working-class subjects. Finally, this paper discusses Tom Zé's most recent work and its contribution to insurgent forms of citizenship in contemporary Brazil involving historically marginalised and impoverished urban communities within the context of neo-liberal globalisation.
Torpedoing the authorship of popular music: a reading of Gorillaz' ‘Feel Good Inc.’
Authors: ECKSTEIN LARS
Published: June 2009

This article addresses problems of authorship and creative authority in popular music, in particular in view of a pervasive split between modes of aesthetic production (involving modernist assemblage, multiple authorship, and the late capitalist logic of major label policies) and modes of aesthetic reception (which tend to take popular music as the organic output of individual performers). While rock musicians have attempted to come to terms with this phenomenon by either performing a ‘Romantic’ sense of authenticity (basically by importing folk values to the production process) or ‘Modernist authenticity’ (by highlighting experimentation and alienation), Damon Albarn and Jamie Hewlett, creators of Gorillaz, found a third way which ingeniously allows them to do both. By creating a virtual rock band, and by hiding their own media personalities behind those of their virtual alter egos, they brought themselves into a position which allows them to produce ‘sincere’ popular music which ‘playfully’ stages the absurdities of major label music business while very successfully operating within its very confines.
Development of health technology assessment in France
Authors: Weill Caroline , Banta David
Published: June 2009

Objectives:The aim of this study was to describe the history of health technology assessment (HTA) in France.

Methods:The approach was a descriptive review done by people who have been very much involved in this history.

Results:The interest in HTA and evaluation as a tool for health decision making goes back to the 1970s in France. During the 1980s, there were several attempts to develop a national HTA agency, which finally came to fruition with the development of the Agence Nationale de l'Evaluation Medicale (ANDEM) in 1989. ANDEM's main success, perhaps, was in making HTA known in France by developing its own assessments, writing and validating appropriate methodologies for assessing medical technology and medical practices, and by organizing in France the development of programs of consensus development conferences, which the ANDEM either organized itself or supported and validated. In the mid-1990s, the mandate of ANDEM was extended to hospital accreditation and the agency's name was changed to Agence Nationale d'Accreditation et d'Evaluation en Sante (ANAES). Finally, in 2005, the National Authority for Health (HAS) was formed to consolidate efforts to centralize the programs of HTA, aiming at helping decision making regarding reimbursement and pricing, in one agency and to define the optimal use of health technology in France.

Conclusions:HTA has become a strong influence in the healthcare system in France. These developments may be considered rather typical of the approach to public policy questions in France, where regulation is more in use than in other countries (at least in the healthcare field). At the same time, this approach has made lobbying and other attempts to influence decisions common as well, so one might say that HTA is more politicized than in some other countries in Europe.
Health technology assessment in Switzerland
Authors: Koch Pedro , Schilling Julian , Läubli Marlène , Mitscherlich Florian , Melchart Dieter , Bellucci Sergio
Published: June 2009

Objectives and Methods:To review Switzerland's mixed public and private healthcare system with regard to health technology assessment (HTA).

Results:In the past, remarkable work in HTA was done. Accomplishments include the following: (i) Switzerland became an early member of the International Network of Agencies for Health Technology Assessment. (ii) HTA has its legal bases in terms of effectiveness, appropriateness, and efficiency. (iii) The federal law allows the introduction of new technologies for a limited time for evaluation. (iv) A Swiss Network for Health Technology Assessment was established. In 2004, federal HTA activities moved from the Swiss Federal Office “of Social Security” to the one for “Public Health.” The Office mainly mandates, manages, and coordinates evaluations attached to its prevention and intervention sections in the fields of AIDS, illegal drugs, and legal drugs.

Conclusions:Because of the absence of a governmental institution assessing and reporting on new health technologies, private and for profit organizations became more important for the decision-making processes. In a regulated market, the implications may be crucial for the public health.
Health technology assessment in the Asia Pacific region
Authors: Sivalal Sadasivan
Published: June 2009

Objectives:Although health technology assessment (HTA) has been well established in all developed countries, it has not found a firm footing in many developing countries. This is especially true of the Asia Pacific region, which has much of the world population.

