Secondary causes of cancer-related anorexia: Recognition in daily practice by a novel checklist, a pilot study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9058-9058
Author(s):  
A. G. Omlin ◽  
F. Strasser
Keyword(s):  
Advanced Cancer ◽  
Epigastric Pain ◽  
Daily Practice ◽  
Therapeutic Interventions ◽  
Future Research ◽  
Advanced Cancer Patients ◽  
Cross Sectional ◽  
Expert Opinions ◽  
The Impact ◽  
Control Study

9058 Background: Secondary - potentially reversible - causes of cancer-related anorexia, a common and devastating complication of advanced cancer, remain poorly recognised in daily practice. To explore the frequency of SecAn and evaluate the practice- guiding-potential (PGP) of a novel clinical assessment checklist (CL-SecAn). Methods: The 11 item CL-SecAn is based on literature review and multiprofessional clinical expert opinions. Patients rate the answers to the questions “I feel anorectic because of [i.e. stomatitis]” by an 1–4 categorical scale (no, little, moderate, a lot). Consecutive patients of an interdisciplinary palliative-oncological outpatient “nutrition & fatigue” clinic (NF-clinic) and of a multicenter cross-sectional advanced cancer pain study completed the CL-SecAn. Charts of the NF-clinic were retrospectively reviewed for onset or change of therapeutic interventions (Tx-SecAn) focused on identified causes of SecAn. Patients with (rating 3 or 4) or without (1 or 2) one of the 11 SecAn causes were compared to estimate PGP. In addition, matched (age, sex, tumor, cachexia) “regular” out-patients are compared to NF-clinic patients for Tx-SecAn. Results: SecAn was present (defined as =3/4) in 63 of 113 (56%) patients (53 NF-clinic, 60 study; f:m 45:68; age 64 [median, range 25, 88]; 30% gastrointestinal, 20% lung, 13% prostate, 10% urogenital, and 17% other cancer, 10% lymphoma). SecAn causes were: stomatitis 4%, dysgeusia 19%, dysphagia 8%, epigastric pain 9%, abdominal pain 14%, constipation19%, diarrhea 5%, defecation after a meal 2%, pain 12%, dyspnoea 3% and fatigue 13%. In 36 (32%) patients more than one cause was present. Tx-SecAn for dysgeusia was applied in 7 of 15 patients (46%) with and 3 of 38 (8%) without Sec-An Dysgeusia. For constipation, Tx-SecAn was modified in 70% with and 27% without Sec-An constipation. The other 9 Sec-An were analysed accordingly. The case-control study is currently ongoing. Conclusions: SecAn causes seem to be common in advanced cancer patients. The CL-SecAn carries a Practice-Guiding-Potential, at least for some of the 11 SecAn causes, its potential might be underrecognized in frequently treated syndromes, such as constipation. Future research will investigate further the impact of CL-SecAn. No significant financial relationships to disclose.

scholarly journals Electronic Health Record Acceptance by Physicians: A Single Hospital Experience in Daily Practice

2021 ◽  
Vol 1 (1) ◽  
pp. 6-17
Author(s):  
Andrija Pavlovic ◽  
Nina Rajovic ◽  
Jasmina Pavlovic Stojanovic ◽  
Debora Akinyombo ◽  
Milica Ugljesic ◽  
...  
Keyword(s):  
Health Care ◽  
Logistic Regression ◽  
Electronic Health Record ◽  
Technology Acceptance ◽  
Daily Practice ◽  
Ease Of Use ◽  
Future Research ◽  
Health Record ◽  
Cross Sectional ◽  
Electronic Health

