Access to legacy-oriented interventions at end of life for pediatric oncology patients: A decedent cohort review.

BACKGROUND: Legacy-oriented interventions have the potential to offer pediatric oncology patients and families comfort at end of life and during bereavement. Certified child life specialists often provide these services, and presently little is known about whether disparities exist in the provision of legacy-oriented interventions. METHODS: In this retrospective decedent cohort study, we examined demographic and clinical characteristics from a sample of 678 pediatric oncology patients who died between 2015 and 2019. Bivariate analysis assessed differences between patients who received any versus no legacy-oriented intervention. Uni- and multivariable logistic regression models assessed associations of baseline characteristics and likelihood of receiving legacy-oriented intervention. Further multivariable analysis explored joint effects of significant variables identified in the univariable analysis. RESULTS: Fifty-two percent of patients received a legacy-oriented intervention. Older adolescents (≥13 years) were less likely (odds ratio [OR]: 1.73, p = .007) to receive legacy-oriented interventions than younger ones. Patients with home/hospice deaths were also less likely (OR: 19.98, p < .001) to receive interventions compared to patients who passed away at SJCRH locations. Hispanic patients (OR: 1.53, p = .038) and those in palliative care (OR: 10.51, p < .001) were more likely to receive interventions. No significant race association was noted. CONCLUSION: All children and adolescents with cancer deserve quality care at end of life, including access to legacy-oriented interventions, yet nearly half of patients in this cohort did not receive these services. By identifying demographic and clinical characteristics associated with decreased odds of receiving legacy-oriented interventions, healthcare professionals can modify end-of-life care processes to improve access. Introducing legacy-oriented interventions early and increasing exposure in community spaces may enhance access to legacy-oriented interventions for pediatric oncology patients.

Intolerance of uncertainty and psychological flexibility as predictors of mental health from adolescence to old age.

PURPOSE: The COVID-19 pandemic brought with it significant social, economic and health uncertainties. These were proposed to impact young people more compared to adults, leading adolescents to report more mental health problems during the pandemic. The current study examined whether differences in cognitive risk (tolerance of uncertainty) and protective (psychological flexibility) factors accounted for age-related differences in depression and anxiety. METHODS: These associations were investigated in the COVID-19 Risks Across the Lifespan (CORAL) cohort (N = 2280, 11-89 years). RESULTS: The results showed that adolescents experienced greater intolerance of uncertainty and lower psychological flexibility compared to adults and older adults. Tolerance of uncertainty did not account for age-related differences in depression or anxiety. However, psychological flexibility conferred more protective advantage for anxiety in adults compared to adolescents. CONCLUSION: The observed age-related differences in risk and protective factors advance our understanding of developmental vulnerabilities to depression and anxiety. Implications for mental health interventions in the context of future pandemics are discussed.

Current and emerging 3D visualization technologies in radiology.

As the field of three-dimensional (3D) visualization rapidly advances, how healthcare professionals perceive and interact with real and virtual objects becomes increasingly complex. Lack of clear vocabulary to navigate the changing landscape of 3D visualization hinders clinical and scientific advancement, particularly within the field of radiology. In this article, we provide foundational definitions and illustrative examples for 3D visualization in clinical care, with a focus on the pediatric patient population. We also describe how understanding 3D visualization tools enables better alignment of hardware and software products with intended use-cases, thereby maximizing impact for patients, families, and healthcare professionals.

Improving trends estimates for specific work-related ill-health conditions when excess zeros are present in a voluntary health reporting scheme.

