Perceived Value of Holistic Needs Assessment in Supporting the Needs of Women With Breast Cancer

BACKGROUND

Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly.

OBJECTIVE

The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.

METHODS

A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.

RESULTS

The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.

CONCLUSION

Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.

IMPLICATIONS FOR PRACTICE

Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.

Machine learning forecasting for COVID-19 pandemic-associated effects on paediatric respiratory infections

OBJECTIVE

The COVID-19 pandemic and subsequent government restrictions have had a major impact on healthcare services and disease transmission, particularly those associated with acute respiratory infection. This study examined non-identifiable routine electronic patient record data from a specialist children's hospital in England, UK, examining the effect of pandemic mitigation measures on seasonal respiratory infection rates compared with forecasts based on open-source, transferable machine learning models.

METHODS

We performed a retrospective longitudinal study of respiratory disorder diagnoses between January 2010 and February 2022. All diagnoses were extracted from routine healthcare activity data and diagnosis rates were calculated for several diagnosis groups. To study changes in diagnoses, seasonal forecast models were fit to prerestriction period data and extrapolated.

RESULTS

Based on 144 704 diagnoses from 31 002 patients, all but two diagnosis groups saw a marked reduction in diagnosis rates during restrictions. We observed 91%, 89%, 72% and 63% reductions in peak diagnoses of 'respiratory syncytial virus', 'influenza', 'acute nasopharyngitis' and 'acute bronchiolitis', respectively. The machine learning predictive model calculated that total diagnoses were reduced by up to 73% (z-score: -26) versus expected during restrictions and increased by up to 27% (z-score: 8) postrestrictions.

CONCLUSIONS

We demonstrate the association between COVID-19 related restrictions and significant reductions in paediatric seasonal respiratory infections. Moreover, while many infection rates have returned to expected levels postrestrictions, others remain supressed or followed atypical winter trends. This study further demonstrates the applicability and efficacy of routine electronic record data and cross-domain time-series forecasting to model, monitor, analyse and address clinically important issues.

Osteofibrous dysplasia of the tibia : the importance of deformity in surveillance

AIMS

Osteofibrous dysplasia (OFD) is a rare benign lesion predominantly affecting the tibia in children. Its potential link to adamantinoma has influenced management. This international case series reviews the presentation of OFD and management approaches to improve our understanding of OFD.

METHODS

A retrospective review at three paediatric tertiary centres identified 101 cases of tibial OFD in 99 patients. The clinical records, radiological images, and histology were analyzed.

RESULTS

Mean age at presentation was 13.5 years (SD 12.4), and mean follow-up was 5.65 years (SD 5.51). At latest review, 62 lesions (61.4%) were in skeletally mature patients. The most common site of the tibial lesion was the anterior (76 lesions, 75.2%) cortex (63 lesions, 62.4%) of the middle third (52 lesions, 51.5%). Pain, swelling, and fracture were common presentations. Overall, 41 lesions (40.6%) presented with radiological deformity (> 10°): apex anterior in 97.6%. A total of 41 lesions (40.6%) were treated conservatively. Anterior bowing < 10° at presentation was found to be related to successful conservative management of OFD (p = 0.013, multivariable logistic regression). Intralesional excision was performed in 43 lesions (42.6%) and a wide excision of the lesion in 19 (18.8%). A high complication rate and surgical burden was found in those that underwent a wide excision regardless of technique employed. There was progression/recurrence in nine lesions (8.9%) but statistical analysis found no predictive factors. No OFD lesion transformed to adamantinoma.

CONCLUSION

This study confirms OFD to be a benign bone condition with low rates of local progression and without malignant transformation. It is important to distinguish OFD from adamantinoma by a histological diagnosis. Focus should be on angular deformity, monitored with full-length tibial radiographs. Surgery is indicated in symptomatic patients and predicted by the severity of the initial angular deformity. Surgery should focus more on the deformity rather than the lesion. Cite this article: Bone Joint J 2022;104-B(2):302-308.

