Fear of Progression in chronic illnesses other than cancer: A systematic review and meta-analysis of a transdiagnostic construct

Fear of cancer recurrence (FCR) is the most common psychosocial issue amongst cancer survivors. However, fear of progression (FoP) has been studied outside of the cancer context. This review aimed to: (1) meta-synthesize qualitative studies of FoP in illnesses other than cancer; and (2) quantify the relationship between FoP and anxiety, depression, and quality of life (QoL) in non-cancer chronic illnesses. We identified 25 qualitative and 11 quantitative studies in a range of chronic illnesses. Participants described fears of progression and recurrence of their illness, including fears of dying, and fears of becoming a burden to family. Fears were often triggered by downward comparison (i.e. seeing people worse off than themselves). Participants coped in different ways, including by accepting the illness or seeking knowledge. Those for whom these fears caused distress reported hypervigilance to physical symptoms and avoidance. Distress, and seeking information, were associated with adherence. In quantitative analyses, FoP was moderately associated with QoL, and strongly associated with anxiety and depression. These results suggest that FoP in illnesses other than cancer is similar to FCR. FoP appears to be an important transdiagnostic construct associated with distress. Evidence-based FCR interventions could be adapted to better manage FoP in other illnesses.

Knowledge and Beliefs Associated with Environmental Health Literacy: A Case Study Focused on Toxic Metals Contamination of Well Water

Environmental health literacy (EHL) is developing as a framework that can inform educational interventions designed to facilitate individual and collective action to protect health, yet EHL measurement poses several challenges. While some studies have measured environmental health knowledge resulting from interventions, few have incorporated skills and self-efficacy. In this study, a process-focused EHL instrument was developed, using the Newest Vital Sign (NVS) health literacy instrument as a model and tailoring it for the context of private well contamination with toxic metals. Forty-seven (47) participants, including undergraduate students and residents of communities with contaminated well water, piloted a prototype EHL instrument alongside NVS. Results suggested a moderate degree of correlation between NVS and the EHL prototype, and significant differences in scores were observed between students and residents. Responses to a self-efficacy survey, tailored for drinking water contaminated with arsenic, revealed significant differences between students and residents on items related to cost and distance. In response to open-ended questions, participants identified a range of potential environmental contaminants in drinking water and deemed varied information sources as reliable. This study highlights differences in knowledge and self-efficacy among students and residents and raises questions about the adequacy of EHL assessments that mimic formal education approaches.

Image distribution in a multi-facility radiology practice

The Cleveland Clinic Health System is a multifacility practice that distributes images electronically. Issues specific to the internal department at the main campus must be addressed with regard to the overall commitment to the healthcare system. Training for new and old employees on diagnostic and transcription equipment is a key issue. Interfacing different systems or different configurations of a system, either hospital or radiology information systems, is many times difficult and sometimes insurmountable. Issues of confidentiality have been addressed. In light of the impending new regulations from the Health Insurance Portability and Accountability Act, are the current system security practices enough?

Testing the taxonomic integrity of Paranthropus boisei sensu stricto

The craniodental hypodigm of Paranthropus boisei sensu stricto is morphologically distinctive, but it has been suggested that the substantial variation in mandibular and dental size in that hypodigm may exceed that which is reasonable to subsume within a single hominin species. In this study, Fligner and Killeen, coefficient of variation (CV)-based and average taxonomic distance (ATD)-based bootstrap tests, were used to compare variation in size and shape of the mandibular corpus remains attributed to P. boisei s.s. with the variation observed in samples of great apes and modern humans. The degree of size variation in the P. boisei s.s. mandibular hypodigm is never observed in human and chimpanzee samples, is rare in gorillas, but is not uncommon in orangutans. However, the shape variation in the fossil group is comparable to the variation in the extant reference groups. Although the size variation in P. boisei s.s. is substantial, it is exaggerated by the effects of taphonomy. The small mandibles are more often abraded, whereas the large mandibles are more likely to have been infiltrated with matrix. On the basis of the results of this investigation of the mandibular corpus, there are no grounds for rejecting the "single-species" hypothesis for P. boisei s.s. When Sokal and Braumann's adjusted CV values were used to predict the index of sexual dimorphism (ISD) for the P. boisei s.s., despite the substantial geological time embraced by the mandibular corpus hypodigm, the predicted value of lnISD, when corrected for taphonomic factors, is comparable to the sexual dimorphism observed within Gorilla.