Introduction: Potential benefits of implementing an electronic health record (EHR) to increase the efficiency of health services and improve the quality of health care are often obstructed by the unwillingness of the users themselves to accept and use the available systems. Aim: The aim of this study was to identify factors that influence the acceptance of the use of an EHR by physicians in the daily practice of hospital health care. Material and Methods: The cross-sectional study was conducted among physicians in the General Hospital Pancevo, Serbia. An anonymous questionnaire, developed according to the technology acceptance model (TAM), was used for the assessment of EHR acceptance. The response rate was 91%. Internal consistency was assessed by Cronbach’s alpha coefficient. A logistic regression analysis was used to identify the factors influencing the acceptance of the use of EHR. Results: The study population included 156 physicians. The mean age was 46.4 ± 10.4 years, 58.8% participants were female. Half of the respondents (50.1%) supported the use of EHR in comparison to paper patient records. In multivariate logistic regression modeling of social and technical factors, ease of use, usefulness, and attitudes towards use of EHR as determinants of the EHR acceptance, the following predictors were identified: use of a computer outside of the office for reading daily newspapers (p = 0.005), EHR providing a greater amount of valuable information (p = 0.007), improvement in the productivity by EHR use (p < 0.001), and a statement that using EHR is a good idea (p = 0.014). Overall the percentage of correct classifications in the model was 83.9%. Conclusion: In this research, determinants of the EHR acceptance were assessed in accordance with the TAM, providing an overall good model fit. Future research should attempt to add other constructs to the TAM in order to fully identify all determinants of physician acceptance of EHR in the complex environment of different health systems.

scholarly journals Engagement with daily testing instead of self-isolating in contacts of confirmed cases of SARS-CoV-2

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alex F. Martin ◽  
Sarah Denford ◽  
Nicola Love ◽  
Derren Ready ◽  
Isabel Oliver ◽  
...  
Keyword(s):  
Pilot Study ◽  
Minority Groups ◽  
Service Evaluation ◽  
Future Research ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Significant Group ◽  
Negative Test ◽  
The Impact ◽  
Close Contacts

Abstract Background In December 2020, Public Health England with NHS Test and Trace initiated a pilot study in which close contacts of people with confirmed COVID-19 were given the option to carryout lateral flow device antigen tests at home, as an alternative to self-isolation for 10–14 days. In this study, we evaluated engagement with daily testing, and assessed levels of adherence to the rules relating to behaviour following positive or negative test results. Methods We conducted a service evaluation of the pilot study, examining survey responses from a subset of those who responded to an evaluation questionnaire. We used an online cross-sectional survey offered to adult contacts of confirmed COVID-19 cases who consented to daily testing. We used a comparison group of contacts who were not offered testing and instead self-isolated. Results Acceptability of daily testing was lower among survey respondents who were not offered the option of testing and among people from ethnic minority groups. Overall, 52% of respondents reported being more likely to share details of people that they had been in contact with following a positive test result, if they knew that their contacts would be offered the option of daily testing. Only 2% reported that they would be less likely to provide details of their contacts. On the days that they were trying to self-isolate, 19% of participants reported that they left the house, with no significant group differences. Following a negative test, 13% of respondents reported that they increased their contacts, but most (58%) reported having fewer risky contacts. Conclusions Our data suggest that daily testing is potentially acceptable, may facilitate sharing contact details of close contacts among those who test positive for COVID-19, and promote adherence to self-isolation. A better understanding is needed of how to make this option more acceptable for all households. The impact of receiving a negative test on behaviour remains a risk that needs to be monitored and mitigated by appropriate messaging. Future research should examine attitudes and behaviour in a context where infection levels are lower, testing is more familiar, and restrictions on activity have been reduced.

scholarly journals Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners

2021 ◽  
Author(s):  
Allison Brown ◽  
Aliya Kassam ◽  
Mike Paget ◽  
Kenneth Blades ◽  
Megan Mercia ◽  
...  
Keyword(s):  
Medical Education ◽  
Medical Training ◽  
Well Being ◽  
World Health ◽  
Future Research ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The World ◽  
Geographic Regions ◽  
The Impact

