Differential effects of an electronic symptom monitoring intervention based on the age of patients with advanced cancer.

BACKGROUND: Symptom monitoring interventions enhance patient outcomes, including quality of life (QoL), health care utilization, and survival, but it remains unclear whether older and younger patients with cancer derive similar benefits. We explored whether age moderates the improved outcomes seen with an outpatient electronic symptom monitoring intervention. PATIENTS AND METHODS: We carried out a secondary analysis of data from a randomized trial of 766 patients receiving chemotherapy for metastatic solid tumors. Patients received an electronic symptom monitoring intervention integrated with oncology care or usual oncology care alone. The intervention consisted of patients reporting their symptoms, which were provided to their physicians at clinic visits, and nurses receiving alerts for severe/worsening symptoms. We used regression models to determine whether age (older or younger than 70 years) moderated the effects of the intervention on QoL (EuroQol EQ-5D), emergency room (ER) visits, hospitalizations, and survival outcomes. RESULTS: Enrollment rates for younger (589/777 = 75.8%) and older (177/230 = 77.0%) patients did not differ. Older patients (median age = 75 years, range 70-91 years) were more likely to have an education level of high school or less (26.6% versus 20.9%, P = 0.029) and to be computer inexperienced (50.3% versus 23.4%, P < 0.001) compared with younger patients (median age = 58 years, range 26-69 years). Younger patients receiving the symptom monitoring intervention experienced lower risk of ER visits [hazard ratio (HR) = 0.74, P = 0.011] and improved survival (HR = 0.76, P = 0.011) compared with younger patients receiving usual care. However, older patients did not experience significantly lower risk of ER visits (HR = 0.90, P = 0.613) or improved survival (HR = 1.06, P = 0.753) with the intervention. We found no moderation effects based on age for QoL and risk of hospitalizations. CONCLUSIONS: Among patients with advanced cancer, age moderated the effects of an electronic symptom monitoring intervention on the risk of ER visits and survival, but not QoL. Symptom monitoring interventions may need to be tailored to the unique needs of older adults with cancer.

Pilot randomized trial of an electronic symptom monitoring intervention for hospitalized patients with cancer.

BACKGROUND: Hospitalized patients with cancer experience a high symptom burden, which is associated with poor health outcomes and increased health care utilization. However, studies investigating symptom monitoring interventions in this population are lacking. We conducted a pilot randomized trial to assess the feasibility and preliminary efficacy of a symptom monitoring intervention to improve symptom management in hospitalized patients with advanced cancer. PATIENTS AND METHODS: We randomly assigned patients with advanced cancer who were admitted to the inpatient oncology service to a symptom monitoring intervention or usual care. Patients in both arms self-reported their symptoms daily (Edmonton Symptom Assessment System and Patient Health Questionnaire-4). Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily team rounds. The primary end point of the study was feasibility. We defined the intervention as feasible if >75% of participants hospitalized >2 days completed >2 symptom reports. We observed daily rounds to determine whether clinicians discussed and developed a plan to address patients' symptoms. We used regression models to assess intervention effects on patients' symptoms throughout their hospitalization, readmission risk, and hospital length of stay (LOS). RESULTS: Among 150 enrolled patients (81.1% enrollment), 94.2% completed >2 symptom reports. Clinicians discussed 60.4% of the symptom reports and developed a plan to address the symptoms highlighted by the symptom reports 20.8% of the time. Compared with usual care, intervention patients had a greater proportion of days with lower psychological distress (B = 0.12, P = 0.008), but no significant difference in the proportion of days with improved Edmonton Symptom Assessment System-physical symptoms (B = 0.07, P = 0.138). Intervention patients had lower readmission risk (hazard ratio = 0.68, P = 0.224), although this difference was not significant. We found no significant intervention effects on hospital LOS (B = 0.16, P = 0.862). CONCLUSIONS: This symptom monitoring intervention is feasible and demonstrates encouraging preliminary efficacy for improving patients' symptoms and readmission risk.ClinicalTrials.gov identifier NCT02891993.