Methods:The beginnings of HTA in this region go back to the work of Dr. David Banta in China and the establishment of the Asian HTA Network. The Network embarked on increasing awareness and building capacity among personnel from the region. Attempts were made to introduce HTA in countries where it did not exist, as well as to strengthen existing HTA programs. The Network had regular meetings, and also carried out a study on the diffusion and utilization of magnetic resonance imaging in the region. In an attempt to boost the efforts of the Network, the author spearheaded the organization of the Asian Regional HTA Conferences in Kuala Lumpur in 2000 and 2003, and in Manila, Philippines, in 2004. In addition, the author carried out a survey on HTA in the region. There are two broad categories of countries in the region: Australia, Malaysia, Singapore, New Zealand, China, Philippines, Korea, Thailand, and Taiwan, which have formal HTA programs, and others for which informal mechanisms or related activities exist, which include Bangladesh, Bhutan, Brunei, Cambodia, India, Indonesia, Laos, Maldives, Mongolia, Nepal, Pakistan, Sri Lanka, and Vietnam.

Results:It is important that once HTA is established, it is used effectively. Perseverance and dedication is needed to ensure the success of an HTA program.

Conclusion:Some countries in the region have effective HTA programs, whereas in some, efforts are being made to establish HTA, or HTA-related activities are being carried out in the absence of a formal HTA program.
Experience with an external quality assurance scheme for antimicrobial susceptibility testing of Neisseria gonorrhoeae in India, 2001–2007
Authors: BALA M. , TAPSALL J. W. , LIMNIOS A. , SOOD S. , RAY K.
Published: June 2009

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae compromises patient treatment and disease control. Epidemiologically based surveillance of AMR in gonococci is needed to optimize standard treatment regimens. Validation of AMR surveillance data depends on external quality assurance schemes (EQAS). AMR surveillance data quality in India during 2001–2007 was assessed by participants testing panels of reference strains and repeated re-challenge with identical controls, accompanied by educative feedback. Overall, correct results were obtained for 944 (82%) of 1030 tests performed for five ‘core’ antibiotics. Aggregated error rates decreased from 33% (123 tests) in 2001 to 4·4% (180 tests) in 2007 with improvements in individual laboratory performance. Cephalosporin test results produced high error rates without improvement. Reference centre and network laboratory collaboration produced marked improvements in test performance through annual EQAS integrating proficiency testing and participant education. More frequent EQAS cycles would assist this process. These experiences may be applicable in similar settings elsewhere.
Perioperative therapy in HER2+ patients
Authors: A’Hern R. P. , Bundred N. J. ,   on behalf of the EPHOS-B Trial Management Group
Published: June 2009

Use of perioperative anti-HER2 therapy presents an opportunity to use a therapy which has been shown to be effective in the adjuvant setting early in the course of a patient’s primary treatment, to assess tumour response in vivo using biomarkers and to potentially improve outcome by suppressing the growth stimulus to cancer cells that is thought to occur due to surgery. Biomarkers measured both before and after a short period of preoperative therapy may offer important predictive and prognostic information that can guide future therapy and follow-up. However, the safety and value of perioperative therapy in this context has not been established and its investigation should therefore be conducted within the context of a randomised, controlled trial. Such a trial, EPHOS-B, will shortly commence in UK alongside POETIC, a parallel trial of perioperative therapy in hormone receptor positive postmenopausal breast cancer.
Nodal micrometastases in early stage breast cancer: two case reports
Authors: Reeder J. , Puhalla S. , Vogel V.
Published: June 2009

The most important predictor of outcome for women with early stage breast cancer is the presence or absence of metastases in the axillary lymph nodes. In the era of sentinel lymph node biopsies and improved pathology techniques, micrometastatic disease can be diagnosed. The question of whether or not to treat these women as if they have nodal disease remains in doubt. In order to further explore this topic, we identified two cases of women with nodal micrometastases at our institution. A literature review of PUBMED and SABCS abstracts was then performed. In this article, we discuss our results and the emerging clinical debate about the management of nodal micrometastases.
Anti-angiogenic therapy: from laboratory to the patient
Authors: Ademuyiwa F. O. , Sledge G. W.
Published: June 2009