Background: The evidence surrounding the impact of COVID-19 on medical learners remains anecdotal and highly speculative despite the anticipated impact and potential consequences of the current pandemic on medical training. The purpose of this study was to explore the extent that COVID-19 initially impacted medical learners around the world and examine global trends and patterns across geographic regions and levels of training. Methods: A cross-sectional survey of medical learners was conducted between March 25–June 14, 2020, shortly after the World Health Organization declared COVID-19 a pandemic. Results: 6492 learners completed the survey from 140 countries. Most medical schools removed learners from the clinical environment and adopted online learning, but students reported concerns about the quality of their learning, training progression, and milestone fulfillment. Residents reported they could be better utilized and expressed concerns about their career timeline. Trainees generally felt under-utilized and wanted to be engaged clinically in meaningful ways; however, some felt that contributing to healthcare during a pandemic was beyond the scope of a learner. Significant differences were detected between levels of training and geographic regions for satisfaction with organizational responses as well as the impact of COVID-19 learner wellness and state-trait anxiety. Conclusions: The disruption to the status quo of medical education is perceived by learners across all levels and geographic regions to have negatively affected their training and well-being, particularly amongst postgraduate trainees. These results provide initial empirical insights into the areas that warrant future research as well as consideration for current and future policy planning.

scholarly journals Pilot Educational Intervention to Promote Safe Pesticide Use Practices Among Farmworkers in Nepal

2020 ◽  
Vol 64 (8) ◽  
pp. 866-875
Author(s):  
Pramesh Koju ◽  
Prabin R Shakya ◽  
Archana Shrestha ◽  
Biraj M Karmacharya ◽  
Sudip Shrestha ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Pesticide Exposure ◽  
Scale Up ◽  
Personal Hygiene ◽  
Future Research ◽  
Health And Environmental Effects ◽  
Cross Sectional ◽  
Handling Practices ◽  
Hands And Feet ◽  
The Impact

Abstract Objectives The misuse of pesticides among farmworkers in Nepal is commonplace. To address this, we implemented a pilot educational intervention (three modules delivered over 3 days and lasting approximately 3 h each) in Kavre District of Nepal. Modules included: (i) health and environmental effects of pesticides, (ii) use of personal protective equipment, and (iii) label literacy and behavioral factors that influence pesticide exposure. In addition, 10 posters with key messages from each of the modules were hung throughout communities. Methods Surveys were administered to cross-sectional convenience samples of farmworkers at baseline (n = 106) and 1 year later (n = 98). Practices relating to pesticides at baseline and endline were compared using multivariable logistic regression to adjust for differences in demographic and socioeconomic characteristics between the samples. Results Compared with the baseline sample, farmworkers in the endline sample were significantly more likely to report: getting information regarding the amount of pesticides to use from experts or pesticide labels (versus personal judgment); wearing gloves while mixing pesticides; wearing boots while working in the field; using personal hygiene practices after handling pesticides such as bathing or washing hands and feet; changing clothes after handling pesticides; checking the wind direction before spraying; and delaying entry for a longer period of time after spraying. Conclusions These results suggest that a simple educational intervention can improve pesticide handling practices among farmworkers in Nepal. Future research should explore the impact of such interventions on pesticide exposure levels and health outcomes, and the potential to scale up these programs nationally.

Family caregivers of advanced cancer patients: self-perceived competency and meaning-making

2019 ◽  
Vol 10 (4) ◽  
pp. 435-442 ◽  
Author(s):  
Irene Teo ◽  
Drishti Baid ◽  
Semra Ozdemir ◽  
Chetna Malhotra ◽  
Ratna Singh ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Family Caregivers ◽  
Advanced Cancer ◽  
Meaning Making ◽  
Negative Relationship ◽  
Psychological Outcomes ◽  
Advanced Cancer Patients ◽  
Cross Sectional ◽  
Tertiary Hospitals ◽  
Anxiety Depression

