Impact of a web-based educational program on Japanese nurses tobacco cessation practice and attitudes in oncology settings

PURPOSE

To evaluate the effects of a short web-based educational program on Japanese nurses' self-reported attitudes toward tobacco cessation and their use of interventions to help smokers to quit.

DESIGN

Prospective, single-group design with a pre-educational survey, a short web-based educational program, and a follow-up survey at 3 months.

METHODS

Clinical nurses were asked to view two prerecorded webcasts about helping smokers quit. They completed two online surveys, one at baseline and one at a 3-month follow-up. Generalized linear models were used to determine changes in nurses' self-reported routine practice after the study intervention.

FINDINGS

A total of 1401 nurses responded to the baseline survey, 678 of whom completed the follow-up survey. Compared with baseline, nurses at follow-up were more likely to advise smokers to quit (odds ratio [OR] = 1.45, 95% confidence interval [CI: 1.15, 1.82]), assess patients' interest in quitting (OR = 1.46, 95% CI [1.01, 1.04]), and assist patients with smoking cessation (OR = 1.34, 95% CI [1.04, 1.72]). However, the proportion of nurses who consistently recommended resources for tobacco cessation did not significantly improve at follow-up.

CONCLUSIONS

This study provides preliminary evidence that a web-based educational program can increase nurses' implementation of tobacco dependence interventions in cancer care practice. Sustaining these educational efforts could increase nurses' involvement in providing these interventions, encourage nurses to refer patients to cessation resources, and support nurses' attitudes towards their role in smoking cessation.

CLINICAL RELEVANCE

Our short web-based educational program can increase nurses' use of tobacco-dependence interventions in cancer care practice. This role can be enhanced with additional information about existing cessation resources that nurses could use to refer patients for support post-discharge. Japanese nurses, when properly educated, are willing and significant contributors to promote tobacco use cessation for cancer patients. The contribution can be facilitated through nursing care protocol that integrate tobacco use cessation interventions within evidence-based cancer care approaches.

DeCoP, a Dermatitis Control Program using a moderately absorbent surgical pad for head and neck cancer patients receiving radiotherapy: a retrospective analysis

OBJECTIVE

We evaluated the clinical characteristics of a Dermatitis Control Program based on a moderately absorbent surgical pad for head and neck cancer patients undergoing (chemo)radiotherapy.

METHODS

We retrospectively reviewed patients who underwent definitive radiotherapy or post-operative radiotherapy and were treated during radiotherapy with a Dermatitis Control Program using a moderately absorbent surgical pad from May 2011 through April 2012. The main protocol was the 'Dermatitis Control Program', a systematic program which consists of a three-step ladder. When radiation dermatitis reached Grade 2, the irradiated area was covered with a moderately absorbent surgical pad. All outpatients and their families were instructed on how to cover and moisten the irradiated area. Radiation dermatitis was evaluated by physicians or nurses at an outpatient clinic and reviewed from photographs.

RESULTS

A total of 116 head and neck cancer patients were treated by definitive or adjuvant (chemo)radiotherapy in our hospital from May 2011 through April 2012. Of these, 85 patients managed their dermatitis using a new device and they were reviewed. Fifty-five patients received chemoradiotherapy, of whom 22 received induction chemotherapy before chemoradiotherapy. Median radiation dose at the onset of Grade 2 dermatitis was 60.0 Gy (range 40-71.2 Gy). Median time to recover from the end of radiotherapy was 10.5 days (range 0-25 days). The rate of recovery from Grade 2 dermatitis within 2 weeks after the end of radiotherapy was 89.4%. The rate of Grade 3 dermatitis was 7.1, with 6.7% in radiotherapy and 7.3% in chemoradiotherapy.

CONCLUSIONS

This study suggests that the DeCoP protocol with a moderately absorbent surgical pad might be useful for the treatment of radiation dermatitis in clinical practice.

