Clinicoradiological outcomes after radical radiotherapy for lung cancer in patients with interstitial lung disease.

Objective: Interstitial lung disease (ILD) is relatively common in patients with lung cancer with an incidence of 7.5%. Historically pre-existing ILD was a contraindication to radical radiotherapy owing to increased radiation pneumonitis rates, worsened fibrosis and poorer survival compared with non-ILD cohorts. Herein, the clinical and radiological toxicity outcomes of a contemporaneous cohort are described. Methods: Patients with ILD treated with radical radiotherapy for lung cancer at a regional cancer centre were collected prospectively. Radiotherapy planning, tumour characteristics, and pre- and post-treatment functional and radiological parameters were recorded. Cross-sectional images were independently assessed by two Consultant Thoracic Radiologists. Results: Twenty-seven patients with co-existing ILD received radical radiotherapy from February 2009 to April 2019, with predominance of usual interstitial pneumonia subtype (52%). According to ILD-GAP scores, most patients were Stage I. After radiotherapy, localised (41%) or extensive (41%) progressive interstitial changes were noted for most patients yet dyspnoea scores (n = 15 available) and spirometry (n = 10 available) were stable. One-third of patients with ILD went on to receive long-term oxygen therapy, which was significantly more than the non-ILD cohort. Median survival trended towards being worse compared with non-ILD cases (17.8 vs 24.0 months, p = 0.834). Conclusion: Radiological progression of ILD and reduced survival were observed post-radiotherapy in this small cohort receiving lung cancer radiotherapy, although a matched functional decline was frequently absent. Although there is an excess of early deaths, long-term disease control is achievable. Advances in knowledge: For selected patients with ILD, long-term lung cancer control without severely impacting respiratory function may be possible with radical radiotherapy, albeit with a slightly higher risk of death.

Epidemiological associations of asthma status and tobacco use, substance use, and substance misuse among adults in the United States, 2015-2019.

Objective: Adults with asthma have a higher prevalence of substance use. However, knowledge is scarce regarding the associations between adults with asthma and tobacco use, substance use, and substance misuse. This study aimed to use national samples of United States adults to assess the comprehensive use and misuse of substances in adults with asthma.Method: This cross-sectional study comprised data drawn from the 2015 to 2019 National Survey on Drug Use and Health. Weighted logistic regressions were used to measure the associations of asthma status (lifetime and current) with last month's tobacco use; substance use (alcohol, marijuana, cocaine, crack, heroin, hallucinogens, inhalants); and substance misuse (pain relievers, tranquilizers, stimulants, sedatives). All regression models were controlled for sociodemographic characteristics, comorbidity, last-month serious psychological distress, and co-substance use and misuse. Results: Adults with lifetime asthma (Nweighted = 115,600,887) were less likely to use cigarettes, cigars, smokeless tobacco, inhalants, and polyuse of any substance. In contrast, adults with current asthma (Nweighted = 765,096,31) were more likely to use pipe tobacco, cocaine, non-prescribed tranquilizers, and less likely to use polytobacco products. Adults with lifetime asthma were associated with fewer last-month tobacco and inhalant use than those without lifetime asthma. However, adults with current asthma were associated with greater last month's pipe tobacco, cocaine, and non-prescribed tranquilizers. Conclusion: Thus, further longitudinal studies are recommended among adults with asthma to effectively design tailored treatment and prevention interventions.

Examining electronic nicotine delivery system use and perception of use among college students with and without asthma across the South.

