Positive effects of a psycho-educational group intervention for children with a chronic disease: first results

OBJECTIVE: To determine the effectiveness of a psycho-educational group intervention for chronically ill children. METHODS: Based on principles from cognitive behavior therapy and information from previous research about children's experiences with coping with a chronic disease we developed an intervention to be used for children with different chronic diseases. The program, called Op Koers (OK), with six sessions for different age groups, was evaluated by standardised and researcher-developed psychological measures. RESULTS: A total of 109 patients participated in the study on the effects of the psycho-educational intervention. Improvements in behavioral-emotional outcomes, social competence, information seeking, relaxation and positive thinking were found both in short and medium term. Additionally, the sessions received positive appraisals. CONCLUSIONS: The program appears to have a significant and positive impact on chronically children. Further research is needed to establish the effects of the intervention. PRACTICE IMPLICATIONS: Beneficial effects can be expected from the implementation of a psycho-educational group intervention for children with heterogeneous chronic health conditions.     

Effectiveness of an online computer-tailored physical activity intervention in a real-life setting

The aim of this study was to evaluate the effectiveness of a computer-tailored physical activity intervention delivered through the Internet in a real-life setting. Healthy adults (n=526), recruited in six worksites, between 25 and 55 years of age were randomized to one of three conditions receiving, respectively, (i) online-tailored physical activity advice + stage-based reinforcement e-mails, (ii) online-tailored physical activity advice only, (iii) online non-tailored standard physical activity advice. At 6-month follow-up, no differences in physical activity between study conditions were found; total physical activity, physical activity at moderate intensity and physical activity in leisure time significantly increased in all study conditions between baseline and follow-up. Further evaluation of the intervention materials showed that the tailored advice was more read, printed and discussed with others than the standard advice. Most of the respondents in the e-mail group indicated to be satisfied about the number, frequency and usefulness of the stage-based e-mails. In conclusion, although tailored advice was appreciated more than standard advice, no evidence was found that an online-tailored physical activity intervention program outperformed online standard information.     

Citrate for continuous renal replacement therapy: safer,better and cheaper

In a previous issue of Critical Care, Schilder and colleagues report the results of their multicenter trial (Citrate Anticoagulation Versus Systemic Heparinization; CASH) comparing regional anticoagulation with citrate to heparin anticoagulation. They found that citrate was safer, more efficacious and cheaper than heparin. In contrast to the largest previous trial, however, a survival benefit was not found, which was the primary endpoint of the CASH trial. Different explanations are possible, including selection bias and a lower severity of disease. Selection bias was high: only 6% of the renal replacement therapy patients were included (versus 56% in the previous trial) and exclusion was 56% for increased risk of bleeding, 2.5 times as frequent as in the previous trial. Thus, the trial with survival benefit apparently included more patients with risk of bleeding and also more severely ill patients and these are the groups that potentially benefit the most from citrate. Nevertheless, the CASH trial is the third large randomized trial showing superiority of citrate over heparin, supporting the recommendation of citrate as first choice anticoagulant.Continuous renal replacement therapy (CRRT) is used for critically ill patients with acute kidney injury in the setting of multiple organ failure. To prevent clotting in the extracorporeal circuit, anticoagulation is required. The commonly used strategies are heparin, causing systemic anticoagulation, and citrate, providing regional anticoagulation of the circuit. As a result, citrate does not increase the patient’s risk of bleeding. On account of this, citrate should be the first choice in critically ill patients. However, many doctors doubt its safety. The time has come to drop this delusion. The recently published multicenter CASH trial (Citrate Anticoagulation versus Systemic Heparinisation) is the third large randomized controlled trial in a row showing superiority of citrate over heparin [1-3]. Citrate was safer, more efficacious and cheaper. In contrast to the OLVG (Onze Lieve Vrouwe Gasthuis) trial [2], however, a survival benefit, which was the primary endpoint of the CASH trial, was not found.     

Can MRI Be Used as a Sole Diagnostic Modality in Determining Clinical Stage in Cervical Cancer?

ObjectiveThe objective of this study was to compare staging by MRI to clinical staging in patients with cervical cancer and to determine the histological accuracy of staging by MRI and examination under anesthesia (EUA) in early stage disease.MethodsThis was a retrospective cohort study of patients diagnosed with cervical cancer between 2010 and 2020 at the Radboud University Medical Centre, the Netherlands. Pretreatment stage (FIGO 2009) by MRI was compared with staging by EUA. Diagnostic accuracy in terms of sensitivity, specificity, positive, and negative predictive value was calculated for MRI and EUA in patients undergoing surgery (early stage disease) with histological results as a reference standard.ResultsA total of 358 patients were included in the study and MRI-based stage differed from EUA stage in 30.7%. In 12.3% this meant a discrepancy in treatment assignment between MRI and EUA. Diagnostic accuracy of MRI in terms of sensitivity and specificity for detecting early stage disease was comparable to EUA in surgical patients. Further analyses showed that premenopausal status, early stage disease and a tumor diameter of <2 cm were associated with improved comparability of MRI and EUA (98%).ConclusionThere is still a large discrepancy between MRI and EUA. In patients with suspected early stage disease, diagnostic accuracy of MRI is similar to EUA, especially for premenopausal women with early stage disease and a tumor diameter of <2 cm.     

Metabolism of docetaxel in mice

Previous studies have shown by quantification of the parent drug and the known metabolites M-1, M-2, M-3 and M-4 that the mass balance of docetaxel in mice and humans is not complete. We therefore used reversed-phase high-performance liquid chromatography (HPLC) with photodiode array (PDA) detection and tandem mass spectrometry to trace and identify putative metabolites in the feces and bile of mice injected intravenously with docetaxel. HPLC-PDA revealed two metabolic products in the feces and more than ten potential new metabolites in the bile. Mass spectrometry was performed on docetaxel reference compound, on the known metabolites M-1, M-2, M-3 and M-4, and on HPLC eluate fractions containing metabolic products, six fractions originating from the bile and two from the feces. The mass spectra of the most abundant unknown metabolite in the bile and the feces were identical, and indicated that this structure contained a carboxyl moiety at the tert-butyl group. Under the conditions of storage this product degraded to metabolite M-4. All other unknown metabolites found in the bile samples were oxidized products, with the oxidations in both the C-13 side chain and the baccatin structure, the latter being a new finding.