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Woodman SH, Govender R, Baker K, Glaister C, Rowe EA, Dunton J, Patterson JM. Primary mode of communication for people with total laryngectomy in the United Kingdom: a cross-sectional survey. J Laryngol Otol 2024:1-24. [PMID: 38602071 DOI: 10.1017/s0022215124000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Sarah H Woodman
- Department of Speech, Voice and Swallowing, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK, Newcastle upon Tyne
| | - Roganie Govender
- Consultant Clinical Academic SLT, University College London Hospital NHS Foundation Trust & Associate Professor, Head & Neck Academic Centre, Division of Surgery & Interventional Science, University College London, UK, London
| | - Kate Baker
- Department of Speech, Voice and Swallowing, The Royal Marsden NHS Foundation Trust, UK, London
| | - Carol Glaister
- Speech and Language Therapy Department, Sandwell and West Birmingham NHS Trust, UK, Birmingham
| | - Elizabeth A Rowe
- Speech and Language Therapy Department, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield
| | - Jane Dunton
- Speech and Language Therapy Department, Guy's and St Thomas' NHS Foundation Trust, London
| | - Joanne M Patterson
- School of Health Sciences, Liverpool Head and Neck Centre, University of Liverpool, Liverpool
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Bolnykh I, Patterson JM, Harding S, Watson LJ, Lu L, Hurley K, Thomas SJ, Sharp L. Cancer-related pain in head and neck cancer survivors: longitudinal findings from the Head and Neck 5000 clinical cohort. J Cancer Surviv 2024:10.1007/s11764-024-01554-x. [PMID: 38421499 DOI: 10.1007/s11764-024-01554-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Reports suggest pain is common in head and neck cancer (HNC). However, past studies are limited by small sample sizes and design and measurement heterogeneity. Using data from the Head and Neck 5000 longitudinal cohort, we investigated pain over a year post-diagnosis. We assessed: temporal trends; compared pain across HNC treatments, stages, sites and by HPV status; and identified subgroups of patients at increased risk of pain. METHODS Sociodemographic and clinical data and patient-reported pain (measured by EORTC QLQ-C30 and QLQ-H&N35) were collected at baseline (pre-treatment), 4- and 12- months. Using mixed effects multivariable regression, we investigated time trends and identified associations between (i) clinically-important general pain and (ii) HN-specific pain and clinical, socio-economic, and demographic variables. RESULTS 2,870 patients were included. At baseline, 40.9% had clinically-important general pain, rising to 47.6% at 4-months and declining to 35.5% at 12-months. HN-specific pain followed a similar pattern (mean score (sd): baseline 26.4 (25.10); 4-months. 28.9 (26.55); 12-months, 17.2 (19.83)). Across time, general and HN-specific pain levels were increased in: younger patients, smokers, and those with depression and comorbidities at baseline, and more advanced, oral cavity and HPV negative cancers. CONCLUSIONS There is high prevalence of general pain in people living with HNC. We identified subgroups more often reporting general and HN-specific pain towards whom interventions could be targeted. IMPLICATIONS FOR CANCER SURVIVORS Greater emphasis should be placed on identifying and treating pain in HNC. Systematic pain screening could help identify those who could benefit from an early pain management plan.
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Affiliation(s)
- Iakov Bolnykh
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle, UK
| | - Joanne M Patterson
- Liverpool Head and Neck Centre, School of Health Science, University of Liverpool, Liverpool, UK
| | - Sam Harding
- Speech and Language Therapy Research Unit, Southmead Hospital North Bristol NHS Hospital Trust, Bristol, UK
| | - Laura-Jayne Watson
- Speech & Language Therapy, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle, UK
- NHS Forth Valley, Stirling, Scotland, UK
| | - Katrina Hurley
- Head & Neck 5000 Study, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Steve J Thomas
- Head & Neck 5000 Study, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle, UK.
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Hepper EC, Wilson J, Drinnan M, Patterson JM. Psychosocial impacts of being nil-by-mouth as an adult: A scoping review. J Adv Nurs 2024. [PMID: 38414146 DOI: 10.1111/jan.16100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 02/29/2024]
Abstract
AIM To map existing evidence and identify gaps in the literature concerning psychosocial impacts of being nil by mouth (NBM) as an adult. DESIGN A scoping review of the literature was undertaken using JBI guidance. A protocol was registered on the Open Science Framework (osf.io/43g9y). Reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). METHODS A comprehensive search of six databases (CINAHL, Embase, MEDLINE, PsycINFO, SCOPUS and Web of Science) was performed for studies published up to February 2023, with no restriction to study type. A scope of the grey literature was also undertaken. Two authors independently assessed eligibility and extracted data. Descriptive statistical analysis and narrative synthesis were used, and patient and public involvement included in funding discussions. RESULTS A total of 23 papers were included in the review, consisting of 14 primary studies (7 qualitative and 7 quantitative) and 9 grey literature. Both global psychological distress and distress specific to being NBM (thirst, missing food and drink) were reported. Caregivers also experience distress from their family member being NBM. Furthermore, social impacts were reported for both patient and caregiver, primarily social isolation and subsequent low mood. CONCLUSION Furthermore, research is needed to understand the prevalence of this population, how best to measure psychosocial impacts and to explore whether (and how) psychosocial impacts change over time. Advancement in this area would enable better service development to optimize care for this patient group. WHAT IS KNOWN ABOUT THIS TOPIC?: Eating and drinking provides more than nutrition and hydration. A wide range of conditions can lead to recommendations for no longer eating and drinking (nil by mouth). Being nil by mouth (NBM) for short periods such as pre-operative fasting causes distress; however, little is understood about impact on longer-term abstinence from eating and drinking. WHAT THIS PAPER ADDS?: Psychosocial consequences of being nil by mouth (NBM)have been investigated by both quantitative and qualitative studies. Being NBM impacts both patients and caregivers in various psychosocial aspects, including distress and social isolation. Several gaps remain, however, regarding ways to measure psychosocial impact of being NBM.
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Affiliation(s)
- Elizabeth C Hepper
- School of Health Sciences, Liverpool University, Liverpool, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John Wilson
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michael Drinnan
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Faraday J, Abley C, Patterson JM, Exley C. An ethnography of mealtime care for people living with dementia in care homes. Dementia (London) 2024:14713012241234160. [PMID: 38380645 DOI: 10.1177/14713012241234160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Many people living with dementia have difficulties at mealtimes, which can result in serious complications for physical and mental health, leading to hospital admissions and even death. However, current training in mealtime care for staff working with this population has been found to be poorly reported, with variable effectiveness. It is essential that care home staff are able to provide good care at mealtimes. This study used ethnography to explore current practice in mealtime care for this population, identify good practice, and understand the factors influencing mealtime care. Approximately 28 h of mealtime observations were conducted in two UK care homes with diverse characteristics. Observations focused on interactions between care staff and residents living with dementia. Twenty-five semi-structured interviews were carried out with care home staff, family carers, and visiting health and social care professionals, to explore mealtime care from their perspectives. A constant comparative approach was taken, to probe emergent findings and explore topics in greater depth. Key thematic categories were identified, including: tensions in mealtime care; the symbolic nature of mealtime care; navigating tensions via a person-centred approach; contextual constraints on mealtime care; and teamwork in mealtime care. The findings indicated that a person-centred approach helps carers to find the right balance between apparently competing priorities, and teamwork is instrumental in overcoming contextual constraints. This evidence has contributed to development of a training intervention for care home staff. Future research should investigate the feasibility of mealtime care training in care homes.
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Affiliation(s)
- James Faraday
- Population Health Sciences Institute, Newcastle University, UK
- Adult Speech and Language Therapy, The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Clare Abley
- Population Health Sciences Institute, Newcastle University, UK
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Fahy E, Cantwell LA, Patterson JM, Cherry MG, Rogers S, Akpan A, Hamilton DW. Treatment priorities and regret in older adults with head and neck cancer: A systematic review. Clin Otolaryngol 2023; 48:809-819. [PMID: 37669764 DOI: 10.1111/coa.14094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The majority of head and neck cancer (HNC) diagnoses are seen in people aged 70 and older; these numbers are set to increase. Greater understanding of treatment needs of older patients with HNC is essential. These older patients often have co-existing health conditions, are prone to frailty and may not prioritise survival when considering treatment options. This systematic review examines the current research with regard to priorities and factors influencing treatment regret in older people with HNC. METHODS Studies were eligible for inclusion if they (i) reported data from patients with a mean age of 65 years or older who had a confirmed diagnosis of HNC and had been treated using surgery, chemotherapy and/or radiotherapy with either palliative or curative intent, (ii) considered patient's priorities or preferences or examined treatment regret as one of the primary outcomes of the study (iii) were published in English. RESULTS Pilot search identified n = 7222 articles; however, following screening, only four papers met the inclusion criteria. Narrative synthesis was indicated to analyse quantitative and qualitative evidence in parallel, as meta-analyses were not possible. DISCUSSION There is a paucity in the literature examining older adults with HNC. There is an indication that older adults prioritise maintaining independence when making treatment decisions and treatment regret is seen in those with high levels of depression with level of frailty also a contributing factor. Clinicians should consider patient's social circumstances, premorbid status and priorities in maintaining independence and managing symptoms when making treatment decisions in this cohort.
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Affiliation(s)
- Emer Fahy
- Speech and Language Therapy, The Clatterbridge Cancer Centre, Liverpool, UK
| | - Linda A Cantwell
- Department of Nutrition & Dietetics, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Joanne M Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre, University of Liverpool, Liverpool, UK
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Simon Rogers
- Department of Maxillofacial, Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Wirral, UK
| | - Asangaedem Akpan
- Liverpool University Hospitals NHS FT & Merseycare NHS FT, Liverpool, UK
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Sharp L, Watson LJ, Lu L, Harding S, Hurley K, Thomas SJ, Patterson JM. Cancer-Related Fatigue in Head and Neck Cancer Survivors: Longitudinal Findings from the Head and Neck 5000 Prospective Clinical Cohort. Cancers (Basel) 2023; 15:4864. [PMID: 37835558 PMCID: PMC10571913 DOI: 10.3390/cancers15194864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
Cancer-related fatigue (CRF) is a common side-effect of cancer and its treatments. For head and neck cancer (HNC), CRF may exacerbate the symptom burden and poor quality-of-life. Using data from the Head and Neck 5000 prospective clinical cohort, we investigated clinically important CRF over a year post-diagnosis, assessing temporal trends, CRF by HNC site and treatment received, and subgroups at higher risk of CRF. Recruitment was undertaken in 2011-2014. Socio-demographic and clinical data, and patient-reported CRF (EORTC QLQ-C30 fatigue subscale score ≥39 of a possible 100) were collected at baseline (pre-treatment) and 4- and 12- months post-baseline. Mixed-effects logistic multivariable regression was used to investigate time trends, compare cancer sites and treatment groups, and identify associations between clinical, socio-demographic and lifestyle variables and CRF. At baseline, 27.8% of 2847 patients scored in the range for clinically important CRF. This was 44.7% at 4 months and 29.6% at 12 months. In the multivariable model, after adjusting for time-point, the odds of having CRF over 12 months were significantly increased in females and current smokers; those with stage 3/4 disease, comorbidities and multimodal treatment; and those who had depression at baseline. The high prevalence of clinically important CRF indicates the need for additional interventions and supports for affected HNC patients. These findings also identified patient subgroups towards whom such interventions could be targeted.