Factors associated with depression and anxiety symptoms in family caregivers of patients with incurable cancer.

BACKGROUND: Family caregivers (FCs) are critically important for patients with cancer, yet they may experience psychological distress related to caregiving demands. We sought to describe rates of depression and anxiety in FCs of patients with incurable cancer and identify factors associated with these symptoms to determine those at greatest risk for psychological distress. PATIENTS AND METHODS: We performed a cross-sectional analysis of baseline data from a randomized trial of early palliative care. We assessed depression and anxiety using the Hospital Anxiety and Depression Scale in patients within 8 weeks of diagnosis of incurable lung or gastrointestinal cancer and their FCs. We also assessed patients' quality of life (Functional Assessment of Cancer Therapy-General), coping strategies (Brief COPE), and their report of the primary goal of their cancer treatment. We used linear regression with purposeful selection of covariates to identify factors associated with FC depression and anxiety symptoms. RESULTS: We enrolled 78.6% (n = 275) of potentially eligible FCs. The majority were female (69.1%) and married to the patient (66.2%). While the proportion of FCs and patients reporting depression did not differ (16.4% versus 21.5%, P = 0.13), FCs were more likely to report anxiety compared with patients (42.2% versus 28.4%, P < 0.001). Patients' use of acceptance coping was associated with lower FC depression (B = -0.42, P < 0.001), while emotional support coping was associated with higher FC depression (B = 0.69, P = 0.001) and lower FC anxiety (B = -0.70, P < 0.001). Patient report that their primary goal of their treatment was to 'cure my cancer' was associated with higher FC depression (B = 0.72, P = 0.03). CONCLUSIONS: Patients with incurable cancer and their FCs report high levels of depression and anxiety symptoms. We demonstrated that patients' coping strategies and prognostic understanding were associated with FC depression and anxiety symptoms, underscoring the importance of targeting these risk factors when seeking to address the psychological distress experienced by FCs.

Prognostic understanding, quality of life and mood in patients undergoing hematopoietic stem cell transplantation.

Little is known about how patients undergoing hematopoietic stem cell transplantation (HCT) and their family caregivers (FC) perceive their prognosis. We examined prognostic understanding in patients undergoing HCT and their FC and its relationship with quality of life (QOL) and mood. We conducted a longitudinal study of patients (and FC) hospitalized for HCT. We used a questionnaire to measure participants' prognostic understanding and asked the oncologists to estimate patients' prognosis prior to HCT. We assessed QOL and mood weekly and evaluated the relationship between prognostic understanding, and QOL and mood using multivariable linear mixed models. We enrolled 90 patients undergoing (autologous (n=30), myeloablative (n=30) or reduced intensity allogeneic (n=30)) HCT. About 88.9% of patients and 87.1% of FC reported it is 'extremely' or 'very' important to know about prognosis. However, 77.6% of patients and 71.7% of FC reported a discordance and more optimistic prognostic perception compared to the oncologist (P<0.0001). Patients with a concordant prognostic understanding with their oncologists reported worse QOL (ß=-9.4, P=0.01) and greater depression at baseline (ß=1.7, P=0.02) and over time ((ß=1.2, P<0.0001). Therefore, Interventions are needed to improve prognostic understanding, while providing patients with adequate psychological support.

Type 2 diabetes mellitus in children.