BACKGROUND: Trends in occupational disease incidence are estimated in voluntary reporting schemes such as The Health and Occupational Reporting (THOR) Network in the UK. Voluntary reporting schemes request responses even if no cases are observed to reduce uncertainty in non-response. This may result in false zeros that bias trends estimates. Analysis using zero-inflated models is unsuitable for specific health outcomes due to overestimates of the excess zeros. Here, we attempt to account for excess zeros while investigating condition-specific trends. METHODS: Zero-inflated negative binomial (ZINB) models were fitted to three THOR work-related ill health surveillance schemes Occupational Skin Disease Surveillance (437 reporters between 1996 and 2019), Occupational Physicians Reporting Activity (1094 between 1996 and 2019) and Surveillance of Work-Related and Occupational Respiratory Disease (878 between 1999 and 2019). The probability associated with a response being a false zero was estimated and applied in weighted negative binomial (wgt-NB) models fitted to specific ill-heath conditions. Three ill-health conditions from the three THOR schemes were considered; contact dermatitis, musculoskeletal and asthma, respectively. RESULTS: Wgt-NB models approximately estimated the incidence rate ratios reported by the ZINB models (eg, EPIDERM; ZINB=0.969, NB=0.963, wgt-NB=0.968) for all health outcome annual trends. This was consistent for specific health outcomes which also tended towards the null (eg, contact dermatitis; NB=0.964, wgt-NB=0.969), indicating potentially overestimated downward trends. Though as the ratio of excess zeros to true zeros decreased in rarer health outcomes, the influence on trends also decreased. CONCLUSIONS: Through weighting, we were able to adjust for excess zeros in health outcome-specific trends estimates. Though uncertainty is still present in underlying reporter behaviour meaning caution should be applied with interpretation of any results.

Surgeon preference for treatment allocation in older people facing major gastrointestinal surgery: an application of the discrete choice experiment methodology.

AIM: Variation in major gastrointestinal surgery rates in the older population suggests heterogeneity in surgical management. A higher prevalence of comorbidities, frailty and cognitive impairments in the older population may account for some variation. The aim of this study was to determine surgeon preference for major surgery versus conservative management in hypothetical patient scenarios based on key attributes. METHOD: A survey was designed according to the discrete choice methodology guided by a separate qualitative study. Questions were designed to test for associations between key attributes (age, comorbidity, urgency of presentation, pathology, functional and cognitive status) and treatment preference for major gastrointestinal surgery versus conservative management. The survey consisting of 18 hypothetical scenarios was disseminated electronically to UK gastrointestinal surgeons. Binomial logistic regression was used to identify associations between the attributes and treatment preference. RESULTS: In total, 103 responses were received after 256 visits to the questionnaire site (response rate 40.2%). Participants answered 1847 out of the 1854 scenarios (99.6%). There was a preference for major surgery in 1112/1847 (60.2%) of all scenarios. Severe comorbidities (OR 0.001, 95% CI 0.000-0.030; P = 0.000), severe cognitive impairment (OR 0.001, 95% CI 0.000-0.033; P = 0.000) and age 85 years and above (OR 0.028, 95% CI 0.005-0.168; P = 0.000) were all significant in the decision not to offer major gastrointestinal surgery. CONCLUSION: This study has demonstrated variation in surgical treatment preference according to key attributes in hypothetical scenarios. The development of fitness-stratified guidelines may help to reduce variation in surgical practice in the older population.

Social media interactions after diagnosis: Social experiences of adolescents and young adults (AYA) with cancer.

PURPOSE: Cancer disrupts the social lives of adolescents and young adults (AYA). Social media may be a resource to engage with social networks, seek entertainment, and receive social support. However, some aspects of social media engagement may be emotionally burdensome and sensitive for AYA to navigate. The aim of this qualitative study was to contextualize the impact of cancer on AYA social media interaction. METHODS: Eight AYA ages 15-21 years and recently diagnosed with cancer participated in a semi-structured interview. AYA were asked about their social media interactions, engagement habits, and online cancer-related disclosure. Interviews averaged 36 min in length and were de-identified and transcribed verbatim and analyzed using thematic analysis. RESULTS: Four salient themes emerged from the data: (1) AYA engage in active and passive social media use depending on the platform, (2) AYA social media habits change due to treatment experiences, (3) AYA evaluate and protect their self-image, privacy, and time, and (4) AYA access social support online and interpret its meaning in different ways. AYA reported using social media, but many altered their frequency and type of interaction after diagnosis. Some were comfortable sharing about cancer and continued to interact actively online; others felt protective and vulnerable, transitioning to media consumption, or withdrawing from use. While social media provided space to receive direct and indirect social support, AYA interpreted the meaning of support in complex ways. CONCLUSIONS: Social media may serve a variety of socio-emotional needs, but not all AYA will benefit from the same types of social media interaction. This study highlights the importance of talking to AYA with cancer about their social media interactions during treatment to better support their coping and adjustment.