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Affiliation(s)
- Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle NE1 7RU, UK;
| | - Laura-Jayne Watson
- Speech & Language Therapy, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, UK;
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle NE1 7RU, UK;
| | - Sam Harding
- Speech and Language Therapy Research Unit, Southmead Hospital North Bristol NHS Hospital Trust, Bristol BS10 5NB, UK;
| | - Katrina Hurley
- Head & Neck 5000 Study, Weston NHS Foundation Trust, University of Bristol, Bristol BS8 1TU, UK (S.J.T.)
| | - Steve J. Thomas
- Head & Neck 5000 Study, Weston NHS Foundation Trust, University of Bristol, Bristol BS8 1TU, UK (S.J.T.)
| | - Joanne M. Patterson
- Liverpool Head and Neck Centre, School of Health Science, University of Liverpool, Liverpool L69 3BG, UK;
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Trimble J, Patterson JM, Wilson JA, Dixit AK, Drinnan M. Screening for silent aspiration in hyperacute stroke: A feasibility study of clinical swallowing examination and cough reflex testing. Int J Lang Commun Disord 2023; 58:1657-1667. [PMID: 37158000 DOI: 10.1111/1460-6984.12893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/31/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Silent aspiration (SA) is common post-stroke and associated with increased risk of pneumonia, length of stay and healthcare costs. Clinical swallow examinations (CSEs) are unreliable measures of SA. There is no consensus on the clinical components that best detect SA. Cough reflex testing (CRT) is an alternative/adjunct whose SA detection accuracy also lacks consensus. AIMS To investigate the feasibility of CSE versus CRT against gold standard flexible endoscopic evaluation of swallowing (FEES) for SA identification and to estimate its prevalence in a hyperacute stroke setting. METHODS & PROCEDURES A single-arm preliminary, prospective, feasibility study of patients less than 72 h post-stroke, over a 31-day period on a hyperacute stroke unit: the Royal Victoria Infirmary, Newcastle-upon-Tyne, UK. Ethical approval for the study was obtained. The study tested the feasibility and acceptability of introducing CRT and developing a standardized CSE. Consent/assent was obtained for all participants. Patients unfit for study were excluded. OUTCOMES & RESULTS A total of 62% of patients less than 72 h post-stroke (n = 61) were eligible. A total of 75% of those approached (n = 30) consented. A total of 23 patients completed all tests. The principal barrier was anxiety regarding FEES. Mean test time for CRT = 6 min; CSE = 8 min; FEES = 17 min. Patients rated CRT and FEES on average as moderately uncomfortable. A total of 30% (n = 7) of participants who received FEES presented with SA. CONCLUSIONS & IMPLICATIONS CRT, CSE and FEES are feasible in 58% of hyperacute stroke patients in this setting. FEES anxiety is the main recruitment barrier and is not always well tolerated. Results support further work to establish optimum methods and differential sensitivity/specificity of CRT and CSE in hyperacute stroke for SA identification. WHAT THIS PAPER ADDS What is already known on this subject SA significantly increases the risk of pneumonia in the early days post-stroke. CSEs are unreliable for identification of SA risk in this population. CRT is gaining popularity as a potential tool to identify stroke patients at risk of SA, though there are questions regarding the efficacy of the clinical protocol currently being used in the UK. What this study adds to existing knowledge This study demonstrates that it is practical and feasible to carry out a larger scale study in this setting to compare CSE and CRT including a consideration of an approach combining both methods for clinical identification of SA versus FEES. Preliminary findings suggest that CSE may have higher levels of sensitivity than CRT for SA identification. What are the potential or actual clinical implications of this work? The results of this study suggest that further work is needed to establish the optimum methods and differential sensitivity/specificity of clinical tools for SA detection in hyperacute stroke.
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Affiliation(s)
- Julie Trimble
- Adult Speech and Language Therapy Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Joanne M Patterson
- Department of Speech and Language Therapy, School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre, University of Liverpool, Liverpool, UK
| | - Janet A Wilson
- Department of Otolaryngology, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anand K Dixit
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Drinnan
- Northern Medical Physics & Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Midgley AW, Levy AR, Rogers SN, Brooker RC, Bryant V, Cherry MG, Lane S, Nugent MM, Price R, Schache AG, Young B, Patterson JM. ACTivity as medicine In Oncology for Head and Neck (ACTIOHN): Protocol for a feasibility study investigating a patient-centred approach to exercise for people with head and neck cancer. PLoS One 2023; 18:e0289911. [PMID: 37624789 PMCID: PMC10456155 DOI: 10.1371/journal.pone.0289911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND AIM Attempts at personalisation of exercise programmes in head and neck cancer (HaNC) have been limited. The main aim of the present study is to investigate the feasibility and acceptability of introducing a remotely delivered, fully personalised, collaborative, and flexible approach to prescribing and delivering exercise programmes into the HaNC usual care pathway. METHODS This is a single arm, feasibility study. Seventy patients diagnosed with HaNC will be recruited from two regional HaNC centres in the United Kingdom. Patients will undertake an 8-week exercise programme designed and delivered by cancer exercise specialists. The exercise programme will start any time between the time of diagnosis and up to 8 weeks after completing treatment, depending on patient preference. The content of the exercise programme will be primarily based on patient needs, preferences, and goals, but guided by current physical activity guidelines for people with cancer. The primary outcome measure is retention to the study. Secondary quantitative outcomes are uptake to the exercise programme, different measures of exercise adherence, pre- and post-intervention assessments of fatigue (Multidimensional Fatigue Symptom Inventory-Short Form), quality of life (SF-36), physical activity levels (International Physical Activity Questionnaire-Short Form), and various components of physical fitness. The outcomes of the nested qualitative study are acceptability and feasibility of the intervention evaluated via interviews with patients, health care professionals, and the cancer exercise specialists. Intervention and participant fidelity will be determined using checklists and scrutiny of each patient's logbook and the cancer exercise specialists' meeting notes. Analysis of quantitative data will be via standard summary statistics. Qualitative data will be analysed using thematic analysis. EXPECTED RESULTS This feasibility study will inform the design and conduct of a future randomised controlled trial. Success will be defined according to a traffic light system for identifying the appropriateness of progression to a randomised controlled trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number registry (ISRCTN82505455).
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Affiliation(s)
- Adrian W. Midgley
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, United Kingdom
- Health Research Institute, Edge Hill University, Ormskirk, Lancashire, United Kingdom
| | - Andrew R. Levy
- Health Research Institute, Edge Hill University, Ormskirk, Lancashire, United Kingdom
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Simon N. Rogers
- Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Liverpool, United Kingdom
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, United Kingdom
| | - Rachel C. Brooker
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Valerie Bryant
- Cancer of Head and Neck Group Experience (CHANGE) Patient and Public Involvement Group, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Mary Gemma Cherry
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Steven Lane
- Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Michael M. Nugent
- Oral and Maxillofacial Surgery, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - Ruth Price
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew G. Schache
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Department of Molecular and Clinical Cancer Medicine, Liverpool Head and Neck Centre, University of Liverpool, Liverpool, United Kingdom
| | - Bridget Young
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Joanne M. Patterson
- Liverpool Head and Neck Centre, School of Health Science, University of Liverpool, Liverpool, United Kingdom
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Doughty HC, Hill RA, Riley A, Midgley AW, Patterson JM, Boddy LM, Rogers SN, Maden M, Williams NH. Barriers to and facilitators of physical activity in adults living with and beyond cancer, with special emphasis on head and neck cancer: a systematic review of qualitative and mixed methods studies. Support Care Cancer 2023; 31:471. [PMID: 37458858 PMCID: PMC10352410 DOI: 10.1007/s00520-023-07925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Physical activity can improve health outcomes for cancer patients; however, only 30% of patients are physically active. This review explored barriers to and facilitators of physical activity promotion and participation in patients living with and beyond cancer. Secondary aims were to (1) explore similarities and differences in barriers and facilitators experienced in head and neck cancer versus other cancers, and (2) identify how many studies considered the influence of socioeconomic characteristics on physical activity behaviour. METHODS CINAHL Plus, MEDLINE, PsycINFO, Scopus and Cochrane (CDSR) were searched for qualitative and mixed methods evidence. Quality assessment was conducted using the Mixed Methods Appraisal Tool and a Critical Appraisal Skills Programme Tool. Thematic synthesis and frequency of reporting were conducted, and results were structured using the Capability-Opportunity-Motivation-Behaviour model and Theoretical Domains Framework. RESULTS Thirty qualitative and six mixed methods studies were included. Socioeconomic characteristics were not frequently assessed across the included studies. Barriers included side effects and comorbidities (physical capability; skills) and lack of knowledge (psychological capability; knowledge). Having a dry mouth or throat and choking concerns were reported in head and neck cancer, but not across other cancers. Facilitators included improving education (psychological capability; knowledge) on the benefits and safety of physical activity. CONCLUSION Educating patients and healthcare professionals on the benefits and safety of physical activity may facilitate promotion, uptakeand adherence. Head and neck cancer patients experienced barriers not cited across other cancers, and research exploring physical activity promotion in this patient group is required to improve physical activity engagement.
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Affiliation(s)
- Hannah C. Doughty
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, L69 3GL UK
| | - Ruaraidh A. Hill
- Department of Health Data Science, University of Liverpool, L69 3GL Liverpool, UK
| | - Andrew Riley
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, L69 3GL UK
| | - Adrian W. Midgley
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, L39 4QP UK
| | - Joanne M. Patterson
- Liverpool Head and Neck Centre, University of Liverpool, L69 3GB Liverpool, UK
| | - Lynne M. Boddy
- The Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 2EX UK
| | - Simon N. Rogers
- Head and Neck Centre, Wirral University Teaching Hospital, Wirral, CH49 5PE UK
| | - Michelle Maden
- Department of Health Data Science, University of Liverpool, L69 3GL Liverpool, UK
| | - Nefyn H. Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, L69 3GL UK
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Lawton M, Crane J, Killen V, Patterson JM. Strategies for expanding patient and public involvement into under-served head and neck cancer communities. Curr Opin Otolaryngol Head Neck Surg 2023; 31:180-184. [PMID: 37144582 DOI: 10.1097/moo.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW In this review, we discuss two case studies in which we summarize the process of expanding patient and public involvement (PPI) representation specific to the head and neck cancer population, highlighting the challenges and successes within each project. The first case study reports on the expansion of HaNC PPI membership, a long-established PPI forum which supports Liverpool Head and Neck Centre research. The second case study describes the establishment of a novel palliative care network in head and neck cancer in the North of England, in which PPI was central to the project's success. RECENT FINDINGS Whilst recognizing diversity is important, it is imperative to acknowledge the contribution of existing members. Engagement with clinicians to reduce issues of gatekeeping is essential. A central theme is that the development of sustainable relationships is critical. SUMMARY The case studies highlight the challenge of identifying and accessing such a diverse population, particularly in the context of palliative care. Successful PPI is dependent on building and maintaining relationship with PPI members, ensuring flexibility in terms of timing, platforms and venues. Relationships formation should not be restricted to the academic-PPI representative dyad but should consider both clinical-academic and community partnerships to ensure those who are part of under-served communities are afforded the opportunities to become involved in research.
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Affiliation(s)
- Michelle Lawton
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre
| | - Julie Crane
- School of Health Sciences, University of Liverpool, Liverpool, UK
| | - Vince Killen
- Vice-Chair HaNC PPI Forum, University of Liverpool, Liverpool, UK
| | - J M Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre
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Fahy E, Brooker RC, Fleming JC, Patterson JM. A review of unplanned admissions in head and neck cancer patients undergoing oncological treatment. Support Care Cancer 2023; 31:328. [PMID: 37154829 PMCID: PMC10165288 DOI: 10.1007/s00520-023-07770-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
AIM Non-surgical treatment for head and neck cancer (HNC) often results in severe toxicities, which are detrimental to a patient's health and quality of life. There is limited published UK data on unplanned hospital admissions and reasons associated with admission. We aim to identify frequencies and reasons for unplanned hospital admissions, highlighting those patient groups who are most vulnerable. METHODS A retrospective study of unplanned hospital admissions of HNC patients receiving non-surgical treatment was completed. An inpatient admission was defined as ≥ 1 night spent in the hospital. To test potential demographic and treatment predictors of inpatient admission, a multiple regression model was constructed using the endpoint measure (unplanned admission), as the dependent variable. RESULTS A cohort of 216 patients was identified over a 7-month period, and 38 of these patients (17%) required an unplanned admission. Treatment type was the only statistically significant predictor of in-patient admission. The majority of admissions were patients receiving chemoradiotherapy (CRT) (58%) with predominant reasons for admission being nausea and vomiting (25.5%) and decreased oral intake/dehydration (30%). Of the patients admitted, 12 had a prophylactic PEG placed pre-treatment, and 18 of 26 admitted without prophylactic PEG required nasogastric tube feeding during their admission. DISCUSSION Almost one-fifth of HNC patients over this time period required hospital admission; the majority of which can be attributed to treatment toxicities when receiving CRT. This is concurrent with other studies which review the impact of radiotherapy versus CRT. Increased support and monitoring, particularly focused on nutrition, are required for patients with HNC who receive CRT. KEY MESSAGE This article describes a retrospective review of a patient undergoing non-surgical treatment for head and neck cancer. These patients frequently require unplanned hospital admission. The results indicate that patients undergoing (chemo)radiotherapy are most vulnerable to deterioration and additional support focused on nutrition for these patients is indicated.
