bluuebunny/crossref_metadata_2025_split huggingface dataset:
Navigating the path to care and death at home—it is not always smooth: a qualitative examination of the experiences of bereaved family caregivers in palliative care
Authors: Lobb Elizabeth A. , Bindley Kristin , Sanderson Christine , MacLeod Roderick , Mowll Jane 
Published: November 2020

AbstractBackground:Care and death at home are generally thought to be beneficial for families. However, there may be bereavement experiences and support needs, which are specific to family caregivers providing end-of-life care in their home. The Palliative Care Home Support Program in New South Wales, Australia, provides end-of-life care packages for patients who wish to die at home. These packages provide up to 48 hours of specialized supportive palliative home-based care, day or night, by community workers specifically trained for the task, working as part of existing community palliative care multidisciplinary teams. Care packages may include assistance with personal hygiene, carer respite, and domestic assistance.Methods:As part of a larger longitudinal mixed-methods study, 28 bereaved caregivers who experienced a home death and/or received the care packages undertook in-depth interviews. Narrative thematic analysis was undertaken to explore their experiences at 6 months post death.Results:Twenty-eight caregivers were experienced or planned for a home death and 21 had a package in place. Five themes were identified: “the achievements of a home death”; “taking on the mantle”; “the burden of witnessing the dying process”; “home as our space/their space”; and “resistance or submission to the ideals of best place of care for family caregivers.”Conclusions:Bereaved caregivers provided accounts of their interactions with health care providers depicting a complex relationship with the care system. Some families struggled to manage boundaries of home and private space as care needs escalated. Ideals about best care and home death are sometimes conflicted, without easy consensus between patient, family, and service providers.Significance:Models of care based on assumptions that home death is straightforwardly beneficial may cause unintended consequences. For future policy, providing care in the private space of the home requires close attention to family concerns and outcomes.
Anxiety and depression in patients with early stage endometrial cancer: A longitudinal analysis from before surgery to 6-month post-surgery
Authors: Sanjida Saira , Kissane David , McPhail Steven M. , Obermair Andreas , Janda Monika 
Published: November 2020

Abstract

Background:
The prevalence of anxiety and depression, and psychological treatment received by patients with endometrial cancer has rarely been studied. The primary aim of this article was to determine the point prevalence and cumulative prevalence of anxiety and depression in patients with endometrial cancer and types of psychological treatment received. The secondary aim was to evaluate the sociodemographic and clinical factors associated with anxiety and depression from before surgery to 6-month post-surgery.

Methods:
Secondary data analysis of an international, multicenter, prospective randomized controlled trial of surgery for stage I endometrial cancer was conducted. Anxiety and depression was established by the Hospital Anxiety and Depression Scale-21 (HADS). Regression models were fitted to examine the association of sociodemographic and clinical characteristics of patients with anxiety and depression.

Results:
Based on a HADS subscale score of ≥11, the highest prevalence of anxiety occurred before surgery (16%, n = 51/318), and the highest prevalence of depression just after surgery (6%, n = 18/314), respectively. The cumulative incidence of anxiety only, depression only, or both anxiety and depression in women within a 6-month timeframe was 15.5% (n = 52/334), 1.8% (n = 6/334), and 7.2% (n = 24/334), respectively. Very few of these patients received mental health support. Comorbid conditions, prescriptions of antidepressants or anxiolytics already at baseline, and non-European ethnicity were associated with depression.

Conclusions:
Up to 16% of patients with endometrial cancer experienced anxiety or depression around the time of diagnosis and treatment, which is lower than reported in broader gynecological cancer samples. The majority of distressed patients did not receive psychological or pharmaceutical treatments. Further research should aim to identify reasons why patients did not receive support to alleviate anxiety and depression.
An implementation science primer for psycho-oncology: translating robust evidence into practice
Authors: Rankin Nicole M. , Butow Phyllis N. , Hack Thomas F. , Shaw Joanne M. , Shepherd Heather L. , Ugalde Anna , Sales Anne E. 
Published: November 2020

Abstract

Background:
It is broadly acknowledged that the next global challenge for psycho-oncology is the implementation of robust evidence-based treatments into routine clinical practice. There is little guidance or texts specific to psycho-oncology to guide researchers and clinicians about implementation science and how to optimally accelerate the translation of evidence into routine practice. This article aims to provide a primer in implementation science for psycho-oncology researchers and clinicians.