Spaced training enhances equine learning performance.

This field experiment examined whether the well-documented benefit of spaced over massed training for humans and other animals generalizes to horses. Twenty-nine randomly selected horses (Equus ferus caballus) repeatedly encountered a novel obstacle-crossing task while under saddle. Horses were randomly assigned to the spaced-training condition (2 min work, 2 min rest, 2 min work, 2 min rest) or the massed-training condition (4 min work, 4 min rest). Total training time per session and total rest per session were held constant. Days between sessions (M = 3) were held as consistent as possible given the constraints of conducting research on a working ranch and safety-threatening weather conditions. During each training session, the same hypothesis-naïve rider shaped horses to cross a novel obstacle. Fifteen of 16 horses in the spaced-training condition reached performance criterion (94% success) while only 5 of 13 horses in the massed-training condition reached performance criterion (39% success). Horses in the spaced-training condition also initiated their first obstacle-crossing faster than horses in the massed-training condition and were faster at completing eight crossings than horses in the massed-training condition. Overall, task acquisition was higher for horses undergoing spaced training despite both groups experiencing the same total work and rest time per session. These findings generalize the learning-performance benefit observed in human spaced practice to horses and offer applied benefit to equine training.

Healthcare professional preferences in the health and fitness assessment and optimization of older patients facing colorectal cancer surgery.

AIM: There are few age- and fitness-specific, evidence-based guidelines for colorectal cancer surgery. The uptake of different assessment and optimization strategies is variable. The aim of this study was to explore healthcare professional opinion about these issues using a mixed methods design. METHODS: Semi-structured qualitative interviews were undertaken with healthcare professionals from a single UK region involved in the treatment, assessment and optimization of colorectal surgery patients. Interviews were analysed using the framework approach. An online questionnaire survey was subsequently designed and disseminated to UK surgeons to quantitatively assess the importance of interview themes. Descriptive statistics were used to analyse questionnaire data. RESULTS: Thirty-seven healthcare professionals out of 42 approached (response rate 88%) were interviewed across five hospitals in the south Yorkshire region. Three broad themes were developed: attitudes towards treatment of the older patient, methods of assessment of suitability and optimization strategies. The questionnaire was completed by 103 out of an estimated 256 surgeons (estimated response rate 40.2%). There was a difference in opinion regarding the role of major surgery in older patients, particularly when there is coexisting dementia. Assessment was not standardized. Access to optimization strategies was limited, particularly in the emergency setting. CONCLUSION: There is wide variation in the process of assessment and provision of optimization strategies in UK practice. Lack of evidence-based guidelines, cost and time constraints restrict the development of services and pathways. Differences in opinion between surgeons towards patients with frailty or dementia may account for some of the variation in colorectal cancer outcomes.

Protocol for a multi-centre observational and mixed methods pilot study to identify factors predictive of poor functional recovery after major gastrointestinal surgery and strategies to enhance uptake of perioperative optimization: Optimizing the care and treatment pathways for older patients facing major gastrointestinal surgery (OCTAGON).

INTRODUCTION: National datasets report large variations in outcomes from older people (≥65 years) between different UK surgical units. This implies that not all patients receive the same level of care or access to resources, such as rehabilitation or allied health professional input. This might impact functional decline. AIMS: Our aim is to evaluate the baseline status of older patients facing major gastrointestinal surgery and the impact of variation in perioperative assessment and provision of perioperative support on functional outcomes. Patients' experiences and views of assessment and optimization will be explored via integrated qualitative semi-structured interviews. METHODS AND ANALYSIS: This multi-centre, pilot cohort study will include patients ≥65 years presenting via both elective and emergency pathways at three to five South Yorkshire NHS hospitals (Clinical Trials registration NCT04545125). The primary outcome is functional recovery measured using the World Health Organization Disability Assessment Schedule 2.0 at 6 weeks post-operation. Secondary outcomes include feasibility, quality of life, length of stay and complication rate. An opportunistic sample size of 120 has been estimated and will inform the design of a future, adequately powered study. For the qualitative study, 20-30 semi-structured patient interviews will be undertaken with patients from the cohort study to explore experiences of assessment and optimization. Interviews will be digitally recorded, transcribed verbatim and analysed according to the framework approach. ETHICS AND DISSEMINATION: This study has been approved by the National Health Service Research Ethics Committee and is registered centrally with Health Research Authority. It has been adopted by the National Institute for Health Research Portfolio scheme. Dissemination will be via international and national surgical and geriatric conferences.