BackgroundFamily caregivers of patients with advanced cancer have been reported to provide long hours of care and be at risk for poor psychological outcomes. Although research has focused on the nature of caregiving burden, little attention has been paid to identifying protective factors that improve caregiver psychological outcomes.AimWe examined the relationship between caregivers’ time spent caregiving and the following psychological outcomes: anxiety, depression and caregiving esteem. Subsequently, we explored the main and moderating effects of caregiver-perceived self-competency and sense of meaning on caregiver psychological outcomes.Design/participantsCross-sectional analysis was conducted using the baseline data from an ongoing cohort study. Family caregivers of advanced cancer patients (n=287) were recruited from two tertiary hospitals in Singapore.ResultsTime spent caregiving was not significantly associated with caregiver anxiety, depression or caregiving esteem. However, significant main effects of self-competency on anxiety and caregiving esteem; and sense of meaning on anxiety, depression and caregiving esteem were observed. Moderator analyses further indicated that self-competency attenuated the positive relationship between time spent caregiving and anxiety, while sense of meaning attenuated the negative relationship between time spent caregiving and caregiving esteem.ConclusionGreater perceived self-competency and sense of meaning are related to better caregiver psychological outcomes, and protect caregivers from worsening outcomes as caregiving hours increase. Our findings suggest that screening caregivers for distress is an important part of care, and that supportive interventions for caregivers should aim to enhance their perceived caregiving competencies and the ability to make meaning of their caregiving role.

scholarly journals Dynamics of Neutrophils-to-Lymphocyte Ratio Predict Outcomes of PD-1/PD-L1 Blockade

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Michele Moschetta ◽  
Mario Uccello ◽  
Benjamin Kasenda ◽  
Gabriel Mak ◽  
Anissa McClelland ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Phase 1 ◽  
Prognostic Score ◽  
Single Agent ◽  
Significant Prognostic Factor ◽  
Advanced Cancer Patients ◽  
Lymphocyte Ratio ◽  
Phase 1 Trials ◽  
The Impact

Introduction. Baseline neutrophil-to-lymphocyte ratio (NLR) has been repeatedly reported as a significant prognostic factor in advanced cancer patients. We explored whether changes in NLR may predict outcome of advanced cancer patients enrolled into phase 1 trials and treated with PD-1/PD-L1 inhibitors. Patients and Methods. Advanced cancer patients enrolled into phase 1 trials between September 2013 and May 2016 and treated with anti-PD-1/PD-L1 agents were included in this retrospective study. NLR was calculated at baseline and after 2 cycles of treatment. Royal Marsden Hospital (RMH) prognostic score and Eastern Cooperative Group (ECOG) performance status (PS) were determined at baseline. Kaplan-Meier estimation and Cox regression analyses were used to assess the impact of NLR dynamics on PFS. Results. Among the 55 patients eligible, 26 (47%) were treated with anti-PD-L1 monotherapy, 22 (40%) received single agent anti-PD-1, and 7 (13%) were given a tyrosine kinase inhibitor (TKI) plus a PD-1 inhibitor. Neither ECOG PS nor RMH prognostic score was significantly associated with PFS in our cohort, whereas changes in NLR significantly impacted on PFS. Conclusion. Changes in the NLR may be a useful predicting factor in advanced cancer patients treated with anti-PD-1/PD-L1 agents. Further prospective trials are needed to verify these findings.

