Acknowledging cancer as a family disease: A systematic review of family care in the cancer setting.

PURPOSE: Family members are a part of the team to improve the outcomes of the person with cancer. Families require support and information to optimise their care, however, their needs are often unacknowledged and within clinical areas there is a lack of family focused interventions. Studies highlight families' needs but lack a family representation. The aim was to explore research with family as the unit-of-care during cancer treatment. METHOD: The Pickering systematic quantitative literature review method; a 15-step process from searching, database development and analysis was followed. Research published 2008-2019 within databases: MEDLINE, SCOPUS, PsycINFO, Cochrane, CINAHL; key words, 'family* or caregiver*, and cancer*, neoplasm* and coping*, distress* in November 2019. Quality assessment completed using Mixed Methods Appraisal Tool, descriptive quantitative analysis and thematic analysis. RESULTS: Studies involving patients and family members were included in the review (N = 73). The analysis identified participants had a mean age of 58 years and primarily lung, breast or prostate cancer. Over 80% were from America and European countries; 93% had a dyad sample, quantitative studies (76%). There was eight intervention studies between four to sixteen weeks long, focused on family wellbeing. Themes described the impact of cancer on the whole family, the importance of communication between family members, and resources for family members. CONCLUSION: The review identified four main scales and optimum intervention styles. Family research in the adult cancer needs to focus on intervention studies, increase international focus and inclusion of other family members such as children, friends and older adults.

Grey-scale silicon diffractive optics for selective laser ablation of thin conductive films.

Laser beam shaping can play a crucial role in improving many laser processes, especially in selective laser patterning of thin films for display devices and solar cells. Typical Gaussian spatial energy distributions can increase damage to the substrate and lead to large crater edge ridges, which are sub-optimal for typical industrial thin film processes. We report on the design, fabrication, and testing of reflective silicon diffractive optics developed for spatial beam shaping at a wavelength of 355 nm. The application of the elements for laser-selective removal of 20 nm indium tin oxide thin films on glass substrates is demonstrated. The design of the phase profile is first generated using the numerical method of computer-generated holography. The phase profiles are realized on a silicon substrate using a novel two-step fabrication technique consisting of a calibrated focused ion beam and an inductively coupled plasma etch. This results in truly grey-scale, blazed diffractive optics, which were analyzed using white light interferometry and atomic force microscopy. Using the diffractive elements with 355 nm nanosecond pulses shows excellent focused spot profiles with a good reproduction of the intended design with a first-order off-axis diffractive efficiency of approximately 80% at a 45 deg angle of incidence.

Strengths and resources used by Australian and Danish adult patients and their family caregivers during treatment for cancer.

PURPOSE: Family plays an essential role in supporting the patient with cancer, however, relatively little attention has been given to understanding the strengths and resources of the family unit across different settings and countries. This study aims to investigate the strengths and resources of patients and family members in Australia and Denmark. METHODS: Using a descriptive, cross-sectional design, 232 patient and family participants from inpatient and outpatient oncology services in Australia and Denmark completed paper based surveys that included the Family Hardiness Index (FHI) and Family Crisis Orientated Personal Evaluation Scales (F-COPES), together with demographic and health information. RESULTS: The family's appraisal of the cancer and ways the family worked together predicted the level of external resources used to manage their circumstances. CONCLUSION: After a cancer diagnosis patients and family respond in different ways related to their family functioning. There is a need for nurses to work closely with the family to understand their strengths and resources, and tailor support and information for family to promote optimal patient outcomes.

Enhancing OSCE preparedness with video exemplars in undergraduate nursing students. A mixed method study.

BACKGROUND: Objective structured clinical examinations (OSCEs) are designed to assess clinical skill performance and competency of students in preparation for 'real world' clinical responsibilities. OSCEs are commonly used in health professional education and are typically associated with high levels of student anxiety, which may present a significant barrier to performance. Students, including nursing students, have identified that flexible access to exemplar OSCEs might reduce their anxiety and enable them to better prepare for such examinations. AIM: To implement and evaluate an innovative approach to preparing students for OSCEs in an undergraduate (registration) acute care nursing course. METHOD: A set of digitized OSCE exemplars were prepared and embedded in the University-based course website as part of usual course learning activities. Use of the exemplars was monitored, pre and post OSCE surveys were conducted, and qualitative data were collected to evaluate the approach. OSCE grades were also examined. FINDINGS: The online OSCE exemplars increased self-rated student confidence, knowledge, and capacity to prepare and provided clarity around assessment expectations. OSCE exemplars were accessed frequently and positively received; but did not impact on performance. CONCLUSION: Video exemplars aid student preparation for OSCEs, providing a flexible, innovative and clear example of the assessment process. Video exemplars improved self-rated student confidence and understanding of performance expectations, leading to increased engagement and reduced anxiety when preparing for the OSCE, but not overall OSCE performance. Such OSCE exemplars could be used to increase staff capacity and improve the quality of the student learning experience.