BackgroundThe effects of environmental tobacco smoke is a risk factor for everyone, but more so for individuals living with asthma. Most studies have focused on youth and young adults as the vulnerable population affected by secondhand smoke with policies related to secondhand smoke enacted to lessen such exposure given the known negative health effects. Most individuals are aware that secondhand exposure to tobacco smoke is not healthy, yet there is a shortage of literature on the secondhand vapor associated with electronic nicotine delivery systems (ENDS). Suggestions for nicotine, metals, and carcinogens in secondhand vapor are beginning to emerge in the literature but are still not common knowledge to the public. This study aims to look at the demographic differences among young adults (college students) with asthma and non-asthma concerning ENDS use. A secondary aim will also look at the difference in perceived health status and perception of harm in the relationship between asthma and ENDS use in these two populations. Methods: A cross-sectional online survey was designed and disseminated to two independent southeastern colleges. The survey was prepared following a comprehensive review of the literature by a group of experts focused on ENDS usage. The survey examined self-reported usage of and perceptions of ENDS within college students with and without asthma. Results: Approximately 50% of college-age students' perceived ENDS vapor as less harmful than traditional cigarette smoke. Around 24% of the students stated they use ENDS daily with over 50% of these students utilizing ENDS in the past 30 days. Asthma was a significant predictor in reporting lower perceived health status than students without asthma and perceived health status was a significant predictor of reporting fewer ever use of ENDS. Higher than the national average, 19% of students self-identified with an asthma diagnosis, and the use of ENDS was 20% in students without asthma and 27% in students with asthma. Conclusions: There are limited studies on perceptions related to ENDS and exposures in college students with and without asthma. Since 2007, various alternative forms of ENDS devices have been marketed. ENDS have gained popularity with young adults and college-age students, while rates of traditional cigarette usage have declined. College students report less perceived harm with ENDS over traditional cigarettes, yet studies acknowledge the high levels of the addictive substance nicotine. Of great concern is the lack of knowledge that college students have regarding nicotine based on their perceptions and the increasing use of these devices in those individuals with underlying respiratory conditions.

Predictors of Vaping Behavior Change in Young Adults Using the Transtheoretical Model: A Multi-Country Study.

Electronic nicotine products remain popular among college students. These products contain heavy metals, carcinogens and the addictive substance nicotine. By understanding where students are in their behavior change can help to determine and focus messages and campaigns. The aim of this study was to assess predictors of the Transtheoretical model in college-aged vaping. This study consisted of an online/Ipad delivery of a voluntary survey to 1249 young adults/college students at 5 universities (International and within the U.S.). Data was analyzed using Stata. Regression analysis was performed to assess predictors of the stages in the Transtheoretical Model of behavior change. Our study found that women tended to be further along in the stages of change as compared to their male counterparts. Additionally, the older students were more likely to be in maintenance stage as compared to the younger students. The students who vaped longer tended to not have advance into any of the stages of change besides precontemplation. Understanding where students are in the stages of change can help to inform behavioral message campaigns enabling more focused targeting of messages and efforts to reduce consumption. Electronic nicotine products are highly prevalent on college campuses, both nationally and internationally. The nicotine is addictive and may result in less of a desire or ability to quit as young adults age.

Substance Use and Misuse among Adults with Chronic Obstructive Pulmonary Disease in the United States, 2015-2019: Prevalence, Association, and Moderation.

BACKGROUND: Despite the advancements in chronic obstructive pulmonary disease (COPD) treatment, complications related to COPD exacerbation remain challenging. One associated factor is substance use/misuse among adults with COPD. Fewer studies, however, examined the prevalence and association between COPD and substance use and misuse. In addition, limited knowledge existed about the moderation effects of serious psychological distress and gender among adults with COPD and substance use/misuse. We aimed, therefore, to measure such prevalence, association, and moderation from nationally representative samples in the United States. METHOD: Data were drawn from the 2015-2019 National Survey on Drug Use and Health. Weighted logistic regressions were used to measure the associations of last-month tobacco (cigarettes, cigars, pipe, and smokeless tobacco products), other licit and illicit substance use (alcohol, marijuana, cocaine, crack, heroin, hallucinogens, and inhalants), and substance misuse (pain relievers, tranquilizers, stimulants, and sedatives) among adults with COPD. Serious psychological distress and gender were tested as moderators in the association between COPD and substance use/misuse. RESULTS: The findings revealed that adults with COPD [Weighted N = 53,115,718) revealed greater odds of cigarettes [adjusted odds ratio (aOR) = 2.48 (95%CI = 1.80-3.42)) and smokeless tobacco (aOR = 3.65 (95%CI = 1.75-7.65)). However, they were less likely to use alcohol (aOR = 0.61 (95%CI = 0.45-0.84)). Adults with COPD who had serious psychological distress were more likely to use pipe tobacco and alcohol; however, they were less likely to use hallucinogens and inhalants. Finally, males compared to females with COPD were less likely to use smokeless tobacco. CONCLUSION: Adults with COPD in the United States were more likely to use tobacco products and less likely to use alcohol. In addition, serious psychological distress and gender were moderators in associations between COPD and substance use but not in substance misuse. Future studies should longitudinally assess the factors that may contribute to the initiation and progression of substance use and misuse among adults with COPD.

