Cancer and depression: Integrating scientific evidence with clinical practice

2011 ◽  
Vol 26 (S2) ◽  
pp. 2210-2210
Author(s):  
D. Eraslan
Keyword(s):  
Clinical Practice ◽  
Everyday Life ◽  
Clinical Setting ◽  
Scientific Evidence ◽  
The Body ◽  
Normal Reaction ◽  
Patients With Cancer ◽  
Existential Crisis ◽  
Diagnosis Of Cancer ◽  
The Impact

A diagnosis of cancer is one of the most distressing events in life. It changes the course of everyday life and causes an existential crisis. This makes some clinicians think that depression is a normal reaction to a diagnosis of cancer. However, the body of evidence suggests that not all people diagnosed with cancer develop depression, but patients with cancer have an increased rate of depression. This presentation will try to combine the latest data on depression and cancer, including the mechanisms underlying depression in these patients and the impact of psychiatric diagnosis on the outcome of cancer. We will then focus on the implications of these data on the diagnosis and management of depression in the clinical setting.

scholarly journals Impact of musculoskeletal degradation on cancer outcomes and strategies for management in clinical practice

2020 ◽  
pp. 1-19
Author(s):  
Aoife M. Ryan ◽  
Erin S Sullivan
Keyword(s):  
Clinical Practice ◽  
Large Scale ◽  
Performance Status ◽  
Muscle Quality ◽  
Early Screening ◽  
Significant Deterioration ◽  
Patients With Cancer ◽  
Operative Outcomes ◽  
Patient Groups ◽  
The Impact

The prevalence of malnutrition in patients with cancer is one of the highest of all patient groups. Weight loss (WL) is a frequent manifestation of malnutrition in cancer and several large-scale studies have reported that involuntary WL affects 50–80% of patients with cancer, with the degree of WL dependent on tumour site, type and stage of disease. The study of body composition in oncology using computed tomography has unearthed the importance of both low muscle mass (sarcopenia) and low muscle attenuation as important prognostic indications of unfavourable outcomes including poorer tolerance to chemotherapy; significant deterioration in performance status and quality of life (QoL), poorer post-operative outcomes and shortened survival. While often hidden by excess fat and high BMI, muscle abnormalities are highly prevalent in patients with cancer (ranging from 10 to 90%). Early screening to identify individuals with sarcopenia and decreased muscle quality would allow for earlier multimodal interventions to attenuate adverse body compositional changes. Multimodal therapies (combining nutritional counselling, exercise and anti-inflammatory drugs) are currently the focus of randomised trials to examine if this approach can provide a sufficient stimulus to prevent or slow the cascade of tissue wasting and if this then impacts on outcomes in a positive manner. This review will focus on the aetiology of musculoskeletal degradation in cancer; the impact of sarcopenia on chemotherapy tolerance, post-operative complications, QoL and survival; and outline current strategies for attenuation of muscle loss in clinical practice.

scholarly journals Longitudinal impact of Welsh clinical leadership fellowship

2020 ◽  
Vol 33 (1) ◽  
pp. 1-11
Author(s):  
Suzanne Phillips ◽  
Alison Bullock
Keyword(s):  
Clinical Practice ◽  
Medical Training ◽  
Healthcare Delivery ◽  
The Body ◽  
Longitudinal Impact ◽  
Structured Interviews ◽  
Clinical Leadership ◽  
Content Type ◽  
Training Programmes ◽  
The Impact