Methods:
We introduce core concepts and principles of implementation science. These include definitions of terms, understanding the quality gap and the need for solid evidence-based interventions.

Results:
The conceptual models, frameworks, and theories that are used in implementation research are outlined, along with evaluative study designs, implementation strategies, and outcomes. We provide a brief overview of the importance of engaging teams with diverse expertise in research and engaging key stakeholders throughout implementation planning, conduct, and evaluation. The article identifies opportunities to accelerate the implementation of evidence-based psychosocial interventions. Opportunities for greater collaboration across disciplines are highlighted. Examples from psycho-oncology and the broader oncology literature are included to help operationalize concepts.

Conclusion:
This article describes the fundamental concepts and principles of implementation science for a psycho-oncology audience, to increase the number and quality of implementation studies across the discipline.
Trends in cancer screening rates among individuals with serious psychological distress: an analysis of data from 2007 to 2016 Japanese national surveys
Authors: Fujiwara Masaki , Higuchi Yuji , Nakaya Naoki , Fujimori Maiko , Yamada Yuto , Wada Riho , Etoh Tsuyoshi , Kakeda Kyoko , Uchitomi Yosuke , Nakayama Tomio , Yamada Norihito , Inagaki Masatoshi 
Published: November 2020

Abstract

Background:
The aim of the present study was to examine whether the increasing trend in cancer screening rates over time in Japan differs between individuals with and without serious psychological distress (SPD).

Methods:
We analyzed a national representative cross-sectional dataset from the 2007, 2010, 2013, and 2016 Comprehensive Surveys of Living Conditions of Japan. We included people under the age of 69 years who met the national program criteria for each type of cancer screening (colorectal, gastric, and lung: n = 94,690, 94,957, and 94,751, respectively). SPD was defined as a score of ≥13 on the Kessler 6 scale. We calculated these cancer screening rates with 95% confidence intervals, stratified by presence or absence of SPD to determine whether cancer screening rates over time between 2007 and 2016 differ between individuals with and without SPD.

Results:
Cancer screening rates in the non-SPD group increased steadily over time from 2007 to 2016 (colorectal, gastric, and lung: 31.4%–46%, 37.2%–44.8%, and 32.1%–51.7%, respectively). They also increased similarly over time in individuals with SPD (colorectal, gastric, and lung: 24.5%–36.3%, 30.2%–37.8%, and 24.8%–39.9%, respectively); however, the rates remained significantly lower than those of people without SPD in all survey years.

Conclusions:
Between 2007 and 2016, cancer screening rates increased similarly over time in individuals with and without SPD. However, gaps in cancer screening in people with SPD remained unresolved.
“Maintaining hope:” challenges in counseling latino patients with advanced cancer
Authors: Costas-Muñiz Rosario , Garduño-Ortega Olga , Torres-Blasco Normarie , Castro-Figueroa Eida , Gany Francesca 
Published: November 2020

Abstract

Background:
Latino cancer patients are at risk of poor psychological adjustment. Therapeutic effectiveness in treating Latino cancer patients with advanced cancer requires managing distress, therapeutic skill, and cultural competency. This mixed-methods study explored mental health providers’ perceptions of the challenging aspects of counseling and caring for Latino patients with advanced cancer.

Methods:
Mental health providers providing services to Latino or Hispanic cancer patients received an emailed web-based survey with open- and closed-ended questions. Providers included psychiatrists, psychologists, social workers, counselors, and other mental health professionals. We invited 154 providers to participate from July 2015 to January 2017. One hundred and four accessed the survey, and 66 eligible providers responded, for a response rate of 43%. Analyses were used to explore whether clinical experience factors and training characteristics were associated with perceiving conversations about cancer (diagnosis, prognosis, and end-of-life) as challenging. Second, the challenging aspects of these conversations were explored qualitatively. Four independent coders coded responses; an inductive content analysis was utilized to analyze the data.