An Analysis of Associations Between Electronic Nicotine Delivery System Users.

BACKGROUND: Electronic nicotine-delivery systems have been increasing in prevalence among young adults. Although these devices are marketed to aid in quit smoking, young adults who do not smoke traditional cigarettes are using these devices. This study explored associations between individuals' quit type (ie, no plans to quit, plans to quit, or quit > 6 months ago) and perceived health status, perception of harm compared to cigarettes, perception of secondhand vapor harm, and reasons for first use. METHODS: We utilized a cross-sectional study design using a 33-item electronic survey questionnaire. The total sample size was 2,792. Out of these the ENDS users were 1,217. The survey was distributed to university students in 5 areas in 3 countries: the United States (ie, Florida, Alabama, and Illinois), Germany (ie, Hamburg) and South Africa (ie, Potchefstroom). RESULTS: Quantitative data analysis indicated that, regardless of quit status, there was a general lack of knowledge regarding secondhand vapor effects. Additionally, young adults are utilizing these products primarily due to peer influence and stress relief. Harm perception may factor into quit attempts using electronic nicotine-delivery systems. CONCLUSIONS: Education provided by respiratory therapists (and to respiratory therapy students) would be valuable as they inform patients and communities of the scholarly literature on vaping devices.

Using Ultrafast X-ray Spectroscopy To Address Questions in Ligand-Field Theory: The Excited State Spin and Structure of [Fe(dcpp)2]2.

We have employed a range of ultrafast X-ray spectroscopies in an effort to characterize the lowest energy excited state of [Fe(dcpp)2]2+ (where dcpp is 2,6-(dicarboxypyridyl)pyridine). This compound exhibits an unusually short excited-state lifetime for a low-spin Fe(II) polypyridyl complex of 270 ps in a room-temperature fluid solution, raising questions as to whether the ligand-field strength of dcpp had pushed this system beyond the 5T2/3T1 crossing point and stabilizing the latter as the lowest energy excited state. Kα and Kß X-ray emission spectroscopies have been used to unambiguously determine the quintet spin multiplicity of the long-lived excited state, thereby establishing the 5T2 state as the lowest energy excited state of this compound. Geometric changes associated with the photoinduced ligand-field state conversion have also been monitored with extended X-ray absorption fine structure. The data show the typical average Fe-ligand bond length elongation of ∼0.18 Å for a 5T2 state and suggest a high anisotropy of the primary coordination sphere around the metal center in the excited 5T2 state, in stark contrast to the nearly perfect octahedral symmetry that characterizes the low-spin 1A1 ground state structure. This study illustrates how the application of time-resolved X-ray techniques can provide insights into the electronic structures of molecules-in particular, transition metal complexes-that are difficult if not impossible to obtain by other means.

Perceptions of non-traditional tobacco products between asthmatic and non-asthmatic college students.

