Exploring the use of the survivorship consult in providing survivorship care

Purpose

Advances in breast cancer treatment have increased survival and contributed to longer periods of survivorship as reported by the Committee CCSsS (Canadian Cancer Statistics) (2011) and Hewitt et al. (2005), increasing the relevance of survivorship care. Survivorship care includes encouraging survivors to acquire the knowledge, skills and confidence to manage their life, as well as engaging survivors through post-diagnosis disease self-management and self-care strategies. The Survivorship Consult (SC) was designed to help survivors reflect on their needs, establish goals and create an action plan.

Methods

Twenty-six breast cancer survivors who participated in the SC at Princess Margaret Cancer Centre took part in semi-structured interviews to assess the survivor experience and effectiveness of the SC. Data from these interviews were coded, and themes were identified using a modified grounded theory approach.

Results

Themes that emerged regarding the experience and effectiveness of the SC included (1) the supportive experience of collaborative dialogue with supportive care clinicians (i.e. nurses, social workers, occupational therapists, etc.), (2) the development of personalized goals that motivated individuals to implement recommendations, (3) an enhanced understanding of their health condition, team and options, (4) an improved ability to identify needs and (5) an increased sense of confidence to manage issues related to care.

Conclusions

The assessment of the SC improved the experience of breast cancer patients by providing a supportive environment where they could feel cared about, by increasing understanding of their condition and its treatment, by improving communication with the care team and by motivating patients to manage care issues. Further research is needed on survivors who conduct the SC before the treatment phase of their cancer trajectory.     

Amygdala and hippocampus volumes in pediatric major depression.

BACKGROUND: The purpose of this study was to measure amygdala and hippocampus volumes in pediatric major depressive disorder (MDD) and to address the question of neuroanatomical continuity with adult-onset depression. METHODS: We studied 20 children and adolescents with MDD (17 female subjects) and 24 healthy comparison subjects (16 female subjects) using 1.5 Tesla magnetic resonance imaging. Group differences in left and right amygdala and hippocampus volumes were examined using repeated measures analyses of covariance, adjusting for age, gender, and whole brain volume. RESULTS: Depressed children had significant reductions of left and right amygdala volumes compared with healthy subjects. Hippocampus volumes did not differ between the groups. No significant correlations were found between amygdala volumes and depressive symptom severity, age at onset, or illness duration. CONCLUSIONS: Smaller amygdalas are present early in the course of pediatric depression and may predispose to the development of this disorder or perhaps more generally of childhood mood disorders. Future research should examine the longitudinal course and functional correlates of amygdala volume abnormalities in childhood-onset depression, including their possible moderation by gender.     

Magnesium deficiency reduces fear-induced conditional lick suppression in mice.

The consequences of broad-scale alterations in magnesium (Mg2+) levels on learning and memory are poorly understood. We have recently demonstrated that adult male mice maintained on an Mg2+-deficient diet exhibit reduced conditional freezing behavior. The purpose of the present study was to determine if the detrimental effect of Mg2+ deficiency in mice extended to another measure of conditional fear, conditioned lick suppression (CLS), as well as to another form of learning, spatial learning in the swim maze task. Adult male C57Bl/6J mice were provided with a normal or Mg2+-deficient diet and were trained and tested ten days later for conditional fear, using CLS and freezing as indicators of learning. Learning in the swim maze was tested in a separate cohort of mice during days 14-18 of diet exposure. Mg2+-deficient mice showed reduced CLS as well as conditional freezing behavior in comparison to control mice. However, learning in the swim maze task was normal in Mg2+-deficient mice. These studies indicate that the detrimental effects of Mg2+ deficiency extend to other measures of conditional fear but not to all forms of learning.     

In their own voices: a qualitative study of women's risk for intimate partner violence and HIV in South Africa

This study qualitatively examines the intersections of risk for intimate partner violence (IPV) and HIV infection in South Africa. Eighteen women seeking services for relationship violence were asked semistructured questions regarding their abusive experiences and HIV risk. Participants had experienced myriad forms of abuse, which reinforced each other to create a climate that sustained abuse and multiplied HIV risk. Male partners having multiple concurrent sexual relationships, and poor relationship communication compounded female vulnerability to HIV and abuse. A social environment of silence, male power, and economic constraints enabled abuse to continue. "Breaking the silence" and women's empowerment were suggested solutions.     

