Oral symptoms in patients with advanced cancer: an observational study using a novel oral symptom assessment scale.

PURPOSE: The aim of this study was to utilise a novel oral assessment tool (the Oral Symptom Assessment Scale/OSAS) to investigate oral symptoms in a cohort of advanced cancer patients receiving specialist palliative care. METHODS: Participants were asked to complete the OSAS, which asks about the presence of 20 oral symptoms in the previous week (and, if present, about the frequency, the severity, and the amount of distress caused by the symptoms). Patients were also asked to complete the Memorial Symptom Assessment Scale - Short Form, and to rate their performance status. RESULTS: Two hundred fifty participants completed the study, and 244 (97.5%) participants reported at least one oral symptom on the OSAS. The median number of oral symptoms reported was five (range, 1 to 18), with dry mouth being the most common symptom (83.5% participants). The total number of oral symptoms was higher in younger participants (p = 0.012), female participants (p = 0.048), and those with a worse performance status (p < 0.001). No other oral symptoms were reported by more than two participants. Statistical analysis identified a number of potential oral symptom clusters. CONCLUSIONS: Oral symptoms (and related oral problems) are common in patients with advanced cancer, and are associated with significant morbidity in this group of patients. TRIAL REGISTRATION: CancerTrials.gov registry reference number: NCT04404920.

Opioid-induced constipation in patients with cancer: a "real-world," multicentre, observational study of diagnostic criteria and clinical features.

The aim of this study was to investigate opioid-induced constipation (OIC) in a large cohort of "real-world" patients with cancer; the objectives were to determine the prevalence of OIC, the utility of a simple screening question, the accuracy of the Rome IV diagnostic criteria, the clinical features of OIC (physical and psychological), and the impact of OIC (quality of life). One thousand patients with cancer were enrolled in the study, which involved completion of the Rome IV diagnostic criteria for OIC, the Bowel Function Index, the Patient Assessment of Constipation Quality of Life questionnaire, and the Memorial Symptom Assessment Scale-Short Form. Participants also underwent a thorough clinical assessment by an experienced clinician (ie, "gold-standard" assessment of OIC). Fifty-nine percent of patients were clinically assessed as having OIC, 2.5% as having another cause of constipation, and 19% as not having constipation but were taking regular laxatives. The simple screening question produced a number of false-negative results (19% of patients), whereas the Rome IV diagnostic criteria had an accuracy of 81.9%. Patients with OIC had more symptoms overall, higher Memorial Symptom Assessment Scale-Short Form subscale scores (and total score), and higher Patient Assessment of Constipation Quality of Life questionnaire subscale scores (and the overall score). Opioid-induced constipation was not associated with demographic factors, cancer diagnosis, performance status, or opioid equivalent dosage: OIC was associated with opioid analgesic, with patients receiving tramadol and transdermal buprenorphine having less constipation. The study confirms that OIC is common among patients with cancer pain and is associated with a spectrum of physical symptoms, a range of psychological symptoms, and an overall deterioration in the quality of life.

EFFECTS OF SURFACE ON TRIPLE HOP DISTANCE AND KINEMATICS.

BACKGROUND: The single leg triple hop (SLTH) test is often utilized by rehabilitation practitioners as a functional performance measure in a variety of patient groups. Accuracy and consistency are important when measuring the patient progress and recovery. Administering the SLTH test on different surfaces, consistent with the patient's sport, may affect the hop distances and movement biomechanics. PURPOSE: The purpose of this study was to examine the effects of court and turf surfaces on the hop distance, limb symmetry index (LSI), and lower extremity kinematics of a SLTH test. METHODS: Recreationally active female participants (n=11, height 163.8 ± 7.1cm, mass 63.1 ± 7.1kg, age 18.9 ± 0.9yrs), without injury, volunteered to participate in the study. Three maximal effort SLTH test trials on two different surfaces (court, synthetic turf) were collected and analyzed using 3D motion analysis techniques. Outcome variables included SLTH test distances and LSI values and sagittal plane kinematics including trunk, hip, knee and ankle range of motion (ROM) during the last two landings of each SLTH test trial. The second landing involves an absorption phase and propulsion phase in contrast to the final landing which involves absorption and final balance on the single leg. Paired t-tests were used to determine differences between surfaces in hop distance and LSI values. Two-way repeated measures ANOVA were used to determine differences between surfaces in kinematic variables. RESULTS: The total SLTH test distance was not statistically different between the court (4.11 ± 0.47m) and turf (4.03 ± 0.42m, p=0.47) surfaces. LSI for the court surface was 100.8 ± 3.0% compared to 99.7 ± 3.0% for turf surface, which was not statistically different (p=0.30). Knee flexion ROM was significantly less (p=0.04) on the turf compared to the court surface during the second landing. Ankle flexion range of motion was also significantly less (p=0.03) during the second landing on turf compared to court. CONCLUSIONS: Type of surface influenced landing kinematics but not total SLTH test distance. When evaluating the quality of landings during a SLTH test, it may be warranted to observe each type of landing and the type of surface used during single leg tests. LEVEL OF EVIDENCE: 2.

