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17 results

  • A qualitative study of patient and provider perspectives on using web-based pain coping skills training to treat persistent cancer pain
  • Christine Rini, Maihan B. Vu, Hannah Lerner, Catherine Bloom, Jessica Carda-Auten, William A. Wood, Ethan M. Basch, Peter M. Voorhees, Katherine E. Reeder-Hayes, Francis J. Keefe
  • Journal: Palliative & Supportive Care / Volume 16 / Issue 2 / April 2018
  • Published online by Cambridge University Press: 07 March 2017, pp. 155-169
  • Print publication: April 2018
  • View abstract
    Objective:

    Persistent pain is common and inadequately treated in cancer patients. Behavioral pain interventions are a recommended part of multimodal pain treatments, but they are underused in clinical care due to barriers such as a lack of the resources needed to deliver them in person and difficulties coordinating their use with clinical care. Pain coping skills training (PCST) is an evidence-based behavioral pain intervention traditionally delivered in person. Delivering this training via the web would increase access to it by addressing barriers that currently limit its use. We conducted a patient pilot study of an 8-week web-based PCST program to determine the acceptability of this approach to patients and the program features needed to meet their needs. Focus groups with healthcare providers identified strategies for coordinating the use of web-based PCST in clinical care.

    Method:

    Participants included 7 adults with bone pain due to multiple myeloma or metastasized breast or prostate cancer and 12 healthcare providers (4 physicians and 8 advanced practice providers) who treat cancer-related bone pain. Patients completed web-based PCST at home and then took part in an in-depth qualitative interview. Providers attended focus groups led by a trained moderator. Qualitative analyses identified themes in the patient and provider data.

    Results:

    Patients reported strongly favorable responses to web-based PCST and described emotional and physical benefits. They offered suggestions for adapting the approach to better fit their needs and to overcome barriers to completion. Focus groups indicated a need to familiarize healthcare providers with PCST and to address concerns about overburdening patients. Providers would recommend the program to patients they felt could benefit. They suggested applying a broad definition of cancer pain and having various types of providers help coordinate program its use with clinical care.

    Significance of results:

    Web-based PCST was acceptable to patients and providers. Our findings suggest that patients could benefit from this approach, especially if patient and provider barriers are addressed.

  • Impact of Universal Gowning and Gloving on Health Care Worker Clothing Contamination
  • Calvin Williams, Patty McGraw, Elyse E. Schneck, Anna LaFae, Jesse T. Jacob, Daniela Moreno, Katherine Reyes, G. Fernando Cubillos, Daniel H. Kett, Ronald Estrella, Daniel J. Morgan, Anthony D. Harris, Marci Drees
  • Journal: Infection Control & Hospital Epidemiology / Volume 36 / Issue 4 / April 2015
  • Published online by Cambridge University Press: 02 January 2015, pp. 431-437
  • Print publication: April 2015
  • View abstract
    OBJECTIVE

    To determine whether gowning and gloving for all patient care reduces contamination of healthcare worker (HCW) clothing, compared to usual practice.

    DESIGN

    Cross-sectional surveys.

    SETTING

    Five study sites were recruited from intensive care units (ICUs) randomized to the intervention arm of the Benefits of Universal Gown and Glove (BUGG) study.

    PARTICIPANTS

    All HCWs performing direct patient care in the study ICUs were eligible to participate.

    METHODS

    Surveys were performed first during the BUGG intervention study period (July–September 2012) with universal gowning/gloving and again after BUGG study conclusion (October–December 2012), with resumption of usual care. During each phase, HCW clothing was sampled at the beginning and near the end of each shift. Cultures were performed using broth enrichment followed by selective media. Acquisition was defined as having a negative clothing culture for samples taken at the beginning of a shift and positive clothing culture at for samples taken at the end of the shift.

    RESULTS

    A total of 348 HCWs participated (21–92 per site), including 179 (51%) during the universal gowning/gloving phase. Overall, 51 (15%) HCWs acquired commonly pathogenic bacteria on their clothing: 13 (7.1%) HCWs acquired bacteria during universal gowning/gloving, and 38 (23%) HCWs acquired bacteria during usual care (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2–0.6). Pathogens identified included S. aureus (25 species, including 7 methicillin-resistant S. aureus [MRSA]), Enterococcus spp. (25, including 1 vancomycin-resistant Enterococcus [VRE]), Pseudomonas spp. (4), Acinetobacter spp. (4), and Klebsiella (2).