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Affiliation(s)
- Emer Fahy
- Speech and Language Therapy, The Clatterbridge Cancer Centre NHS Foundation Trusts, 65 Pembroke Place, Liverpool, L7 8YA, UK.
| | - Rachel C Brooker
- The Clatterbridge Cancer Centre NHS Foundation Trusts, Liverpool, UK
| | - Jason C Fleming
- Liverpool Head & Neck Centre, Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Liverpool, L9 7AL, UK
| | - Joanne M Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre, University of Liverpool, Liverpool, UK
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Hepper EC, Patterson JM. Healthcare Professionals' Perceptions of Stabilized Edible Foam with Adults with Severe Dysphagia; an exploratory study: Use of stabilized edible foam with adults with dysphagia: Use of stabilized edible foam with adults with dysphagia. Int J Lang Commun Disord 2023; 58:226-240. [PMID: 36040239 DOI: 10.1111/1460-6984.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Improving the quality of life for individuals with severe dysphagia is a priority when considering new areas of dysphagia management, especially if this increases opportunities to participate in social activities associated with eating and drinking. Edible foam is widely researched and available in the food industry; however, the use of edible foam within the field of dysphagia remains unexplored. Despite no research published on effectiveness and safety, a commercial product currently on the market is widely distributed across both Europe and the UK, including 28 NHS Trusts, suggesting that it is increasingly being used in clinical practice. AIMS To explore the perceptions and experiences of healthcare professionals on the use of stabilized edible foam (SEF) with adults with severe dysphagia in order to inform areas for future research in this novel dysphagia intervention. METHODS & PROCEDURES Healthcare professionals were recruited using purposeful sampling and snowballing technique. A total of 56 healthcare professionals were initially approached, of which 10 completed the semi-structured interviews. Interview questions were developed from a topic guide and a pilot questionnaire. OUTCOMES & RESULTS Thematic analysis was used to identify three themes: potential impact, consideration of risk and perceived experiences. Overarching each of these themes was the element of the unknown. CONCLUSIONS & IMPLICATIONS Use of SEF with adults with dysphagia is in its infancy. Whilst results indicate that some clinicians are embracing this novel approach, others express concerns. Therefore, further research is needed, particularly in relation of direct experience of individuals and contra-indications. WHAT THIS PAPER ADDS What is already known on the subject The use of SEF with individuals with swallowing problems is a relatively novel area of dysphagia intervention in the UK. There are currently no published studies on its effectiveness and safety profile. What this paper adds to existing knowledge This study provides valuable preliminary work into the area of SEF and adults with severe dysphagia, capturing the experience and perceptions of healthcare professions who have an awareness of SEF. What are the potential or actual clinical implications of this work? Increasing clinicians and researcher's awareness of this novel area of dysphagia management.
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Affiliation(s)
- Elizabeth C Hepper
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Joanne M Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre University of Liverpool, Liverpool, UK
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13
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Midgley AW, Levy AR, Cunha FA, Key A, Patterson JM, Rogers SN. Safety and Feasibility of Cardiopulmonary Exercise Testing in Head and Neck Cancer Survivors. Clin Physiol Funct Imaging 2022; 43:170-180. [PMID: 36533848 DOI: 10.1111/cpf.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/06/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Assess safety and feasibility of the cardiopulmonary exercise test (CPET) for evaluating head and neck cancer (HaNC) survivors. Also compare their cardiorespiratory fitness to age and sex-matched norms and establish current physical activity levels. METHODS Fifty HaNC survivors [29 male; mean (SD) age, 62 (8) years], who had completed treatment up to 1 year previously, were recruited. Participants performed a CPET on a cycle ergometer to symptom-limited tolerance. Participants completed a questionnaire to report contributory factors they perceived as influencing test termination. Physical activity levels were determined using a self-reported physical activity questionnaire. RESULTS Three participants did not complete the CPET because (1) poor fitting mouthpiece and naso-oral mask due to facial disfiguration from surgery; (2) knee pain elicited by cycling; and (3) early CPET termination due to electrocardiogram artefacts. Participants reached a mean peak oxygen uptake that was 34% lower than predicted and the mean (SD) CPET duration of 7:52 (2:29) min:s was significantly lower than the target test duration of 10 min (p < 0.001). Leg muscle aches and/or breathing discomfort were major contributory factors influencing test termination for 78% of participants, compared to 13% for dry mouth/throat and/or drainage in the mouth/throat. No major adverse events occurred. Participants were categorised as 26% active, 8% moderately active, and 66% insufficiently active. CONCLUSION These preliminary data suggest the CPET appears safe and feasible for most HaNC survivors when strict exclusion criteria are applied; however, low levels of cardiorespiratory fitness should be considered when calculating an appropriate ramp rate.
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Affiliation(s)
- Adrian W. Midgley
- Department of Sport & Physical Activity and Cardiorespiratory Research CentreEdge Hill UniversityOrmskirkL39 4QPUK
| | - Andrew R. Levy
- Department of Psychology and Cardiorespiratory Research CentreEdge Hill UniversityOrmskirkL39 4QPUK
| | - Felipe A. Cunha
- Post‐Graduate Program in Exercise Science and Sports, University of Rio de Janeiro StateRio de JaneiroBrazil
| | - Angela Key
- Angela Key, Respiratory LaboratoryLiverpool University Hospitals NHS Foundation TrustLower LaneLiverpoolUK
| | - Joanne M. Patterson
- Joanne Patterson, PhD, Liverpool Head and Neck Centre, School of Health ScienceUniversity of LiverpoolLiverpoolUK
| | - Simon N. Rogers
- Faculty of Health, Social Care and MedicineEdge Hill University, Ormskirk, L39 4QP and Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation TrustLower LaneLiverpoolUK
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Alamer A, Jones R, Drinnan M, Simpson AJ, Griffin M, Patterson JM, Althuwaybi A, Ward C, Forrest IA. Oropharyngeal swallowing physiology and safety in patients with Idiopathic Pulmonary Fibrosis: a consecutive descriptive case series. BMC Pulm Med 2022; 22:422. [PMCID: PMC9670476 DOI: 10.1186/s12890-022-02232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Introduction
Dysphagia occurs in multiple respiratory pathophysiologies, increasing the risk of pulmonary complications secondary to aspiration. Reflux associated aspiration and a dysregulated lung microbiome is implicated in Idiopathic Pulmonary Fibrosis (IPF), but swallowing dysfunction has not been described. We aimed to explore oropharyngeal swallowing in IPF patients, without known swallowing dysfunction.
Methods
Fourteen consecutive outpatients with a secure diagnosis of IPF were recruited and the 10-item Eating Assessment Tool (Eat 10) used to assess patient perception of swallowing difficulty. Oropharyngeal swallowing was assessed in ten patients using Videofluoroscopy Swallow Studies (VFSS). The studies were rated using validated scales: Penetration-Aspiration Scale (PAS); standardised Modified Barium Swallow Impairment Profile (MBSImP).
Results
EAT-10 scores indicated frank swallowing difficulty in 4/14 patients. Videofluoroscopy Studies showed that 3/10 patients had airway penetration, and one aspirated liquid without a cough response. Median MBSImp for oral impairment was 5, range [3–7] and pharyngeal impairment 4, range [1–14] indicating, overall mild alteration to swallowing physiology.
Conclusion
We conclude that people with IPF can show a range of swallowing dysfunction, including aspiration into an unprotected airway. To our knowledge, this is the first report on swallowing physiology and safety in IPF. We believe a proportion of this group may be at risk of aspiration. Further work is indicated to fully explore swallowing in this vulnerable group.
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Menger F, Deane J, Patterson JM, Fisher P, O’Hara J, Sharp L. The nature and content of rumination for head and neck cancer survivors. Front Psychol 2022; 13:995187. [DOI: 10.3389/fpsyg.2022.995187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionHead and neck cancer (HNC) diagnosis and treatment can be a significant life trauma. Some HNC survivors experience post-traumatic growth (PTG), which has been linked with better health-related quality-of-life. Empirical research on PTG, and theoretical models, point to the importance of being able to purposely make sense of the traumatic experience. Intrusive rumination, by contrast, is linked to poorer outcomes. This study explored HNC survivors’ experiences of rumination.MethodsTwenty HNC survivors between 9 months and 5 years post-diagnosis were recruited (11 male, 9 female, age range 46–83). They had a range of HNC sub-types and cancer treatments. Participants underwent a semi-structured interview about their cancer diagnosis and treatment. Reflexive thematic analysis identified themes and sub-themes around rumination.ResultsFour themes with linked subthemes on the content and process of rumination were identified. Theme 1 was rumination and worry related to diagnosis. Here, survivors discussed how the HNC diagnosis and plans for treatment had dominated their initial thoughts. Theme 2 was processing the trauma of HNC. This theme reflected rumination on the traumatic experience of diagnosis and treatment and how the participant was reacting to it. Theme 3 was considering the impact. This theme encompassed retrospective thinking (e.g., on treatment decisions made) and comparisons between the participant now versus the early days after diagnosis. Theme 4 was continued rumination. This theme included ongoing intrusive and distressing rumination about the trauma and impact of cancer. Those who expressed ongoing rumination revisited fears (e.g., concerns about their future) or returned to negative experiences (e.g., distressing exchanges with healthcare professionals or what they perceived as poor care).ConclusionThis study uniquely describes the nature and content of rumination following HNC. Early intrusive rumination is common and may reflect perceptions of cancer as an existential threat. Over time, rumination can become more reflective and move towards deliberate meaning-making. Some HNC survivors may benefit from interventions to reduce barriers to this transition. The content of distressing and difficult to control rumination (commonly focused on ongoing fears or inability to resolve difficult experiences) helps to identify those who may benefit from more directed psychological support.