OBJECTIVE: Electronic nicotine delivery systems (ENDS) use is common among college students and there are perceptions that ENDS are not as harmful as traditional cigarettes. The aim of this study was to examine differences in ENDS use, risk perceptions, and co-occurring smoking behaviors between college students with and without asthma. METHODS: The study consisted of a cross-sectional online survey with a final sample size of 898 college students. The voluntary participation survey was disseminated to all undergraduate and graduate students at a mid-sized liberal arts university in the Southeast U.S. in the Fall of 2014. RESULTS: Approximately 19.7% reported that they had been previously diagnosed with asthma. Forty three percent of participants (n = 384) used ENDS in the past 30 days. Equivalent percentages of college students with asthma (46.9%) and college students without asthma (46.9%) have tried ENDS. Overall participants indicated that they perceived ENDS use as less (44%) or equally (38%) as harmful as cigarettes. College students with asthma had 2.85 (95% CI: 1.18-6.89) greater odds of being in the poly-user class, which was characterized by dual use of ENDS, combustible cigarettes, hookah, and marijuana. CONCLUSIONS: In this study, college students with asthma were similar to their peers with regard to their use of ENDS and related risk perceptions; however, a small subsample of those with asthma exhibited problematic smoking behaviors characterized by dual use of multiple tobacco products including marijuana.

Nursing Care of Adult Hematopoietic Stem Cell Transplant Patients and Families in the Intensive Care Unit: An Evidence-based Review.

This article addresses evidence-based practice related to adult hematopoietic stem cell transplant (HSCT) patients when admitted to the intensive care unit. Specifically, it addresses non-HSCT staff, patient, and family needs and the strategies to address those needs.

Prevalence of and beliefs about electronic cigarettes and hookah among high school students with asthma.

PURPOSE: To assess current cigarette, hookah, and electronic cigarette (e-cigarette) use among high school students with and without asthma. Beliefs and use of tobacco products by a household member were also examined. METHODS: The 2014 Florida Youth Tobacco Survey was administered to high school students to assess current use of cigarettes, hookah, and e-cigarettes (i.e., within past 30 days). Student's home exposure and beliefs about cigarettes, hookah, and e-cigarettes were also assessed. Students were randomly selected using a two-stage cluster probability design. RESULTS: Adolescents with asthma had a higher prevalence of current hookah (14.0%) and e-cigarette use (12.4%) compared with their peers (10.9%, 10.2%, respectively). Adolescents with asthma were also at increased risk for current use of cigarettes (adjusted odds ratio [AOR]: 1.24), hookah (AOR: 1.32), and e-cigarettes (AOR: 1.34). Adolescents with asthma reported positive beliefs about tobacco products and were more likely to report living with individuals who used cigarettes (31.5%), hookah (12.1%), and e-cigarettes (15.5%) compared with their peers (26.5%, 8.5%, 12.5%, respectively). CONCLUSIONS: Adolescents with asthma reported tobacco product use, positive beliefs about tobacco products, and high potential home exposure to tobacco products. There is a pressing need for education regarding potential harm of alternative tobacco products among adolescents with asthma.

Human Papilloma Virus (HPV) Oral Prevalence in Scotland (HOPSCOTCH): A Feasibility Study in Dental Settings.

The purpose of this study was to test the feasibility of undertaking a full population investigation into the prevalence, incidence, and persistence of oral Human Papilloma Virus (HPV) in Scotland via dental settings. Male and female patients aged 16-69 years were recruited by Research Nurses in 3 primary care and dental outreach teaching centres and 2 General Dental Practices (GDPs), and by Dental Care Teams in 2 further GDPs. Participants completed a questionnaire (via an online tablet computer or paper) with socioeconomic, lifestyle, and sexual history items; and were followed up at 6-months for further questionnaire through appointment or post/online. Saline oral gargle/rinse samples, collected at baseline and follow-up, were subject to molecular HPV genotyping centrally. 1213 dental patients were approached and 402 individuals consented (participation rate 33.1%). 390 completed the baseline questionnaire and 380 provided a baseline oral specimen. Follow-up rate was 61.6% at 6 months. While recruitment was no different in Research Nurse vs Dental Care Team models the Nurse model ensured more rapid recruitment. There were relatively few missing responses in the questionnaire and high levels of disclosure of risk behaviours (99% answered some of the sexual history questions). Data linkage of participant data to routine health records including HPV vaccination data was successful with 99.1% matching. Oral rinse/gargle sample collection and subsequent HPV testing was feasible. Preliminary analyses found over 95% of samples to be valid for molecular HPV detection prevalence of oral HPV infection of 5.5% (95%CI 3.7, 8.3). It is feasible to recruit and follow-up dental patients largely representative / reflective of the wider population, suggesting it would be possible to undertake a study to investigate the prevalence, incidence, and determinants of oral HPV infection in dental settings.