OBJECTIVE: To provide an overview of type 2 diabetes in children and discuss short-term and long-term management strategies. METHODS: We review the distinction among various types of diabetes mellitus as they apply to children. In addition, we discuss determining the precise diagnosis between the two major variants--type 1 and type 2 diabetes--and clinical management of type 2 diabetes in children. RESULTS: A dramatic increase in the incidence of type 2 diabetes in children has been noted, which is commensurate with an overall increase in obesity. In Arizona, this trend has been similar to that reported in Ohio and Arkansas. Glucose toxicity of the pancreas, which occurs with chronic hyperglycemia and impairs insulin secretion, may lead to manifestation of florid diabetic ketoacidosis and requires insulin therapy at diagnosis. For successful long-term management of type 2 diabetes in a child, a program that includes weight reduction must be implemented. CONCLUSION: Obesity-related diabetes is increasing at an alarming rate in children. Physicians responsible for the care for pediatric patients should be aware of this trend and should become familiar with management strategies for type 2 diabetes.

1/f noise in etched groove surface acoustic wave (SAW) resonators.

Measurements of 1/f (or flicker) frequency fluctuations in SAW resonators fabricated with etched groove reflectors on single crystal quartz have shown that the observed noise levels vary inversely with device size. These measurements were made on sixteen 450 MHz resonators of four different sizes. The 1/f noise levels were also evaluated on twenty-eight other SAW resonators ranging in frequency from 401 to 915 MHz. This additional data provides valuable information on the dependence of the flicker noise levels on resonator frequency. A model based an localized, independent velocity fluctuations in the quartz is proposed which correctly fits the observed size and frequency dependence of the measured 1/f noise levels. This model suggests that the velocity fluctuations originate in small regions (much less than ~5 mum in diameter) randomly distributed throughout the quartz with an average separation of about 5 mum between independent (incoherent) sources. The magnitude of the localized fractional velocity fluctuations, Deltav/v, averaged over a 5 micron cube is on the order of 1x10 (-9).

Extremely low-phase-noise SAW resonators and oscillators: design and performance.

The authors describe prototype low-noise SAW (surface acoustic wave) resonator oscillators which have demonstrated state-of-the-art phase-noise performance not only at their fundamental operating frequencies in the 400- to 600-MHz range but also after 16x frequency multiplication to X-band as well. SAW resonator designs with overmoded cavities, very wide apertures, and dual apertures, as well as modified fabrication techniques, have been used to realize an overall reduction in an oscillator's phase-noise spectrum, i.e. white phiM, flicker FM, and random-walk FM. The S resonators can typically handle incident RF power in excess of +20 dBm, a key requirement to achieving an extremely low oscillator-phase-noise floor. A novel burn-in procedure at relatively high incident-RF-power levels (>27 dBm) was used to reduce both the flicker FM and random-walk FM phase-noise levels. Using these various techniques, a 5- to 15-dB improvement in the overall phase-noise spectrum for several prototype oscillators was demonstrated.

Topical application of garlic reduces northern fowl mite infestation in laying hens.

Northern fowl mites (NFM) are external parasites that can lower egg production and cause anemia and even death in laying hens. An experiment was conducted with New Hampshire Red and Single Comb White Leghorn laying hens. Hens were individually caged and provided a complete laying diet and water ad libitum. Hens were assigned to groups in a way that assured that treatments, within each breed, would be applied to comparable numbers of birds with light and heavy mite infestations. Each hen was sprayed around the vent with either water or 10% garlic juice in water. Spraying continued each week for 3 wk. During the fourth week, each bird was scored for the presence of NFM on its skin and feathers. A small snippet of feathers was removed from below the vent of each hen and placed in a labeled petri dish with a round, white filter paper insert. The NFM content of each dish was scored by two individuals approximately 1 h after sampling. There was no significant difference in the NFM scores for hens based on breed or future treatment. After the birds were treated for 3 wk, there was no significant difference in external NFM scores based on breed. There were significantly fewer NFM on the birds treated with garlic juice compared with controls, based on external and petri dish scoring (P < 0.002 and P < 0.04, respectively). The reduction in external NFM score was also significant (P < 0.004), with controls declining approximately 0.2 units, whereas garlic-treated hens had a 1.8-unit decrease in external NFM score. Topical application of garlic juice may be an effective way to decrease NFM in laying hens.

Gardner's syndrome and chondrosarcoma of the hyoid bone.