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Watson L, Woodman SH, Ganderton D, Hutcheson KA, Pringle S, Patterson JM. Development of the remote 100 ml water swallow test versus clinical assessment in patients with head and neck cancer: Do they agree? Head Neck 2022; 44:2769-2778. [DOI: 10.1002/hed.27194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 08/09/2022] [Accepted: 08/31/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Laura‐Jayne Watson
- Speech and Language Therapy, South Tyneside and Sunderland NHS Foundation Trust Sunderland Royal Hospital Sunderland UK
| | - Sarah H. Woodman
- South Tees Hospital NHS Foundation Trust James Cook University Hospital Middlesbrough UK
| | - Deborah Ganderton
- Speech and Language Therapy, Manchester Foundation Trust North Manchester General Hospital Manchester UK
| | - Kate A. Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology and Audiology The University of Texas M. D. Anderson Cancer Center Houston Texas USA
| | - Shirley Pringle
- Liverpool Head and Neck Centre Research Team Liverpool University Hospitals Liverpool UK
| | - Joanne M. Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre University of Liverpool Liverpool UK
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17
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Watson L, Hamilton D, Patterson JM. Patient experience of the acute post-surgical period following total laryngectomy during the COVID-19 era. Int J Lang Commun Disord 2022; 57:737-748. [PMID: 35403774 PMCID: PMC9111097 DOI: 10.1111/1460-6984.12709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Total laryngectomy (TL) results in permanent functional changes requiring rapid development of complex new skills. A significant portion of this learning happens in the acute post-surgical stage. There is increasing interest in enhanced recovery after surgery (ERAS) protocols in TL; however, implementation has been difficult. COVID-19 has placed significant pressures on acute services, requiring rapid service changes for TL patients. AIMS To understand the acute patient experience of having a TL both before and during COVID-19. METHODS & PROCEDURES Semi-structured interviews using a pre-designed topic guide were conducted with 10 people who had undergone a TL within the last 2 years. Participants were recruited by their speech and language therapists using purposive sampling. Braun and Clarke's iterative approach to data collection and thematic analysis was used to generate key themes from the data. OUTCOMES & RESULTS Thematic analysis identified four main themes: (1) pre-operative information-giving: 'it was just words'; (2) decision-making influences: 'I just wanted them to get it all out and get it over with'; (3) coping with adjustment to the new normal: 'this is part of me now'; and (4) the importance of relationship-building: 'when you've had something like this, you need some care and understanding'. CONCLUSIONS & IMPLICATIONS The need for an individualized approach to TL intervention which incorporates medical and psycho-social approaches from pre-treatment to acute discharge is vital. ERAS models should be reviewed to shift beyond the medical model alone. Rapid service changes due to COVID-19 did not contribute any major changes to the acute patient-reported experience. WHAT THIS PAPER ADDS What is already known on the subject We know that ERAS protocols have the potential to improve patient outcomes following TL. However, the research does not consider anything other than the early oral feeding debate and it has therefore been difficult to implement ERAS protocols in current service models. COVID19 required head and neck cancer services to make quick changes to surgical pathways, with the potential that some ERAS protocols had been adopted inadvertently. In order to understand the impact of this, we need to understand the patient experience following TL both before and during COVID19. What this paper adds to existing knowledge This paper used qualitative interviews to understand the acute patient experience following TL both during and before COVID19. Findings from these interviews highlighted that people were on the most part, well prepared for the functional changes they would experience after surgery. However, people felt there were gaps in service delivery at the pre-treatment and early discharge home period. Overall, the gaps identified were from a more psycho-social need suggesting that future ERAS models of care should consider both medical and psycho-social principles to enhance patient experience and outcome. What are the potential or actual clinical implications of this work? Pre-treatment services provided to people who have a TL could be reviewed to help maximize long-term adjustment to life. Areas which could be reviewed include the method and mode of information delivery. Further work needs to be done in partnership with community services to improve the immediate discharge home experience.
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Affiliation(s)
- Laura‐Jayne Watson
- Speech & Language TherapySouth Tyneside & Sunderland NHS Foundation TrustSunderland Royal HospitalSunderlandUK
| | - David Hamilton
- OtolaryngologyHead and Neck SurgeryFreeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Joanne M. Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck CentreUniversity of LiverpoolLiverpoolUK
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18
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Stephen SE, Murphy JM, Beyer FR, Sellstrom D, Paleri V, Patterson JM. Early postoperative functional outcomes following transoral surgery for oropharyngeal cancer: A systematic review. Head Neck 2021; 44:530-547. [PMID: 34882886 DOI: 10.1002/hed.26938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022] Open
Abstract
There has been increased interest in the use of transoral surgery (TOS) for the treatment of oropharyngeal cancer (OPC). This systematic review summarizes the available evidence for validated functional outcomes following TOS for OPC, within the early postoperative period. Key databases were searched. Primary TOS resections of human subjects were included. Validated functional outcomes extracted included instrumental assessment, clinician rated, and patient reported measures. Database searches yielded 7186 titles between 1990 and December 2020. Full-text articles were obtained for 296 eligible studies, which were screened and a resulting 14 studies, comprising 665 participants were included in the review. Oropharyngeal dysfunction following TOS was observed across all three categories of outcome measures (OMs) reported and was dependent on pretreatment function, T-classification, and tumor volume. Future investigations should include optimal OMs to be used in the postoperative setting to allow for conclusive comparisons.
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Affiliation(s)
- Sarah E Stephen
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jennifer M Murphy
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Diane Sellstrom
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Vinidh Paleri
- Head and Neck Unit, Royal Marsden Hospital, London, UK
| | - Joanne M Patterson
- School of Health Sciences, Liverpool Head and Neck Cancer Centre, University of Liverpool, Liverpool, UK
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19
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Neilson LJ, Sharp L, Patterson JM, von Wagner C, Hewitson P, McGregor LM, Rees CJ. The Newcastle ENDOPREM™: a validated patient reported experience measure for gastrointestinal endoscopy. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000653. [PMID: 34697041 PMCID: PMC8547355 DOI: 10.1136/bmjgast-2021-000653] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/05/2021] [Indexed: 12/27/2022] Open
Abstract
Objectives Measuring patient experience of gastrointestinal (GI) procedures is a key component of evaluation of quality of care. Current measures of patient experience within GI endoscopy are largely clinician derived and measured; however, these do not fully represent the experiences of patients themselves. It is important to measure the entirety of experience and not just experience directly during the procedure. We aimed to develop a patient-reported experience measure (PREM) for GI procedures. Design Phase 1: semi-structured interviews were conducted in patients who had recently undergone GI endoscopy or CT colonography (CTC) (included as a comparator). Thematic analysis identified the aspects of experience important to patients. Phase 2: a question bank was developed from phase 1 findings, and iteratively refined through rounds of cognitive interviews with patients who had undergone GI procedures, resulting in a pilot PREM. Phase 3: patients who had attended for GI endoscopy or CTC were invited to complete the PREM. Psychometric properties were investigated. Phase 4 involved item reduction and refinement. Results Phase 1: interviews with 35 patients identified six overarching themes: anxiety, expectations, information & communication, embarrassment & dignity, choice & control and comfort. Phase 2: cognitive interviews refined questionnaire items and response options. Phase 3: the PREM was distributed to 1650 patients with 799 completing (48%). Psychometric properties were found to be robust. Phase 4: final questionnaire refined including 54 questions assessing patient experience across five temporal procedural stages. Conclusion This manuscript gives an overview of the development and validation of the Newcastle ENDOPREM™, which assesses all aspects of the GI procedure experience from the patient perspective. It may be used to measure patient experience in clinical care and, in research, to compare patients’ experiences of different endoscopic interventions.
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Affiliation(s)
- Laura J Neilson
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK .,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Paul Hewitson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Colin J Rees
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
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20
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Patterson JM, Lu L, Watson LJ, Harding S, Ness AR, Thomas S, Waylen A, Pring M, Waterboer T, Sharp L. Associations between markers of social functioning and depression and quality of life in survivors of head and neck cancer: Findings from the Head and Neck Cancer 5000 study. Psychooncology 2021; 31:478-485. [PMID: 34591369 DOI: 10.1002/pon.5830] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate associations between markers of social functioning (trouble with social eating and social contact), depression and health-related quality of life (QOL) among head and neck cancer survivors. METHODS This cross-sectional analysis included individuals with oral cavity, oropharynx, larynx, salivary gland and thyroid cancers from Head and Neck 5000 alive at 12 months. Trouble with social eating and social contact were measured using items from EORTC QLQ-H&N35 and QOL using EORTC QLQ-C30; responses were converted into a score of 0-100, with a higher score equalling more trouble or better QOL. A HADS subscale score of ≥8 was considered significant depression. Associations between tertiles of trouble with social eating and social contact and depression and QoL were assessed using multivariable logistic and linear regression (with robust errors), respectively. RESULTS Of 2561 survivors, 23% reported significant depression. The median QOL score was 75.0 (interquartile range 58.3-83.3). For trouble with social eating, after confounder adjustment, those in the intermediate and highest tertiles had higher odds of depression (intermediate: OR = 4.5, 95% CI 3.19-6.45; high: OR = 21.8, 15.17-31.18) and lower QOL (intermediate:β = -8.7, 95% CI -10.35 to -7.14; high: β = -24.8, -26.91 to -22.77). Results were similar for trouble with social contact. CONCLUSION We found strong clinically important associations between markers of social functioning and depression and QOL. More effective interventions addressing social eating and contact are required. These may help survivors regain their independence, reduce levels of isolation and loneliness, and depression, and improve QOL outcomes generally.
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Affiliation(s)
- Joanne M Patterson
- Liverpool Head and Neck Centre, School of Health Science, University of Liverpool, Liverpool, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | - Sam Harding
- Bristol Speech and Language Therapy Research Unit, Southmead Hospital North Bristol NHS Hospital Trust, Bristol, UK
| | - Andy R Ness
- NIHR Bristol Biomedical Research Centre, University of Bristol and Weston NHS Foundation Trust and University of Bristol, UK and Bristol Dental School, University of Bristol, Bristol, UK.,Bristol Dental School, University of Bristol, Bristol, UK
| | - Steve Thomas
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Andrea Waylen
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Miranda Pring
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
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21
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Govender R, Behenna K, Brady G, Coffey M, Babb M, Patterson JM. Shielding, hospital admission and mortality among 1216 people with total laryngectomy in the UK during the COVID-19 pandemic: A cross-sectional survey from the first national lockdown. Int J Lang Commun Disord 2021; 56:1064-1073. [PMID: 34351676 PMCID: PMC8441848 DOI: 10.1111/1460-6984.12656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 05/15/2023]
Abstract
BACKGROUND People with a total laryngectomy (PTL) rely on a permanent opening in their neck (stoma) to breathe. This altered anatomy may increase susceptibility to contracting and transmitting SARS-CoV-2. AIMS To report on (1) the frequency and characteristics of PTL who tested positive for COVID-19, (2) the receipt of advice regarding shielding and patient self-reports of shielding, (3) hospital admissions and length of stay, and (4) mortality rates in this group during the first UK national lockdown. METHODS & PROCEDURES This is a cross-sectional survey and case note review. National Health Service (NHS) centres providing care to PTL were invited to participate via the Royal College of Speech and Language Therapists' (RCSLT) Head & Neck Clinical Excellence Networks and through social media. PTL were reviewed by their speech and language therapist either in person or via telehealth between 30 March and 30 September 2020. Data were collected within the time frame covered by the Control of Patient Information (COPI) notice issued for COVID-19 and included information on COVID-19 testing, shielding, hospital admissions, length of stay and deaths. Information was submitted to the lead NHS site using a custom designed data-capture worksheet. Analysis was performed using descriptive statistics, including proportions and frequency counts. Pearson's Chi squared tests were used to compare categorical data using a 5% significance level. OUTCOMES & RESULTS Data were obtained from 1216 PTL from 26 centres across the UK. A total of 81% were male; mean age was 70 years (28-97 years). Of the total group, 12% received a COVID-19 test. A total of 24 (2% of total sample) tested positive for COVID-19. Almost one-third of PTL (32%) received a government letter or were advised to shield by a healthcare professional. During the data collection time frame, 12% had a hospital admission (n = 151) with a median length of stay of 1 day (1-133 days), interquartile range (IQR) = 17 days. A total of 20 of these admissions (13%) had tested positive for COVID-19 with a median length of stay of 26 days, IQR = 49 days. The overall mortality was 4% (41 patients), with eight deaths occurring within 28 days of testing positive for COVID-19. CONCLUSIONS & IMPLICATIONS This study highlighted the lack of routine national data for neck-breathers with which to compare the current findings. Greater testing in the community is necessary to understand the prevalence of COVID-19 in PTL and if this group is indeed more susceptible. The potential for nasopharyngeal and tracheal aspirates to show differing results when testing for COVID-19 in neck-breathers requires further investigation. WHAT THIS PAPER ADDS What is already known on the subject? People with total laryngectomy (PTL) have an altered anatomy for breathing and speaking. The presence of a neck stoma poses an additional virus entry point aside from the nose, mouth and conjunctiva. This could increase the susceptibility to COVID-19 for PTL. What this paper adds? This is the first national audit to provide data on shielding, hospital admissions and mortality for patients with total laryngectomy in the UK over the pandemic. The overall mortality in PTL over the first lockdown did not appear to be higher than the "best case" estimates from previous years. However, one in three PTL who acquired COVID-19 and were admitted to hospital, died within 28 days of testing positive. These findings are relevant to the current care and management of PTL over the pandemic but also highlights important knowledge gaps. What are the potential or actual clinical implications of this work? This study highlights gaps in the collection of baseline information on hospital admissions, length of stay and mortality for people with laryngectomy in the UK, restricting comparisons between the current data and historical data. The need for further research on whether neck-breathers should be tested via both nasopharyngeal and tracheal aspirates is important not just currently, but also in case of any future respiratory epidemics.