Service quality for Type 2 diabetes in Australia: the patient perspective.

AIMS: To assess the service quality of care as perceived by people with Type 2 diabetes mellitus. METHODS: A cross-sectional survey using a self-administered questionnaire was carried out among members of Diabetes Australia-Queensland with Type 2 diabetes. For 12 aspects of service quality derived from a literature review and focus group research, patients scored the relative importance of the aspects and their perception of quality of received care. A measure of service quality was derived by combining the relative importance and actual performance. RESULTS: A total of 603 people with Type 2 diabetes participated. Of the 12 aspects of care, communication, availability of support group, safety and prevention had the highest scores for importance; support group and basic amenities had the highest average performance values; but the highest service quality values were for support group, basic amenities, dignity and confidentiality. Younger participants had lower service quality scores (P = 0.001) and participants with good control of their diabetes had higher scores (P < 0.001). Compared with the reference population, our sample had 8.7% fewer people under 65 years old. CONCLUSIONS: From the perspective of people with Type 2 diabetes, there is a notable gap between their expectations and what they have actually received in most aspects of provided care. In addition, overall service quality and six aspects of service quality (choice of care provider, accessibility, prevention, continuity, timeliness and safety) were identified to be of inadequate quality. Hence, this study demonstrates a significant opportunity to improve quality of healthcare services.

Studies comparing low molecular weight heparin with heparin for the treatment of thromboembolism: a literature review.

The use of heparin for the prophylaxis and treatment of venous and arterial thrombosis had been the standard of care for clinicians until 1982. At that time the introduction of depolymerized heparin for the prophylaxis of deep vein thrombosis in surgical patients was introduced. A number of such products, low molecular weight heparins (LMWH) were patented and introduced as new drugs during the ensuing of 20 years. Each LMWH had to be given a clinical trial against standard heparin for the several thromboembolic disorders for which heparin was the standard of care. By definition LMWH had to have unequal factor Xa and IIa inhibitor potency, expressed as a Xa-IIa ratio of greater than 1. They also had a molecular weight reduction to about one third that of heparin. A major advantage of LMWH over heparin was the subcutaneous route of injection for treatment of thrombotic disorders in contrast to the intravenous route for heparin. They had greater bioavailability than heparin by the subcutaneous route, a longer half-life and better predictability of dose response. It was found that routine laboratory monitoring was unnecessary. When given a trial against heparin, LMWH was equally safe and effective for most venous and arterial disorders. A new synthetic version of (pentasaccharide) both heparin and LMWH has been at least if not more effective than one LMWH (enoxaparin).

Aminophylline does not protect against radiocontrast nephropathy in patients undergoing percutaneous angiographic procedures.

BACKGROUND: Radiocontrast nephropathy (RCN) is one of the leading causes of hospital-acquired acute renal insufficiency. Adenosine, a renal vasoconstrictor, is thought to play a role in RCN. In this study, aminophylline, a non-selective adenosine-competitive inhibitor, was evaluated as a potential agent to protect against RCN. METHODS: Twenty-six patients treated with 200 mg intravenous aminophylline immediately prior to percutaneous coronary and peripheral procedures were individually matched to 26 controls for baseline creatinine (Cr), diabetes mellitus and amount of contrast used. The aminophylline-treated group was also similar to control with respect to baseline ejection fraction, amount of post-procedure hydration, age, blood pressure and the use of nephrotic drugs. RESULTS: There was no significant difference between the change from baseline Cr to peak measured Cr in either cases or controls. Also, when a change in Cr > or =25% from baseline was considered significant, Fisher's exact test did not show a difference between the 2 groups. CONCLUSION: Aminophylline does not appear to add a protective role in preventing against RCN in patients undergoing percutaneous angiographic procedures.