Purpose This paper aims to evaluate the longer-term impact of the 12-month Welsh clinical leadership fellowship. Design/methodology/approach Semi-structured interviews with 10 out of 14 trainee doctors who were fellows between 2013-2016, exploring how leadership knowledge and skills were used in clinical practice, impact on patient care and influence on careers. Data, gathered in 2017 when participants had completed the fellowship between 1-3 years, were analysed thematically. Findings All found the fellowship rewarding. The experience was felt to advantage them in consultant interviews. They gained insight into the wider influence on organisations and the complexity of issues facing senior clinicians. Although subtle, the impact was significant, equipping fellows with negotiation skills, enabling them to better influence change. Indirect impact on clinical practice was evidenced by enhanced confidence, teamworking skills and progression of improvement projects. However, the use of skills was limited by lack of seniority within teams, demands of medical training and examinations. The negativity of others towards management and leadership was also noted by some. Research limitations/implications Small participant numbers limit generalisability. Practical implications The fellowship is designed to equip participants with skills to lead improvements in healthcare delivery. Those more advanced in their medical training had greater opportunity and seniority to lead change and were better placed to apply the learning. This has implications for whom the training should be targeted. Originality/value A rare study exploring the longer-term impact of a leadership programme on later clinical practice, which adds to the body of knowledge of impact and efficacy of leadership training programmes in healthcare environments.

scholarly journals Nutritional Complications and the Management of Patients with Gastroenteropancreatic Neuroendocrine Tumors

2019 ◽  
Vol 110 (5) ◽  
pp. 430-442 ◽  
Author(s):  
Erin Laing ◽  
Nicole Kiss ◽  
Michael Michael ◽  
Meinir Krishnasamy
Keyword(s):  
Clinical Practice ◽  
Neuroendocrine Tumors ◽  
Dietary Habits ◽  
Somatostatin Analogs ◽  
The United States ◽  
The Body ◽  
Care Needs ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Vitamin Deficiencies ◽  
The Impact

Neuroendocrine tumors (NETs) have increased in incidence and prevalence over the past 2 decades and affect approximately 170,000 people in the United States alone. Gastroenteropancreatic (GEP) NETs (GEP NET) are a heterogeneous group of rare tumors that have distinct effects on the body due to their tumor location and potential to secrete hormones and peptides. Clinical practice guidelines and consensus guidelines for GEP NETs with regard to best practice for diagnosis, treatment, and medical management are available, but the supportive care needs and optimal nutritional management of patients affected by these unique tumors remain under-researched: evidence to guide clinical practice is lacking. The pathophysiology of the disease and its treatment can cause various symptoms that can have significant effects on vitamin synthesis and absorption, dietary habits, weight change, and appetite. Deficiency of fat-soluble vitamins and niacin exists amongst patients with GEP NET, particularly those on treatment with somatostatin analogs and with serotonin-secreting tumors, respectively. Malnutrition and dietary modification amongst patients with GEP NET is more prevalent than initially thought: up to 25% of inpatients with GEP NET are malnourished. Food intolerance is also reported in up to 40–90% of these patients, though its misdiagnosis is common. This review summarizes the evidence regarding the impact of GEP NET and its treatment on nutritional factors in these patients with emphasis on malnutrition, vitamin deficiencies, dietary intake, and quality of life. Recommendations for clinical practice and research approaches to address these nutritional issues are discussed.

scholarly journals Good practice for guidance development – review of consensus methods

2019 ◽  
Vol 17 (4) ◽  
pp. 217-229
Author(s):  
Jacek Siwiec ◽  
Magdalena Konieczna ◽  
Magdalena Koperny
Keyword(s):  
Clinical Practice ◽  
Formal Methods ◽  
Scientific Evidence ◽  
Methodological Approach ◽  
Good Practice ◽  
Consensus Conference ◽  
Nominal Group ◽  
Consensus Methods ◽  
Wide Range ◽  
The Impact