Angiogenesis, or new vessel formation, plays a key role in the process of tumor growth and metastasis in breast cancer. Recent large phase-III trials (E2100 and AVADO) demonstrate the clinical utility of bevacizumab in combination with front-line taxane-based chemotherapy in patients with metastatic breast cancer, leading to its recent approval in the United States and Europe. Several other anti-angiogenic strategies against vascular endothelial growth factor are in various phases of clinical development. This paper reviews the data on bevacizumab in metastatic breast cancer and other anti-angiogenic strategies on development in breast cancer.
Challenges of illness in metastatic breast cancer: A low-income African American perspective
Authors: Rosenzweig Margaret Quinn , Wiehagen Theresa , Brufsky Adam , Arnold Robert
Published: June 2009

Objective:

Disparities in breast cancer survival and treatment for African American and low income women are well documented, yet poorly understood. As care for women with metastatic breast cancer (MBC) evolves to a chronic care model, any inequities in optimal treatment and management of symptoms must also be identified and eliminated. The purpose of this study was to explore how race and income status influence women's experiences with MBC, particularly the management of symptoms, by describing the perceived challenges and barriers to achieving optimal symptom management among women with MBC and exploring whether the perceived challenges and barriers differed according to race or income.

Method:

Quantitative techniques were used to assess demographics, clinical characteristics, symptom distress, and quality of life and to classify women into groups according to race and income. Qualitative techniques were used to explore the perceived challenges, barriers, and potential influences of race and income on management of symptoms in a prospective sample of 48 women with MBC.

Results:

Commonalities of themes across all groups were faith, hope, and progressive loss. Low-income African American women uniquely experienced greater physical and social distress and more uncertainty about treatment and treatment goals than the other delineated racial and economic groups.

Significance of results:

There are many commonalities to the challenges of illness presented to women with MBC. There are also interesting, emerging thematic racial and economic differences, most compelling among the low income African American women with resultant practice and research implications.
Caring for a person in advanced illness and suffering from breathlessness at home: Threats and resources
Authors: Gysels Marjolein H. , Higginson Irene J.
Published: June 2009

Objective:

Little is known about the factors that mediate the caregiving experience of informal carers at home, which could inform about ways of supporting them in their caregiving role. Our objective was to investigate the caring experience of carers for patients with an advanced progressive illness (chronic obstructive pulmonary disease [COPD], heart failure, cancer, or motor neuron diseases [MND]), who suffer from breathlessness.

Methods:

A purposive sample of 15 carers was selected. They were recruited via the patients they cared for (who suffered from COPD, cancer, MND, or heart failure) from the hospital and the community. Data were collected through semistructured, in-depth interviews. All were tape-recorded and transcribed verbatim. The analysis used a Grounded Theory approach and NVivo software facilitated the management and analysis of the data.

Results:

Several key issues affected caring in a positive or a negative way. The threats to caring were uncertainty, carers' own health problems, an imploded world, negative reactions from outside, person loss, and acute exacerbations. Resources that carers drew on were acceptance, self-care, availability of support, feeling that caring is a shared responsibility with the patient, and “getting on with” caring in case of emergencies. Breathlessness was particularly challenging, and carers did not have any strategies to relieve the symptom. They were ill prepared for acute exacerbations.

Significance of results:

Carers need to be included in opportunities for support provision in advanced illness. Negotiated involvement of a health professional could buffer the heavy responsibilities related to home care. They could provide problem-solving skills and build on the resources that carers draw on in response to what they experience as most threatening to their caring role.
Techniques for framing questions in conducting family meetings in palliative care
Authors: Dumont Isabelle , Kissane David
Published: June 2009

Objective:

Family therapy has developed several approaches to framing questions within family meetings, but few of these techniques have been adapted for palliative care. We focus on the application of questioning techniques from systemic family therapy to palliative care. More specifically, we describe and give examples of the model of asking questions developed by Karl Tomm (1988) through its application in Family Focused Grief Therapy (FFGT), a preventive intervention delivered to high-risk families during palliative care and bereavement.

Methods:

First, the type of questions used across the course of therapy is explored based on the interventive questioning model. Then, a case example is provided to demonstrate the use and adaptation of this model in a palliative care setting.