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Affiliation(s)
- Roganie Govender
- University College London HospitalHead & Neck Academic CentreLondonUK
- Department of Applied Health ResearchInstitute of Epidemiology & HealthcareUniversity College LondonLondonUK
| | - Katherine Behenna
- ENT/HNC SLT DepartmentNottingham University Hospitals Healthcare TrustNottinghamUK
| | - Grainne Brady
- Department of SpeechVoice and Swallowing, The Royal Marsden NHS Foundation TrustLondonUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Margaret Coffey
- Department of Surgery and CancerImperial College LondonLondonUK
- Imperial College Healthcare Trust, SLT DepartmentCharing Cross HospitalLondonUK
| | - Malcolm Babb
- National Association of Laryngectomee ClubsLondonUK
| | - Joanne M. Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck CentreUniversity of LiverpoolLiverpoolUK
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Lin DJ, Altamimi J, Pearce K, Wilson JA, Patterson JM. Psychometric Properties of the MDADI-A Preliminary Study of Whether Less is Truly More? Dysphagia 2021; 37:323-332. [PMID: 33709289 PMCID: PMC8948102 DOI: 10.1007/s00455-021-10281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 02/27/2021] [Indexed: 11/28/2022]
Abstract
The MD Anderson Dysphagia Inventory (MDADI) is a 20-item dysphagia-specific QOL questionnaire with four subscales: global, emotional, functional, and physical. It is widely used in clinical practice and in research; however, its psychometric properties have been under-researched. We aim to evaluate the organisation of the MDADI subscales and identify any redundant items. The MDADI is a routinely collected outcome measure at two centres in northeast England. Questionnaires completed at three months following treatment were extracted from these existing databases. Factor analysis was carried out with the aim of reducing redundancy among the set of questionnaire items. Cases with missing values were excluded. A total of 196 complete patient questionnaires were used in factor analysis. A one-factor model accounted for around 50% of the total variance in item responses. The top five endorsed items (abbreviated by the questionnaire item keywords: Excluded, Irritate, Esteem, Social, and Why) in this one factor appeared in three (emotional, functional, and physical) of the four supposed MDADI subscales, i.e. global, emotional, functional, and physical. Our results suggest an overlap of three MDADI subscales across the top five endorsed items. The content of the top five questions all appear related to the psychosocial aspects of swallowing. This implies some redundancy of the items in the original subscales of the questionnaire. Using the most endorsed items, it appears feasible to abbreviate the 20-item MDADI questionnaire to a 5-item “MiniDADI” questionnaire, which is likely to have greater utility in routine clinical practice outside of research settings.
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Affiliation(s)
- Daniel J Lin
- Translational and Clinical Research Institute, Newcastle University, 3rd Floor, William Leech Building, Medical School, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
| | - Jenan Altamimi
- Faculty of Medical Sciences Graduate School, Newcastle University, Newcastle upon Tyne, UK
| | - Kim Pearce
- Faculty of Medical Sciences Graduate School, Newcastle University, Newcastle upon Tyne, UK
| | - Janet A Wilson
- Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.,Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
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Scott SI, Kathrine Ø Madsen A, Rubek N, Charabi BW, Wessel I, Fredslund Hadjú S, Jensen CV, Stephen S, Patterson JM, Friborg J, Hutcheson KA, Kehlet H, von Buchwald C. Long-term quality of life & functional outcomes after treatment of oropharyngeal cancer. Cancer Med 2020; 10:483-495. [PMID: 33277795 PMCID: PMC7877346 DOI: 10.1002/cam4.3599] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/27/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022] Open
Abstract
Functional and QoL outcomes were compared longitudinally in a cohort of patients treated for oropharyngeal squamous cell carcinoma (OPSCC) with primary transoral robotic surgery (TORS) or radiotherapy (RT). Forty‐four patients undergoing primary TORS (n = 31) or RT (n = 13) for any stage OPSCC were included. Only low‐stage disease was treated with TORS. Functional outcomes were: salivary flow rate, image‐based swallowing function, and a self‐reported 10‐point scale comparing current swallowing function to baseline (CvB scale). QoL was assessed with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ‐C30), Head & Neck Module (EORTC QLQ‐HN35), and MD Anderson Dysphagia Inventory (MDADI). Shoulder impairment was assessed with Neck Dissection Impairment Index (NDII) and Oxford Shoulder Score (OSS). In the RT group, salivary flow rates had significantly declined at 12‐month follow‐up, with the biggest declines in QoL subscale scores recorded in the RT group for dry mouth and sticky saliva. Swallowing function on imaging studies was overall good, with no severe dysphagia within 1 year although, both treatment groups showed significant deterioration relative to baseline at the 12‐month follow‐up with increased DIGEST scores and pharyngeal retention. Shoulder impairment was rare at 1 year in both groups. A comprehensive examination of this cohort treated for OPSCC showed overall good functional and QoL outcomes 1 year after treatment. However, persistent impairment was seen in both groups with regards to swallowing function. In the TORS group, at 12‐months follow‐up, the QoL questionnaires showed worse scores in only one subscale (sticky saliva).
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Affiliation(s)
- Susanne I Scott
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kathrine Ø Madsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niclas Rubek
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Birgitte W Charabi
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sara Fredslund Hadjú
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Cancer Late Effects Research Unit (CASTLE), Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Claus V Jensen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sarah Stephen
- Department of Speech, Voice and Swallow, ENT, Freeman Hospital, Newcastle upon Tyne, UK
| | - Joanne M Patterson
- School of Health Sciences / Head and Neck Cancer Centre, University of Liverpool, Liverpool, UK
| | - Jeppe Friborg
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kathrine A Hutcheson
- Department of Head and Neck Surgery, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henrik Kehlet
- Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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24
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Patterson JM, Govender R, Roe J, Clunie G, Murphy J, Brady G, Haines J, White A, Carding P. COVID-19 and ENT SLT services, workforce and research in the UK: A discussion paper. Int J Lang Commun Disord 2020; 55:806-817. [PMID: 32770652 PMCID: PMC7436215 DOI: 10.1111/1460-6984.12565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high-risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. AIMS To discuss the threats and opportunities from the COVID-19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. METHODS & PROCEDURES The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple-group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. MAIN CONTRIBUTION The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID-19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non-instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face-to-face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. CONCLUSIONS & IMPLICATIONS The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post-COVID era to re-evaluate current practice, embrace opportunities and evaluate new ways of working. What this paper adds What is already known on the subject ENT/laryngology SLTs manage patients with a range of conditions, including voice disorders, airway problems and HNCs. The diverse scope of clinical practice involves highly specialized assessment and treatment practices in patients in high-risk categories. A large majority of active research projects in this field are patient focused and involve instrumental assessment. The COVID-19 pandemic has created both opportunities and threats for ENT SLT clinical services, workforce and research. What this paper adds to existing knowledge This study provides a discussion of the threats and opportunities from the COVID-19 pandemic for ENT/laryngology SLT with specific reference to clinical practice, workforce and research leadership. What are the potential or actual clinical implications of this work? The COVID-19 pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. Changes to clinical practice, professional remits and research priorities are of indeterminant duration at this time, and some components could be permanent. Significant clinical practice, workforce and research opportunities may exist in the post-COVID era.
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Affiliation(s)
- Joanne M Patterson
- Liverpool Head and Neck Centre/School for Health SciencesUniversity of Liverpool, LiverpoolUK
| | - Roganie Govender
- Head and Neck Cancer Centre and Research Department of Behavioural Science & HealthUniversity College Hospitals LondonUniversity College LondonLondonUK
| | - Justin Roe
- National Centre for Airway ReconstructionDepartment of Otolaryngology, Head and Neck SurgeryImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial CollegeLondonUK
- Department of Speech, Voice and SwallowingThe Royal Marsden NHS Foundation TrustLondonUK
| | - Gemma Clunie
- National Centre for Airway ReconstructionDepartment of Otolaryngology, Head and Neck SurgeryImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial CollegeLondonUK
| | - Jennifer Murphy
- Department of Speech, Voice and Swallowing, ENT OutpatientsNewcastle Upon Tyne Hospitals NHS TrustNewcastle Upon TyneUK
| | - Grainne Brady
- Department of Speech, Voice and SwallowingThe Royal Marsden NHS Foundation TrustLondonUK
| | - Jemma Haines
- Wythenshawe HospitalManchester University NHS Foundation TrustUniversity of Manchester NIHR Manchester Biomedical Research Centre Northwest Lung CentreManchesterUK
| | - Anna White
- Department of Ear, Nose and Throat, Queens Medical CentreNottingham University Hospitals NHS TrustNottinghamUK
| | - Paul Carding
- Oxford Institute of Nursing, Midwifery and Allied Health ResearchFaculty of Health & Life Sciences Oxford Brookes UniversityOxfordUK
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25
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Affiliation(s)
- Joanne M. Patterson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Speech and Language Therapy, Sunderland Royal Hospital, United Kingdom
- School of Health Sciences, University of Liverpool, United Kingdom
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26
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Stelmes JJ, Gregoire V, Poorten VV, Golusiñski W, Szewczyk M, Jones T, Ansarin M, Broglie MA, Giger R, Klussmann JP, Evans M, Bourhis J, Leemans CR, Spriano G, Dietz A, Hunter K, Zimmermann F, Tinhofer I, Patterson JM, Quaglini S, Govaerts AS, Fortpied C, Simon C. Organ Preservation and Late Functional Outcome in Oropharyngeal Carcinoma: Rationale of EORTC 1420, the "Best of" Trial. Front Oncol 2019; 9:999. [PMID: 31696052 PMCID: PMC6817682 DOI: 10.3389/fonc.2019.00999] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/17/2019] [Indexed: 01/25/2023] Open
Abstract
Dysphagia represents one of the most serious adverse events after curative-intent treatments with a tremendous impact on quality of life in patients with head and neck cancers. Novel surgical and radiation therapy techniques have been developed to better preserve swallowing function, while not negatively influencing local control and/or overall survival. This review focuses on the current literature of swallowing outcomes after curative treatment strategies. Available results from recent studies relevant to this topic are presented, demonstrating the potential role of new treatment modalities for early- and intermediate-stage oropharyngeal cancers. Based on this, we present the rationale and design of the currently active EORTC 1420 "Best of" trial, and highlight the potential of this study to help prioritizing either surgery- or radiation-based treatment modalities for the treatment of oropharyngeal cancer in the future.