Introduction. The process of synthesizing scientific evidence and translating elaborate scientific research findings into recommendations for clinical practice is one of the most complex and significant initiatives in health care. In connection with the increasing number of recommendations, previously unformalised elements such as the process of consensus decision-making require developing a methodological approach. The use of consensus methods serves to reduce the impact of psychosocial factors in the formulation of recommendations and to increase the degree of process transparency. The aim of the publication is to present formal methods of achieving consensus used in the process of developing clinical practice guidelines. Materials and methods. The review focuses on results of reports analyzing the procedure and methods of developing clinical recommendations, with particular emphasis on the identification of consensus methods. Results. Many international and national organizations and institutions develop recommendations or adapt guidelines developed by others. They use both informal and formal instruments to deal with divergent expert opinions. The most popular formal methods of achieving consensus identified in the review are the Delphi method, the nominal group technique, the RAND/UCLA method, the consensus conference, and the combinations of individual approaches. Formal methods have been shown to lead to less biased and more reliable recommendations. Regardless of the method used, the guidelines should clearly define the quorum and document the process of agreeing a common standpoint on recommendations, guidelines and recommendations. Conclusions. Clinical guidelines have become an important tool influencing clinical practice. The participation of many experts representing the opinions and interests of different groups makes it necessary to apply a methodological and structured approach so that all participants have the opportunity to voice their opinion and to ensure process transparency, deal with misunderstandings and achieve a consensual position. The consensus methods allow to provide a wide range of stakeholders clinicians, policy makers, patients – with agreed rules of conduct in a given topic. The formal consensus methods and recommendations based on these methods combine scientific evidence with the practice and experience of experts.

scholarly journals Impact of the grasping test on women’s cardiovascular systems, and the possibility of replacing the orthostatic tolerance test with it

2014 ◽  
Vol 27 (4) ◽  
pp. 217-219
Author(s):  
Karolina Zaluska ◽  
Tomasz Sawicki ◽  
Bartlomiej Kulesza ◽  
Adam Nogalski
Keyword(s):  
Clinical Practice ◽  
Cardiovascular System ◽  
Tolerance Test ◽  
Female Students ◽  
Physiological Parameters ◽  
The Body ◽  
Orthostatic Tolerance ◽  
Heart Rates ◽  
Blood Pressures ◽  
The Impact

Abstract The aim of this study was to test the impact of the Grasping Test (GT) on the female cardiovascular system and to ascertain the possibility of using this to replace the Orthostatic Tolerance Test (OT). In this study, 15 volunteer female students were examined, and their physiological parameters - their systolic (SBP) and diastolic blood pressures (DBP), and their heart rates (HR) - were compared. We found that the Orthostatic Tolerance Test (changing the position of the body from recumbent to upright) and the Grasping Test induced meaningful but similar changes in the functioning of the women’s cardiovascular system. The results confirm that there were significant similarities between the cardiovascular system measurements as produced through the Orthostatic Tolerance Test and the Grasping Test. The possibility of introducing the procedure into clinical practice is a crucial factor for continuing our research in the wider population.

scholarly journals IMPLEMENTAÇÃO DE EVIDÊNCIAS CIENTÍFICAS NA ASSISTÊNCIA AO PARTO NORMAL: ESTUDO LONGITUDINAL

2017 ◽  
Vol 8 (1) ◽  
pp. 27
Author(s):  
Rafael Cleison Silva Dos Santos
Keyword(s):  
Clinical Practice ◽  
Longitudinal Study ◽  
Educational Intervention ◽  
Medical Records ◽  
Clinical Audit ◽  
Scientific Evidence ◽  
Maternity Hospital ◽  
The State ◽  
The Impact ◽  
Childbirth Care

