An online Symptom Care and Management System to monitor and support patients receiving chemotherapy: A pilot study

This pilot study aimed to explore the benefits of an online Symptom Care and Management System (SCMS) in the home monitoring and symptom management of patients receiving chemotherapy. A single‐group experimental design was employed, and four patients aged 39–59 years undergoing their first chemotherapy treatment were recruited from one cancer centre in Singapore from November 2010 to February 2011. A mixed method was used to collect patient's data. All patients used the SCMS to record and send daily symptom reports to the cancer centre and receive symptom management advice from the nurse via teleconferencing. Patients' perceptions on the use of the system were evaluated. All participants believed that the system improved the management of their symptom and felt reassured they were being monitored at home. The results presented in this pilot study suggest that the SCMS has the potential to enhance the remote monitoring, feasible and acceptable way for a specific group of cancer patients to manage their symptom at home.     

Natural history of chronic hepatitis B:Phases in a complex relationship

Chronic hepatitis B(CHB)is a condition of globalprevalence and its sequelae include cirrhosis and hepatocellular carcinoma.The natural history of CHB isa complex interplay of virological,environmental andhost factors.The dynamic relationship between thevirus and host evolves over the duration of the infection and different phases of the disease have been observed and described.These have been conceptualizedin terms of the state of balance between the host immune system and the hepatitis B virus and have beengiven the labels immune tolerant,immune clearance,immune control and immune escape although othernomenclature is also used.Host factors,such as age atinfection,determine progression to chronicity.Virological factors including hepatitis B viral load,mutationsand genotype also have an impact on the adverseoutcomes of the infection,as do hepatotoxic cofactorssuch as alcohol.Our understanding of the natural history of CHB has evolved significantly over the past fewdecades and characterizing the phase of disease ofCHB remains an integral part of managing this virus in the clinic.     

肺静脉隔离治疗心力衰竭患者的心房颤动

<正> 肺静脉隔离被越来越多地用于治疗心力衰竭患者的心房颤动(房颤)。本研究为前瞻性多中心临床试验,我们将有症状的、药物不能控制的房颤、射血分数(LVEF)≤40%、纽约心脏协会心功能分级(NYHA)Ⅱ～Ⅲ级的患者随机分配到肺静脉隔离治疗组或房室结消融     

Adults with Congenital Heart Disease: Psychological Needs and Treatment Preferences

Objective. Approximately one‐third of adult congenital heart disease (ACHD) patients have mood or anxiety disorders, the majority of which go untreated. The extent to which this group of patients is interested in psychological services is, however, unknown. This study investigated the perceived psychological needs of patients and their mental health treatment preferences. Design. Participants completed an anonymous survey with items regarding mental health treatment history, preferences for future treatment, Internet use, and interest in peer support. Results. A total of 155 ACHD patients completed study questionnaires (mean age = 39 years; 50% female). Forty percent of patients reported previous mental health treatment. Some 51% of patients (73/142) indicated significant interest in at least 1 of 7 defined areas of psychological treatment (managing mood and/or anxiety, coping with a cardiac condition, stress management, anger management, relationship difficulties, substance use, and smoking cessation). Patients were most interested in stress management and coping with heart disease; one‐third of patients (48/141 and 47/141, respectively) expressed high interest in these 2 topics. There was a consistent preference for psychological treatment to be provided over the Internet vs. in person or over the telephone; 94% of the patients had Internet access. In total, 35% of patients (51/145) were interested in receiving peer support. Conclusions. It is not only health providers who recognize the importance of psychological care for ACHD patients. As a group, patients are also interested in psychological treatment and peer support. Programs are encouraged to provide psychological services and maximize opportunities for interactions with other patients.     