Risk factors associated with respiratory infectious disease-related presenteeism: a rapid review.

BACKGROUND: Workplace transmission is a significant contributor to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks. Previous studies have found that infectious illness presenteeism could contribute to outbreaks in occupational settings and identified multiple occupational and organisational risk factors. Amid the COVID-19 pandemic, it is imperative to investigate presenteeism particularly in relation to respiratory infectious disease (RID). Hence, this rapid review aims to determine the prevalence of RID-related presenteeism, including COVID-19, and examines the reported reasons and associated risk factors. METHODS: The review followed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search approach and focused on studies published in English and Chinese. Database searches included MEDLINE, EMBASE, Web of Science, China Knowledge Resource Integrated Database (CNKI) and preprint databases MedRxiv and BioRxiv. RESULTS: The search yielded 54 studies, of which four investigated COVID-19-related presenteeism. Prevalence of work presenteeism ranged from 14.1 to 55% for confirmed RID, and 6.6 to 100% for those working with suspected or subclinical RID. The included studies demonstrated that RID-related presenteeism is associated with occupation, sick pay policy, age, gender, health behaviour and perception, vaccination, peer pressure and organisational factors such as presenteeism culture. CONCLUSIONS: This review demonstrates that presenteeism or non-adherence to isolation guidance is a real concern and can contribute to workplace transmissions and outbreaks. Policies which would support workers financially and improve productivity, should include a range of effective non-pharmaceutical inventions such as workplace testing, promoting occupational health services, reviewing pay and bonus schemes and clear messaging to encourage workers to stay at home when ill. Future research should focus on the more vulnerable and precarious occupational groups, and their inter-relationships, to develop comprehensive intervention programs to reduce RID-related presenteeism.

Current evidence for the effectiveness of psychosocial interventions for children undergoing medical procedures.

BACKGROUND: Because more than three million children are hospitalized every year in the United States, psychosocial and emotional impacts of hospitalization on children cannot be overlooked. As such, a variety of psychosocial support services are offered in pediatric facilities to reduce the negative effects often associated with hospitalization. This review examines current evidence for the effectiveness of common psychosocial interventions for children and youth undergoing medical procedures. METHODS: A total of 34 studies that met selection guidelines, as outlined in Section 2, were included and coded based on study characteristics, intervention type, and study outcomes. RESULTS: Findings from this literature review indicate that most studies examining the efficacy of psychosocial interventions reported at least positive outcomes for children. Although the review highlighted an overall pattern for improved outcomes following psychosocial intervention, there were some differences in outcomes based on type of intervention. In general, procedural support, preparation, and coping strategies were associated with reduced child anxiety/fear and distress. Procedural support was commonly associated with reduced pain, although many types of interventions demonstrated reduction in child pain. Procedural support was associated with improved procedural success. CONCLUSIONS: This systematic review illustrates the benefits of offering psychosocial interventions, such as procedural support, preparation, teaching coping strategies, and medical play, that support children undergoing medical procedures. There is a need for additional studies that examine psychosocial interventions, including studies that examine long-term outcomes post-procedure or hospitalization. Furthermore, more studies need to collect cost-analysis information specific to the use of psychosocial interventions.

Behavioral flexibility of a generalist carnivore.