GABAergic and pallidal terminals in the thalamic reticular nucleus of squirrel monkeys

The ultrastructure of synaptic terminals from the external segment of the globus pallidus and of other synaptic terminals positive for gamma-aminobutyric acid (GABA) was examined in the thalamic reticular nucleus (TRN) of squirrel monkeys. Two GABA-positive terminals types were commonly encountered within the TRN neuropil. The most common type of GABAergic terminals (F terminals) are filled with dispersed pleomorphic synaptic vesicles and clusters of mitochondria. These terminals establish multiple symmetric synapses upon the somata and dendrites of TRN neurons. The external pallidal terminals, labeled with WGA-HRP, arise from thinly myelinated axons and correspond to the medium to large F terminals. A less prevalent population of smaller GABAergic synaptic profiles was also identified. The synaptic profiles in this second group contain considerably fewer pleomorphic synaptic vesicles in small irregular clusters and fewer mitochondria, establish symmetric synapses, are postsynaptic to other axonal terminals, are presynaptic to dendrites and soma, and are unlabeled following pallidal injections of WGA-HRP.

Noradrenergic innervation of the thalamic reticular nucleus: a light and electron microscopic immunohistochemical study in rats

Fluoro-ruby injections in the rat locus coeruleus result in scattered chain-like arrays of varicose anterogradely labeled axons within the thalamic reticular nucleus of rats. An abundant meshwork of axons giving rise to en passant boutons is detected immunohistochemically within this thalamic nucleus by means of an antibody to dopamine-beta-hydroxylase (DBH). The density of DBH-positive axonal boutons within the reticular nucleus neuropil is greater than that found in the relay nuclei of the dorsal thalamus (with the exception of the anterior group nuclei). Single DBH-positive axons appear to contact both proximal and distal dendrites and occasionally the somata of reticular nucleus neurons. Labeled axons are seen closely juxtaposed not only to the swollen segments of the beaded reticular neuron dendrites, but to the constricted segments as well. Electron microscopic examination of DBH-positive axon terminals within the reticular nucleus neuropil indicates that many of the axonal boutons detected light microscopically participate in asymmetric synaptic contacts. The postsynaptic densities of these synapses are thicker than those of nearby symmetric synapses, but often subtend a shorter length of the postsynaptic membrane than the densities associated with other nearby asymmetric synapses. These observations indicate that the ascending noradrenergic system, in addition to influencing the dorsal thalamus and the cerebral cortex directly, is well situated to influence signal transmission through the nuclei of the dorsal thalamus indirectly via a moderately dense terminal projection upon the thalamic reticular nucleus.

Light and electron microscopic evidence for a GABAergic projection from the caudal basal forebrain to the thalamic reticular nucleus in rats

Neurons in the magnocellular nucleus of the caudal basal forebrain extend an axonal projection which arborizes within the reticular nucleus of the thalamus. The present study addresses the ultrastructure and neurochemistry of this projection in rats. Many labeled terminals are apparent within the thalamic reticular nucleus following Phaseolus vulgaris leucoagglutinin injections into the caudal basal nucleus; anterogradely labeled axon terminals most commonly contact both somata and dendrites of reticular nucleus neurons with symmetric membrane specializations. Thus, the majority of the labeled terminals examined contrast with choline acetyltransferase positive terminals which have been previously identified as contacting dendrites and forming asymmetric synapses within this nucleus. Many of the neurons within the caudal basal nucleus which are retrogradely labeled following tracer injections into the thalamic reticular nucleus are gamma-aminobutyric acid (GABA) immunoreactive. In addition, following injections of Phaseolus vulgaris leucoagglutinin or fluoro-ruby into the caudal basal forebrain, some of the labeled axonal swellings and boutons within the thalamic reticular nucleus also contain glutamic acid decarboxylase. These results indicate that a significant component of the projection is GABAergic. These anatomical observations suggest that the projection from the caudal basal nucleus onto the thalamic reticular nucleus could facilitate the relay of information through the dorsal thalamus by inhibiting reticular nucleus neurons, and thus, in turn, disinhibiting thalamic relay neurons.