Results:
Mental health providers describe encountering many challenges in their therapeutic discussions with Latino cancer patients.

Conclusions:
It is imperative to understand the factors associated with the perceived difficulty of these conversations, as well as the characteristics of these conversations, to develop culturally sensitive interventions and programs for patients and training interventions for providers.
Admission Psychosocial Characteristics of Critically Ill Children and Acute Stress*
Authors: Nelson Lara P. , Lachman Sage E. , Goodman Kelsey , Gold Jeffrey I. 
Published: November 2020

Objectives:
Children are at increased risk for developing acute stress and post-traumatic stress following admission to the PICU. The primary objective of this investigation was to explore the prehospitalization psychosocial characteristics of children admitted to the PICU and their association with acute stress.

Design:
Observational.

Setting:
The PICU at an urban, academic, pediatric medical center.

Patients:
Children, 8–17 years old with an expected PICU stay greater than 24 hours were recruited.

Measurements and Main Results:
During the admission, they completed questionnaires and a semistructured interview evaluating prehospitalization psychosocial symptoms, including prehospitalization post-traumatic stress, quality of life, and current acute stress. One hundred eleven children were enrolled (mean age = 12.9 yr; 60% male; 58% Latino). Half (51%) reported a prehospitalization history of trauma and nearly all (96%) of these children had post-traumatic stress. They had significant impairment on all domains of quality of life. Children reported high rates of acute stress during their hospitalization, 74.8% acute stress symptoms, and 6% met diagnostic criteria for acute stress disorder. Univariate analysis showed associations between child age, quality of life, chronic illness, and post-traumatic stress with more severe acute stress. Multiple linear regression modeling of acute stress was done accounting for child age, acute versus chronic illness, quality of life, and post-traumatic stress; prehospitalization quality of life and post-traumatic stress remained significantly associated with the development of inhospital acute stress and accounted for 34% of the variance of the model.

Conclusions:
The current investigation is a novel evaluation of the prehospitalization psychosocial characteristics of children admitted to a PICU. The children enrolled reported high rates of acute stress, which was associated with a history of post-traumatic stress and worsened quality of life. The relation with post-traumatic stress is consistent with prior research into complex post-traumatic stress disorder and increases concerns about long-term psychosocial outcomes. Our data advance understanding of the factors contributing to acute stress during hospitalizations and may add to recognizing the importance of models integrating psychosocial support.
Use of Prospective Audit and Feedback to Reduce Antibiotic Exposure in a Pediatric Cardiac ICU
Authors: Schwenk Hayden T. , Kruger Jenna F. , Sacks Loren D. , Wood Matthew S. , Qureshi Lubna , Bio Laura L. 
Published: November 2020

Objectives:
We sought to determine whether a prospective audit and feedback intervention decreased antibiotic utilization in a pediatric cardiac ICU and to describe the characteristics of prospective audit and feedback audits and recommendations.

Design:
Before-after study.

Setting:
Pediatric cardiac ICU of a freestanding children’s hospital.

Patients:
All patients admitted to the cardiac ICU.

Interventions:
A prospective audit and feedback program was established in our hospital’s pediatric cardiac ICU on December 7, 2015. The antimicrobial stewardship program audited IV antibiotics, communicated prospective audit and feedback recommendations to the cardiac ICU, and regularly reviewed recommendation adherence. Mean monthly antibiotic utilization 18 months before (“preprospective audit and feedback”; from June 1, 2014 to November 30, 2015) and 24 months after (“prospective audit and feedback”; from January 1, 2016 to December 31, 2017) prospective audit and feedback implementation was compared. Antibiotic audit data during the prospective audit and feedback period were reviewed to capture the characteristics of prospective audit and feedback audits, recommendations, and adherence.