Unusual facet cyst containing struvite and hydroxyapatite

This case report describes a patient with severe back pain and radiculopathy. She was found to have a facet cyst within the lumbar spine that appeared to contain calcium on MRI and CT. Upon aspiration the cyst was found to contain calcium ammonium phosphate (struvite) and calcium phosphate (hydroxyapatite). Ammonia production in the presence of urease-producing bacteria is responsible for the production of struvite in the human body. We postulate that there was a prior infection of the facet with urease-producing bacteria, thus accounting for the production of the struvite within the facet cyst.

Practice variation in the diagnosis and treatment of osteoporosis: a case for more effective physician education in primary care

Bone mineral density (BMD) performed by dual energy x-ray absorptiometry (DEXA) has been used at our institution as a screening test for osteoporosis since 1986. Of 2789 bone densitometry tests done between 1992 and 1996 on women aged 51-75 years, 1743 (62.5%) were ordered by general internists (GIM), endocrinologists (ENDO), rheumatologists (RHEUM), and a metabolic bone disease specialist (MBDS). We compared the percentage of densitometry tests ordered by GIM, ENDO, RHEUM, and MBDS resulting in one of three possible diagnoses (normal, osteopenia, or osteoporosis). Applying the World Health Organization's (WHO) definition of normal (< 1 standard deviation [SD] below the mean for young, adult women), osteopenia (> or = 1 SD-< 2.5 SD below the mean), and osteoporosis (> or = 2.5 SD below the mean), we found that 34% of patients tested between 1992 and 1996 were osteoporotic, 42% were osteopenic, and 24% had normal bone density results. The rate of osteoporosis diagnosis was highest in the MBDS cohort (chi 2 = 9.19, p = 0.002) compared with patients in the other cohorts. To explore trends in management of this condition, a random sample of osteoporotic women aged 51-75 who had densitometry in 1996 (n = 82) was obtained. Review of medical records revealed that 73% were on some form of osteoporosis treatment (bisphosphonate, estrogen, or calcitonin, with or without calcium and vitamin D supplementation). Treatment rates differed significantly, however, by the ordering physician specialty (96% for MBDS, 63% for ENDO, 75% for RHEUM, and 53% for GIM, chi (2)3df = 11.37, p = 0.01). There were no significant differences in selected clinical or demographic characteristics between patients treated by GIM and MBDS. This variation in treatment rates suggests that an opportunity to enhance primary care physicians' recognition and treatment of osteoporosis exists. Making osteoporosis management an educational focus may help narrow differences in practice and improve the effectiveness of a larger number of physicians treating patients with this problem.

Integrated diagnostic workstation

As the current radiology practice continues to grow and the community practice becomes more dispersed, completed examinations will be routed elsewhere for reading. This newer model eliminates the work card, uses a worklist to organize activities at the reading station, and provides global access to any previous images and reports. Having all pertinent examination and image information located in one system within the Radiology Department will provide date for better management of resources, including radiologists.

Implementation of an electronic teaching file using web technology

The implementation of an electronic teaching file using web technology is discussed in this article. A web client server model is used for a standard web browser capable of displaying joint photographic Experts Group (JPEG) compression images. Like other web-based teaching files, this teaching file in a similar way uses a database containing information. This database section of the teaching file allows flexible database querying and viewing of pages generated by hypertext markup language (HTML). Because the browser client is so flexible, images types such as video and 3D representations with virtual reality markup language (VRML) can be displayed.

How well can we estimate the information carried in neuronal responses from limited samples?

It is difficult to extract the information carried by neuronal responses about a set of stimuli because limited data samples result in biased estimates. Recently two improved procedures have been developed to calculate information from experimental results: a binning-and-correcting procedure and a neural network procedure. We have used data produced from a model of the spatiotemporal receptive fields of parvocellular and magnocellular lateral geniculate neurons to study the performance of these methods as a function of the number of trials used. Both procedures yield accurate results for one-dimensional neuronal codes. They can also be used to produce a reasonable estimate of the extra information in a three-dimensional code, in this instance, within 0.05-0.1 bit of the asymptotically calculated value--about 10% of the total transmitted information. We believe that this performance is much more accurate than previous procedures.