Results:

At the beginning of therapy, the most frequent questions were linear and circular, moving around the family to build up a picture of events from everyone's perspective. As for the frequency of reflexive and strategic questions, these increased as the therapy progressed, bringing the family to new perspectives. The case example fleshes out the importance of each type of question, all of which have a proper place in the course of therapy.

Significance of results:

These illustrations highlight the value of having a model of questioning styles to guide the clinician when exploring palliative care issues, such as care provision, coping and grief, intimacy, and discussing death. This framework could be useful in guiding supervisors, trainees, and clinicians seeking to build skills and optimize their interventions in a palliative care setting.
Patients' views on decision making in advanced cancer
Authors: Philip Jennifer , Gold Michelle , Schwarz Max , Komesaroff Paul
Published: June 2009

Objective:

To explore patients' understanding of decision making in the treatment of advanced cancer and to determine the factors they believe important to these processes in their care.

Methods:

Surveys were distributed to consecutive outpatients with advanced malignancy attending a comprehensive cancer treatment center.

Results:

Patients believed that the medical condition (94%), their doctors' experience (81%), and the medical literature (73%) are the most important factors for decisions made in their care. They also value their relationship with the doctor (63%) and their own (the patients') values (63%), and just over a third considered their family's values and the doctors' personality important. Most did not believe the doctors' values should influence decisions made. They were mindful of the uncertainty involved in decisions in the setting of advanced cancer.

Significance of results:

Overall, patients were satisfied with the decision-making processes and they understood and highly regarded the incorporation of factors, other than their medical condition, in their care.
Strength through adversity: Bereaved cancer carers' accounts of rewards and personal growth from caring
Authors: Wong W.K. Tim , Ussher Jane , Perz Janette
Published: June 2009

Objective:

Many studies have identified negative and distressing consequences experienced by informal cancer carers, but less attention has been given to positive and beneficial aspects of caring. This qualitative study examined the positive aspects of caring as subjectively constructed by bereaved informal cancer carers, a group of individuals who are in a position to make sense of their caring experiences as a coherent whole.

Method:

Twenty-three bereaved informal cancer carers were interviewed, and their accounts were analyzed using a thematic analytical approach from a phenomenological perspective.

Results:

The participants were able to identify positive and beneficial aspects of caring. These included the discovery of personal strength, through adversity, acceptance, and necessity; the deepening of their relationship with the person for whom they cared; and personal growth through altered relationships with others and altered perspectives on living. Many participants gave accounts of focusing on these positive benefits when they reflected on their caring experiences.

Significance of results:

We concluded that benefit finding in the face of adverse events serves an important function in allowing individuals to incorporate difficult experiences into their worldview in a meaningful way, thus maintaining positive beliefs about the world. This has implications for the development of interventions for informal cancer carers and for those who are bereaved following caring.
A feasibility study of a two-session home-based cognitive behavioral therapy–insomnia intervention for bereaved family caregivers
Authors: Carter Patricia A. , Mikan Sabrina Q. , Simpson Cherie
Published: June 2009

Objective:

In 2008 over two million family caregivers will become bereaved. The vast majority of these caregivers have provided ‘round-the-clock care for a period ranging from months to years. Bereaved family caregivers report insomnia symptoms that persist beyond 1 year, longer than what is seen in bereaved noncaregivers, placing them at increased risk of depression and complicated grief. Despite some rewarding elements, caregiving is a stressful and exhausting role that often requires the caregiver to restructure his or her life around the needs of the patient. Once the patient dies, the structure is lost. Cognitive behavioral therapy interventions are effective in providing structure. This pilot study explored the feasibility of a two-session home-based cognitive behavioral therapy–insomnia (CBT-I) intervention for bereaved family caregivers.

Method:

A 5-week longitudinal descriptive study design was used with 11 adult primary family caregivers of patients who died from cancer. A master's prepared nurse delivered two CBT-I intervention sessions in participant homes. Data collection sessions occurred at baseline, 3, and 5 weeks. A debriefing session was held at Week 6.

Results:

Participant evaluations of the intervention indicated that it was feasible and acceptable (e.g., 100% would recommend it to others); objective data further supported its feasibility (e.g., 100% completed the trial). In addition, when comparing baseline with Weeks 3 and 5, participants demonstrated improvement in insomnia and depressive symptoms.