Receptor subtypes mediating adenosine-induced dilation of cerebral arterioles.

The purpose of this study was to investigate the receptor subtypes that mediate the dilation of rat intracerebral arterioles elicited by adenosine. Penetrating arterioles were isolated from the rat brain, cannulated with the use of a micropipette system, and luminally pressurized to 60 mmHg. Both adenosine and the A2A receptor-selective agonist CGS-21680 induced dose-dependent vasodilation (-logEC(50): 6.5 +/- 0.2 and 8.6 +/- 0.3, respectively). However, adenosine, which is capable of activating both A2A and A2B receptors, caused a greater maximal dilation than CGS-21680. The A2A receptor-selective antagonist ZM-241385 (0.1 microM) only partially inhibited the dilation induced by adenosine but almost completely blocked CGS-21680-induced dilation. Neither 8-cyclopentyl-1,3-dipropylxanthine (0.1 microM), an A1 receptor-selective antagonist, nor MRS-1191 (0.1 microM), an A3 receptor-selective antagonist, attenuated adenosine dose responses. Moreover, ZM-241385 had no effect on the dilation induced by ATP (10 microM) or acidic (pH 6.8) buffer. We concluded that the A2A receptor subtype mediates adenosine-induced dilation of intracerebral arterioles in the rat brain. Furthermore, our results suggest that A2B receptors may also participate in the dilation response to adenosine.

Feast and famine: socioeconomic disparities in global nutrition and health.

OBJECTIVE: To review current information on under- and over-malnutrition and the consequences of socioeconomic disparities on global nutrition and health. DESIGN: Malnutrition, both under and over, can no longer be addressed without considering global food insecurity, socioeconomic disparity, both globally and nationally, and global cultural, social and epidemiological transitions. SETTING: The economic gap between the more and less affluent nations is growing. At the same time income disparity is growing within most countries, both developed and developing. Concurrently, epidemiological, demographic and nutrition transitions are taking place in many countries. RESULTS: Fully one-third of young children in the world's low-income countries are stunted because of malnutrition. One-half of all deaths among young children are, in part, a consequence of malnutrition. Forty percent of women in the developing world suffer from iron deficiency anaemia, a major cause of maternal mortality and low birth weight infants. Despite such worrying trends, there have been significant increases in life expectancy in nearly all countries of the world, and continuing improvements in infant mortality rates. The proportion of children malnourished has generally decreased, although actual numbers have not in sub-Saharan Africa and south Asia. Inequalities are increasing between the richest developed countries and the poorest developing countries. Social inequality is an important factor in differential mortality in both developed and developing countries. Many countries have significant pockets of malnutrition and increased mortality of children, while obesity and non-communicable diseases (NCDs) prevalences are increasing. Not infrequently it is the poor and relatively disadvantaged sectors of the population who are suffering both. In the industrialized countries, cardiovascular disease incidence has declined, but less so in the poorer socioeconomic strata. CONCLUSIONS: The apparent contradictions found represent a particular point in time (population responses generally lag behind social and environmental transitions). They do also show encouraging evidence that interventions can have a positive impact, sometimes despite disadvantageous circumstances. However, it seems increasingly unlikely that food production will continue to keep up with population growth. It is also unlikely present goals for reducing protein-energy malnutrition prevalence will be reached. The coexistence of diseases of undernutrition and NCDs will have an impact on allocation of resources. Action needs to be continued and maintained at the international, national and individual level.

Comparison of right ventricular outflow tract and apical lead permanent pacing on cardiac output.

Cardiac output was measured in 89 patients using transthoracic continuous-wave echo Doppler comparing right ventricular outflow tract pacing with the right ventricular apex at the time of permanent pacemaker implantation. Overall, cardiac output improved 18.8% (p <0.0001) and cardiac index 21.0% (p <0.0001) with outflow tract placement; patients with a lower baseline cardiac index had a greater percent improvement with outflow tract placement.

Frequency of late potentials on signal-averaged electrocardiograms during thallium stress testing in coronary artery disease.