Accessing totally implantable venous access systems on the day of placement does not significantly increase the risk of infection.

PURPOSE: Totally implantable venous access systems (ports) are commonly placed and have a low complication rate. The most common complication is infection, which can have very negative effects on patients resulting in hospitalization and/or treatment delay in the setting of neoplasm. While a number of variables have been studied in relation to diminishing infectious rates, one remaining question is the effect of accessing the port on day of placement, which is the aim of this retrospective study. MATERIALS AND METHODS: After internal review board approval the electronic medical records of 2,006 patients who underwent port placement between 10/1/2008 and 9/30/2013 were reviewed. Of these patients 628 were excluded as they did not have complete placement and removal data available, leaving 1378 patients in our cohort. RESULTS: There was a significantly longer number of infection-free catheter days in the out-patient cohort as compared to the in-patient cohort (p = 0.027). In-patients mean day after placement when the port was first accessed (DAP) (0.5) was statistically earlier (closer to placement) than the out-patients DAP (7.2) (p<0.0001). However, the increased likelihood of infection could not be explained by DAP (p = 0.2029) even when controlling for in-patient and out-patient status (p = 0.97). CONCLUSIONS: Accessing the port on the day of placement does not significantly contribute to an increased likelihood of infection. This study seems to indicate that placing a port on the first day of outpatient therapy likely optimally balances respect for patient time with infection control.

Statistical considerations for a chronic bioassay study: Exposure to Decamethylcyclopentasiloxane (D5) and incidence of uterine endometrial adenocarcinomas in a 2-year inhalation study with Fischer rats.

Decamethylcyclopentasiloxane (D5) is a cyclic siloxane used in the production of industrial and consumer products. Four groups of 60 Fischer-344 female rats were analyzed for uterine endometrial adenocarcinoma (inhalation study with exposure levels in ppm/number of observed cases: 0/0, 10/1, 40/0, and 160/5) by exact regression (logistic, Poisson), the max poly-3 trend test, and a random effects probit model. When comparing the 160 ppm group to controls after 24 months, the incidence of adenocarcinomas was elevated (borderline significant); it was significant when all exposure levels were included. Four sets of (historical) control groups were formed, with varying heterogeneity. The effect of D5 was either significant or borderline significant when comparing all control sets to the 160 ppm group. When considering all exposure groups using any of the analysis methods, a significant effect was observed when the high dose group was included in the analysis; the effect was not significant when the high dose group was not included. The evidence tends to support the conclusion that D5 at the highest dose level (160 ppm) results in an increased incidence of adenocarcinomas. However, it is important to verify any potential effect through a biological investigation.

Asthma in schoolchildren in Monroe county, Florida: school-based needs assessment.

OBJECTIVES: Asthma is the most common chronic pediatric condition (14%) and the leading cause of school absenteeism in the USA. However, little is known about asthma prevalence and distribution in schoolchildren in the Florida Keys region (Monroe County). Thus, the objectives of this study were to assess asthma prevalence, symptoms, cost and distribution in schoolchildren in the Florida Keys region and to pinpoint where asthma management services are most needed. METHODS: Cross-sectional survey data on asthma prevalence, symptoms and socio-demographics was collected and analyzed by race, sex, grade and zip code. A total of 2313 parents of schoolchildren in the Florida Keys completed the adapted Harlem Empowerment Zone Asthma Initiative Questionnaire. The questionnaire was distributed to school principals, who sent them home with students to be filled out by parents or caregivers. We also analyzed data from the online Monroe County 2012 Florida Youth Tobacco Survey, the 2011 Florida CHARTS, the Medical Expenditures Panel Survey, and emergency departments (ED). Data were analyzed by race, sex, and grade. RESULTS: In total 14.5% of respondents had been told their child had asthma and 9.6% reported their child had wheezing in the last 12 months. The prevalence was higher in the Lower Keys and Key West regions. Parents from households where anyone smoked cigarettes (OR 1.52, 95% CI 1.11-2.09) and those who had a male child (1.53, 1.17-2.00) more often reported that their child had asthma. The rate of asthma-related ED visits for Black non-Hispanic schoolchildren (1202 per 100,000) was substantially higher than the numbers for White (250.2 per 100,000) and Hispanic schoolchildren (325.1 per 100,000). Most of the direct cost of asthma was concentrated in children in grades four through seven ($1236.02-$2147.02 per child). CONCLUSIONS: The asthma prevalence in a sample of schoolchildren in the Florida Keys region was comparable to the nationwide prevalence. Black non-Hispanic schoolchildren had more asthma-related ED visits that White and Hispanic schoolchildren. Most of the direct cost of asthma is concentrated in children in late elementary through early middle school grades. Interventions are needed, particularly targeting Black schoolchildren in late elementary through early middle school grades in Lower Keys and Key West region.