Impacts of the COVID-19 Pandemic and Self-Isolation on Students and Staff in Higher Education: A Qualitative Study

This qualitative study explored the impact of COVID-19 self-isolation and social restriction measures on university students, through the perspectives of both students and the staff supporting them. The study comprised 11 focus groups (students) and 26 individual interviews (staff) at a higher education institution in England during a period of national lockdown (January-March 2021). Participants were university students (n = 52) with self-isolation experiences and university staff (n = 26) with student-facing support roles. Focus group and interview data were combined and analysed using an inductive thematic approach. Four themes emerged: 'Adaptation during the pandemic', 'Practical, environmental, and emotional challenges of self-isolating', 'Social factors and their impact on COVID-19 testing and self-isolation adherence', and 'Supporting self-isolation'. Students and staff struggled with the imposed restrictions and shift to online education. Students found it difficult to adapt to new expectations for university life and reported missing out on professional and social experiences. Students and staff noted concerns about the impact of online teaching on educational outcomes. Students endorsed varied emotional responses to self-isolation; some felt unaffected whilst others experienced lowered mood and loneliness. Students were motivated by pro-social attitudes; campaigns targeting these factors may encourage continued engagement in protective behaviours. Staff struggled to manage their increased workloads delivering support for self-isolating students. Universities must consider the support needs of students during self-isolation and prepare for the long-term impacts of the pandemic on student wellbeing and educational attainment. Greater support should be provided for staff during transitional periods, with ongoing monitoring of workforce stress levels warranted.

Perceptions and Experiences of the University of Nottingham Pilot SARS-CoV-2 Asymptomatic Testing Service: A Mixed-Methods Study

We aimed to explore student and staff perceptions and experiences of a pilot SARS-CoV-2 asymptomatic testing service (P-ATS) in a UK university campus setting. This was a mixed-method study comprised of an online survey, and thematic analysis of qualitative data from interviews and focus groups conducted at the mid-point and end of the 12-week P-ATS programme. Ninety-nine students (84.8% female, 70% first year; 93.9% P-ATS participants) completed an online survey, 41 individuals attended interviews or focus groups, including 31 students (21 first year; 10 final year) and 10 staff. All types of testing and logistics were highly acceptable (virus: swab, saliva; antibody: finger prick) and 94.9% would participate again. Reported adherence to weekly virus testing was high (92.4% completed ≥6 tests; 70.8% submitted all 10 swabs; 89.2% completed ≥1 saliva sample) and 76.9% submitted ≥3 blood samples. Students tested to "keep campus safe", "contribute to national efforts to control COVID-19", and "protect others". In total, 31.3% had high anxiety as measured by the Generalized Anxiety Disorder scale (GAD-7) (27.1% of first year). Students with lower levels of anxiety and greater satisfaction with university communications around P-ATS were more likely to adhere to virus and antibody tests. Increased adherence to testing was associated with higher perceived risk of COVID-19 to self and others. Qualitative findings revealed 5 themes and 13 sub-themes: "emotional responses to COVID-19", "university life during COVID-19", "influences on testing participation", "testing physical and logistical factors" and "testing effects on mental wellbeing". Asymptomatic COVID-19 testing (SARS-CoV-2 virus/antibodies) is highly acceptable to students and staff in a university campus setting. Clear communications and strategies to reduce anxiety are likely to be important for testing uptake and adherence. Strategies are needed to facilitate social connections and mitigate the mental health impacts of COVID-19 and self-isolation.

Concerns, coping and the electronic Holistic Needs Assessment: experiences of UK breast cancer survivors

Background

Physical and psychological concerns associated with a breast cancer diagnosis continue long after treatment. Macmillan Cancer Support developed an electronic Holistic Needs Assessment (eHNA) to help identify these concerns and allow a healthcare professional to address these as part of The Recovery Package.

Aims

The study aim was to understand the women's experiences of having breast cancer, and of completing Macmillan's eHNA as part of their care.

Methods

A qualitative approach was adopted. Semi-structured interviews were undertaken with 15 women, 12-18 months following surgical treatment for invasive breast cancer. Thematic analysis identified key themes.

Results

Four main themes were identified in relation to experiences of the eHNA, experiences of breast cancer, coping with breast cancer and the psychological effects of surviving. Perceptions towards the eHNA varied; some women viewed the eHNA as a research tool for hospital use rather than a beneficial aspect of their care. Several participants felt unable to raise their psychological concerns on the eHNA.

Conclusions

Although experiences differ, psychological issues remain a key factor for women with breast cancer, lasting long after treatment. The eHNA is not currently used to its potential or recognised by women as a tool to support their care. Further research is needed into how the eHNA can be used effectively to capture psychological concerns and determine best approaches to implementation of the tool to support individualised care.