There appears to be a total of five cases of chondrosarcoma of the hyoid bone (not all associated with Gardner's syndrome). The case reported herein is one that was first reported in the literature on Gardner's syndrome and the second reported instance of a patient with Gardner's syndrome who had a malignant bone tumor.

Neoplasms of the temporal bone.

A series of 209 patients with chemodectomas and malignant neoplasms of the external auditory canal and middle ear seen during a 20-year period at the Mayo Clinic was reviewed. Ninety-nine patients had chemodectomas, and 110 had malignant lesions; 57 of the 110 patients with malignancies had squamous cell carcinoma. The study revealed that patients with chemodectomas had a normal expected length of survival, whereas patients with malignant lesions (especially those with squamous cell carcinomas and embryonal rhabdomyosarcomas) did poorly.

Testicular touch preparation cytology.

PURPOSE: The applications, technique and limitations of testicular touch preparation cytology in evaluation of the infertile man are described. MATERIALS AND METHODS: The technique and histological results of testicular touch preparation cytology for normal specimens and various pathological conditions of male infertility are described in detail. RESULTS: Testicular touch preparation cytology is able to differentiate between late spermatids and mature spermatozoa, as well as to identify other spermatogenic elements. CONCLUSIONS: Touch preparation cytology has 2 important purposes: 1) distinguishing between maturation arrest at the late spermatid stage and normal spermatogenesis, and 2) determining whether obstruction is the cause of azoospermia. While testis biopsy is the gold standard, touch preparation cytology is an extremely important adjunct because of its ability to define whole sperm. The urologist and pathologist are better able to make a diagnosis when routine biopsy and touch preparation cytology are performed.

Comparison of the mechanical properties of Simplex P, Zimmer Regular, and LVC bone cements.

The mechanical properties of the three cement preparations most widely used in the United States were compared by conducting tensile and fatigue tests on Simplex P, LVC, and Zimmer Regular bone cements. Specimens of all three cement preparations were prepared for mechanical testing with and without centrifugation of the cement immediately after mixing. Although the results of the tensile testing revealed a few specific instances of significant differences in the tensile properties of the three cement preparations, there was no consistent evidence that one cement was superior in tension to the others. However, the fatigue properties of Simplex P were consistently and significantly superior to the fatigue properties of both LVC and Zimmer Regular bone cements. Centrifugation of the cement immediately after mixing significantly improved both the tensile and fatigue properties of all three bone cements. However, the fatigue strength of centrifuged Simplex P was substantially and significantly superior to the fatigue strength of the centrifuged LVC and Zimmer Regular bone cements. Since in total joint replacements bone cement is subjected to cyclic loading, these data suggest that centrifuged Simplex P is a preferable bone cement to LVC and to Zimmer Regular cement with or without centrifugation.

Comparison and optimization of three centrifugation systems for reducing porosity of Simplex P bone cement.

Simplex P bone cement was spun for 30, 60, and 120 seconds in three different centrifugation systems (I.E.C. HN-S II, I.E.C. clinical, and Johnson & Johnson) to determine whether differences among the three systems also produce differences in the improvement of the fatigue strength of the cement. The fatigue properties of the cement after centrifugation were also assessed when it was mixed with monomer that had been chilled to 0 degrees C. There were important and statistically significant differences in the fatigue life of Simplex P spun for the same duration in the different centrifuges. Simplex P prepared as recommended by the manufacturer had an average fatigue life of 15,143 cycles in the test system used. Optimum centrifugation among the techniques studied increased the fatigue life nearly fivefold, to the range of 71,000 cycles. Taking into account both the fatigue strength and the viscosity of the cement, the optimum centrifugation system for improving the fatigue life of Simplex P bone cement is the Miller cartridge containing two packs of cement spun in the IEC-HN-S II centrifuge. The authors recommend 30 seconds of centrifugation if the monomer is not chilled prior to mixing and 60 seconds if the monomer is chilled.