Measurements and Main Results:
Mean cardiac ICU IV antibiotic use decreased 20% (701 vs 880 days of therapy per 1,000 patient days, p = 0.001) during the prospective audit and feedback period compared with the preprospective audit and feedback period. There was no difference in mean cardiac ICU length of stay (p = 0.573), mean hospital length of stay (p = 0.722), or the rate of discharge due to death (p = 0.541). There were 988 antibiotic audits and 370 prospective audit and feedback recommendations (37% recommendation rate) during the study period. The most commonly audited antibiotic category was broad-spectrum gram-negative agents and the most common indication for use was sepsis. Broad-spectrum gram-positive agents were more likely to be associated with a recommendation.

Conclusions:
There was a significant reduction in antibiotic use following implementation of a prospective audit and feedback program in our pediatric cardiac ICU. Over one-third of antibiotics audited in our cardiac ICU were associated with a prospective audit and feedback recommendation, revealing important targets for future antimicrobial stewardship efforts in this population.
The Association of Laboratory Test Abnormalities With Mortality Risk in Pediatric Intensive Care*
Authors: Pollack Murray M. , Chamberlain James M. , Patel Anita K. , Heneghan Julia A. , Rivera Eduardo A. Trujillo , Kim Dongkyu , Bost James E. 
Published: November 2020

Objectives:
To determine the bivariable associations between abnormalities of 28 common laboratory tests and hospital mortality and determine how mortality risks changes when the ranges are evaluated in the context of commonly used laboratory test panels.

Design:
A 2009–2016 cohort from the Health Facts (Cerner Corporation, Kansas City, MO) database.

Setting:
Hospitals caring for children in ICUs.

Patients:
Children cared for in ICUs with laboratory data.

Interventions:
None.

Measurements and Main Results:
There were 2,987,515 laboratory measurements in 71,563 children. The distribution of laboratory test values in 10 groups defined by population percentiles demonstrated the midrange of tests was within the normal range except for those measured predominantly when significant abnormalities are suspected. Logistic regression analysis at the patient level combined the population-based groups into ranges with nonoverlapping mortality odds ratios. The most deviant test ranges associated with increased mortality risk (mortality odds ratios > 5.0) included variables associated with acidosis, coagulation abnormalities and blood loss, immune function, liver function, nutritional status, and the basic metabolic profile. The test ranges most associated with survival included normal values for chloride, pH, and bicarbonate/total Co
2. When the significant test ranges from bivariable analyses were combined in commonly used test panels, they generally remained significant but were reduced as risk was distributed among the tests.

CONCLUSIONS:
The relative importance of laboratory test ranges vary widely, with some ranges strongly associated with mortality and others strongly associated with survival. When evaluated in the context of test panels rather than isolated tests, the mortality odds ratios for the test ranges decreased but generally remained significant as risk was distributed among the components of the test panels. These data are useful to develop critical values for children in ICUs, to identify risk factors previously underappreciated, for education and training, and for future risk score development.
Circumscribed Myositis Ossificans of the Masseter Muscle
Authors: Li Yang , Park Hong-Ju , Jung Seunggon , Kook Min-Suk 
Published: November 2020

Abstract
The authors report a case of myositis ossificans traumatica of the masseter muscles. A 21-year-old man developed masseter myositis after orthognathic surgery to treat facial asymmetry. The myositis may have been triggered by factors such as calcification of a hematoma, periosteum implantation after surgical trauma, and local soft tissue injury. An intraoral incision was made to excise the ectopic bone, resulting in resolution of the patient's symptoms including limited oral opening.
Serum Levels of Branched Chain Amino Acids Predict Duration of Cardiovascular Organ Failure in Septic Shock
Authors: Puskarich Michael A. , McHugh Cora , Flott Thomas L. , Karnovsky Alla , Jones Alan E. , Stringer Kathleen A. 
Published: November 2020

ABSTRACT

Background:
Sepsis shifts cardiac metabolic fuel preference and this disruption may have implications for cardiovascular function. A greater understanding of the role of metabolism in the development and persistence of cardiovascular failure in sepsis could serve to identify novel pharmacotherapeutic approaches.