Objetivo: avaliar o impacto de uma intervenção educativa sobre práticas obstétricas e desfechos perineais. Método: estudo longitudinal, segundo a metodologia de implementação de evidências científicas na prática clínica, realizado com enfermeiros e médicos, puérperas e prontuários em uma maternidade pública de referência no estado do Amapá. Resultado: após a intervenção educativa, mais profissionais recomendaram as posições lateral e verticais no período expulsivo do parto; mais puérperas relataram as práticas de puxo dirigido e manobra de Kristeller; menos prontuários indicaram a laceração espontânea e graus de lacerações maiores. Conclusão: a intervenção educativa proporcionou resultados melhores, mas não estatisticamente significativos.Descritores: Auditoria clínica, Períneo, Pesquisa translacional.IMPLEMENTATION OF SCIENTIFIC EVIDENCES IN NORMAL CHILDBIRTH CARE: LONGITUDINAL STUDYObjective: to evaluate the impact of an educational intervention on obstetric practices and perineal outcomes. Method: longitudinal study, according to the methodology of implementation of scientific evidence in clinical practice, performed with nurses and doctors, puerperas and medical records in a referred public maternity hospital in the state of Amapá. Result: after the educational intervention, more professionals recommended the lateral and vertical positions in the expulsive period of childbirth; More puerperas reported the practices of directed pull and maneuver of Kristeller; Less medical records indicated spontaneous laceration and higher degrees of lacerations. Conclusion: the educational intervention provided better results, but not statistically significant.Descriptors: Clinical audit, Perineum, Translational research.IMPLEMENTACIÓN DE LA EVIDENCIA CIENTÍFICA EN LA ATENCIÓN DE PARTO NORMAL: UN ESTUDIO LONGITUDINALObjetivo: Evaluar el impacto de una intervención educativa sobre las prácticas obstétricas y resultados perineales. Método: Estudio longitudinal, de acuerdo con la metodología de implementación de la evidencia científica en la práctica clínica, realizada con las enfermeras y los médicos, las madres y los registros en una referencia maternidad pública en el estado de Amapá. Resultado: Después de la intervención educativa, la mayoría de los profesionales recomiendan las posiciones laterales y verticales en la segunda etapa del parto; más madres reportaron las prácticas de extracción y maniobra dirigida Kristeller; a menos que los registros que se indican las laceraciones espontáneas y un mayor grado de laceraciones. Conclusión: La intervención educativa poca mejora de las prácticas y los resultados perineales.Descriptores: Auditoría clínica, Perineo, Investigación traslacional.

scholarly journals Protein status of people with phenylketonuria: a scoping review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e049883
Author(s):  
Sarah Firman ◽  
Radha Ramachandran ◽  
Kevin Whelan ◽  
Oliver C Witard ◽  
Majella O’Keeffe
Keyword(s):  
Scoping Review ◽  
Scientific Evidence ◽  
Grey Literature ◽  
The Body ◽  
Future Research ◽  
Advisory Group ◽  
Protein Status ◽  
Ethical Approval ◽  
Review Protocol ◽  
The Impact

IntroductionPhenylketonuria (PKU) is a disorder of protein metabolism resulting in an accumulation of phenylalanine in the body. Dietary management consists of altering the sources of ingested protein to limit phenylalanine intake. Current dietary protein guidelines for PKU are based on limited scientific evidence, thus it remains unclear whether current practice leads to optimal protein status in people with PKU. To date, no attempt has been made to systematically evaluate the protein status of people with PKU, using a combination of validated anthropometric, biochemical and functional measurement tools. Furthermore, factors known to influence protein status in the general population warrant consideration when determining protein status in individuals with PKU, alongside factors unique to PKU such as the type of protein substitute consumed. Understanding the impact of these variables on protein status is crucial to developing a personalised approach to protein recommendations for optimising health and functional outcomes in people with PKU. Therefore, the aim of this scoping review is to examine existing evidence regarding the protein status of people with PKU, and to investigate the nutritional and lifestyle variables that influence protein status.Methods and analysisThis review will be guided by Arksey and O’Malley’s framework, along with guidance from Levac et al, Pawliuk et al and the Joanna Briggs Institute. The following databases will be searched: MEDLINE (Ovid), Embase, CENTRAL, Web of Science and Scopus, alongside grey literature. Identified literature will be assessed by two independent reviewers for inclusion. Descriptive numerical analysis will be performed and a narrative summary will accompany the tabulated results describing how study findings relate to the review questions.Ethics and disseminationThis review protocol does not require ethical approval. Findings will be disseminated through peer-reviewed publication, presented at relevant conferences, and shared with a patient research advisory group to inform discussions on future research.

scholarly journals Accredited Interactive Web-Based Application for the 2016 International Clinical Practice Guidelines on Thrombosis in Cancer: Improving Knowledge Transfer in Daily Clinical Practice

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5954-5954
Author(s):  
Dominique Farge
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Web Based ◽  
Patients With Cancer ◽  
The Impact