Corticocortical connections of anatomically and physiologically defined subdivisions within the inferior parietal lobule

The anatomical and functional organization of the inferior parietal lobule was investigated in macaque monkeys by using anterograde and retrograde anatomical tracing techniques and single cell recording techniques in awake, behaving monkeys. The connections of areas 7a and 7b, and of two previously unexplored areas, the lateral intraparietal area (LIP) and the dorsal prelunate area (DP), were examined in detail. Functional mapping experiments were performed in all four areas. Prior to this study the pathways for visual input to area 7a were unclear. In these experiments we found several direct projections from extrastriate visual areas, including the lateral intraparietal (LIP), dorsal prelunate (DP), parieto-occipital (PO), and medial superior temporal (MST) areas into area 7a. Using the observed laminar patterns of connections between areas 7a, LIP, and DP and other extrastriate cortical areas, we were able to construct a hypothetical flow of visual information processing from striate cortex to area 7a. A broader hierarchy was also produced, which relates the positions of areas 7a, 7b, LIP, and DP to various cortical fields in the parietal, temporal, and frontal lobes. By combining single cell recording techniques in trained monkeys with anatomical tracing techniques, we have parceled the inferior parietal lobule into several subdivisions on the basis of both anatomical and physiological grounds. A clear segregation of visual and somatosensory responses was found in the inferior parietal lobule with areas 7a, LIP, and DP being visual and visual-motor and area 7b being primarily somatosensory. A similar segregation was found anatomically with areas 7a, LIP, and DP being interconnected primarily with other visual cortical areas and area 7b being connected with several somatosensory areas. Area 7b was also found to connect to a few visual cortical areas, and these connections likely account for the small but consistent number of visually responsive cells that are found in this region. Areas LIP, DP, and 7a differed in receptive field and saccade-related properties. Area 7a visual receptive fields were very large and usually bilateral with a small but significant number of them having receptive field centers in the ipsilateral visual field. Area DP and LIP receptive fields were smaller and the receptive field peaks were almost always confined to the contralateral visual field. Areas 7a, DP, and LIP all contained cells with saccade-related responses; however, in area 7a there were fewer saccade cells than area LIP, and presaccadic responses were only observed in area LIP.(ABSTRACT TRUNCATED AT 400 WORDS)

Induction of somatic sensory inputs to the lateral geniculate nucleus in congenitally blind mice and in phenotypically normal mice

The incidence of aberrant innervation of the lateral geniculate nucleus by ascending somatic sensory axons was examined following injections of wheat germ agglutinin conjugated with horseradish peroxidase into the dorsal column nuclei of adult mice which were: (1) normal; (2) normal, but bilaterally enucleated on the day of birth; (3) normal, but received a large unilateral lesion of the rostral cortex on the day of birth; (4) normal, bilaterally enucleated, as well as unilaterally lesioned in the rostral cortex on the day of birth; (5) homozygous for an ocular retardation mutation (orj/orj); or (6) homozygous for the orj mutation and received a large unilateral lesion of the rostral cerebral cortex on the day of birth. In the phenotypically normal animals which were untreated, no somatic sensory inputs enter into the dorsal lateral geniculate nucleus. A few labeled axons enter into and arborize within the dorsal lateral geniculate nucleus in normal animals which received bilateral enucleations or unilateral rostral cortical lesions on the day of birth. However, in congenitally blind animals and in phenotypically normal animals which received bilateral enucleations as well as unilateral rostral cortical lesions on the day of birth, a significant number of labeled axons enter into and arborize within the dorsal lateral geniculate nucleus. Among all these experimental groups, the densest innervation of the lateral geniculate nucleus occurred in congenitally blind animals which received rostral cortical lesions on the day of birth. In these, robust arborizations of labeled somatic sensory axons occupy a substantial extent of the lateral geniculate nucleus. These results not only demonstrate that ascending somatic sensory axons can be rerouted to the lateral geniculate nucleus, but also indicate that the ability of a thalamic afferent pathway to undergo extensive reorganization and to innervate inappropriate thalamic targets following early perturbations is not unique to the retinal projection (in which this has previously been demonstrated), and may be a more general characteristic of the major thalamic afferent systems.