Significance of results:

The results of this pilot study suggest that the intervention is feasible and acceptable and produces promising effects on insomnia and depressive symptoms in bereaved family caregivers.
Fatigue in relatives of palliative patients
Authors: Carlsson Maria E.
Published: June 2009

Objectives:

The relatives’ burdens in palliative care are considerable and may cause fatigue. The overall aim of this study was to gain a greater understanding of fatigue in relatives of patients cared for in palliative care settings.

Methods:

This study has a descriptive, comparative, and cross-sectional design. The sample consisted of relatives of all patients cared for in palliative care settings in Uppsala County during a specific day. Relatives completed a questionnaire consisting of the Multidimensional Fatique Inventory (MFI-20) and questions from the Karolinska Sleepiness Scale (KSS) and Karolinska Sleep questionnaire (KSQ).

Results:

Relatives (n = 56) scored high on every dimension on the MFI-20 scale. Two significant negative correlations were found to exist between age and fatigue, with younger relatives reporting more mental fatigue (p < .01) and more reduced activity (p < .01) than older relatives. Relatives of patients in institutional care had higher values concerning mental fatigue (p < .01) and reduced motivation (p < .05). Relatives of mostly bedridden patients were significantly more tired but did not have significantly less motivation than relatives of mostly ambulatory patients.

Significance of results:

The findings imply that fatigue is highly prevalent in relatives of patients in palliative care. The sample in this study scored higher in comparison with norm values and also in comparison with relatives of patients with end-stage renal disease. Their scores were similar to those of cancer patients undergoing radiotherapy.
Using the differential from complete blood counts as a biomarker of fatigue in advanced non-small-cell lung cancer: An exploratory analysis
Authors: Paddison Johanna S. , Temel Jennifer S. , Fricchione Gregory L. , Pirl William F.
Published: June 2009

Objective:

Fatigue is currently recognized as an undertreated symptom in cancer. To date the association between fatigue and inflammatory activation has not been examined in patients with advanced cancer. Our exploratory investigation considered whether variations in routinely available hematological parameters relate to the severity of fatigue reports.

Methods:

Fatigue, white blood cell differential, and hemoglobin concentration were assessed in 44 Stage IIIb and IV non-small-cell lung cancer (NSCLC) patients. Days of survival and the relative timing of treatment discontinuation were also recorded. Relationships between fatigue intensity and length of survival and between fatigue and hematological variables were examined using binomial and linear regressions respectively.

Results:

When we controlled for effects related to age, gender, and time until treatment termination, more intense fatigue was associated with shorter survival (β = −.34, p = .03). Lower hemoglobin concentrations were associated with more intense fatigue (β = −.36, p = .04). When we controlled for the effect attributable to hemoglobin, higher neutrophil (β = .43, p = .01) and monocyte (β = .31, p = .05) concentrations were associated with reports of more severe fatigue.

Significance of results:

This exploratory study provides empiric data showing that the severity of fatigue reported by advanced-stage NSCLC patients is significantly associated with length of survival. Consistent with existing data, linear regression identified a negative association between fatigue intensity and hemoglobin concentration. When we controlled for this effect, further linear regressions identified significant relationships between fatigue and blood concentrations of neutrophils and monocytes. Further, the magnitude of relationship between myeloid cell concentrations and fatigue was similar to the effect size identified for the relationship between hemoglobin and fatigue. Thus, the indirect measure of inflammatory state provided by routinely assessed myeloid cell counts appears to play as strong a role as the established variable, hemoglobin, in accounting for the fatigue reported by this sample of advanced-stage lung cancer patients.
Effect of music therapy on oncologic staff bystanders: A substantive grounded theory
Authors: O'Callaghan Clare , Magill Lucanne
Published: June 2009

Objective:

Oncologic work can be satisfying but also stressful, as staff support patients and families through harsh treatment effects, uncertain illness trajectories, and occasional death. Although formal support programs are available, no research on the effects of staff witnessing patients' supportive therapies exists. This research examines staff responses to witnessing patient-focused music therapy (MT) programs in two comprehensive cancer centers.