Effectiveness of Supportive Educative Learning programme on the level of strain experienced by caregivers of stroke patients in Thailand

In Thailand, the crude death rate from stroke is 10.9/100 000 population and increasing. Unlike Western countries where community rehabilitation programmes have been established to provide services following the acute stage of stroke recovery, there is no stroke rehabilitation team in the community in Thailand. Therefore, family caregivers are the primary source for ongoing care and support. While family members accompany patients during their hospitalisation, they receive little information about how to assist their relatives, and as a result feel inadequately trained, poorly informed and dissatisfied with the support that is available after discharge. Family caregivers report that they suffer both physically and psychologically and find themselves overwhelmed with strain, experiencing burden and exhaustion. This study aimed to develop and implement a nurse‐led Supportive Educative Learning programme for family caregivers (SELF) of stroke survivors in Thailand and to evaluate the effect of the SELF programme on family caregiver’s strain and quality of life. This was a non‐randomised comparative study with concurrent controls, using a two‐group pre‐test and post‐test design. A total of 140 stroke survivors and 140 family caregivers were recruited; 70 patients/caregiver pair in each group. Caregivers of patients admitted to the intervention hospital following an acute stroke received the intervention, while caregivers of patients admitted to the comparison hospital received the usual care provided at the hospital. The data were collected prior to discharge of the patients and after 3 months. The family caregivers in the intervention group had a significantly better quality of life than the comparison group (GHQ‐28 at discharge t = 2.82, d.f. = 138, P = 0.006; and at 3 months t = 6.80, d.f. = 135, P < 0.001) and they also reported less strain (Caregiver Strain Index at discharge t = 6.73, d.f. = 138, P < 0.001; and at 3 months t = 7.67, d.f. = 135, P < 0.001). This research demonstrated that providing education and support to the family caregiver of stroke survivors can reduce caregiver strain and enhance their quality of life.     

Assessing impact of organised breast screening across small residential areas—development and internal validation of a prediction model

Monitoring screening mammography effects in small areas is often limited by small numbers of deaths and delayed effects. We developed a risk score for breast cancer death to circumvent these limitations. Screening, if effective, would increase post‐diagnostic survivals through lead‐time and related effects, as well as mortality reductions. Linked cancer and BreastScreen data at four hospitals (n = 2,039) were used to investigate whether screened cases had higher recorded survivals in 13 small areas, using breast cancer deaths as the outcome (M1), and a risk of death score derived from TNM stage, grade, histology type, hormone receptor status, and related variables (M2). M1 indicated lower risk of death in screened cases in 12 of the 13 areas, achieving statistical significance (p < .05) in 5. M2 indicated lower risk scores in screened cases in all 13 areas, achieving statistical significance in 12. For cases recently screened at diagnosis (<6 months), statistically significant reductions applied in 8 areas (M1) and all 13 areas (M2). Screening effects are more detectable in small areas using these risk scores than death itself as the outcome variable. An added advantage is the application of risk scores for providing a marker of screening effect soon after diagnosis.     

Copy number variations in three children with sudden infant death

Sudden death of an infant is a devastating event that needs an explanation. When an explanation cannot be found, the case is labeled as sudden infant death syndrome or unclassified sudden infant death. The influence of genetic factors has been recognized for sudden infant death, but copy number variations (CNVs) as potential risk factors have not been evaluated yet. Twenty-seven families were enrolled in this study. The tissue specimens from deceased children were obtained and array-based comparative genomic hybridization (array-CGH) experiments were performed on the genomic DNA isolated from these specimens using Agilent Technologies Custom 4 × 44K arrays. Quantitative polymerase chain reaction experiments were performed to confirm the overlapping duplication and deletion region in two different cases. A de novo CNV is detected in 3 of 27 cases (11%). In case 1, an ∼3-Mb (chr 8: 143,211,215-qter) duplication on 8q24.3-qter and a 4.4-Mb deletion on the 22q13.3-qter (chr 22: 45,047,068-qter) were detected. Subtelomeric chromosome analysis of the father and the surviving sibling of case 1 showed a balanced reciprocal translocation, 46,XY,t(8;22)(q24.3;q13.3). A 240-kb (chr 6: 26,139,810-26,380,787) duplication and a 1.9-Mb deletion (chr 6: 26,085,971-27,966,150) at chromosome 6p22 were found in cases 2 and 3, respectively. Array-CGH and conventional cytogenetic studies did not reveal the observed CNVs in the parents and the siblings of cases 2 and 3. The detected CNVs in cases 2 and 3 encompassed several genes including the major histone cluster genes. Array-CGH analysis may be beneficial during the investigations after sudden infant death.