Impact of an outpatient interdisciplinary team (IDT) consultation on symptom clusters in advanced cancer patients seen at a supportive care outpatient clinic (OSC) in a tertiary cancer center

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20542-e20542
Author(s):  
S. Yennurajalingam ◽  
D. L. Urbauer ◽  
R. Chacko ◽  
D. Hui ◽  
Y. A. Amin ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Interdisciplinary Team ◽  
Well Being ◽  
Symptom Clusters ◽  
Advanced Cancer Patients ◽  
Edmonton Symptom Assessment Scale ◽  
Cluster Composition ◽  
The Impact

e20542 Background: Advanced cancer patients develop severe physical and psychosocial symptom clusters. There is limited data on the impact of an outpatient interdisciplinary team (IDT) consultation lead by palliative care specialists on symptom clusters. Cluster composition and consistence, response rate and predictors of response are unknown. Methods: 914 consecutive patients with advanced cancer presenting in the OSC from Jan 2003 to Oct 2008 with a complete Edmonton symptom assessment scale at the initial and follow-up visit (median 14 days, range 1–4 wks), and CAGE status (alcohol screening) were reviewed. Wilcoxon ranked sign test was used to determine whether symptoms changed over time. Principal components factor analysis with varimax rotation was used to determine clusters of symptoms at baseline and at follow-up. The number of factors calculated was determined based upon the number of eigen values that were greater than one. Results: Median age was 59 yrs, female were 46%. The most common primary cancer was Lung (19%). Baseline and follow-up visit scores (mean, SD) were: fatigue 5.7 (2.1) and 5.2 (2.2, p<0.0001), pain 4.9 (2.6) and 4.1 (2.6 p<0.0001), nausea 1.8 (2.4) and 1.7 (2.3, p=0.1), depression 2.6 (2.5) and 2.2(2.4,p<0.0001), anxiety 2.9 (2.7) and 2.4 (2.4, p<0.0001), drowsiness 3.2 (2.8) and 3.2 (2.6, p=0.7), dyspnea 2.6 (2.7) and 2.4 (2.6), p=0.0027), appetite 4.2(2.7) and 3.9 (2.7, p<0.0001), sleep 4.2 (2.6) and 3.8 (2.6, p<0.0001) and well being 4.3 (2.5) and 3.9 (2.3, p<0.0001). During the follow- up the symptom clusters varied from a 3 factor to a 2 factor model, reflecting the impact of the IDT on symptom burden. CAGE positive and CAGE negative patients had a significantly different symptom cluster model. Conclusions: Cluster composition differs when patients are assessed and managed by an IDT and among patients who screen positive for alcoholism. [Table: see text] No significant financial relationships to disclose.

Impact of bladder cancer (BC) on health-related quality of life (HRQL) in 1,476 older Americans.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9549-9549
Author(s):  
Chunkit Fung ◽  
Chintan Pandya ◽  
Katia Noyes ◽  
Emelian Scosyrev ◽  
Deepak M. Sahasrabudhe ◽  
...  
Keyword(s):  
Smoking Status ◽  
Cross Sectional Study ◽  
Older Age ◽  
Future Research ◽  
Cross Sectional ◽  
Older Americans ◽  
Comorbidity Score ◽  
Before And After ◽  
Related Quality ◽  
The Impact