    CONCLUSION

    Nearly 25% of HCWs practicing usual care (gowning and gloving only for patients with known resistant bacteria) contaminate their clothing during their shift. This contamination was reduced by 70% by gowning and gloving for all patient interactions.

    Infect Control Hosp Epidemiol 2014;00(0): 1–7

  • Noonan, Costello and cardio–facio–cutaneous syndromes: dysregulation of the Ras–MAPK pathway
  • William E. Tidyman, Katherine A. Rauen
  • Journal: Expert Reviews in Molecular Medicine / Volume 10 / October 2008
  • Published online by Cambridge University Press: 09 December 2008, e37
  • Print publication: October 2008
  • View abstract

    A class of developmental disorders caused by dysregulation of the Ras-induced mitogen-activated protein kinase (MAPK) cascade (the Ras–MAPK pathway) has emerged. Three of these disorders – Noonan, Costello and cardio–facio–cutaneous syndromes – have overlapping phenotypic features characterised by distinctive facial dysmorphia, cardiac defects, musculoskeletal and cutaneous abnormalities, and neurocognitive delay. The germline mutations associated with these disorders are in genes that encode proteins of the Ras–MAPK pathway. In vitro studies have determined that the overwhelming majority of these mutations result in increased signal transduction down the pathway, but usually to a lesser degree than somatic mutations in the same genes that are associated with cancer. The Ras–MAPK pathway is essential in the regulation of the cell cycle, differentiation, growth and senescence, so it is not surprising that germline mutations that affect its function have profound effects on development. Here we review the clinical consequences of the known molecular lesions associated with Noonan syndrome, Costello syndrome and cardio–facio–cutaneous syndrome, and explore possible therapeutic modalities for treatment.

  • Semiquantitative analysis of collagen types in the hypertrophied left ventricle
  • KATHERINE A. LINEHAN, ANNE-MARIE L. SEYMOUR, PAMELA E. WILLIAMS
  • Journal: The Journal of Anatomy / Volume 198 / Issue 1 / January 2001
  • Published online by Cambridge University Press: 20 March 2001, pp. 83-92
  • Print publication: January 2001
  • View abstract

    Cardiac fibrosis is a characteristic feature of left ventricular hypertrophy. The aim of this study was to develop a simple and accurate method to analyse collagen accumulation, taking into account the variation in cardiac muscle fibre orientation and nonuniform collagen distribution. This technique was used to determine the amount and types of collagen that accumulate during pressure overload cardiac hypertrophy. These data were correlated with myocyte size, and with the diastolic stress–strain relationship of the intact myocardium. Myocyte size was significantly increased in the hypertrophied hearts, compared with age and sex matched controls (control 363±25 μm2 vs experimental 244μm2; mean±S.E., P < 0.05). No overall collagen accumulation was observed in the hypertrophied hearts, but a significant increase in collagen I was found with a reduction in the amount of collagen III in experimental animals. Since no increase in diastolic stiffness of the hearts was observed, these results indicate that an increase in the overall collagen content of the heart, rather than the upregulation of a specific type, may be necessary to cause diastolic dysfunction.

  • 2 - Reproduction and its psychopathology
  • Edited by Regina C. Casper, Stanford University, California
  • Book: Women's Health
  • Published online: 08 February 2010
  • Print publication: 13 December 1997, pp 14-35
  • View abstract

    Summary

    Early writers, such as Hippocrates, saw the womb as the seat of emotions and invoked the image of the wandering womb as stirring up emotions in women. Estrogen and progesterone are lipophilic steroid hormones that directly and indirectly affect central nervous system neurons involved in the regulation of mood and cognition. In light of the findings from animal studies, investigators set out with much optimism to identify hormonal changes in blood, and rarely in cerebrospinal fluid (CSF), to establish relationships to the symptoms reported in premenstrual dysphoric disorder (PDD). Several studies have reported that prevalence rates for depressive disorders during pregnancy are similar to those in non-pregnant women. The postpartum blues are experienced by 39-85 percent of women. Classically, the blues begin between 3 to 5 days after delivery with mood lability, sleep disturbances, fatigue, and problems with memory and concentration.
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