Axonal arborizations of a magnocellular basal nucleus input and their relation to the neurons in the thalamic reticular nucleus of rats

A dense axonal plexus, arising in a portion of the magnocellular basal nucleus, was identified in the thalamic reticular nucleus in adult rats. The details of these axonal arbors as well as their relation to the neurons of the reticular nucleus were investigated by using Phaseolus vulgaris leucoagglutinin injections into the basal nucleus and intracellular injections of Lucifer yellow into reticular nucleus neurons. Axons arising in the caudal basal nucleus at the medial margin of the globus pallidus do not enter the dorsal thalamus but are confined to the reticular nucleus, where they arborize widely and densely. Neurons in the reticular nucleus are large, with sparsely spined and beaded dendrites, which radiate within the plane of the nucleus. Bouton-like swellings along basal nucleus axons are often found apposed to the somata of reticular nucleus neurons, although many are also apposed to dendrites. These morphological observations suggest a second potentially significant route, in addition to its well-known direct cortical projection, through which the magnocellular basal nucleus could influence cortical function: it may, by strategically modulating the excitability of reticular nucleus neurons, alter the general state of the thalamus and hence affect the initial transmission of information to the cortex.

Observations on the development of certain ascending inputs to the thalamus in rats. I. Postnatal development

We have studied the postnatal development of the major ascending afferents to the thalamus in postnatal rats using tetramethylbenzidine histochemistry following wheat germ agglutinin-conjugated horseradish peroxidase injections into either the dorsal column nuclei, the deep cerebellar nuclei, or the inferior colliculus. By the day of birth, the efferents from each of these regions have already entered, and arborized extensively within, their appropriate thalamic relay nuclei. However, the overall distribution of each of these ascending afferent systems differs dramatically from that seen in mature rats. In neonatal rats, a substantial proportion of the ascending axons extend beyond the thalamus and often enter the internal capsule, some bypassing the thalamus altogether. In addition, some of the axons which enter and arborize within the thalamus extend beyond their appropriate terminal field into adjoining thalamic nuclei. Retrograde tracing experiments utilizing Fast blue indicate that the cells of origin of these overshooting axons are distributed similarly to the cells of origin of the definitive thalamic afferents. These early erroneous projections are all subsequently eliminated and the characteristically restricted adult distribution of each afferent system is evident by P30. These results indicate that developmental overgrowths and targeting errors of thalamic afferent fibers are not unique to the visual system (where they have been documented previously), but may be a general feature in the development of these pathways.

The thalamic relations of the caudal inferior parietal lobule and the lateral prefrontal cortex in monkeys: divergent cortical projections from cell clusters in the medial pulvinar nucleus