Late potentials detected by signal-averaged electrocardiography (SAECG) are an important noninvasive indicator identifying patients with previous myocardial infarction at risk for developing ventricular tachycardia. The role of myocardial ischemia in the development of late potentials is undefined. This study attempts to determine if late potentials on SAECG can be produced during scintigraphically proven ischemia. A signal-averaged electrocardiogram was obtained before and immediately after single-photon emission computed tomography thallium exercise testing in 51 patients. Reversible ischemia was documented in 25 cases with no significant changes in the parameters of SAECG; patients with previous myocardial infarction (n = 10) also had no significant changes from baseline. Multivariate analysis with respect to reversible ischemia and previous myocardial infarction was unrevealing. Patients with late potentials at baseline (n = 10) who developed reversible ischemia (n = 5) had a shorter QRS duration than those with late potentials at baseline and no reversible ischemia. The data indicate that exercise-induced scintigraphically proven ischemia does not alter SAECG even in the presence of previous myocardial infarction. Patients with late potentials at baseline may actually have a shortened QRS duration during reversible ischemia as opposed to the expected lengthening of the QRS.

Thallium-201 scintigraphy after intravenous infusion of adenosine compared with exercise thallium testing in the diagnosis of coronary artery disease.

Adenosine is an endogenously produced compound that has significant effects as a coronary and systemic vasodilator. Previous studies suggest that intravenous infusion of adenosine, coupled with thallium-201 scintigraphy, may have specific value as a noninvasive means of evaluating coronary artery disease. The purpose of this study was to compare the diagnostic value of adenosine thallium testing with that of standard exercise thallium testing. One hundred subjects were studied with exercise thallium imaging and thallium imaging after adenosine infusion, including 47 with angiographically proved coronary artery disease and 53 control subjects. The overall sensitivity of the thallium procedures was 81% for the exercise study and 83% for the adenosine study (p = NS); the specificity was 74% for the exercise study and 75% for the adenosine study (p = NS). The diagnostic accuracy of the exercise study was 77% and that of the adenosine study was 79%. Ninety-four percent of subjects had an adverse effect due to the adenosine infusion; however, most of these effects were mild and well tolerated. All adverse effects abated within 30 to 45 s of the termination of the study, consistent with the very brief half-life of the agent. Thus, thallium-201 scintigraphy after intravenous infusion of adenosine has a diagnostic value similar to that of exercise thallium testing for evaluation of coronary artery disease. Adenosine thallium testing may be particularly useful in evaluating patients unable to perform treadmill exercise testing.

Interaction of heparinoids with platelets: comparison with heparin and low molecular weight heparins.

Heparin interacts with platelets to impair collagen-induced aggregation and adhesion to collagen. Low molecular weight heparin and heparinoids have little or no inhibitory activity in these platelet-collagen interactions. Thrombin-induced aggregation of platelets is inhibited by any of the glycosaminoglycans that will block the action of thrombin on fibrinogen. However, heparin is a much more potent inhibitor than low molecular weight heparins or heparinoids at equigravimetric concentrations in these reactions. The inhibition of ristocetin or asialo-von Willebrand factor aggregation of platelets is partially blocked by high dose heparin but not by low molecular weight heparin or heparinoids. The heparin-induced IgG antibody, produced to a heparin-platelet complex, aggregates platelets strongly in the presence of heparin, less strongly in the presence of low molecular weight heparins and pentosan polysulfate and not at all with dermatan sulfate or the pentasaccharide. Heparan sulfate does interact with platelets and this antibody, which is of interest because of the heparan sulfate on endothelial cells. Clinical information to date suggests a low incidence of heparin antibodies in patients receiving only low molecular weight heparin of the depolymerized type. Whether long-term clinical use of low molecular weight heparins, heparan sulfate, and dermatan sulfate will give rise to specific antibodies that would cause a similar problem as heparin remains to be seen.

In vitro studies of the interaction of heparin, low molecular weight heparin and heparinoids with platelets.

Heparin, low molecular weight heparins, and heparinoids were studied for their ability to inhibit the aggregation of platelets by various agonists and for their ability to adhere to collagen. Heparin was a very effective inhibitor of aggregation with collagen and with ristocetin as it was with adhesion to collagen. The heparinoids showed little effect on aggregation or adhesion. Heparan sulfate and pentosan polysulfate did show slight inhibitory activity against collagen aggregation and adhesion and both interacted with the antibody induced by heparin therapy. It is of interest that dermatan sulfate and the pentasaccharide were almost inert in these experiments, and are unlikely to induce bleeding by inhibition of platelet function. It is highly probable that interference with the interaction of von Willebrand factor with platelets and collagen is a major mechanism for bleeding in the heparinized patient.