Abstract Venous thromboembolism (VTE) is a major therapeutic concern in cancer patients and the leading cause of death after metastasis. Providing anticoagulant therapy to this patient population is challenging because cancer patients are at increased risk of VTE recurrence and bleeding, and treatment management is often complicated by other co-morbidities that affect choice of anticoagulation. The International Initiative on Thrombosis and Cancer (ITAC-CME) is a multidisciplinary group of International academic clinicians, researchers, and experts dedicated to reducing the global burden of VTE and its consequences in cancer patients. In 2013, the group published international clinical practice guidelines for the treatment and prophylaxis of VTE in cancer (1, 2). In collaboration with CME solutions, an accredited CME provider, ITAC-CME developed a mobile web-based application to promote the international implementation of the 2013 guidelines, in English and French (www.itacc-cme.org). Usage of the app has steadily increased every year since its release. ITAC-CME recently revised its consensus recommendations according to a systematic review of the literature up to January 2016. In particular, the ISTH-endorsed updated recommendations provide a guidance on the use of the direct oral anticoagulants based on the current level of evidence (3). ITAC-CME and CME solutions have updated the web-based application to support the 2016 guidelines. The app also includes several new features, including interactive case-based CME learning activities, with pre- and post-activity practice assessments. These pre- and post-test metrics will be documented to record international clinical practice patterns, and monitor the impact of the app on the adoption of the 2016 guidelines into clinical practice worldwide. Translation of the 2016 updated app into additional languages is planned. The application has been submitted for accreditation with the royal College of Physicians and surgeons of Canada, the American Medical Association, the European Union of Medical Specialists, l' Organisme Gestionnaire du Développement Professionnel Continu, and the European Board for Accreditation in Hematology. 1 Debourdeau P, Farge D, Beckers M, Baglin C, Bauersachs RM, Brenner B, Brilhante D, Falanga A, Gerotzafias GT, Haim N, Kakkar AK, Khorana AA, Lecumberri R, Mandala M, Marty M, Monreal M, Mousa SA, Noble S, Pabinger I, Prandoni P, Prins MH, Qari MH, Streiff MB, Syrigos K, Büller HR, Bounameaux H. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. J Thromb Haemost. 2013 Jan;11(1):71-80. 2 Farge D, Debourdeau P, Beckers M, Baglin C, Bauersachs RM, Brenner B, Brilhante D, Falanga A, Gerotzafias GT, Haim N, Kakkar AK, Khorana AA, Lecumberri R, Mandala M, Marty M, Monreal M, Mousa SA, Noble S, Pabinger I, Prandoni P, Prins MH, Qari MH, Streiff MB, Syrigos K, Bounameaux H, Büller HR. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer.J Thromb Haemost. 2013 Jan;11(1):56-70 3 Farge D, Bounameaux H , Brenner B, Cajfinger F, Debourdeau P, Khorana AA, Pabinger I, Solymoss S, Douketis J, Kakkar A. 2016 International Clinical Practice Guidelines Including Guidance for the Direct Oral Anticoagulants in the Treatment and Prophylaxis of Venous Thromboembolism in Patients With Cancer. Lancet Onccology 2016 (in press) Disclosures No relevant conflicts of interest to declare.

Resources from Reformed Spirituality for Christian Spiritual Formation in Clinical Practice

2001 ◽  
Vol 29 (1) ◽  
pp. 62-71 ◽  
Author(s):  
Dennis Morgan ◽  
Mark Yarhouse
Keyword(s):  
Clinical Practice ◽  
Spiritual Formation ◽  
Clinical Setting ◽  
Reformed Theology ◽  
Christian Psychology ◽  
The Impact ◽  
Reformed Spirituality

The purposes of this article are to introduce the reader to Reformed theology and to begin to discuss implications of Reformed spirituality on the practice of Christian psychology. A discussion of a case example will be utilized to consolidate the reader's understanding of the Reformed theological tradition and its application to Christian spiritual formation in a clinical setting. This article implies that the impact of Reformed theology and spirituality on clinical practice is profound enough to warrant further investigations of theologically congruent psychotherapies.