Does the Kensey catheter keep a coaxial position inside the arterial lumen?: An in-vitro angioscopic study

Angioscopy was used to evaluate the “self-centering” ability of three Kensey catheters (KC) with different flexibility: one 8Fr “peripheral” and two 5Fr “coronary” (I & II). Angioscopic observations were made inside arteries. 5–18 mm in diameter. There was a good correlation between flexibility and self-centering of the KC [r=0.83, p<0.05]. Increasing the flow rate of rinsing solution from 18 to 60 ml/min prolonged coaxial position from 8.9±3.3 to 36±2.2 sec/min of activation [p<0.001]. A smaller effect on coaxial position was exerted by increasing cam speed from 5.2±0.7 to 19.2±1.6 sec/min (p<0.001). In conclusion, angioscopy showed that the KC has a limited ability to maintain a coaxial position inside the arterial lumen and operators cannot rely on its self-centering property.     

Synthesis of a fluorescent derivative of cyclosporin A for high-performance liquid chromatography analysis

A direct assay method for use in studies of cyclosporin binding must be highly sensitive and selective since it must be capable of measuring the concentrations encountered in the protein-free matrix. The failure of current HPLC methods to achieve the sensitivity required for binding studies may be attributed to the use of UV detection, which relies on the relatively weak end-absorption of cyclosporin A. A method involving fluorescence derivatization was sought with the aim of increasing HPLC assay sensitivity. A method is described for producing a fluorescent derivative of cyclosporin A, a compound which has no functional groups which are easily derivatized. However, intramolecular rearrangement of cyclosporin A to form its structural isomer, isocyclosporin A, exposes a secondary amine which can be reacted with dansyl chloride to produce a fluorescent derivative. This two-step derivatization procedure was used as the basis of an HPLC fluorescence assay. Although this assay is not sufficiently sensitive to measure concentrations encountered in the protein-free matrix during plasma binding studies, the method does point to the possible development of a more sensitive assay using a derivatizing reagent other than dansyl chloride.     

Pulsed Radiofrequency Application in the Treatment of Chronic Pain

Abstract:   The efficacy of pulsed radiofrequency (PRF) in the treatment of painful lumbosacral spondylosis has been reported. This case series reviews 22 consecutive patients presenting to clinic who had been previously treated with PRF with good results. Patients being prescribed opioids were excluded. During the PRF application, tissue temperature was limited to 43°C. A minimum of 200 mA of current was delivered in each case. The minimum current (at 50 Hz) necessary to stimulate the involved nerve was recorded. The duration of time from PRF treatment until the patient requested a subsequent application was documented. The effective duration of PRF in patients treated for lumbosacral spondylosis ranged from 5 to 18 months (mean ± SD: 9 ± 3.7 months; n  = 16). PRF applications to dorsal root ganglia were effective from 2 to 12 months (7 ± 3.8 months; n  = 8). Similar results were observed when PRF was applied to cervical medial branch nerves, one suprascapular nerve, and one stellate ganglion. The mean (50 Hz) sensory stimulation thresholds obtained before treatment ranged from 0.08 V to 0.14 V. In this select population of patients not receiving controlled substances, who had a favorable response to a previous PRF application, the duration of pain relief supports the use of PRF as an effective pain treatment.     

Phase II study of two-weekly temozolomide in patients with high-grade gliomas.

Palliative chemotherapy has an increasing role in the management of recurrent high-grade gliomas. Temozolomide is a well-tolerated agent that results in objective responses and stabilisation of disease. Theoretically, temozolomide may be more effective when given in a prolonged schedule rather than the standard 5 days-monthly schedule. This Phase II study examined the efficacy and toxicity of temozolomide when given in a two-weekly schedule. Twenty-five patients received 150 mg/m2 temozolomide daily for seven days alternating with seven days of no treatment. One cycle of temozolomide was a total of two weeks treatment in every 28 days. Of the 25 evaluable patients, there was one complete response (4%), four partial responses (16%) and 10 patients had disease stablisation (40%). The progression free survival at 6 months was 56%. Two-weekly temozolomide was well tolerated with only four episodes of Grade 3 thrombocytopenia. Overall, two-weekly temozolomide is an active and well tolerated schedule, but does not appear to improve on the activity of temozolomide using the standard 5-day schedule.