Intrarectal formalin treatment for haemorrhagic radiation-induced proctopathy: efficacy and safety.

AIM: Pelvic radiotherapy is limited by dose-dependent toxicity to surrounding organs. The aim of this prospective study was to evaluate the efficacy and safety of intrarectal formalin treatment for radiotherapy-induced haemorrhagic proctopathy (RHP) at the Royal Marsden Hospital. METHOD: Adult patients were enrolled. Haemoglobin was evaluated before and after formalin treatment. Antiplatelet and/or anticoagulation treatment and administration of transfusion were recorded. The interval between completion of radiotherapy and the first intrarectal 5% formalin treatment was assessed and the dose of radiotherapy was evaluated. Clinical assessment of the frequency and amount of rectal bleeding (rectal bleeding score 1-6) and endoscopic appearance (grade 0-3) were classified. Complications were recorded. RESULTS: Nineteen patients were enrolled, comprising 13 men (68%) and 6 women. The mean age was 75 ± 9 years. The median time between completion of radiotherapy and the first treatment was 20 months [interquartile range (IQR) 15 months] and the median dose of radiotherapy was 68 Gy (IQR 14 Gy). Thirty-two procedures were performed (average 1.7 per patient). In total, 9/19 (47%) patients were receiving anticoagulation and/or antiplatelet medication and 5/19 (26%) received transfusion prior to treatment. The mean value of serum haemoglobin before the first treatment was 110 ± 18 g/L and afterwards it was 123 ± 16 g/L (p = 0.022). The median rectal bleeding score before the first treatment was 6 (IQR 0) and afterwards 2 (IQR 1-4; p < 0.001), while the median endoscopy score on the day of first treatment was 3 (IQR 0) compared with 1 (IQR 1-2) on the day of the last treatment 1 (p < 0.001). One female patient with a persistent rectal ulcer that eventually healed (18 months of healing) subsequently developed rectovaginal fistula (complication rate 1/19, 5%). CONCLUSIONS: Treatment with intrarectal formalin in RHP is effective and safe.

Developing advanced clinical practice skills in gastrointestinal consequences of cancer treatment.

This article explores the transition from a clinical nurse specialist (CNS) towards developing advanced clinical practice skills within a gastrointestinal consequences of cancer clinic. It presents data on the first 50 patients assessed by the CNS from a prospective service evaluation, demonstrating how this informed the nurse's future learning. There is high demand for advanced clinical practice skills to address unmet health needs and improve the quality, efficiency, and sustainability of healthcare services. However, a literature review found no literature on developing advanced clinical practice skills in this setting. Emerging themes from the service evaluation focused on barriers and enablers, ongoing support, organisational commitment and working in a multidisciplinary team. Blended learning provided both structured and opportunistic learning, embedding both formal and tacit knowledge, as roles require increasing flexibility. Clinical supervision and reflective practice were key in maintaining professional and peer support.

Reflective practice applied in a clinical oncology research setting.

Regular reflective practice group sessions, focusing on enhancing mindfulness, were piloted as part of a support programme for researchers in a clinical oncology setting. METHODS: As a previous systematic review highlighted a wide variety of approaches and a lack of published evidence on the use of specific models for reflective practice in health care, a scoping review of existing literature describing reflective practice models preceded piloting the programme with the research team. The Mindful Attention Awareness Scale (MAAS) was used to assess the benefit for participants. Scores from the first and last session were analysed using a paired-sample t-test. Feedback from questionnaires was analysed using descriptive statistics (for Likert scales) and direct quotes from free text exemplified the experience. RESULTS: Seven people participated. Six were female, all were research nurses except for one research allied health professional. The median age was 37 (range: 23-40 years). The average time since graduation was 10 years (range: 1.5-18 years). All researchers worked in a tertiary oncology setting. Although a total of 21 reflective practice sessions were facilitated, the median number of sessions attended was 9 (range: 2-21). The mean MAAS score improved from 57.83 to 62.83 (p=0.0146). The participants rated the experience and impact as positive. CONCLUSION: The results of the MAAS score indicate that mindfulness was enhanced by the sessions. The feedback from the participants highlighted the impact on their professional development. This is encouraging to support developing similar facilitated reflective practice programmes in different settings.

