Sexual function after cancer: paying the price of survivorship.

Sexual dysfunction is one of the most prevalent and distressing treatment side effects for millions of female cancer survivors, yet the majority of survivors do not receive necessary information, support, or treatment for these sexual consequences. Cancer can devastate the body and impair sexual function and body image. Furthermore, all primary modalities of cancer treatment (surgery, radiotherapy, chemotherapy, and hormonal therapy) have the potential to negatively impact sexual function. Assessment and identification by clinicians can be done efficiently and easily with short validated tools using a style of inquiry which starts by acknowledging how common sexual dysfunction is amongst cancer survivors rather than asking direct questions. Sexual concerns are impacted by psychological, biological, and interpersonal factors, and a multidisciplinary approach to treatment allows clinicians to comfortably inquire, assess, and refer if treatment is beyond their comfort or expertise.

TrueNTH sexual recovery study protocol: a multi-institutional collaborative approach to developing and testing a web-based intervention for couples coping with the side-effects of prostate cancer treatment in a randomized controlled trial.

BACKGROUND: Over half of men who receive treatment for prostate suffer from a range of sexual problems that affect negatively their sexual health, sexual intimacy with their partners and their quality of life. In clinical practice, however, care for the sexual side effects of treatment is often suboptimal or unavailable. The goal of the current study is to test a web-based intervention to support the recovery of sexual intimacy of prostate cancer survivors and their partners after treatment. METHODS: The study team developed an interactive, web-based intervention, tailored to type of treatment received, relationship status (partnered/non-partnered) and sexual orientation. It consists of 10 modules, six follow the trajectory of the illness and four are theme based. They address sexual side effects, rehabilitation, psychological impacts and coaching for self-efficacy. Each includes a video to engage participants, psychoeducation and activities completed by participants on the web. Tailored strategies for identified concerns are sent by email after each module. Six of these modules will be tested in a randomized controlled trial and compared to usual care. Men with localized prostate cancer with partners will be recruited from five academic medical centers. These couples (N = 140) will be assessed prior to treatment, then 3 months and 6 months after treatment. The primary outcome will be the survivors' and partners' Global Satisfaction with Sex Life, assessed by a Patient Reported Outcome Measure Information Systems (PROMIS) measure. Secondary outcomes will include interest in sex, sexual activity, use of sexual aids, dyadic coping, knowledge about sexual recovery, grief about the loss of sexual function, and quality of life. The impact of the intervention on the couple will be assessed using the Actor-Partner Interaction Model, a mixed-effects linear regression model able to estimate both the association of partner characteristics with partner and patient outcomes and the association of patient characteristics with both outcomes. DISCUSSION: The web-based tool represents a novel approach to addressing the sexual health needs of prostate cancer survivors and their partners that-if found efficacious-will improve access to much needed specialty care in prostate cancer survivorship. TRIAL REGISTRATION: Clinicaltrials.gov registration # NCT02702453 , registered on March 3, 2016.

Toddlers' persistence in the emerging occupations of functional play and self-feeding.

OBJECTIVE: This descriptive study explores motivation of toddlers who are typically developing to persist with challenging occupations. METHOD: The persistence of 33 children, 12 to 19 months of age (M = 15.7 months), in functional play and self-feeding with a utensil was examined through videotape analysis of on-task behaviors. RESULTS: A modest correlation was demonstrated between the percentages of on-task time in the two conditions (r = .44, p < .01). Although chronological age was not associated with persistence, participants' age-equivalent fine motor scores were correlated with persistence with challenging toys (r = .39, p < .03) but not with self-feeding with a utensil. Having an older sibling was associated with longer periods of functional play, t(32) = 3.02, p < .005, but the amount the parent urged the child to eat with a utensil was not associated with persistence in self-feeding. CONCLUSION: The modest association between on-task time for functional play and self-feeding with a utensil reveals that factors other than urge to meet perceptual motor challenges lead to children's persistence. The results reinforce the importance of considering not only challenging activities, but also the experienced meaning that elicits optimal effort and, thus, learning.

Imaging the pediatric pelvis: the normal and abnormal genital tract and simulators of its diseases.

Imaging of the pediatric pelvis has proven of great use in defining the normal and abnormal genital tracts. Sonography is the key screening tool and often the only tool necessary for the diagnosis of problems related to ambiguous genitalia, ovarian and uterine masses, amenorrhea, and abdominal and pelvic pain. Computed tomography (CT) and magnetic resonance imaging (MRI) have key roles in the global assessment of the pelvis particularly with regard to the assessment of tumor spread.

Role of routine percutaneous hip aspirations prior to prosthesis revision.

We undertook a retrospective review of 78 percutaneous hip aspirations performed as a prerequisite to prosthetic revision or replacement. Although the majority of the patients were already scheduled for revision or replacement, many aspirations were requested as part of the "routine" algorithm in the evaluation of a painful hip. Cultures from the aspirated fluid were compared with those obtained intraoperatively (where possible) and to the clinical suspicion of infection. Many of the selected patients had clinical and/or radiographic indications of pain. Our results yielded no evidence of infection (0%) when there was no clinical suspicion of infection (60 patients). Clinical suspicion for infection was high in 7 patients; aspirates demonstrated infection in 5 of them. One aspiration was false negative for infection, but subsequent intraoperative cultures were positive. When the clinical suspicion was intermediate or equivocal (11 patients), results were negative in 9 and positive in 2, both at aspiration and intraoperatively. We contend that routine percutaneous hip aspirations do not need to be performed when a prosthetic revision or replacement is contemplated if the clinical suspicion for infection is low. Hip aspiration and arthrography should not be eliminated, however, when the clinical suspicion is equivocal or high or when there is no apparent cause for a painful prosthesis.

Thyroid function in hyperemesis gravidarum.

Twenty-five patients with severe persistent vomiting were studied. On admission they were given the diagnosis of hyperemesis gravidarum. Hyperemesis was defined as vomiting of sufficient severity to warrant admission to hospital and iv therapy, which was not associated with any other condition known to cause vomiting other than the pregnancy itself. Ten (40%) of the patients had free thyroxine levels which were elevated on admission with hyperemesis. The free thyroxine normalised when the patients were well but still pregnant and remained normal post partum. Longitudinal data for nine other thyroid parameters are given and all illustrate the transient nature of the disturbed function in hyperemesis gravidarum.