scholarly journals Prior History of Venous Thromboembolism Is a Significant Risk Factor for Recurrence of Thrombosis after Cancer Diagnosis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 32-33
Author(s):  
Sargam Kapoor ◽  
Aman Opneja ◽  
Jahnavi Gollamudi ◽  
Lalitha V. Nayak
Keyword(s):  
Cancer Diagnosis ◽  
Factor V Leiden ◽  
Personal History ◽  
Prior History ◽  
Cancer Type ◽  
Patients With Cancer ◽  
History Of ◽  
Diagnosis Of Cancer ◽  
Recurrent Vte ◽  
The Impact

Introduction: The risk of venous thromboembolism (VTE) is increased in patients with cancer and contributes to significant morbidity, treatment delays and mortality. The Khorana score is the most well-validated VTE risk prediction tool that guides use of prophylactic anticoagulation in patients with cancer. The Khorana score includes cancer type, body mass index (BMI), hemoglobin, platelet count and leukocyte count but not a prior history of VTE which may increase the risk of recurrent VTE. Scant published data have suggested that a personal history of VTE increases the risk of VTE recurrence by 2 to 7-fold after cancer diagnosis. In this study, we examine the impact of history of VTE on VTE recurrence in a large cohort of patients with cancer. Methods: We performed a retrospective cohort study of patients diagnosed with cancer using aggregated de-identified data from electronic medical record of >300 major hospitals in US (IBM Watson Explorys). Patients with a personal history of VTE (deep vein thrombosis and/ or pulmonary embolism) more than one year prior to the diagnosis of cancer were included. Within this cohort, patients who developed recurrent VTE within 180 days of diagnosis of cancer were identified. The primary end-point was the incidence of cancer associated VTE (CVTE) in patients with prior history of VTE as compared to patients without history of VTE. Baseline characteristics including age, race, gender, BMI, prothrombotic mutations (Factor V Leiden, prothrombin gene 20210A mutation), antineoplastic agent use, cancer type and laboratory values (as included in Khorana risk score) were compared in all patients. Results: A total of 4,159,400 patients with a diagnosis of cancer were included. Of these, 138,820 patients (3.3%) had a history of VTE >1 year prior to being diagnosed with cancer. The incidence of CVTE at 180 days was 10-fold higher in those with prior history of VTE compared to those without (36.9% vs 3.66%; OR 15.4, 95% CI 15.22-15.6, P value <0.0001). While the inherent risk of CVTE varied based on cancer type (highest risk of 10.5% in pancreatic cancer), the risk of recurrent VTE in patients with prior VTE history is magnified to a similar degree across all cancer types as shown in Figure 1. Baseline characteristics including age, race, gender and cancer type distribution were similar in all groups, as shown in Table 1. Factor V Leiden mutation or activated protein C resistance (FVL/APC) was more prevalent in patients with prior history of VTE and subsequent CVTE (3%) as compared to all patients with CVTE regardless of history (1%), as shown in Table 1. A higher BMI was noted in patients with prior history of VTE (49% and 71% respectively in patients with and without CVTE) as compared to 41% in all patients with CVTE. Greater use of antineoplastic agents (41%) was noted in the group of patients with prior history of VTE and subsequent CVTE as compared to patients with prior VTE but no CVTE (36%). Conclusion: Our study highlights that a prior personal history of VTE >1 year before cancer diagnosis significantly increases the risk of cancer associated VTE independently, regardless of other established risk factors for VTE suggesting that this group of patients, especially those undergoing anti-cancer treatment may benefit from prophylactic anticoagulation. Increased incidence of FVL/ APC in patients with prior history of VTE and recurrent CVTE may reflect increased testing for prothrombotic mutations in this cohort. Our ongoing efforts include examining the effect of addition of history of VTE to the Khorana score. Finally, large prospective observational studies would be key to assess the impact of history of VTE on cancer thrombosis. Disclosures No relevant conflicts of interest to declare.

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