Ammonia Storage by Reversible Host-Guest Site Exchange in a Robust Metal-Organic Framework

MFM-300(Al) shows reversible uptake of NH3 (15.7 mmol g-1 at 273 K and 1.0 bar) over 50 cycles with an exceptional packing density of 0.62 g cm-3 at 293 K. In situ neutron powder diffraction and synchrotron FTIR micro-spectroscopy on ND3 @MFM-300(Al) confirms reversible H/D site exchange between the adsorbent and adsorbate, representing a new type of adsorption interaction.

Reversible adsorption of nitrogen dioxide within a robust porous metal-organic framework

Nitrogen dioxide (NO₂) is a major air pollutant causing significant environmental^1,2 and health problems^3,4. We report reversible adsorption of NO₂ in a robust metal-organic framework. Under ambient conditions, MFM-300(Al) exhibits a reversible NO₂ isotherm uptake of 14.1 mmol g^-1, and, more importantly, exceptional selective removal of low-concentration NO₂ (5,000 to <1 ppm) from gas mixtures. Complementary experiments reveal five types of supramolecular interaction that cooperatively bind both NO₂ and N₂O₄ molecules within MFM-300(Al). We find that the in situ equilibrium 2NO₂ ↔ N₂O₄ within the pores is pressure-independent, whereas ex situ this equilibrium is an exemplary pressure-dependent first-order process. The coexistence of helical monomer-dimer chains of NO₂ in MFM-300(Al) could provide a foundation for the fundamental understanding of the chemical properties of guest molecules within porous hosts. This work may pave the way for the development of future capture and conversion technologies.

Spontaneous reversal of the developmental aging of normal human cells following transcriptional reprogramming

AIM

To determine whether transcriptional reprogramming is capable of reversing the developmental aging of normal human somatic cells to an embryonic state.

MATERIALS & METHODS

An isogenic system was utilized to facilitate an accurate assessment of the reprogramming of telomere restriction fragment (TRF) length of aged differentiated cells to that of the human embryonic stem (hES) cell line from which they were originally derived. An hES-derived mortal clonal cell strain EN13 was reprogrammed by SOX2, OCT4 and KLF4. The six resulting induced pluripotent stem (iPS) cell lines were surveyed for telomere length, telomerase activity and telomere-related gene expression. In addition, we measured all these parameters in widely-used hES and iPS cell lines and compared the results to those obtained in the six new isogenic iPS cell lines.

RESULTS

We observed variable but relatively long TRF lengths in three widely studied hES cell lines (16.09-21.1 kb) but markedly shorter TRF lengths (6.4-12.6 kb) in five similarly widely studied iPS cell lines. Transcriptome analysis comparing these hES and iPS cell lines showed modest variation in a small subset of genes implicated in telomere length regulation. However, iPS cell lines consistently showed reduced levels of telomerase activity compared with hES cell lines. In order to verify these results in an isogenic background, we generated six iPS cell clones from the hES-derived cell line EN13. These iPS cell clones showed initial telomere lengths comparable to the parental EN13 cells, had telomerase activity, expressed embryonic stem cell markers and had a telomere-related transcriptome similar to hES cells. Subsequent culture of five out of six lines generally showed telomere shortening to lengths similar to that observed in the widely distributed iPS lines. However, the clone EH3, with relatively high levels of telomerase activity, progressively increased TRF length over 60 days of serial culture back to that of the parental hES cell line.

CONCLUSION

Prematurely aged (shortened) telomeres appears to be a common feature of iPS cells created by current pluripotency protocols. However, the spontaneous appearance of lines that express sufficient telomerase activity to extend telomere length may allow the reversal of developmental aging in human cells for use in regenerative medicine.

A comparison of the insertion characteristics of the laryngeal tube and the laryngeal mask airway: a study of the ED50 propofol requirements

The purpose of this prospective randomised double-blind study was to determine the effective dose of propofol required for the successful first attempt insertion of the laryngeal tube compared with the laryngeal mask airway in patients co-induced using alfentanil 5 microg.kg(-1), undergoing short elective gynaecological procedures. The first patient in each group received propofol 2.5 mg.kg(-1) for induction. In accordance with Dixon's up-and-down method, the dose of propofol for consecutive patients in each group was varied with increments or decrements of 0.5 mg.kg(-1) based on the previous patient 'all-or-none' purposeful movement response to first attempt of insertion of the randomised device. The ED50 (SD) of propofol was 2.66 (0.86) mg.kg(-1) and 2.33 (0.37) mg.kg(-1) for the laryngeal tube and laryngeal mask patients, respectively, which did not reach statistical significance (p = 0.40). We conclude therefore that the insertion of the two airway devices requires similar bolus doses of propofol when alfentanil is used as the co-induction drug.