Exploring the experience of returning to work after personal bereavement.

BACKGROUND: The ability of nurses with experience of personal bereavement to work with patients can have immediate and/or long-term repercussions on their personal and professional life. AIMS: To explore the experience of a personal bereavement, through the death of a significant relative or friend, for nurses working in palliative care. METHODS: A multicentre qualitative study interviewed nurses working in palliative care who experienced a significant bereavement within the last 24 months. FINDINGS: Key themes: circumstances surrounding bereavement; conflict between the personal and professional; returning to work; grief as a continuum. Advice to bereaved nurses was for them to be open and honest and that work can be grounding; that they should take time off; that grief does not stop on returning to work; and that they should do what feels right for them. CONCLUSIONS: Bereaved palliative care nurses strive to maintain their roles in the face of bereavement. Hospices have a significant part to play in offering ongoing support and flexibility.

Good concordance between patients and their non-professional carers about factors associated with a 'good death' and other important end-of-life decisions.

OBJECTIVES: The aim of this study was to investigate concordance between patients and non-professional carers about factors associated with a 'good death' and other end-of-life decisions. METHODS: Patients completed a questionnaire about end-of-life care issues, and were asked to rank the importance of factors linked to a 'good death'. Carers also completed a questionnaire about end-of-life care issues relating to the patient, and whether or not they agreed with those choices (ie, medical treatments, PPD). Carers were also asked to rank the importance of factors linked to a 'good death' to the patient, and to them personally at that point in time. RESULTS: Only 69% of patients stated they had discussed their preferences for end-of-life care with their respective carer. The rankings were similar for the patient and the carer's views of what was important for the patient, although the patients ranked 'to be involved in decisions about my care' as less important than the carers, while the carers ranked 'to have sorted out my personal affairs' as less important than the patients. CONCLUSIONS: When discussions around end-of-life choices do occur, carers generally appear to agree with the patients' preferences around end-of-life treatment, and preferred place of death.

Observational study of sleep disturbances in advanced cancer.

OBJECTIVES: To determine the prevalence of nightmares, sleep terrors and vivid dreams in patients with advanced cancer (and the factors associated with them in this group of patients). METHODS: The study was a multicentre, prospective observational study. Participants were patients with locally advanced/metastatic cancer, who were under the care of a specialist palliative care team. Data were collected on demographics, cancer diagnosis, cancer treatment, current medication, performance status, sleep quality (Pittsburgh Sleep Quality Index), dreams and nightmares, and physical and psychological symptoms (Memorial Symptom Assessment Scale-Short Form). RESULTS: 174 patients completed the study. Sleep quality was poor in 70.5% participants and was worse in younger patients and in inpatients (hospital, hospice). 18% of patients reported nightmares, 8% sleep terrors and 34% vivid dreams. Nightmares were associated with poor sleep quality and greater sleep disturbance; nightmares were also associated with greater physical and psychological burden. Nightmares (and vivid dreams) were not associated with the use of opioid analgesics. CONCLUSIONS: Nightmares do not seem to be especially common in patients with advanced cancer, and when they do occur, there is often an association with sleep disturbance, and/or physical and psychological burden.

Management of the marine environment: integrating ecosystem services and societal benefits with the DPSIR framework in a systems approach.

Ever increasing and diverse use of the marine environment is leading to human-induced changes in marine life, habitats and landscapes, making necessary the development of marine policy that considers all members of the user community and addresses current, multiple, interacting uses. Taking a systems approach incorporating an understanding of The Ecosystem Approach, we integrate the DPSIR framework with ecosystem services and societal benefits, and the focus this gives allows us to create a specific framework for supporting decision making in the marine environment. Based on a linking of these three concepts, we present a set of basic postulates for the management of the marine environment and emphasise that these postulates should hold for marine management to be achieved. We illustrate these concepts using two case studies: the management of marine aggregates extraction in UK waters and the management of marine biodiversity at Flamborough Head, UK.

Creating intoxigenic environments: marketing alcohol to young people in Aotearoa New Zealand.