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Affiliation(s)
- Jean-Jacques Stelmes
- Department of Radiation Oncology, University Hospital Zurich (USZ), Zurich, Switzerland
| | - Vincent Gregoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | | | - Wojciech Golusiñski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznań, Poland
| | - Mateusz Szewczyk
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznań, Poland
| | - Terry Jones
- Liverpool Head and Neck Centre, University of Liverpool, Liverpool, United Kingdom
| | - Mohssen Ansarin
- Division of Otolaryngology Head and Neck Surgery, European Institute of Oncology, Milan, Italy
| | - Martina A Broglie
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Zurich (USZ), Zurich, Switzerland
| | - Roland Giger
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Bern University Hospital and University of Bern, Inselspital, Bern, Switzerland
| | - Jens Peter Klussmann
- Department of Otolaryngology-Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Mererid Evans
- Velindre University NHS Trust, Wales, United Kingdom
| | - Jean Bourhis
- Department of Radiation Oncology, CHUV, Lausanne, Switzerland
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centres, VU University, Amsterdam, Netherlands
| | - Giuseppe Spriano
- Department of Otolaryngology Head and Neck Surgery, Humanitas University Milan, Rozzano, Italy
| | - Andreas Dietz
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
| | - Keith Hunter
- Academic Unit of Oral Medicine, Pathology and Surgery, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Frank Zimmermann
- Department of Radiation Oncology, University of Basel, Basel, Switzerland
| | - Ingeborg Tinhofer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Radiooncology and Radiotherapy, Berlin, Germany
| | - Joanne M Patterson
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | | | | | - Christian Simon
- Service d'Oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne (UNIL), Lausanne, Switzerland
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27
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Patterson JM. Late Effects of Organ Preservation Treatment on Swallowing and Voice; Presentation, Assessment, and Screening. Front Oncol 2019; 9:401. [PMID: 31165044 PMCID: PMC6536573 DOI: 10.3389/fonc.2019.00401] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/29/2019] [Indexed: 11/23/2022] Open
Abstract
The prevalence of head and neck cancer (HNC) survivors is on the rise. Treatments for HNC can have a major deleterious impact on functions such as swallowing and voice. Poor functional outcomes are strongly correlated with distress, low quality of life, difficulties returning to work and socializing. Furthermore, dysphagia can have serious medical consequences such as malnutrition, dehydration, and pneumonia. A conservative estimate of the percentage of survivors living with dysphagia in the long-term is between 50 and 60%. Evidence is emerging that functions can worsen over time, sometimes several years following treatment due to radiation-associated fibrosis, neuropathy, intractable edema, and atrophy. Muscles lose their strength, pliability, stamina, and range, speed, precision, and initiation of movements necessary for swallowing and voice functions. Late treatment effects can go unrecognized, and may only be identified when there is a medical complication such as hospitalization for aspiration pneumonia. In the routine healthcare setting methods of evaluation include a detailed case history, a thorough clinical examination and instrumental assessments. Interventions for late treatment effects are limited and it is imperative that patients at risk are identified as early as possible. This paper considers the role of screening tests in monitoring swallowing and detecting aspiration in the long-term. Further work is indicated for addressing this pressing and increasingly common clinical problem.
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Affiliation(s)
- J M Patterson
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- Speech and Language Therapy Department, City Hospitals Sunderland Foundation Trust, Sunderland, United Kingdom
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Patterson JM, McColl E, Carding PN, Wilson JA. Swallowing beyond six years post (chemo)radiotherapy for head and neck cancer; a cohort study. Oral Oncol 2018; 83:53-58. [PMID: 30098779 DOI: 10.1016/j.oraloncology.2018.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/10/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The objective of this prospective study is to report on long-term swallowing outcomes in a group of head and neck cancer patients following (chemo) radiotherapy treatment, assess for changes over time and identify any predictor variables of outcome. MATERIALS AND METHODS 42 survivors were assessed on four swallowing measures and followed up from pre-treatment to six years post 3D (chemo) radiotherapy. Measures included a swallowing specific QOL questionnaire, penetration-aspiration scale, dietary restrictions and a timed water swallow test. RESULTS At six years, 71% reported swallowing difficulties on the questionnaire. One fifth of patients had aspiration, with a raised risk of chest infection. Seven percent required a laryngectomy for a dysfunctional larynx. Despite this, half the group reported having a normal diet. There was variation in the pattern of change between one and six years. A significant deterioration was only observed in the timed water swallow test (p < 0.0001). Larger radiotherapy volume predicted this outcome. None of the variables tested predicted outcome for the other three swallow measures. CONCLUSION Patients continue to report swallowing difficulties at six years, with a proportion having persistent aspiration. Further work on identifying the risk factors associated with aspiration tolerance, aspiration pneumonia, prevention and management is warranted. Long-term dysphagia remains a significant and serious concern following (chemo) radiotherapy for HNC and swallowing outcomes should continue to be monitored over time.
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Affiliation(s)
- J M Patterson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK; Speech & Language Therapy Dept., Sunderland Royal Hospital, Sunderland, UK.
| | - E McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - P N Carding
- School of Allied and Public Health, Australian Catholic University, Brisbane, Australia
| | - J A Wilson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Patterson JM, Fay M, Exley C, McColl E, Breckons M, Deary V. Feasibility and acceptability of combining cognitive behavioural therapy techniques with swallowing therapy in head and neck cancer dysphagia. BMC Cancer 2018. [PMID: 29291726 DOI: 10.1186/s12885‐017‐3892‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Head and neck cancer squamous cell carcinoma (HNSSC) patients report substantial rates of clinically significant depression and/or anxiety, with dysphagia being a predictor of distress and poorer quality of life. Evidence-based dysphagia interventions largely focus on the remediation of physical impairment. This feasibility study evaluates an intervention which simultaneously uses a psychological therapy approach combined with swallowing impairment rehabilitation. METHODS This prospective single cohort mixed-methods study, recruited HNSCC patients with dysphagia, from two institutions. The intervention combined Cognitive Behavioural Therapy with swallowing therapy (CB-EST), was individually tailored, for up to 10 sessions and delivered by a speech and language therapist. Primary acceptability and feasibility measures included recruitment and retention rates, data completion, intervention fidelity and the responsiveness of candidate outcome measures. Measures included a swallowing questionnaire (MDADI), EORTC-QLQH&N35, dietary restrictions scale, fatigue and function scales and the Hospital Anxiety and Depression Scale (HADS), administered pre-, post-CB-EST with three month follow-up and analysed using repeated measures ANOVA. Qualitative interviews were conducted to evaluate intervention processes. RESULTS A total of 30/43 (70%) eligible patients agreed to participate and 25 completed the intervention. 84% were male, mean age 59 yrs. Patients were between 1 and 60 months (median 4) post-cancer treatment. All patients had advanced stage disease, treated with surgery and radiotherapy (38%) or primary chemoradiotherapy (62%). Pre to post CB-EST data showed improvements in MDADI scores (p = 0.002), EORTC-QLQH&N35 (p = 0.006), dietary scale (p < 0.0001), fatigue (p = 0.002) but no change in function scales or HADS. Barriers to recruitment were the ability to attend regular appointments and patient suitability or openness to a psychological-based intervention. CONCLUSIONS CB-EST is a complex and novel intervention, addressing the emotional, behavioural and cognitive components of dysphagia alongside physical impairment. Preliminary results are promising. Further research is required to evaluate efficacy and effectiveness.
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Affiliation(s)
- J M Patterson
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK. .,Speech & Language Therapy Department, Sunderland Royal Hospital, Sunderland, UK.
| | | | - C Exley
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - E McColl
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - M Breckons
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - V Deary
- Psychology Department, Northumbria University, Newcastle upon Tyne, UK
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Petkar I, Rooney K, Roe JWG, Patterson JM, Bernstein D, Tyler JM, Emson MA, Morden JP, Mertens K, Miles E, Beasley M, Roques T, Bhide SA, Newbold KL, Harrington KJ, Hall E, Nutting CM. DARS: a phase III randomised multicentre study of dysphagia- optimised intensity- modulated radiotherapy (Do-IMRT) versus standard intensity- modulated radiotherapy (S-IMRT) in head and neck cancer. BMC Cancer 2016; 16:770. [PMID: 27716125 PMCID: PMC5052945 DOI: 10.1186/s12885-016-2813-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent dysphagia following primary chemoradiation (CRT) for head and neck cancers can have a devastating impact on patients' quality of life. Single arm studies have shown that the dosimetric sparing of critical swallowing structures such as the pharyngeal constrictor muscle and supraglottic larynx can translate to better functional outcomes. However, there are no current randomised studies to confirm the benefits of such swallow sparing strategies. The aim of Dysphagia/Aspiration at risk structures (DARS) trial is to determine whether reducing the dose to the pharyngeal constrictors with dysphagia-optimised intensity- modulated radiotherapy (Do-IMRT) will lead to an improvement in long- term swallowing function without having any detrimental impact on disease-specific survival outcomes. METHODS/DESIGN The DARS trial (CRUK/14/014) is a phase III multicentre randomised controlled trial (RCT) for patients undergoing primary (chemo) radiotherapy for T1-4, N0-3, M0 pharyngeal cancers. Patients will be randomised (1:1 ratio) to either standard IMRT (S-IMRT) or Do-IMRT. Radiotherapy doses will be the same in both groups; however in patients allocated to Do-IMRT, irradiation of the pharyngeal musculature will be reduced by delivering IMRT identifying the pharyngeal muscles as organs at risk. The primary endpoint of the trial is the difference in the mean MD Anderson Dysphagia Inventory (MDADI) composite score, a patient-reported outcome, measured at 12 months post radiotherapy. Secondary endpoints include prospective and longitudinal evaluation of swallow outcomes incorporating a range of subjective and objective assessments, quality of life measures, loco-regional control and overall survival. Patients and speech and language therapists (SLTs) will both be blinded to treatment allocation arm to minimise outcome-reporting bias. DISCUSSION DARS is the first RCT investigating the effect of swallow sparing strategies on improving long-term swallowing outcomes in pharyngeal cancers. An integral part of the study is the multidimensional approach to swallowing assessment, providing robust data for the standardisation of future swallow outcome measures. A translational sub- study, which may lead to the development of future predictive and prognostic biomarkers, is also planned. TRIAL REGISTRATION This study is registered with the International Standard Randomised Controlled Trial register, ISRCTN25458988 (04/01/2016).
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Affiliation(s)
- Imran Petkar
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
| | - Keith Rooney
- Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB UK
| | - Justin W. G. Roe
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
| | - Joanne M. Patterson
- Speech and Language Therapy Department, Sunderland City Hospitals NHS Foundation Trust, Kayll Road, Sunderland, SR4 7TP UK
- Institute of Health and Society, University of Newcastle, Newcastle upon Tyne, NE1 7RU UK
| | - David Bernstein
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
| | - Justine M. Tyler
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
| | - Marie A. Emson
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
| | - James P. Morden
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
| | - Kathrin Mertens
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
| | - Elizabeth Miles
- Mount Vernon Hospital, Rickmansworth Road, Northwood, HA6 2RN UK
| | - Matthew Beasley
- University Hospitals Bristol, Horfield Road, Bristol, BS2 8ED UK
| | - Tom Roques
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY UK
| | - Shreerang A. Bhide
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
| | - Kate L. Newbold
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
| | - Kevin J. Harrington
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
| | - Emma Hall
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
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Abstract
Objectives: Edema is a common side effect of radiotherapy for head and neck cancer. Systems have been developed to record and monitor changes that occur after radiotherapy. These lack the sensitivity to record edema in specific laryngopharyngeal structures. The aim of this study was to develop a rating scale to measure edema in the larynx and pharynx. Methods: This was an exploratory study to develop a new measure, with the help of an expert panel, assessing interrater and intrarater reliability. A consensus group developed the rating scale. Eleven structures and 2 spaces were identified as areas sensitive to the development of edema. The terms no, mild, moderate, and severe were used to describe the degrees of edema. The scale was piloted and then tested for interrater and intrarater reliability on 5 speech and language therapists. They viewed 25 nasendolaryngoscopic images (23 patients who had had radiotherapy and 2 healthy volunteers). The images were rated with the scale. This process was repeated 1 week later. Results: Images were taken from patients with oral, oropharyngeal, nasopharyngeal, or laryngeal cancer. All had had radiotherapy or chemoradiotherapy. All raters were experienced in viewing larynges via nasendolaryngoscopy. The interrater reliability for scoring the edema rating scale was moderate (weighted kappa, 0.54). Lower levels of agreement were found for the tongue base, valleculae, pharyngeal walls, and anterior commissure. The intrarater reliability was very good (weighted kappa, 0.84). Conclusions: The edema rating scale can be scored with very good test-retest reproducibility and moderate levels of agreement between clinicians. Modifications to the method are suggested to increase interrater reliability.