9549 Background: The impact of BC on HRQL is poorly understood. To our knowledge, this is the first and largest cross-sectional study that compares HRQL of patients before and after BC diagnosis (DX). Methods: Our sample included 1,476 BC patients (≥ age 65) within the SEER-Medicare Health Outcomes Survey linkage database (1998-2007). We assessed differences in HRQL as measured by SF-36 physical (PCS) and mental (MCS) summary scores in patients who had a survey >1 yr before BC DX (n=620) and those who had a survey after BC DX (n=856). We compared groups by year from BC DX using regression analyses and results were adjusted for cancer stage, race, gender, age at BC DX, marital status, education, income, smoking status, activity of daily living (ADLs), and non-cancer comorbidities. Results: Patients who had a survey after BC DX were diagnosed with BC at an older age than those with a survey before BC DX (55.9% at age ≥75 yr vs. 36.8%; P<0.01). Other baseline demographic and socioeconomic characteristics were similar. Baseline HRQL were poor in patients before DX (PCS mean=40.1; MCS mean=51.1) with 50.6% and 31.9% of them having comorbidity score ≥2 and impairment of ≥1 ADLs, respectively. After BC DX, significant decreases in PCS (-2.7; 95% CI -3.8,-1.7) and MCS (-1.4; 95% CI -2.6, -0.3) were observed, with HRQL being lowest in those who had BC DX within 1 yr (PCS mean= 36.6; MCS mean=49.7). Declines in PCS during the <1, 1-3, 3-5, 5-10, and 10+ yr periods after BC DX compared to before BC DX were -3.8 (P<0.01), -2.5 (P<0.01), -2.2 (P=0.01), -1.1 (P=0.19) and -0.8 (P=0.57) whereas decreases in MCS were -2.0 (P=0.01), -2.2 (P<0.01), -1.2 (P=0.21), -0.1 (P=0.92), -0.8 (P=0.62) respectively. More advanced BC, lower educational level, higher comorbidity score, and impaired ADLs were significantly associated with both worse PCS and MCS after BC DX (P<0.05). Lower income and older age at BC DX showed significant association with low PCS (P<0.05). Conclusions: Older BC patients are a vulnerable population with poor baseline HRQL. HRQL of patients after BC DX is significantly worse than HRQL of patients before DX, possibly due to therapy and/or disease progression. Future research that evaluates interventions to improve HRQL in older patients with BC is critical.

A combined treatment approach for cachexia and cancer-related anemia in advanced cancer patients: A randomized placebo-controlled trial.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 189-189 ◽  
Author(s):  
Clelia Madeddu ◽  
Giulia Gramignano ◽  
Luciana Tanca ◽  
Maria Cristina Cherchi ◽  
Carlo Aurelio Floris ◽  
...  
Keyword(s):  
Energy Metabolism ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Cancer Progression ◽  
Iron Metabolism ◽  
Combined Treatment ◽  
Advanced Cancer Patients ◽  
Tnf Α ◽  
Cancer Related Anemia ◽  
The Impact

189 Background: Cancer progression is characterized by specific energy metabolism alterations and by symptoms including fatigue, anorexia, nausea, depression, which results in cachexia syndrome and compromised quality of life (QL). This condition is often associated to anemia (cancer-related anemia, CRA), which negatively impacts patient QL and disease outcome. Methods: Adult advanced cancer patients with cachexia (i.e., weight loss > 5% in the previous 6 months) and CRA were randomly assigned (1:1 by computer generated list) to receive 3 months of a combined approach consisting of celecoxib (200 mg/day), L-carnitine (2 g/day), curcumin (Meriva) (4 g/day) and lactoferrin (200 mg/day) or placebo. The rationale for selecting these agents was: L-carnitine for modulating cell energy metabolism; celecoxib for counteracting inflammation, which is a key feature of cachexia; curcumin for its antiinflammatory and antioxidant action, without disregarding its action on the NF-kB and JAK-STAT pathway and the related synthesis of proinflammatory cytokines; lactoferrin for its ability to regulate iron metabolism in anemic cancer patients. Primary endpoints were improvement of lean body mass (LBM), appetite, fatigue and anemia. Additionally, we assessed the impact of treatment on the main metabolic/inflammatory and iron metabolism parameters: C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, leptin, reactive oxygen species (ROS), glutathione peroxidase, serum iron, ferritin, hepcidin and erythropoietin (EPO). Results: From January 2013 to March 2014, 66 patients have been enrolled. The combination arm was more effective than placebo arm in improving body weight, LBM, appetite, fatigue, and anemia. Among secondary parameters IL-6, TNF-α, CRP, ROS, ferritin, hepcidin and EPO decreased, while leptin increased significantly in the combination arm. No significant changes were observed in the placebo arm. Conclusions: To date a standard effective treatment of cancer cachexia is lacking. Our combined multitargeted approach was able to improve the nutritional and immunometabolic alterations of cachexia, ameliorate patient QL and correct CRA.

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