Waterpipe tobacco smoking impact on public health: implications for policy.

BACKGROUND: Given the increasing evidence of its negative health effects, including contributions to both infectious and chronic diseases, waterpipe tobacco smoking raises public health concerns beyond even those presented by traditional smoking. METHODS: Identification of Clean Indoor Air Acts (CIAAs) from each of the 50 United States and District of Columbia were retrieved and examined for inclusion of regulatory measures where waterpipe tobacco smoking is concerned. Several instances of exemption to current CIAAs policies were identified. The cumulative policy lens is presented in this study. RESULTS: States vary in their inclusion of explicit wording regarding CIAAs to the point where waterpipe tobacco smoking, unlike traditional smoking products, is excluded from some legislation, thereby limiting authorities' ability to carry out enforcement. CONCLUSION: Consistent, comprehensive, and unambiguous legislative language is necessary to prevent establishments where waterpipe tobacco smoking occurs from skirting legislation and other forms of regulatory control. Stricter laws are needed due to the increasing negative health impact on both the smoker and the bystander. Actions at both the federal and state levels may be needed to control health risks, particularly among youth and young adult populations.

Efficacy of the saponin component of Impatiens capensis Meerb.in preventing urushiol-induced contact dermatitis.

ETHNOPHARMACOLOGICAL RELEVANCE: Many different tribes of American Indians used jewelweed, Impatiens capensis Meerb, as a plant mash to reduce development of poison ivy dermatitis. Saponins are a natural soapy constituent found within plants. A 2012 study suggested that saponins may be present in jewelweed which could be responsible for its efficacy in preventing rash development following contact with Toxicodendron radicans (L.) Kuntze (poison ivy). This study validated this hypothesis and demonstrated additional biological activity of the jewelweed saponin containing extract. MATERIALS AND METHODS: Fresh I. capensis leaves were extracted with methanol and further partitioned between ethyl acetate and water, with a final separation between water and n-butanol, to obtain a saponin containing extract. The presence of saponins in the extract was demonstrated by the observation of foaming and using a vanillin colorimetric assay for total saponins. Efficacy of the saponin containing extracts in rash reduction was tested by brushing poison ivy (PI) onto the forearms of volunteers (N=23) in six locations and treating these PI exposed areas with distilled water (control), saponin containing extracts, fresh plant mashes, and soaps made with and without plant extracts. Saponin containing extracts were further tested for biological activity against both gram negative and gram positive bacteria and against cancer cell lines A-375, HT-29, and MCF-7. Additionally, because saponins have been shown to have a stimulatory effect in cardiac muscle 2 µl saponin extract was applied superficially to black worms, Lumbriculus variegatus (N=5). RESULTS, AND CONCLUSIONS: Both saponin containing extracts and all soaps tested were effective in reducing poison ivy dermatitis; thus, saponin content correlates with PI rash prevention. No apparent antibiosis was observed against any bacteria tested; however, dose response cytotoxicity was documented against MCF-7 breast cancer cells and cytostatic activity was seen against the HT-29 colon cancer cell lines. Lumbriculus variegatus exhibited a 138% increase in heart rate over baseline rate five minutes post treatment implying a possible positive chronotropic effect.