Bile Acid Malabsorption as a Consequence of Cancer Treatment: Prevalence and Management in the National Leading Centre.

The aim was to establish prevalence of bile acid malabsorption (BAM) and management in patients who underwent treatment for malignancy. Retrospective evaluation of data in patients seen within six months (August 2019-January 2020) was carried out. Demographic, nuclear medicine (Selenium Homocholic Acid Taurine (SeHCAT) scan result), clinical (previous malignancy, type of intervention (medication, diet), response to intervention) and laboratory (vitamin D, vitamin B12 serum levels) data were searched. In total, 265 consecutive patients were reviewed. Out of those, 87/265 (33%) patients (57 females, 66%) were diagnosed with BAM. Mean age was 59 +/- 12 years. The largest group were females with gynaecological cancer (35), followed by haematology group (15), colorectal/anal (13), prostate (9), upper gastrointestinal cancer (6), another previous malignancy (9). Severe BAM was most common in haematology (10/15; 67%) and gynaecological group (21/35; 60%). Medication and low-fat diet were commenced in 65/87 (75%), medication in 10/87 (11%), diet in 6/87 (7%). Colesevelam was used in 71/75 (95%). Symptoms improved in 74/87 (85%) patients. Vitamin D insufficiency/deficiency was diagnosed in 62/87 (71%), vitamin B12 deficiency in 39/87 (45%). BAM is a common condition in this cohort however treatments are highly effective.

Australian health professionals' perspectives of psychosocial adjustment to visible differences: A qualitative analysis of pediatric populations.

Living with a visible difference (e.g., disfigurement) can compromise a child's psychological wellbeing. Although some children can adjust well, others can develop a range of appearance-related issues such as social anxiety, low self-esteem, and body dissatisfaction. However, current research fails to confirm what factors contribute to appearance-related distress, and what factors buffer the consequences of living with a visible difference. Semi-structured qualitative interviews were conducted with 16 Australian specialist health professionals who care for children with visible differences. Interviews explored the type of appearance-related psychosocial concerns presented to a pediatric hospital, perspectives on the impact of appearance-related distress, as well as factors and processes that health professionals perceive influence adjustment. Data were subjected to inductive thematic analysis. Rich evidence was offered by health professionals, which demonstrated deep understanding of the psychological wellbeing of their patients. Three themes were identified: Mind, Body, and Soul; Stages of Life; and Individual Differences. Findings highlighted the complexity of appearance-related distress, with individual differences in adjustment, and the powerful impact it can have on a child's short and long-term psychosocial wellbeing. The importance of reaching consensus in the conceptualisation and measurement of psychological wellbeing is stressed, and key domains associated with adjustment are proposed.

Implementation and outcomes of the RAPID programme: Addressing the front end of the lung cancer pathway in Manchester.

INTRODUCTION: Patients with suspected lung cancer require computed tomography (CT), specialist interpretation of the CT and a consultation with a specialist. Significant time savings could be made with rapid access to these components in the front end of the lung cancer pathway. METHODS: The RAPID programme was launched at Manchester's Wythenshawe Hospital in April 2016. This pathway offers next working day CT for patients with suspected lung cancer, immediate 'hot' reporting of CT images and a same day consultation with a diagnostic specialist. RESULTS: From April 2016 to January 2019, 1,027 patients were referred to the RAPID programme. The median time from referral to CT was 3 days. The CT was hot reported in 94% of patients. The median time from CT to triage and consultation with a diagnostic specialist was 0 days. Overall 56% and 90% of patients had completed a CT and consultation within 3 and 7 days of referral, respectively (0% and 24% prior to implementation). CONCLUSION: Through simple reorganisation of workload, we have significantly reduced the pathway for patients with suspected lung cancer to meet a specialist with a reported CT, something we firmly believe is replicable across all hospitals.