Method:

In Study 1, staff were invited to anonymously complete an open-ended questionnaire asking about the relevance of a music therapy program for patients and visitors (what it does; whether it helps). In Study 2, staff were theoretically sampled and interviewed regarding the personal effects of witnessing patient-centered music therapy. Data from each study were comparatively analyzed according to grounded theory procedures. Positive and negative cases were evident and data saturation arguably achieved.

Results:

In Study 1, 38 staff unexpectedly described personally helpful emotional, cognitive, and team effects and consequent improved patient care. In Study 2, 62 staff described 197 multiple personal benefits and elicited patient care improvements. Respondents were mostly nursing (57) and medical (13) staff. Only three intrusive effects were reported: audibility, initial suspicion, and relaxation causing slowing of work pace. A substantive grounded theory emerged applicable to the two cancer centers: Staff witnessing MT can experience personally helpful emotions, moods, self-awarenesses, and teamwork and thus perceive improved patient care. Intrusive effects are uncommon. Music therapy's benefits for staff are attributed to the presence of live music, the human presence of the music therapist, and the observed positive effects in patients and families.

Significance of results:

Patient-centered oncologic music therapy in two cancer centers is an incidental supportive care modality for staff, which can reduce their stress and improve work environments and perceived patient care. Further investigation of the incidental benefits for oncologic staff witnessing patient-centered MT, through interpretive and positivist measures, is warranted.
Cancer patients' reluctance to discuss psychological distress with their physicians was not associated with underrecognition of depression by physicians: A preliminary study
Authors: Okuyama Toru , Endo Chiharu , Seto Takashi , Kato Masashi , Seki Nobuhiko , Akechi Tatsuo , Furukawa Toshiaki A. , Eguchi Kenji , Hosaka Takashi
Published: June 2009

Objective:

To investigate the association between cancer patients' reluctance for emotional disclosure to their physician and underrecognition of depression by physicians.

Methods:

Randomly selected ambulatory patients with lung cancer were evaluated by the Hospital Depression and Anxiety Scale (HADS), and those with scores over the validated cutoff value for adjustment disorder or major depressive disorder were included in this analysis. The data set included the responses to the 13-item questionnaire to assess four possible concerns of patients in relation to emotional disclosure to the treating physician (“no perceived need to disclose emotions,” “fear of the negative impact of emotional disclosure,” “negative attitude toward emotional disclosure,” “hesitation to disturb the physician with emotional disclosure”). The attending physicians rated the severity of depression in each patient using 3-point Likert scales (0 [absent] to 2 [clinical]). Depression was considered to be underrecognized when the patients had a HADS score above the cutoff value, but in whom the depression rating by the attending physician was 0.

Results:

The HADS score was over the cutoff value in the 60 patients. The mean age was 65.1 ± 10.0, and 82% had advanced cancer (Stage IIIb or IV or recurrence). Depression was underrecognized in 44 (73%) patients. None of the four factors related to reluctance for emotional disclosure was associated with the underrecognition of depression by the physicians. None of the demographic or cancer–related variables were associated with depression underrecognition by physicians.

Significance of results:

The results did not support the assumption that patients' reluctance for emotional disclosure is associated with the underrecognition of depression by physicians.
Staff grief and support systems for Japanese health care professionals working in palliative care
Authors: Shimoinaba Kaori , O'Connor Margaret , Lee Susan , Greaves Judi
Published: June 2009

Objective:

This article is a literature report on grief issues for health care professionals, undertaken to identify Japanese nurses' grief experience when they work in palliative care units. Health care professionals' grief experience and its impact have not been well understood or identified as a significant issue in Japan.

Methods:

Published articles relating to this study were searched using electronic catalogues such as CINAHL and PsycINFO, books, and research publications. Key words used for the search were “grief,” “palliative care,” “nurse,” “staff support,” and “Japan.” Both English and Japanese were used for the literature search in order to collect information regarding nurses' grief and support systems in Japan and elsewhere. The literature search covered the period 1990–2006 inclusive.

Results:

This article explores these issues in the literature as preparation for establishing a study that will particularly look at the influence of nurses' grief on the quality of care provided.

Significance of results:

Consideration of Japanese culture as it relates to death and dying and to nursing culture is a significant part of this work.