Hookah smoking and harm perception among asthmatic adolescents: findings from the Florida youth tobacco survey.

BACKGROUND: Hookah tobacco smoking has increased in prevalence among Florida adolescents and is often viewed as a safer alternative to cigarette smoking by young adults. Asthmatic adolescents are at increased risk of the negative health effects of hookah smoking. The purpose of this study is to examine if hookah use and harm perception vary by asthma status. METHODS: The Florida Youth Tobacco Survey was conducted in 2012 among 36,578 high school students. Secondary data analysis was conducted to compare the rates of hookah use among asthmatic youth to their nonasthmatic counterparts. Risk perception of hookah use compared to cigarette smoking was also assessed among asthmatic and nonasthmatic adolescents. RESULTS: One in 5 high school students reported lifetime asthma. These asthmatic students have a significantly higher prevalence of hookah smoking and greater perception of hookah use as being less harmful than cigarette smoking, than their nonasthmatic counterparts. Among asthmatics, 12th graders and Hispanic students had the highest prevalence of hookah smoking. CONCLUSION: Common misperceptions of hookah smoking as being less harmful than cigarette smoking are prominent among high school students in Florida and are greater among students with asthma than those students who do not have asthma. Efforts to increase education to dispel the myths surrounding hookah smoking as a safer alternative to cigarette smoking needs to exist at the high school level for both students with and without asthma.

The family experience following bone marrow or blood cell transplantation.

AIM: To explore how families with children at home managed 4-12 months after an adult family member was discharged from the hospital to home following bone marrow or blood cell transplantation. BACKGROUND: Studies of these families have been limited in number. The Family Management Style Framework offers a conceptual framework relevant to families with children who have an adult member who has undergone a bone marrow or blood cell transplant. DESIGN: This was a descriptive, qualitative, one-point-in-time study. METHOD: Content analysis in relation to the three conceptual components of the Family Management Style Framework was employed; inductive thematic analysis determined the emergent conceptual dimensions present in the data. The sample was composed of 29 participants: 15 transplant recipients and 14 significant others who met the study criteria in 2008 and 2009. Each patient and his or her significant other were interviewed; the audio-recorded interviews were analysed after transcription. FINDINGS: The three conceptual components of the Family Management Style Framework: (1) definition of the situation; (2) management behaviours; and (3) perceived consequences, were validated as relevant for this sample across all participants. New conceptual dimensions were also present, inclusive of recovery view, support base, financial picture, management domains, perceived consequences to the whole family, and perceived consequences to the dyad relationships. CONCLUSION: There are several overarching findings in this study, notably that recovery at home is a family experience. Implications for nursing practice include the need for effective transitional care for the patient and family.

Effects of sepsis on neonatal thrombopoiesis.

We serially evaluated the effects of sepsis and/or necrotizing enterocolitis (NEC) on neonatal thrombopoiesis, using a panel of tests that included platelet counts, thrombopoietin concentrations (Tpo), circulating megakaryocyte progenitor concentrations (CMPs), and reticulated platelets (RPs). Variables analyzed included sepsis type, time after onset of sepsis, platelet counts, and gestational (GA) and postconceptional ages (PCA). Twenty neonates were enrolled. Ten had Gram-negative, six had Gram-positive, and four had presumed sepsis. Four neonates had NEC stage II or higher, and six developed thrombocytopenia. Overall, septic neonates had significantly elevated Tpo concentrations and circulating megakaryocyte progenitors. The highest Tpo levels were associated with Gram-negative or presumed sepsis. RP percentages were increased only in neonates with low platelet counts, while RP counts (RP% x platelet count) were elevated in neonates with high platelet counts. Our findings suggest that septic neonates up-regulate Tpo production, leading to increased megakaryocytopoiesis and platelet release, although the degree of upregulation is moderate. The changes in RP% and RP count most likely reflect increased thrombopoiesis with variable degrees of platelet consumption. In addition, our findings suggest that different factors, likely including level of illness and/or specific platelet or bacterial products, can down-regulate the magnitude of the thrombopoietic response.