Methods:
Secondary analysis of prospective quantitative proton nuclear magnetic resonance (1H-NMR) metabolomic data from patients enrolled in a phase II randomized control trial of L-carnitine in septic shock. Participants with a sequential organ failure assessment (SOFA) score of > = 5, lactate > = 2, and requiring vasopressor support for at least 4 h were eligible for enrollment. The independent prognostic value of metabolites to predict survival with shock resolution within 48 h and vasopressor free days were assessed. Concentrations of predictive metabolites were compared between participants with and without shock resolution at 48 h.

Results:
Serum 1H-NMR metabolomics data from 228 patients were analyzed. Eighty-one (36%) patients met the primary outcome; 33 (14%) died prior to 48 h. The branched chain amino acids (BCAA), valine, leucine, and isoleucine were univariate predictors of the primary outcome after adjusting for multiple hypothesis testing, while valine remained significant after controlling for SOFA score. Similar results were observed when analyzed based on vasopressor free days, and persisted after controlling for confounding variables and excluding non-survivors. BCAA concentrations at 48 h significantly discriminated between those with shock resolution versus persistent shock.

Conclusions:
Among patients with septic shock, BCAA concentrations independently predict time to shock resolution. This study provides hypothesis generating data into the potential contribution of BCAAs to the pathophysiology of cardiovascular failure in sepsis, opening areas for future investigations.
Implications of Tumor Characteristics and Treatment Modality on Local Recurrence and Functional Outcomes in Children With Chest Wall Sarcoma
Authors: Harris Courtney J. , Helenowski Irene , Murphy Andrew J. , Mansfield Sara A. , LaQuaglia Michael P. , Heaton Todd E. , Cavalli Michele , Murphy Joseph T. , Newman Erika A. , Overmen Richard E. , Kartal Tanvi T. , Cooke-Barber J. , Donaher Addison , Malek Marcus M. , Kalsi Ranjeet , Kim Eugene S. , Zobel Michael J. , Goodhue Catherine J. , Naik-Mathuria Bindi J. , Jefferson Imory N. , Roach Jonathan P. , Mata Claudia , Piché Nelson , Joharifard Shahrzad , Sultan Serge , Short Scott S. , Meyers Rebecka L. , Bleicher Josh , Le Hau D. , Janek Kevin , Bütter Andreana , Davidson Jacob , Aldrink Jennifer H. , Richards Holden W. , Tracy Elisabeth T. , Commander Sarah J. , Fialkowski Elizabeth A. , Troutt Misty , Dasgupta Roshni , Lautz Timothy B. 
Published: November 2020

Objective:
To determine the impact of tumor characteristics and treatment approach on (1) local recurrence, (2) scoliosis development, and (3) patient-reported quality of life in children with sarcoma of the chest wall.

Summary of Background Data:
Children with chest wall sarcoma require multimodal therapy including chemotherapy, surgery, and/or radiation. Despite aggressive therapy which places them at risk for functional impairment and scoliosis, these patients are also at significant risk for local recurrence.

Methods:
A multi-institutional review of 175 children (median age 13 years) with chest wall sarcoma treated at seventeen Pediatric Surgical Oncology Research Collaborative institutions between 2008 and 2017 was performed. Patient-reported quality of life was assessed prospectively using PROMIS surveys.

Results:
The most common diagnoses were Ewing sarcoma (67%) and osteosarcoma (9%). Surgical resection was performed in 85% and radiation in 55%. A median of 2 ribs were resected (interquartile range = 1–3), and number of ribs resected did not correlate with margin status (P = 0.36). Local recurrence occurred in 23% and margin status was the only predictive factor
(HR 2.24, P = 0.039). With a median follow-up of 5 years, 13% developed scoliosis (median Cobb angle 26) and 5% required corrective spine surgery. Scoliosis was associated with posteriorrib resection (HR 8.43; P= 0.003) and increased number of ribs resected (HR 1.78; P = 0.02). Overall, patient-reported quality of life is not impaired after chest wall tumor resection.

Conclusions:
Local recurrence occurs in one-quarter of children with chest wall sarcoma and is independent of tumor type. Scoliosis occurs in 13% of patients, but patient-reported quality of life is excellent.