Activated microglia are the principal glial source of thromboxane in the central nervous system

Thromboxane A2(TxA2) is a potent vasoconstrictor associated with cerebrovascular disease and is thought to be synthesized within tissues of the brain. In order to determine the cellular sources of TxA2 in the central nervous system (CNS), we measured the release of the stable metabolite TxB2 in cultures of mixed or highly enriched populations of brain glia. Using techniques which isolated large numbers of highly enriched microglia and astroglia, we found that only microglia release TxB2. Moreover, microglia, not astroglia, contain the requisite synthetic enzyme thromboxane synthase. Phagocytic signals and lipopolysaccharide are potent stimulants of microglial release of thromboxane, with lesser effects shown by platelet activating factor and substance P. We conclude that microglia, when activated, are the principal source of brain-derived thromboxane and may help to control vascular flow at sites of acute CNS injury.

The effects of gender and type of diabetes on HDL-cholesterol

OBJECTIVE

To investigate the influence of gender and type of Diabetes on plasma lipoproteins and post-heparin plasma lipoprotein lipase and hepatic lipase activities.

DESIGN AND PATIENTS

Cross sectional study of 22 lean Type 2 diabetic subjects (11 men, 11 women) individually matched for gender, BMI and HbA1 with 22 Type 1 (C-peptide negative) diabetic subjects.

MEASUREMENTS

Samples were taken for fasting lipids and post heparin samples were obtained for estimation of post heparin lipolytic activity.

RESULTS

In men, HDL-Cholesterol was higher in Type 1 diabetes [1.56 (range 0.97-2.27) vs 1.07 (0.54-1.78) mmol/l, p = 0.009] and this was reflected in both HDL2-cholesterol [0.42 (0.02-1.36) vs 0.22 (0.01-0.90) mmol/l, p = 0.05] and HDL3-cholesterol [1.00 (0.75-1.51) vs 0.72 (0.53-0.87) mmol/l, p = 0.02] subfractions while serum triglyceride concentrations were similar. Lipoprotein lipase activity was higher in men with Type 1 diabetes [16.2 (6.2-42.4) vs 9.77 (5.6-22.6) mmol/h/l, p = 0.02] while hepatic lipase activities were similar [15.7 (9.3-23.0) vs 14.0 (6.8-24.0) mmol/h/l, NS). In women, there were no significant differences between Type 1 and Type 2 diabetes in triglycerides, HDL-C, HDL2 or HDL3. Lipoprotein lipase activity was higher in Type 1 women [19.3 (14.1-35.7) vs 11.0 (7.2-15.2) mmol/h-1 1-1, p = 0.0006] but lipatic lipase activity was also higher [12.1 (4.8-20.5) vs 7.3 (2.3-21.4) mmol/h-1 1-1, p = 0.023].

CONCLUSION

In non-obese diabetic subjects, men with Type 1 diabetes have higher HDL-cholesterol than those with Type 2 diabetes, possibly due to the action of peripheral insulin on lipoprotein lipase activity, while in women, HDL-cholesterol concentrations were similar in Type 1 and Type 2 subjects possibly because of lowered lipatic lipase activity in Type 2 women which offsets the increased lipoprotein lipase activity of the Type 1 women.

Radiology image interpretation system: modified observer performance study of an image interpretation expert system

Application of computer-based expert systems to diagnostic medical problems has been described in many areas including clinical diagnosis and radiology. Expert systems are computer programs that contain encoded expert knowledge to provide expert advice. A modified observer-performance study was done comparing the efficacy of the Radiology Image Interpretation System (RIIS), an expert system that diagnoses focal bone abnormalities, and radiology residents on a known set of 44 abnormal and 10 normal cases. Modified receiver operating characteristic curves for four inexperienced residents, five experienced residents, and RIIS were generated using the set of known radiographs. The true-positive rates of RIIS and the residents at false-positive rates of 0.05, 0.15, and 0.20 were estimated using the modified receiver operating characteristics curve and were compared using a paired t test. On the average, the RIIS system was less accurate when compared with experienced and inexperienced residents but the difference was only significant for experienced residents at a false-positive rate of 0.05. RIIS performed better than inexperienced residents when RIIS was used by experienced residents but this difference was not significant.