Opening a Pandora's Box that can't be salvaged: Health professionals' perceptions of appearance-related care in an Australian pediatric specialist hospital.

Many children and young people struggle adjusting to the psychosocial consequences (e.g., body dissatisfaction, social anxiety, and stigmatisation) of visible differences (or disfigurement). As appearance-affecting conditions often require specialist multidisciplinary team care, health professionals are in a unique position to offer psychosocial support and intervention. However, there is a dearth of literature on how appearance-related concerns are managed in pediatric hospital settings. Sixteen Australian specialist health professionals participated in semi-structured qualitative interviews to address this gap. Interviews explored current appearance-related psychosocial service provision, barriers in accessing appearance-related care, and perceptions of online platforms to deliver specialist support and intervention. Thematic analysis demonstrated four themes: We can do it better, Capability versus availability, Online generation, and Putting appearance on the agenda. This research highlighted the potential value of online platforms to increase accessibility to specialist appearance-related care, the need for more psychosocial resources to be integrated into appearance-related specialities, prioritising the development of low to medium appearance-related support and intervention, increasing the appearance-related knowledge of health professionals and families, and the need for more holistic approaches in routine care.

The efficacy of a low-fat diet to manage the symptoms of bile acid malabsorption - outcomes in patients previously treated for cancer.

Dietary fat ingestion triggers bile secretion into the gastrointestinal tract. Bile acid malabsorption affects >1% of the population, causing loose stool and other gastrointestinal symptoms. The diagnosis is frequently missed. Treatments are often considered ineffective. We evaluated low-fat diets for managing gastrointestinal symptoms in these patients. All patients reporting type 6 or 7 stool were offered a selenium-75 homocholic acid taurine (SeHCAT) scan. Prospective data in patients with 7-day scan retention <20% were analysed. -Patients requiring a bile acid sequestrant were given this before receiving dietary advice. Patients completed a 7-day food diary before dietetic consultations. Personalised dietary interventions, providing 20% of daily energy from fat, were prescribed. Symptoms were assessed using a modified gastrointestinal symptom rating scale questionnaire before and 4-12 weeks after dietary intervention. A total of 114 patients (49 male, median age 64 years, median body mass index 27 kg/m2) were evaluated. 44% of these patients were taking colesevelam. After dietary intervention, there was statistically significant improvement in abdominal pain and nocturnal defecation (0.2% alpha, p=0.001). Improvement in bowel frequency, urgency, flatulence, belching, borborygmi and stool consistency were seen, but did not reach statistical significance (p≤0.004-0.031). Dietary intervention is an effective treatment option for patients with symptomatic bile acid malabsorption and should be routinely considered.

Guide to managing persistent upper gastrointestinal symptoms during and after treatment for cancer.

BACKGROUND: Guidance: the practical management of the gastrointestinal symptoms of pelvic radiation disease was published in 2014 for a multidisciplinary audience. Following this, a companion guide to managing upper gastrointestinal (GI) consequences was developed. AIMS: The development and peer review of an algorithm which could be accessible to all types of clinicians working with patients experiencing upper GI symptoms following cancer treatment. METHODS: Experts who manage patients with upper GI symptoms were asked to review the guide, rating each section for agreement with the recommended measures and suggesting amendments if necessary. Specific comments were discussed and incorporated as appropriate, and this process was repeated for a second round of review. RESULTS: 21 gastroenterologists, 11 upper GI surgeons, 9 specialist dietitians, 8 clinical nurse specialists, 5 clinical oncologists, 3 medical oncologists and 4 others participated in the review. Consensus (defined prospectively as 60% or more panellists selecting 'strongly agree' or 'agree') was reached for all of the original 31 sections in the guide, with a median of 90%. 85% of panellists agreed that the guide was acceptable for publication or acceptable with minor revisions. 56 of the original 61 panellists participated in round 2. 93% agreed it was acceptable for publication after the first revision. Further minor amendments were made in response to round 2. CONCLUSIONS: Feedback from the panel of experts developed the guide with improvement of occasional algorithmic steps, a more user-friendly layout, clearer time frames for referral to other teams and addition of procedures to the appendix.