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Affiliation(s)
- Joanne M Patterson
- Department of Surgical and Reproductive Sciences, University of Newcastle, Newcastle Upon Tyne, United Kingdom
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Patterson JM, McColl E, Wilson J, Carding P, Rapley T. Head and neck cancer patients’ perceptions of swallowing following chemoradiotherapy. Support Care Cancer 2015; 23:3531-8. [DOI: 10.1007/s00520-015-2715-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
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Brockbank S, Miller N, Owen S, Patterson JM. Pretreatment information on dysphagia: exploring the views of head and neck cancer patients. J Pain Symptom Manage 2015; 49:89-97. [PMID: 24929028 DOI: 10.1016/j.jpainsymman.2014.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 04/08/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT Swallowing difficulties (dysphagia) are a common acute and chronic side effect of head and neck cancer (HNC) treatment. Dysphagia is associated with medical concerns such as malnutrition and pulmonary health as well as quality of life outcomes. Providing information on the likely changes to swallowing is an important component of pretreatment preparation. There is little research providing the patients' perspective in this area. OBJECTIVES This is a qualitative study to describe patients' views on pretreatment information regarding changes to eating, drinking, and swallowing after chemoradiotherapy treatment for HNC. METHODS A purposive sample of 24 patients with HNC with a range of post-treatment dysphagia severity, up to two years after chemoradiotherapy, was selected to participate in focus groups or semistructured interviews. Thematic analysis was conducted by two researchers, and results were verified with three participants. RESULTS Half of the participants presented with mild dysphagia, with the remainder having moderate to severe dysphagia. Mean age was 59 years, and mean time post-treatment was 10 months. Data were grouped into three main themes and subthemes: expectations about treatment outcomes and whether information correlated with pretreatment information; presentation of information, including the format and delivery; and the difficulties with absorption and retention of information. CONCLUSION Patients require information on the impact and prognosis for their swallowing ability. There was a general preference for verbal information, from someone knowledgeable about dysphagia. However, there are also individual preferences for the manner and pace at which this information is delivered. Further research is indicated to explore ways of providing information that is individually tailored to patients' needs and preferences.
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Affiliation(s)
- Sally Brockbank
- Department of Speech, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicholas Miller
- Department of Speech, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah Owen
- Speech & Language Therapy Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Joanne M Patterson
- Speech & Language Therapy Department, Sunderland Royal Hospital, Sunderland, United Kingdom.
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Patterson JM, McColl E, Carding PN, Hildreth AJ, Kelly C, Wilson JA. Swallowing in the first year after chemoradiotherapy for head and neck cancer: clinician- and patient-reported outcomes. Head Neck 2013; 36:352-8. [PMID: 23780908 DOI: 10.1002/hed.23306] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This prospective study evaluated swallowing outcomes prechemoradiotherapy (pre-CRT) up to 1 year post-CRT, in a substantial cohort of patients with head and neck cancer and explored factors predicting outcome. METHODS One hundred twelve patients were assessed pretreatment and at 3, 6, and 12 months posttreatment using a questionnaire, endoscopic assessment, water swallow test, and diet score. RESULTS Seventy-one patients were retained, the majority had oropharyngeal (53%) or hypopharyngeal cancer (20%). A marked deterioration occurred between pretreatment and 3 months posttreatment (p ≤ .01). Significant improvement between 3 and 12 months was found on 2 swallowing measures, but not self reported. Three of the 4 pretreatment assessments predicted outcomes at 1 year. CONCLUSION CRT results in a marked deterioration on different paradigms of swallowing measurements. Improvement occurs on some clinical measures, but limited change is observed in patients' perceptions. Pretreatment measures are important indicators of long-term dysphagia. Swallowing recovery is complex, taking different courses between clinical tests and perspectives.
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Affiliation(s)
- Joanne M Patterson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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Luebbe MK, Patterson JM, Jenkins KH, Buttrey EK, Davis TC, Clark BE, McCollum FT, Cole NA, MacDonald JC. Wet distillers grains plus solubles concentration in steam-flaked-corn-based diets: Effects on feedlot cattle performance, carcass characteristics, nutrient digestibility, and ruminal fermentation characteristics. J Anim Sci 2011; 90:1589-602. [PMID: 22147473 DOI: 10.2527/jas.2011-4567] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Two experiments were conducted to determine the effects of wet distillers grain plus solubles (WDG; <15% sorghum grain) concentration in steam-flaked corn (SFC) diets on feedlot performance, carcass characteristics, ruminal fermentation, and diet digestibility. In Exp. 1, six hundred crossbred steers (364 ± 35 kg of BW) were used in a randomized complete block design with 8 replications/treatment. Dietary treatments consisted of a dry-rolled corn (DRC) control diet without WDG, a SFC control without WDG, and SFC with 4 WDG concentrations (15, 30, 45, 60% DM basis) replacing SFC, cottonseed meal, urea, and yellow grease. Final BW, ADG, G:F, HCW, and 12th-rib fat depth were greater (P ≤ 0.05) for SFC compared with DRC. Dry matter intake tended (P = 0.06) to be greater for DRC compared with SFC. Final BW, ADG, G:F, HCW, 12th-rib fat depth, and marbling score decreased linearly (P < 0.01) with increasing WDG concentration. In Exp. 2, six ruminally and duodenally cannulated crossbred steers (481 ± 18 kg of BW) were used in a 6 × 6 Latin square design using the same diets as Exp. 1. Ruminal, postruminal, and total tract OM and NDF digestibility were not different (P > 0.14) for DRC compared with SFC. Ruminal and total tract starch digestibility were greater (P < 0.01) for SFC compared with DRC. Dry matter and OM intake were not different (P ≥ 0.43) among WDG treatments. Ruminal and total tract OM digestibility decreased linearly (P < 0.01) with increasing WDG concentration. Intake, ruminal digestibility, and total tract digestibility of NDF increased linearly (P < 0.01) with increasing WDG concentration. Starch intake decreased linearly (P < 0.01) with increasing WDG concentration. Ruminal starch digestibility increased (P = 0.01) with increasing concentration of WDG. Total tract starch digestibility decreased quadratically (P < 0.01) with increasing concentration of WDG. Feeding SFC improved steer performance compared with DRC. The concentration of WDG and corn processing method influences nutrient digestibility and ruminal fermentation. The addition of WDG in SFC-based diets appears to negatively affect animal performance by diluting the energy density of the diet.
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Affiliation(s)
- M K Luebbe
- Texas AgriLife Research, Amarillo 79106, USA
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Abstract
Objective. Assess patients’ perspectives on the severity, time course, and relative importance of swallowing deficit before and after (chemo)radiotherapy for head and neck cancer. Study Design. Before-and-after cohort study. Setting. Head and neck cancer UK multidisciplinary clinic. Subjects and Methods. A total of 167 patients with a primary cancer, mostly laryngopharyngeal, completed the MD Anderson Dysphagia Index (MDADI) and the University of Washington Quality of Life Questionnaire (UWQOL) before treatment and at 3, 6, and 12 months. Pretreatment swallowing, age, gender, and tumor site and stage were assessed. Statistical methods used were Mann-Whitney, analysis of variance, and logistic regression. Results. There was a sharp deterioration in swallowing on average by 18%, from before treatment to 3 months post treatment (mean difference in MDADI score = 14.5; P < .001). Treatment schedule, pretreatment score, and age accounted for 37% of the variance in 3-month posttreatment MDADI scores. There was then little improvement from 3 to 12 months. Patients treated with only 50-Gy radiotherapy reported significantly less dysphagia at 1 year than patients receiving higher doses or combined chemoradiation ( P < .001). Swallowing was the most commonly prioritized of the 12 UWQOL domains both before and after therapy. The MDADI and UWQOL scores were strongly correlated: ρ > 0.69. Conclusion. Swallowing is a top priority before and after treatment for the vast majority of patients with head and neck cancer. Swallowing deteriorates significantly posttreatment ( P < .001). Treatment intensity, younger age, and lower pretreatment scores predict long-term dysphagia. After chemoradiation, there is little improvement from 3 to 12 months.
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Affiliation(s)
- Janet A. Wilson
- Newcastle University and Freeman Hospital Newcastle upon Tyne, UK
| | - Paul N. Carding
- Newcastle University and Freeman Hospital Newcastle upon Tyne, UK
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Patterson JM, McColl E, Carding PN, Kelly C, Wilson JA. Swallowing performance in patients with head and neck cancer: a simple clinical test. Oral Oncol 2009; 45:904-7. [PMID: 19502104 DOI: 10.1016/j.oraloncology.2009.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 03/23/2009] [Accepted: 03/23/2009] [Indexed: 11/27/2022]
Abstract
Few simple clinical measures are available to monitor swallowing performance in head and neck cancer. Water swallow tests (WST) have been used as a part of clinical assessments in neurological dysphagia. The aim of this paper is to evaluate the utility of the 100 mL WST in head and neck cancer patients. The 100 mL WST was performed on 167 head and neck cancer patients. Measures were compared with respect to tumor site/stage, gender and age. The cohort was compared with published healthy controls. The test was quick to administer with excellent compliance. Patients had significantly poorer swallows than the published control group (mean reduction 1.6 mL/s). Function worsened with increased tumor stage and for patients with pharyngeal tumors. The 100 mL WST is an effective swallowing performance measure and is easily incorporated into a clinical examination. This paper provides benchmark data on the 100 mL WST for individuals with head and neck cancer.
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Affiliation(s)
- Joanne M Patterson
- Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne NE2 4AA, UK.
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Abstract
OBJECTIVES HIV voluntary counselling and testing (VCT) is important for prevention, detection and treatment of HIV infection. A study was conducted to determine the extent of utilization of VCT, and to study the attitudes and preferences of the community regarding VCT. METHODS A total of 301 adults, aged 18-49 years, residing in Nakuru, Kenya were randomly selected using a two-stage sampling process. A self-administered questionnaire delivered during home visits was used to collect data over a 4-week period. RESULTS The majority of study participants (184 of 287; 64.1%) had never been tested for HIV; 77 (26.8%) had received VCT, and 26 (9.1%) had received HIV testing without counselling. A total of 219 (78.2%) of the 280 responding participants expressed readiness to have VCT. The majority of participants (216 of 296; 73%) preferred VCT, while 46 (15.5%) preferred testing without counselling. The majority (227; 76.7%) preferred couple testing and dedicated clinics and private doctors' offices as testing facilities. The choice of a nearby facility was ranked above the provision of anonymity by most participants (162 of 298; 54.4%; vice versa for 136 of 298; 45.6%). CONCLUSIONS With HIV/AIDS continuing to be a major public health concern in Kenya, the issues surrounding acceptance and use of VCT need to be addressed. Enhancing community awareness of the benefits of early HIV diagnosis, providing couple-based VCT as an integral part of VCT and increasing access to VCT testing sites may enhance utilization of VCT.