The thalamic relations of the caudal inferior parietal lobule and the dorsolateral prefrontal cortex in monkeys have been investigated with both anterograde and retrograde neuroanatomical tracing techniques. The results of these experiments indicate that the medial pulvinar nucleus (Pul.m.) is the principal thalamic relay to the gyral surface of the caudal inferior parietal lobule (area 7a). Within the Pul.m. there are two or three disklike aggregates of neurons which project to area 7a; these disklike neuronal aggregates are oriented from dorsomedial to ventrolateral and extend over most of the rostrocaudal extent of the nucleus. Within these disks there are rodlike clusters of neurons which are elongated in the rostrocaudal dimension of the thalamus, and which project in a topographically ordered manner to area 7a. Thus, the more rostrally located neurons within the Pul.m. disks project to more rostral parts of area 7a and, conversely, the more caudally located neurons project to the caudal part of this cortical field. Similarly, the medial part of each disk projects to the lateral part of area 7a while the laterally placed neurons project to the medial part of the cortical field. In addition to its input from the Pul.m., area 7a is also reciprocally connected with the magnocellular division of the nucleus ventralis anterior, with the nuclei which abut upon the medullary capsule of the laterodorsal nucleus, and with the suprageniculate nucleus and the nucleus limitans. The cortex on the lateral bank of the intraparietal sulcus (the so-called lateral intraparietal area, LIP) projects principally to the lateral pulvinar nucleus (Pul.l) of the thalamus rather than to Pul.m. Area LIP has been found to project to the pregeniculate nucleus, the zona incerta, the anterior pretectal nucleus, and the superior colliculus. Area 7a projects to none of these structures, but it does project to the posterior pretectal nucleus. The thalamic relations of the neighboring cortical regions, such as the prelunate gyrus and area 7b, are also distinct from those of area 7a. It thus seems that the prelunate gyrus is primarily interconnected with the Pul.l., and area 7b with the oral pulvinar nucleus. Taken together these different subcortical relationships provide further evidence for the view that the caudal inferior parietal lobule is not a homogeneous cortical area, but is composed of a number of subsidiary fields. The projection from the Pul.m. to the lateral prefrontal cortex arises from disklike aggregates of neurons, similar in their orientation to the neuronal disks that project to area 7a.(ABSTRACT TRUNCATED AT 400 WORDS)

Callosal and prefrontal associational projecting cell populations in area 7A of the macaque monkey: a study using retrogradely transported fluorescent dyes

The spatial interrelationship of neurons in area 7a in the inferior parietal lobule that project through the corpus callosum to the corresponding field in the contralateral hemisphere or to the ipsilateral prefrontal cortex has been analyzed in macaque monkeys by using double-labeling procedures with retrogradely transported fluorescent dyes. The populations of callosal and associational projecting neurons have similar laminar distributions and are topographically intermingled. Less than 1% of the neurons were double-labeled, thus suggesting that the two populations are largely separate. Two-dimensional reconstructions of the distribution of labeled cells made on flattened reconstructions of the inferior parietal lobule revealed that the areal distribution of the two cortico-cortical output arrays is complex. Although each pattern of labeling showed some discontinuities in density, there was no obvious periodicity within or between the spatial distributions of the two projecting populations. It was consistently observed that the cortex of the lateral wall of the intraparietal sulcus, adjacent to area 7a, projects more heavily to the prefrontal cortex than does area 7a itself.

Anatomical evidence for segregated focal groupings of efferent cells and their terminal ramifications in the cerebellothalamic pathway of the monkey

Patterns of termination of the cerebellothalamic pathway were investigated using anterograde tracing techniques. The thalamic projections from each of the deep cerebellar nuclei are topographically organized in two and possibly in three dimensions. First, the caudo-rostral cerebellar nuclear dimension is mapped onto the mediolateral dimension within the cell-sparse ventral lateral thalamic region (VPLo, VLc, VLps, and nucleus X). By correlating this topographic ordering with the previously established lamellar organization of the cell-sparse thalamic region a somatotopy is inferred within the deep cerebellar nuclei, with caudal body parts represented anteriorly and rostral body parts represented posteriorly in each nucleus. A second topography consists of the mapping of the mediolateral dimension of the dentate and interpositus nuclei onto the ventrodorsal dimension of the lamellae in the thalamus. Since the thalamic connections with motor cortex predict a somatotopic organization with distal body parts ventral and axial parts dorsal in thalamus, each cerebellar nucleus should, therefore, represent axial body parts laterally and distal parts medially. A third mapping dimension is shown for the dentatothalamic projection: dorsal parts of the dentate nucleus project posteriorly within the cell-sparse thalamic region, and ventral parts project anteriorly. The significance of this as regards representation of the body is not known. Subsidiary foci of terminations within the cell-sparse thalamic region are visible following tritiated amino acid injections into each of the deep cerebellar nuclei. Following dentate injections these foci appear as anteroposteriorly elongated, rod-like aggregations of terminations which are similar to the rod-like aggregations of thalamocortical relay cells which have been demonstrated following focal injections of horseradish peroxidase into the motor cortex. The interpositothalamic and the fastigiothalamic terminations are elongated and appear as focal clusters in all planes of section. The interpositothalamic clusters are distributed within posterodorsally curving planar sheets. An anterograde double labeling technique, using a combination of the autoradiographic technique with the axonal degeneration technique, was used to investigate the interrelations of the terminations from different nuclei and from different parts of the same nucleus. Rods from different parts of the dentate nucleus terminate independently of one another. Dentatothalamic rods and interpositothalamic clusters, though interdigitating within the same thalamic region, do not overlap. This topographic and modular organization of the cerebellothalamic pathway suggests that the cerebellar input may reflect both the somatotopic and the columnar organization of the motor cortex.

