Navigating the seasons of survivorship in community oncology.

Nurses have an important role in the development, implementation, and evaluation of cancer survivorship programs. Growing numbers of cancer survivors challenge community oncology practices to incorporate survivorship care according to new standards and guidelines. In response, one community-based oncology clinic created an advanced practice nurse (APN)-led survivorship program using the concept of Seasons of Survival as a guide. Survivorship care, when based on a more expansive definition of survivorship as beginning at the time of diagnosis, encompasses holistic nursing and multidisciplinary care. The APN assesses each patient's concerns and quality of life using a validated measure to tailor survivorship and supportive care. This article reviews the foundation and structure of the program in detail, describes program implementation using case studies, and outlines the program evaluation process and results.

Implementing the commission on cancer standards for survivorship care plans.

The number of adult cancer survivors in the United States has exceeded 13 million and continues to rise, yet care for these survivors continues to be poorly coordinated and their needs remain inadequately addressed. As one solution to this growing problem, the Institute of Medicine in 2006 recommended the delivery of a survivorship care plan (SCP) to each patient completing active treatment. The American College of Surgeons Commission on Cancer subsequently published its Program Standard 3.3, requiring accredited programs to implement treatment summaries and SCPs by 2015, to help improve communication, quality, and coordination of care for cancer survivors. As practices and cancer centers around the country have undertaken SCP implementation efforts, myriad barriers to their preparation and delivery have emerged, with time and human resource burden top among these, in addition to a lack of proven outcomes. Fortunately, a growing number of publications document practical and feasible delivery models, and an increasingly robust body of research on stakeholder preferences is available to focus SCP implementation efforts.

Serious infections after unrelated donor transplantation in 136 children: impact of stem cell source.

How the infection risks compare after umbilical cord blood (UCB) and bone marrow (BM) transplantation is not known. Therefore, we compared serious infections in the 2 years after pediatric myeloablative unrelated donor transplantation with unmanipulated BM (n = 52), T cell-depleted (TCD) BM (n = 24), or UCB (n = 60) for the treatment of hematologic malignancy. Overall, the cumulative incidence of 1 or more serious infections was comparable between groups (BM, 81%; TCD, 83%; UCB, 90%; P = .12). Furthermore, by taking all serious infections into account and using multivariate techniques with unmanipulated BM as the reference, there were also no significant differences between groups (TCD relative risk [RR], 1.6; P = .10; UCB RR, 1.0; P = .84). Within the time periods days 0 to 42, days 43 to 100, and days 101 to 180, the only difference was a greater risk of viral infections from days 0 to 42 in TCD recipients (RR, 3.5; P = .02). Notably, after day 180, TCD recipients had a significantly increased infection risk (RR, 3.1; P = .03), whereas the risk in UCB recipients (RR, 0.5; P = .23) was comparable to that in BM recipients. Other factors associated with an increased infection risk in the 2 years after transplantation were age > or = 8 years, graft failure, and severe acute graft-versus-host disease. These data suggest that the risk of serious infection after pediatric UCB transplantation is comparable to that with unmanipulated BM.

Chemosensory stimuli for the walking legs of the crayfish Procambarus clarkii.

Studies of chemoreception in crustaceans have shown that flesh-eating species can detect amino acids, nucleotides and derivatives, and amines, while most herbivorous and omnivorous species are additionally sensitive to carbohydrates. We used extracellular recording techniques to evaluate the effectiveness of a range of nitrogen-containing compounds (mostly amino acids), bile acids, and carbohydrates in stimulating chemoreceptor cells present in the second and third pereopods of the omnivorous crayfish Procambarus clarkii. When applied at a final concentration of approximately 100 microM, effective stimuli were trehalose, leucine, cellobiose, glycine, sucrose, maltose, and ammonium (from most to least effective). The other 17 compounds tested, many chosen because they are potent stimuli for other crustaceans, were ineffective stimuli for P. clarkii. Concentration-response functions were determined for three single cells that were sensitive to ammonium, for five multiunit fibers sensitive to glycine, and for six multiunit fibers sensitive to leucine. Thresholds ranged from 10 nM to 10 micro, functions were generally linear when plotted against the log of the stimulus concentration, and there was little evidence of saturation. While P. clarkii is sensitive to only seven of 24 compounds tested, the compounds that proved stimulatory should serve as cues for location and identification of food items preferred by this omnivorous crustacean.