Does alcohol stimulate appetite and energy intake?

It has been anecdotally suggested that alcohol stimulates appetite and so increases energy intake in people who have poor appetite. This review sought to systematically review the evidence for this practice, using the mini-review approach (Griffiths, 2002). Among the eight studies reviewed, only one showed a significant difference in appetite ratings between the alcohol and no alcohol preload. However, significant differences were found in energy intake following a high-dose alcohol preload as opposed to a no-alcohol preload, in three out of the eight studies reviewed. One further study reported an increase in energy intake after the alcohol preload but this failed to reach statistical significance. In conclusion, the effect of alcohol on appetite appears largely unsubstantiated. Alcohol's effect on energy intake does appear significant, but further research is necessary owing to small sample sizes.

An exploration of four web-based open and flexible learning modules in post-registration nurse education.

UNLABELLED: This paper presents an exploratory evaluation of four newly developed web-based modules for post-registration nurses. The topics for the modules were: dermatology; diabetes; mentorship; and prescribing. STUDY OBJECTIVE: To explore the students' perceptions of the web-based modules before and after completing the modules. DESIGN: A pre-post test design using questionnaires and group interviews. PARTICIPANTS: 39 students enrolled on the modules, pre-module data were collected on 74% (n = 29) and post-module data on 71% (n = 28). None of students had previous web-based education experience. 79% (n = 31) completed and 66% (n = 26) passed the modules. Students level of IT skills prior to commencing the modules were important in explaining module completion and outcome. The modules were rated highly in terms of achieving learning outcomes with moderate ratings for level of support and utility of learning materials. The content analysis of the interviews highlighted the importance of preparing students ensuring they have the IT and independent learning skills necessary to participate in web-based learning programmes, together with a number of issues relating to the accessibility of the learning materials. The perceived benefits of this mode of learning were that they offered flexible and resource rich learning. The downside was that the learning can be isolating. CONCLUSIONS: This form of learning may not be suited to all groups of nurses or all educational topics. Further research is required to establish the educational benefits of different approaches to e-learning.

Children's Evaluation of Other People's Self-Descriptions.

Children's evaluations of what people communicate about themselves were examined in three studies with a total of 296 participants (aged four to 12). Participants heard scenarios in which characters' motivations to reveal truthful information were systematically manipulated to examine (1) children's understanding that people do not always reveal true information, and (2) children's use of contextual cues to judge the credibility of what individuals say about themselves. Results from Study 1 suggest that elementary school children are quite sophisticated at reasoning with reference to motive information. Study 2 suggests that preschool children can also make use of motive information that is salient and familiar. For example, even preschool children responded that boys are less likely than girls to reveal to peers that they like to play with dolls. Study 3 suggests that children's reasoning about self-presentation is linked to their beliefs about social acceptability norms.

Preschool children's reasoning about ability.

Young children's reasoning about ability was investigated among 155 preschoolers (M = 4 years, 10 months) across 3 studies. Results suggest that preschoolers are sensitive to mental state information when making judgments about another child's ability: They judged a child who finds a task easy to be smarter than one who finds the same task hard. Systematic patterns of errors on recall tasks suggest that preschoolers perceive positive correlations between (a) exerting effort and experiencing academic success, and (b) being nice and having high academic ability. Results from a comparison group of forty 9- to 10-year-olds (M = 9 years, 10 months) suggest that the preschool findings generally reflect emerging patterns of reasoning about ability that persist into later childhood, but that the perceived correlations between high effort and academic outcomes and between social and academic traits diminish with age.