Total knee replacement: radiologic findings in failure of porous-coated metal-backed patellar component

One technique for replacing the articular surface of the patella in total knee replacement is the use of a cementless porous-coated metal-backed polyethylene component. Anteroposterior, lateral, and Merchant or skyline radiographs in 10 cases of porous-coated metal-backed components that failed were evaluated for component alignment, component displacement, radiolucencies, loose beads, and integrity of the patellar component. Component failure was documented by surgery in all 10 cases. Seven cases of failure involved the patellar pegs or junction of the pegs with the metal backing and three cases involved the polyethylene portion. In the seven cases of peg-metal backing failure, three cases showed loose beads before failure and seven cases showed displacement of the metal backing at time of failure. All three cases of polyethylene failure showed narrowing or displacement of the polyethylene portion. Our experience shows that displacement of the metal backing, displacement of the polyethylene, and disruption of patellar pegs are seen in failed porous-coated metal-backed patellar components. Loose beads may be seen before peg-metal backing failure.

Bone quality. Roentgenographic versus histologic assessment of hip bone structure

Bone quality is an accepted criterion for determining fixation options for total hip arthroplasty (THA). Eighty patients with 95 uncemented THAs were evaluated by comparing preoperative roentgenographic assessment with histologic evaluation of bone biopsy specimens obtained from the ipsilateral iliac crest. Roentgenographic analysis of bone quality was performed using the Singh and Engh indices. Histologic evaluation employed a quantitative analysis of static and dynamic parameters of bone turnover on undecalcified sections. Extensive statistical analysis comparing roentgenographic with histologic parameters of bone quality showed: (1) no relationship of the two roentgenographic indices to trabecular bone volume and most other histologic parameters and (2) a high incidence of bone abnormalities. Bone quality is an imprecise term and is inadequately measured by these roentgenographic indices. Histologic measurement offers a more precise means of analyzing the relationship of the bone environment to the performance of the THA.

Hepatobiliary imaging to demonstrate drainage patterns in a patient with an indwelling hepatic catheter

The presence of normal biliary flow was established in a patient with an indwelling hepatic catheter placed to drain an intrahepatic cyst cavity with the use of sequential hepatobiliary scintiscans. In the initial study drainage was demonstrated from the indwelling catheter; when the catheter was clamped, drainage was observed in the native biliary system. Serial biliary scintigraphy not only confirmed the patency of the hepatobiliary system, but served as a guide in the removal of the intrahepatic catheter.

Noninvasive testicular screening in childhood leukemia

To evaluate the potential of transscrotal ultrasound and magnetic resonance imaging as noninvasive screening methods we studied 8 boys with acute lymphocytic leukemia before testicular biopsy. Ultrasonic images of the testes were performed in 4 patients, including 2 with negative and 2 with positive biopsies, and all images were interpreted as normal. Magnetic resonance images of the testes also were interpreted as normal in 4 patients, including 2 with negative and 2 with positive biopsies, and they were technically inadequate in the remaining 4. The results suggest that neither transscrotal ultrasonography nor magnetic resonance imaging as currently applied may substitute reliably for testicular biopsy as a screen for occult testicular leukemia.

The appearance of a large mesenteric varix on a technetium-99m red blood cell gastrointestinal bleeding study

Detection of gastrointestinal bleeding using Tc-99m labeled RBCs has proven to be clinically useful although false-positive images associated with abnormal vascularity remain problematic. The scintigraphic appearance of a large mesenteric varix is presented, and its potential confusion with gastrointestinal bleeding is discussed. Correlative CT and angiographic images are presented.

Cerebral venous angiomas

Several unusual cases of cerebral venous angiomas as well as some characteristic cases are reported. The characteristic angiographic feature is that of a collection of dilated medullary veins draining into a single large draining vein, which appears first in the early venous phase and persists into the late venous phase of the arteriogram. Computed tomography (CT) was abnormal in 12/13 cases. The draining vein was the most common abnormality identified on CT. Coronal and sagittal reconstruction may be helpful in demonstrating the draining vein. A case of large twin venous angiomas, a case of hemorrhage from a venous angioma, and a case of a venous angioma with an incidentally associated glioblastoma are presented.

Substrate effect on 2,3-butylene glycol production by Rhizopus nigricans and Penicillium expansum

Rhizopus nigricans and Penicillium expansum produced 2,3-butylene glycol which accumulated in natural and artificial media with time. Mycelial mats of P. expansum decreased the quantity of a diacetyl substrate and converted part of this substrate into acetylmethylcarbinol (AMC) and 2,3-butylene glycol. Mycelial mats of P. expansum also decreased AMC substrate with the formation of 2,3-butylene glycol. 2,3-Butylene glycol decreased slightly during incubation with the fungal mat. The formation of AMC was suppressed significantly by cysteine and ascorbic acid.