Promoter variants in tissue inhibitor of metalloproteinase-3 (TIMP-3) protect against susceptibility in pigeon breeders' disease

BACKGROUND

Tissue inhibitors of metalloproteinases (TIMPs) play a major role in extracellular matrix turnover in the lung. However, in chronic lung disorders such as idiopathic pulmonary fibrosis (IPF) and pigeon breeders' disease (PBD), TIMPs may promote an adverse non-degradative environment. We hypothesised that polymorphisms in TIMP-3 could affect susceptibility to IPF and PBD.

METHODS

Two promoter variants, -915A>G and -1296T>C, were genotyped in 323 healthy subjects, 94 subjects with IPF, 115 with PBD, and 90 exposed to avian antigen but without PBD. The severity of fibrosis in lung tissue and the clinical outcome after 1 year was determined in the PBD group.

RESULTS

The variants did not influence susceptibility to IPF, but the rare alleles of both variants appeared to be protective against susceptibility to PBD (odds ratio (OR) for carriage of at least one rare allele from either variant 0.48, 95% CI 0.30 to 0.76, p = 0.002). Haplotype analysis of positions -915 and -1296 estimated four haplotypes: *A*T, *G*T, *A*C and *G*C, respectively. Their frequencies differed overall between subjects with PBD and healthy subjects (p = 0.0049) and this was attributable primarily to the *G*C haplotype (OR 0.53, 95% CI 0.36 to 0.77, p = 0.001). The severity of fibrosis correlated with poorer outcome in the PBD group (r = 0.73, p<0.01) but no relationship was seen between the *G*C haplotype and outcome or fibrosis. However, PBD subjects with the *G*C haplotype did have proportionally fewer lymphocytes in their bronchoalveolar fluid than those with the common *A*T haplotype (p = 0.029).

CONCLUSIONS

TIMP-3 variants appear to contribute to susceptibility to PBD. This may be through the inflammatory reaction rather than the fibrotic reaction.

Comparison of wounds created by non-bladed trocars and pyramidal tip trocars in the pig

Wounds made by the Endopath nonbladed obturator, the Step trocar, and conventional pyramidal tip trocars were compared. The endopath nonbladed obturator and the Step trocar made wounds by separating tissue fibers, whereas the pyramidal tip trocar cut tissue fibers. The wounds of the Endopath nonbladed obturator and the Step trocar were similar in length but were narrower than wounds made by the pyramidal tip trocar. Further studies are needed to determine whether the wounds made by the Endopath nonbladed obturator and the Step trocar will have fewer complications than conventional pyramidal tip trocars.

Papillon-Lefèvre syndrome: a case report

This case report discusses a very rare condition; Papillon-Lefèvre Syndrome. This is an autosomal recessive condition in which the main features are hyperkeratosis of the palms and the soles and severe periodontal destruction.

What determines post-traumatic stress disorder symptomatology for survivors of childhood sexual abuse?

OBJECTIVE

The aim of this paper was to ascertain which childhood abuse experiences are associated with post-traumatic stress disorder (PTSD) symptomatology for women survivors of childhood sexual abuse (CSA).

METHOD

Seventy-three women attending a Family Health Counselling Service's Sexual Abuse Program were invited to participate in a study looking at the effectiveness of sexual abuse counselling. Initially, the women completed a series of self-report questionnaires including a measure of PTSD symptoms, and were interviewed about childhood abuse experiences.

RESULTS

PTSD symptoms were associated with higher levels of all psychopathology. However, more interestingly, the severity of PTSD symptoms was also associated with the extent of CSA which involved actual sexual intercourse. This association of repeated abuse involving sexual intercourse with PTSD symptoms was still significant (partial coefficient = .30, p, .000) even when controlling for general level of psychopathology.

CONCLUSIONS

One of the long-term effects of child sexual abuse (CSA) is post-traumatic stress disorder (PTSD), and the women who reported multiple abusive episodes which involved sexual intercourse had increased symptoms of PTSD.