Innovative problem solving, repeated innovation, learning, and inhibitory control are cognitive abilities commonly regarded as important components of behaviorally flexible species. Animals exhibiting these cognitive abilities may be more likely to adapt to the unique demands of living in novel and rapidly changing environments, such as urbanized landscapes. Raccoons (Procyon lotor) are an abundant, generalist species frequently found in urban habitats, and are capable of innovative problem solving, which makes them an ideal species to assess their behavioral flexibility. We gave 20 captive raccoons a multi-access puzzle box to investigate which behavioral and cognitive mechanisms enable the generation of innovative and flexible behaviors in this species. Over two-thirds of raccoons tested were not only capable of innovative problem solving, but displayed repeated innovation by solving more than one solution on the multi-access puzzle box and demonstrated that they learned multiple solutions to a novel problem. Although we found no relationship between our measure of inhibitory control and a raccoon's ability to exhibit repeated innovations, we did find a positive relationship between the diversity of behaviors that an individual exhibited when interacting with the problem and the number of solution types that they solved. We identified other predictors of problem-solving performance, including neophobia and persistence. Finally, we examine the implications of our results in the context of the cognitive-buffer hypothesis and consider whether the widespread success of an adaptive generalist carnivore could be due in part to having these cognitive and behavioral traits.

The Effects of Low-Intensity Therapeutic Ultrasound on Measurable Outcomes: A Critically Appraised Topic.

Clinical Scenario: Therapeutic ultrasound (US) is a popular modality among health care professionals and is used to treat a variety of musculoskeletal conditions. A new technology has been established to allow for the miniaturization of the US unit. Patients receive treatment with the device secured to them, eliminating the portability constraint of traditional US units. Early studies suggest that this portable unit can deliver low-intensity acoustic energy achieving the same temperature increase and pain relief that come from traditional US units, in a more versatile and patient-friendly manner. CLINICAL QUESTION: What effects does low-intensity therapeutic ultrasound (LITUS) have on measurable outcomes? Summary of Key Findings: The literature was searched for level 4 evidence or higher that investigated the effectiveness of LITUS. The literature search produced 3 possible studies related to the clinical question: 2 randomized controlled trials and 1 case series met the inclusion and exclusion criteria. Of the included studies, 1 study investigated the effects of LITUS on tissue temperature, 2 studies investigated the effects of LITUS on pain, and 1 study investigated LITUS effects on function. Clinical Bottom Line: The evidence supports the use of the LITUS unit to increase tissue temperature, decrease pain, and increase function. Therefore, practitioners may consider the use of the LITUS unit in patient populations over the use of the traditional high-intensity US treatment. Strength of Recommendation: In accordance with the 2009 Centre for Evidence-Based Medicine levels of evidence, there is grade I (insufficient) evidence to support the positive effects of the LITUS device for improving the following clinical outcomes: tissue temperature, decreasing pain, and increasing function. The inconsistency in the measured outcomes across the 3 studies only allows for minimal support of the LITUS device, warranting further research. Although clinical outcomes were different in each study, consistent evidence ranging from 4 to 1B levels were found in the 3 included studies.

Readmissions after general surgery: a prospective multicenter audit.

BACKGROUND: Readmission rates after surgical procedures are viewed as a marker of quality of care and as a driver to improve outcomes in the United Kingdom, they are not remunerated. However, readmissions are not wholly avoidable. The aim of this study was to develop a regional overview of readmissions to determine the proportion that might be avoidable and to examine predictors of readmissions at a unit level. METHODS: We undertook a prospective multicenter audit of readmissions following National Health Service funded general surgical procedures in five National Health Service hospitals and three independent sector providers over a 2-wk period. Basic demographic and procedure data were captured. Readmissions to hospitals were identified through acute admissions lists. Reason for readmission was identified, and the readmission data assessed by a senior surgical doctor as to whether it was avoidable. RESULTS: We identified 752 operations in the study period with all followed up to 30 d. The overall rate of readmissions was 4.7%, with 40% of these judged as being potentially avoidable. Pain and wound problems accounted for the vast majority of avoidable readmissions. The number of unavoidable readmissions was correlated with the workload of each center (r = 0.63, P = 0.06) and as with the higher (British United Provident Association) complexity of surgery (r = 0.90, P = 0.01). Patient and demographic factors were not associated with readmissions. CONCLUSIONS: This prospective audit describes readmission rates after general surgery. Volume and complexity of work are associated with readmission rates. A large proportion of readmissions could be reduced by attention to analgesia and outpatient arrangements for wound management.

Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis.