Alcohol consumption among young people in New Zealand is on the rise. Given the broad array of acute and chronic harms that arise from this trend, it is a major cause for alarm and it is imperative that we improve our knowledge of key drivers of youth drinking. Changes wrought by the neoliberal political climate of deregulation that characterised the last two decades in many countries including Aotearoa (Aotearoa is a Maori name for New Zealand) New Zealand have transformed the availability of alcohol to young people. Commercial development of youth alcohol markets has seen the emergence of new environments, cultures and practices around drinking and intoxication but the ways in which these changes are interpreted and taken up are not well understood. This paper reports findings from a qualitative research project investigating the meaning-making practices of young people in New Zealand in response to alcohol marketing. Research data included group interviews with a range of Maori and Pakeha young people at three time periods. Thematic analyses of the youth data on usages of marketing materials indicate naturalisation of tropes of alcohol intoxication. We show how marketing is used and enjoyed in youth discourses creating and maintaining what we refer to as intoxigenic social environments. The implications are considered in light of the growing exposure of young people to alcohol marketing in a discussion of strategies to manage and mitigate its impacts on behaviour and consumption.

Out-of-hours prescribing: a survey of current practice in the UK.

This postal survey was developed to establish the current practice for out-of-hours (OOH) prescribing accepted in palliative care units throughout the UK. Around 144 palliative care units were sent a questionnaire and 94 units responded (65.3%). All of the responding units had non-resident medical on call cover. Although verbal orders currently appear to be the most popular communication method for OOH prescribing (84.1%), there was a wide range of other communication systems in use including email, fax and BlackBerry. There appears to be a lack of specific guidance and clarity relating to the use of remote prescribing. It seems that guidance has not kept up with changes in working patterns and technology, and in time this will hopefully change. In the meantime, all staff groups should be involved in the development of local procedures and policies appropriate to local circumstances, which pay due regard to the relevant legislation and clinical governance standards available at the time.

Magnetic resonance imaging volumetric analysis of the putamen in children with ADHD: combined type versus control.

OBJECTIVE: Volumetric differences in the putamen of boys with ADHD combined subtype with psychopathic traits and controls are investigated. METHOD: The putamen in 24 archival magnetic resonance imaging scans of 12 boys in residential treatment with symptoms of ADHD and psychopathic traits and 12 community control boys are analyzed using Display software. RESULTS: There are no differences found in the total, left, and right putamen volumes across the ADHD or control group. A significant reversal of asymmetry across groups is found; children with ADHD more frequently have a smaller left putamen than right. In contrast, the control group more frequently has a smaller right than left putamen. CONCLUSION: A reversal of symmetry in the putamen (as found in the caudate) may relate to ADHD symptomology as well as to psychopathic traits.

Changes in the expression pattern of the plasma membrane H+-ATPase in developing Ricinus communis cotyledons undergoing the sink/source transition.

The plasma membrane (PM) H+-ATPase is thought to play a key role in generating the proton motive force used to drive the uptake and accumulation of solutes in plant cells. Changes in its expression pattern were studied in the Ricinus communis L. cotyledon as it changed from a sink to a source organ. Expression was monitored in 3-, 10- and 14-day-old cotyledons using an antibody to the maize PM H+-ATPase. The antibody labelled a 100-kDa protein in membrane fractions prepared from cotyledons and this protein occurred at higher levels in the PM-enriched fractions compared to those enriched in intracellular membranes. Immunostaining of tissue sections of 3-day-old Ricinus cotyledons (sinks) with this antibody demonstrated that the PM H+-ATPase was highly expressed in the lower epidermal cells and also in the vascular bundles, particularly the phloem. The high expression in the epidermis suggests that these cells may be important in the initial active uptake of solutes from the endosperm. A similar distribution was observed in the 10-day-old seedlings but, in addition, larger, more spherical cells (idioblasts) had developed in the lower and upper epidermal layers and these were also labelled. In 14-day-old seedlings the cotyledons are no longer reliant on nutrients from the endosperm (which has totally degraded) and they are functioning as source organs. This is reflected in a decrease in PM H+-ATPase expression in the lower epidermal cells, apart from idioblasts and stomatal guard cells. The latter were also observed in the upper epidermis. Expression remained high in the vascular bundles of 14-day-old seedlings with strong staining in the phloem.

Utility of decision support tools for assessing acute risk of violence.

The authors evaluated the utility of 3 decision support tools for assessing acute risk of violence in patients undergoing behavioral emergencies that warranted hospitalization. Information available at the time of admission to a short-term psychiatric unit was coded from the medical charts of 100 patients using the Historical, Clinical, Risk Management-20 (HCR-20), the Hare Psychopathy Checklist-Screening Version (PCL-SV), and the McNiel-Binder Violence Screening Checklist (VSC). Nurses rated violence that later occurred during hospitalization with the Overt Aggression Scale. Scores on all 3 instruments were associated with the likelihood of violence. The strongest predictive relationships were obtained for indices of clinical risk factors rather than historical risk factors. The results suggest that decision support tools, particularly those that emphasize clinical risk factors, have the potential to improve decision making about violence risk in the context of behavioral emergencies.