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Affiliation(s)
- T K Irungu
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
Recently there has been considerable original research into the use of the botulinum neurotoxins in idiopathic detrusor overactivity (DO). This common condition underlies the overactive bladder syndrome in a significant proportion of cases and was previously known as idiopathic detrusor instability. Failure of initial pharmacotherapy in this condition leaves few effective conservative/medical treatment options. Early reports of botulinum toxin (BoNT) therapy have been extremely promising, and the therapy appears to bridge the gap in such patients, before resorting to invasive surgical procedures. Approximately 30 studies have been reported often with widely differing techniques and some clinicians are beginning to administer BoNT for this unlicensed indication. This has led to the urgent need to critically review all available evidence to assess efficacy, safety and technique. In addition to performing a systematic Medline review, all abstracts presented to urological, urogynaecological and incontinence meetings that reported BoNT usage in idiopathic DO were analysed. Remarkable efficacy has been demonstrated in the vast majority of reported series and the treatment has also been used safely in paediatric and elderly populations. Side effects in all populations appear to be minimal and short lived. However, all the series are small and there remains a considerable number of fundamental questions to be answered. Hopefully large-scale robust randomised controlled trials will provide the necessary answers to facilitate the widespread adoption of this technique. Until then caution must be exercised in this unlicensed indication.
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Affiliation(s)
- A K Patel
- Sheffield Teaching Hospitals NHS Trust, Urology Research Department, Royal Hallamshire Hospital, Sheffield, UK
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Patterson JM, McHenry EW, Crandall WA. The physiological properties of vitamin A: A specific effect upon body weight and body composition in the albino rat. Biochem J 2006; 36:792-4. [PMID: 16747509 PMCID: PMC1266871 DOI: 10.1042/bj0360792] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J M Patterson
- The School of Hygiene, University of Toronto and the Laboratory of Hygiene, Department of Pensions and National Health, Ottawa
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Patterson JM, Johnson MH, Zimonjic DB, Graubert TA. Characterization of Ly-6M, a novel member of the Ly-6 family of hematopoietic proteins. Blood 2000; 95:3125-32. [PMID: 10807778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
The Ly-6 family includes a number of highly homologous, low molecular weight glycophosphatidylinositol-linked proteins expressed on hematopoietic and lymphoid cells. The best characterized family member is Sca-1 (Ly-6A/E), an antigen commonly used for purification of murine pluripotent hematopoietic cells. We sought to characterize the genomic locus surrounding the Sca-1 gene. We identified several overlapping P1 artificial chromosomes containing the Sca-1 gene and mapped one of these to mouse chromosome 15D3.1-3.3, the region previously shown to contain members of the murine Ly-6 gene family. We then mapped this clone and found that the Sca-2 gene lies 35.4 kilobase (kb) downstream of Sca-1 in the opposite transcriptional orientation. This is the first direct demonstration of physical linkage of Ly-6 genes. A novel gene, highly homologous to Sca-1 was identified and localized 13.4 kb downstream of Sca-1. This gene, which we designated Ly-6M, shares several structural features conserved among members of the Ly-6 family. Ly-6M messenger RNA (mRNA) is easily detectable in hematopoietic tissue (bone marrow, spleen, thymus, peritoneal macrophages) as well as kidney and lung. No mRNA expression was detected in heart, stomach, liver, small intestine, brain, or skin. Ly-6M protein is detectable on 10% to 15% of peripheral blood leukocytes, including monocytes and a subpopulation of B220(+) cells. Ly-6M is broadly distributed in the bone marrow, with prominent expression on monocytes and myeloid precursors. The identification and characterization of Ly-6M adds a new member to a complex family of homologous, tightly linked genes that have proven extremely useful reagents for defining populations within the hematopoietic system.
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Affiliation(s)
- J M Patterson
- Division of Bone Marrow Transplantation and Stem Cell Biology, Washington University School of Medicine, St Louis, MO 63110, USA
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Abstract
The purpose of this study was to examine hand sensibility of surgeons wearing single and double latex gloves. Evaluation of hand sensibility, including cutaneous pressure thresholds, moving two-point discrimination, and static two-point discrimination, was performed on 25 surgeons (mean age 45 years). The dominant hand index finger was assessed with no glove, single glove, and double glove. The majority of surgeons had a moving and static two-point discrimination of 2 or 3 mm. The lowest cutaneous pressure thresholds were found when measured with no gloves and increased with single and double gloves. Statistically significant differences in cutaneous pressure thresholds using Semmes-Weinstein monofilaments were found for gloves versus no gloves (p < 0.0003) and single versus double gloves (p = 0.0003). Statistically significant differences in moving two-point discrimination were found for no gloves versus double gloves (p = 0.05) and single versus double gloves (p = 0.02). In conclusion, we found significant differences in hand sensation when measured with single and double gloves.
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Affiliation(s)
- C B Novak
- Division of Plastic and Reconstructive Surgery at the Washington University School of Medicine, St. Louis, MO, USA
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Abstract
OBJECTIVE To evaluate surgeons' concern regarding risk awareness and behavioral methods of protection against bloodborne pathogen transmission during surgery. METHODS A 29-item questionnaire was sent to 914 surgeons from two universities and two surgical societies. RESULTS The questionnaire was returned by 768 active surgeons. Slight or moderate concern about contracting human immunodeficiency virus (HIV) was reported by most surgeons; 8% reported extreme concern and 4% reported no concern. In total, 605 surgeons reported having been vaccinated against hepatitis B; surgeons in practice <7 years were most likely to be vaccinated. Most surgeons did not routinely use double gloves: 92 of 768 surgeons reported that they always use double gloves when performing surgery, and 83 reported that they usually use double gloves. There was a statistically significantly higher proportion of surgeons who always or usually use double gloves who also had hepatitis B vaccinations. Most surgeons incorrectly estimated the seroconversion rates with exposure to a patient with HIV (66% incorrect), hepatitis B (88% incorrect), or hepatitis C (84% incorrect). Most surgeons never or rarely report needle-stick injuries, and only 17% always report needle-stick injuries. CONCLUSIONS Most surgeons underestimate the risk of bloodborne pathogens and do not routinely use double gloves.
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Affiliation(s)
- J M Patterson
- Division of Plastic & Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Garwick AW, Patterson JM, Bennett FC, Blum RW. Parents' perceptions of helpful vs unhelpful types of support in managing the care of preadolescents with chronic conditions. Arch Pediatr Adolesc Med 1998; 152:665-71. [PMID: 9667538 DOI: 10.1001/archpedi.152.7.665] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To identify parents' perceptions of helpful vs unhelpful types of social support received in managing the care of preadolescents with chronic conditions. DESIGN Multimethod cohort study with 1-year follow-up. SETTING General community. PARTICIPANTS Volunteer, consecutive sample of parents of 124 preadolescents with a variety of chronic conditions. METHODS In-depth, in-home interviews conducted with parents. Quantitative data from the Social Support Assessment questionnaire was used to assess and compare sources and types of helpful support at baseline and 1 year later. Content analytic methods were used to categorize unsupportive behaviors described by parents during the first interview. RESULTS Both mothers and fathers reported that other family members were the primary source of helpful emotional and tangible support, while health care providers were the primary source of helpful informational support. The amount of perceived support from family members, community members, and service providers stayed relatively stable over time, except that fathers reported a significant increase in helpful emotional and informational support from extended family members from baseline to 1 year later. Also, 388 incidents of unsupportive behaviors were identified; the majority of these behaviors were attributed to health professionals and extended family members. CONCLUSION While patterns of perceived support remained relatively stable over a 1-year period, reports of unsupportive behaviors suggest gaps in service and problems that must be addressed to improve the care that children with chronic conditions and their families receive.
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Affiliation(s)
- A W Garwick
- Maternal and Child Health Program, University of Minnesota Schools of Public Health, Minneapolis, USA
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Abstract
We questioned parents of 182 young children with a variety of chronic health conditions concerning the amount of emotional, informational, and tangible social support they received from the family, community, and service providers. We also asked parents to describe nonsupportive or hurtful behaviors received from family or community members. Both mothers and fathers reported that family members provided the most emotional and tangible social support and service providers the most informational support. The amount of perceived support from all sources increased over time, but 78% of mothers and 60% of fathers reported at least one instance of nonsupport from these same sources, primarily from extended family members and health professionals. We encourage health professionals to show respect and to provide timely, accurate information in a sensitive manner to parents whose child has a chronic health condition and to assist parents in handling nonsupportive behaviors from family and friends.
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Affiliation(s)
- J M Patterson
- School of Public Health, University of Minnesota, Minneapolis 55455, USA
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Patterson JM, Zakon HH. Transdifferentiation of muscle to electric organ: regulation of muscle-specific proteins is independent of patterned nerve activity. Dev Biol 1997; 186:115-26. [PMID: 9188757 DOI: 10.1006/dbio.1997.8580] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Transdifferentiation is the conversion of one differentiated cell type into another. The electric organ of fishes transdifferentiates from muscle but little is known about how this occurs. To begin to address this question, we studied the expression of muscle- and electrocyte-specific proteins with immunohistochemistry during regeneration of the electric organ. In the early stages of regeneration, a blastema forms. Blastemal cells cluster, express desmin, fuse into myotubes, and then express alpha-actinin, tropomyosin, and myosin. Myotubes in the periphery of the blastema continue to differentiate as muscle; those in the center grow in size, probably by fusing with each other, and lose their sarcomeres as they become electrocytes. Tropomyosin is rapidly down-regulated while desmin, alpha-actinin, and myosin continue to be diffusely expressed in newly formed electrocytes despite the absence of organized sarcomeres. During this time an isoform of keratin that is a marker for mature electrocytes is expressed. One week later, the immunoreactivities of myosin disappears and alpha-actinin weakens, while that of desmin and keratin remain strong. Since nerve fibers grow into the blastema preceding the appearance of any differentiated cells, we tested whether the highly rhythmic nerve activity associated with electromotor input plays a role in transdifferentiation and found that electrocytes develop normally in the absence of electromotor neuron activity.
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Affiliation(s)
- J M Patterson
- Department of Zoology and Center for Developmental Biology, University of Texas at Austin, 78712, USA
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Abstract
The electric organ of electric fish develops from a myogenic lineage. We have used immunohistochemistry and immunoblotting to determine which features of the muscle phenotype are retained and whether any new ones are expressed in mature electrocytes of the electric fish Sternopygus. The muscle-specific intermediate filament desmin was found throughout the electrocytes, and different desmin antibodies detected molecules with different subcellular distributions. Western blots confirm that these antibodies recognize a protein of MW = 53 kD, the molecular weight of desmin. Other muscle proteins were also present within electrocytes: Actin and sarcomeric alpha-actinin were found within the subsynaptic membrane beneath the plasmalemma of the electrocytes, and talin and acetylcholine receptors were detected both at the innervated posterior face and at the non-innervated anterior face. This was confirmed using rhodamine-conjugated alpha-bungarotoxin. Neither myosin heavy chain nor tropomyosin was present in electrocytes. Finally, we detected within electrocytes a type I acidic keratin that forms a filamentous meshwork within each cell. Immunoblots corroborate this result: A keratin-positive doublet of MW = 50 kD and 57 kD was found in both electrocytes and skin. Myosin, actin, talin, tropomyosin, desmin, alpha-actinin, and acetylcholine receptor, but not keratin, were all expressed in fish skeletal muscle fibers. Thus, electrocytes retain some muscle-specific proteins, do not express others, and in addition, express a non-muscle protein.
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Affiliation(s)
- J M Patterson
- Department of Zoology, University of Texas, Austin 78712, USA
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Patterson JM. Hepatitis C virus: a need to research the risk. Todays OR Nurse 1995; 17:40-1. [PMID: 7597751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
All families experience many different life events, strains, and hassles over their life spans. Stress emerges in the family when demands exceed capabilities. When this imbalance persists and becomes larger, children and other family members often show signs and symptoms of distress, including health-related problems. Pediatricians are increasingly called on to evaluate this situation and to be helpful to stressed families and their children. A family assessment model is presented to aid pediatricians in helping families to identify the sources and degree of stress they are experiencing, and even more importantly, to facilitate their ability to discover and use their own strengths and resources. The goal for the pediatrician is to promote balance and resilience in families, which, in turn, will contribute to better health and functioning in children.
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Affiliation(s)
- J M Patterson
- Department of Maternal and Child Health, School of Public Health, University of Minnesota, Minneapolis
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