BACKGROUND: Ischaemic colitis is an infrequent but serious complication following repair of abdominal aortic aneurysm (AAA), with high mortality rates. This systematic review set out to identify risk factors for the development of ischaemic colitis after AAA surgery. METHODS: A systematic search of the MEDLINE, EMBASE and CINAHL databases was performed. This search was limited to studies published in the English language after 1990. Abstracts were screened by two authors. Eligible studies were obtained as full text for further examination. Data was extracted by two authors, and any disputes were resolved via consensus. Extracted data was pooled using Mantel-Haenszel random effects models. Bias was assessed using two Cochrane-approved tools. Effect sizes are expressed as relative risk ratios alongside the 95 % confidence interval. Statistical significance was defined at the level of p < 0.05. RESULTS: From 388 studies identified in the initial search, 33 articles were included in the final synthesis and analysis. Risk factors were grouped into patient (female gender, disease severity) and operative factors (peri-procedural hypotension, operative modality). The risk of ischaemic colitis was significantly higher when undergoing emergency repair versus elective (risk ratio (RR) 7.36, 3.08 to 17.58, p < 0.001). Endovascular repair reduced the likelihood of ischaemic colitis (RR 0.22, 0.12 to 0.39, p < 0.001). DISCUSSION: The quality of published evidence on this subject is poor with many retrospective datasets and inconsistent reporting across studies. Despite this, emergency presentation and open repair should prompt close monitoring for the development of IC.

Activation of virus uptake through induction of macropinocytosis with a novel polymerizing peptide.

A 27-aa peptide (P27) was previously shown to decrease the accumulation of human immunodeficiency virus type 1 (HIV-1) in the supernatant of chronically infected cells; however, the mechanism was not understood. Here, we show that P27 prevents virus accumulation by inducing macropinocytosis (MPC). Treatment of HIV-1- and human T-cell lymphotropic virus type 1 (HTLV-1)-infected cells with 2-10 µM P27 caused cell membrane ruffling and uptake of virus and polymerized forms of the peptide into large vacuoles. As demonstrated by electron microscopy, activation of MPC did not require virus or cells infected with virus, as P27 initiated its own uptake in the absence of virus. Inhibitors of MPC, Cytochalasin D and amiloride, decreased P27-mediated uptake of soluble dextran and inhibited P27-induced virus uptake by >60%, which provides further evidence that P27 induces MPC. In CD4(+) HeLa cells, HIV-1 infection was enhanced by P27 up to 4-fold, and P27 increased infection at concentrations as low as 20 nM. The 5-aa C-terminal domain of P27 was necessary for virus uptake and may be responsible for the polymerization of P27 into fibrils. These forms of P27 may play a key role in triggering MPC, making this peptide a useful tool for studying virus uptake and infection, as well as MPC of other macromolecules.

Convenience, food and family lives. A socio-typological study of household food expenditures in 21st-century Belgium.

This article aims to uncover the extent to which convenience foods have become embedded in today's diets. The paper focuses on households' food expenditures, collected by Statistics Belgium in 2005. The results show that households' reliance on (semi-) convenience food items and away-from-home consumption clearly differs over the life-course and amongst different social groups. Findings show that single-living households (single men in particular) look for more convenience in their food preparation patterns compared to couples and households with children. The consumption of semi-convenient meal components seems to be more closely related to the conventional definition of home-cooking, with older-generation, lower-educated, non-working and 'traditional' nuclear households being more likely to spend a larger share of their food budget on non-convenient and 'shortcut' ingredients.

Convenience on the menu? A typological conceptualization of family food expenditures and food-related time patterns.

One of the most fundamental, but also controversial, food trends of the past years is convenience food. This article investigates the underexplored relationship between the heterogeneity in (convenience) food consumption (a feature of a food culture's cuisine) and meal patterns (characteristics of a food culture's structure). This study hopes to illustrate that convenience food can be interpreted both as a means to maintain a food culture's structure and as a means to overturn it. Latent Class Cluster Analysis is performed using data from the HBS 2005 survey on families' food expenditures to conceptualize convenience-orientation and to examine the relationships with families' meal behaviors. Whereas outsourcing cooking is most prevalent among single-person households; two-or more-person households are most likely to buy unprocessed and natural foods and to spend most time cooking and eating in. A higher consumption of convenience food is also more likely to affect individuals' kitchen than table habits.