Distribution of cerebellar terminations and their relation to other afferent terminations in the ventral lateral thalamic region of the monkey

The efferent projections of the deep cerebellar nuclei were studied and their fiber trajectories and thalamic termination zones described. The thalamic termination zones for the dentate, interposed and fastigial nuclei are identical and coincide with the cytoarchitectonically unique cell-sparse region of the ventral lateral complex. This region includes nuclei VPLo, VLc, VLps, X and extensions of these between the cell clusters of nucleus VLo. The inputs from dentate and interpositus are contralateral, dense, and their termination patterns extend continuously throughout all nuclear components of the cell-sparse zone. Interdigitation of these two inputs within the cell-sparse region is directly demonstrated. The fastigial input is more restricted but bilateral. Each of the deep cerebellar nuclei also projects to the central lateral nucleus of the intralaminar complex. The strong interconnection of the cell-sparse zone with cortical area 4 is confirmed. The patterns of retrogradely labeled thalamocortical cells and of anterogradely labeled corticothalamic terminations following cortical injections of horseradish peroxidase and of tritiated amino acids, extend continuously through the VPLo-VLc region and its extensions, but do not invade the posteriorly situated VPLc nucleus. Thalamic inputs from the dorsal column nuclei terminate independently within the morphologically distinct VPLc nucleus adjacent to the cell-sparse cerebellar terminal zone. The dorsal column-lemniscal terminations do not overlap the cerebellar terminations. The clear segregation of the two sets of terminations is demonstrated directly using an anterograde double labeling method. Spinothalamic terminations end in VPLc but extend into the cerebellar terminal zone. Another ascending input, from the vestibular nuclei, is also shown to terminate within the cell-sparse zone. Comparison with other studies implies that cerebellar, pallidal and substantia nigral inputs do not converge in the monkey thalamus and that the nuclei in which they terminate project to different cortical areas. The relation of these and of sensory influences ascending to motor cortex from the periphery are discussed.

Cytoarchitectonic delineation of the ventral lateral thalamic region in the monkey

The cytoarchitecture of the ventral lateral region of the primate thalamus has been appraised in the frontal, parasagittal and horizontal planes. A morphologically distinct region, possessing a sparse and diffuse distribution of large and small neurons is identified. The region includes several nuclei previously separately named by Olszewski. These are nuclei VPLo, VLc, X, VLps, and some cellular extensions into the VLo nucleus. The whole zone is continuous, and it is shown that no clear separation exists between any of the previously identified subnuclei. Connectional grounds are given for suggesting that this region should be considered as a common cerebellar relay nucleus to motor cortex. Morphological criteria for distinguishing the cell-sparse nucleus from adjacent nuclei are given. These cytological criteria provide a basis for the experimental analysis of cortical and subcortical connectivity of the ventral lateral thalamic region. Close attention was paid to the border between the VPLo nucleus and the VPLc nucleus. VPLc is separated from VPLo by a clear border, and no transitional zone can be detected in the parasagittal or horizontal planes. Previous ambiguities in the delineation of the VPLo-VPLc border probably stem from analysis in the frontal plane, in which the border is not clear.