Evaluation of comprehensive violence prevention education: effects on student behavior

PURPOSE

This study evaluates the impact on student behavior of violence prevention education in school settings.

METHODS

School records were obtained for three panels (1985, 1986, and 1987) of urban public high school students (n = 1,523) who were nonrandomly assigned to three different conditions of school-based violence prevention education: (1) in a class-specific comprehensive educational intervention, (2) as part of a school-wide violence prevention initiative, and (3) no exposure. Changes in suspension status from sophomore to junior year were tracked within exposure groups and the risk of junior year suspension was compared across exposure groups, controlling for age, gender, race, absenteeism, and previous year suspension.

RESULTS

The class-specific exposure, compared to a not-exposed group from the same school showed a significant 71% reduction in suspension rates (RR = .286, CI .12, .66). The school-wide exposure school shows reductions in and maintenance of very low rates of junior year suspension in each cohort year, although these are not always statistically significantly different from not-exposed groups.

CONCLUSION

Results indicate that violence prevention education can reduce negative school behaviors, particularly when other supportive curricula and activities are added.

The VNA (visiting nurse association) and SCP (senior companion program) program: a natural partnership

Senior companions can be the eyes and ears of a visiting nurse association, with companions turning into friends and offering the nurturing and emotional support that VNAs may not have time to provide with the ever-increasing demand for home care.

A single i.v. dose of ondansetron 8 mg prior to induction of anaesthesia reduces postoperative nausea and vomiting in gynaecological patients

The effect of a single intravenous dose of ondansetron in preventing postoperative nausea and emesis (retching and vomiting) (PONV) was investigated in a randomized, double-blind, placebo-controlled, multicentre, international study. Women of ASA class I-III, requiring gynaecological laparotomy, vaginal hysterectomy, or major vaginal surgery were selected for study. Two hundred and thirty-five received placebo, 231 received 1 mg ondansetron, 228 received 8 mg ondansetron and 229 received 16 mg ondansetron, as an infusion over five minutes before the induction of anaesthesia. A standardized balanced anaesthetic technique was employed. This consisted of premedication with either diazepam or temazepam, thiopentone induction, maintenance with nitrous oxide in oxygen supplemented with enflurane or isoflurane, intraoperative analgesia with fentanyl, neuromuscular blockade with any choice of agent and reversal with neostigmine and atropine. Postoperative analgesia was achieved with morphine, and prochlorperazine or metoclopramide were given if a rescue antiemetic was required. A greater percentage of patients in the 8 mg and 16 mg ondansetron groups experienced no postoperative emesis (44% and 39% respectively) than in the placebo and 1 mg ondansetron groups (29% and 28% respectively) for the first 24 hr postoperative period (8 mg vs placebo and 1 mg: P < or = 0.001; 16 mg vs placebo: P < 0.05; 16 mg vs 1 mg: P < 0.05). Similarly, the percentage of patients who did not experience postoperative nausea were 20%, 26%, 31% and 28% for the placebo, 1 mg, 8 mg and 16 mg ondansetron treatment groups, respectively (8 mg and 16 mg vs placebo P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Seniors caring for seniors. Expanding eldercare services

The Visiting Nurse Associations of America is spearheading a national demonstration project to create partnerships between nonprofit, community-based visiting nurse associations and the Senior Companion Program in an attempt to expand the scope of person-to-person volunteer programs and long-term care services.

Effects of a chiropractic adjustment on changes in pupillary diameter: a model for evaluating somatovisceral response

The relationship between a cervical chiropractic adjustment, in subluxated vs. unsubluxated subjects, and autonomic response monitored as change in pupillary diameter was evaluated in 15 subjects. The results indicate that: a) a successful adjustment elicits either a parasympathetic or sympathetic response; b) the vertebral level at which the adjustment is administered has undetectable specificity for the parasympathetic or sympathetic input to the pupil; c) unsubluxated subjects generally exhibit no change in pupillary diameter following a sham adjustment and d) subluxated subjects exhibit variable preadjustment pupillary diameters, with significant pupillary diameter changes in response to an adjustment. These data suggest that autonomic input to the pupil may be influenced by subluxation, as well as the magnitude and direction of force exerted during the chiropractic adjustment. An anatomical pathway through which the observed responses may occur is proposed.