Is the Give Youth a Voice questionnaire an appropriate measure of teen‐centred care in paediatric oncology: a Rasch measurement theory analysis

Background

Adolescents have their own views about the cancer care they receive and how they feel they are treated, but their opinions are rarely solicited.

Objective

To determine whether the 56‐item Give Youth a Voice (GYV‐56), its subscales and its 20‐item short‐form, are clinically meaningful and psychometrically sound instruments that can be used to measure teen‐centred care (TCC) in paediatric oncology.

Design

Qualitative interviews and a questionnaire survey.

Setting and participants

Qualitative interviews with 38 childhood cancer survivors. GYV‐56 data collected from 200 paediatric cancer patients and survivors.

Main outcome measure

The GYV‐56, which measures the following four aspects of service delivery: Supportive and respectful relationships; Information sharing and communication; Supporting independence; and Teen‐centred services.

Results

Qualitative data provided broad support for the TCC conceptual framework and GYV‐56 items. After post‐hoc reduction of the response options from 7 to 3 (to correct for disordered thresholds), fit to the Rasch model was good, most items showed acceptable fit residuals and chi‐square P‐values, scale reliability were supported and item locations defined a continuum for TCC that was well‐targeted to the sample. By calibrating the items for each subscale and the short‐form to the full scale, the scores obtained on each measure are directly comparable.

Conclusion

Our study found initial support for use of the GYV with a reduced response option format for examining TCC in the adolescent oncology patients. in this paediatric population. Further research using the GYV is needed to elaborate upon our findings.     

血管生成抑制剂抗胃癌微淋巴管生成的实验研究

目的 通过建立未分化人胃腺癌SGC-7901原位移植裸鼠模型,应用2-(8-羟基-6-甲氧基-1-氧-1-氢-2-苯并吡喃-3-羟基)丙酸(NM-3)和卡铂的腹腔化学治疗,观察其对裸鼠原位移植人胃癌微淋巴管生成的影响.方法 建立人胃癌SGC-7901原位种植BALB/C裸鼠模型28只,随机分为4组,每组7只,分别腹腔内注射0.9%氯化钠溶液、NM-3(10 mg/kg)、卡铂(5 mg/kg)和NM-3+卡铂,2次/周.8周后处死裸鼠,采用定量免疫组化染色检测淋巴管内皮细胞透明质酸受体(LYVE)-1、肾小球足突细胞膜黏蛋白、同源异型盒转录因子(Prox)-1;计数微淋巴管密度(LMVD)值.结果 卡铂组、NM-3组及NM-3+卡铂组LYVE-1表达值均较0.9%氯化钠溶液组下降,但差异无统计学意义(P值均＞0.05);NM-3组及NM-3+卡铂组肾小球足突细胞黏蛋白、Prox-1值较0.9%氯化钠溶液组及卡铂组均显著下降(P＜0.05).NM-3组及NM-3+卡铂组LMVD值分别为4.72±0.50和4.78±0.38,较0.9%氯化钠溶液组及卡铂组均显著下降[7.35±0.55和6.98±0.35,P＜0.05].结论 NM-3能抑制胃癌微淋巴管生成,抑制肿瘤的生长和转移.     

膜型狼疮肾炎中NEPH1与Nephrin的研究

目的 研究肾小球足细胞相关蛋白NEPH1和Nephrin在膜型狼疮肾炎(V-LN)蛋白尿产生中的作用.方法 选择V-LN 25例,18例同期住院的特发性膜性肾病(IMN)作对照,另取5例因肾脏肿瘤行一侧肾切除的远端相对正常肾脏组织作为健康对照;检测尿常规、尿蛋白定量(24 h)、肝功能、肾功能、血脂、血清补体、尿补体(C3)及尿N-乙酰-β-D氨基葡萄糖苷酶(NAG),2组病例肾组织作常规病理检查和NEPH1、Nephrin免疫荧光染色,激光共聚焦显微镜观察NEPH1、Nephrin表达和分布的变化,组间两两比较采用t检验.结果 2组病例尿蛋白定量(24 h)[(3.5±0.6)和(3.7±0.7)g]、血清白蛋白[(26±3)和(24±3)g/L]、血清肌酐[(108±9)和(102±8)μmol/L]、尿C3[(3.4±0.8)和(3.8±1.1)mg/L]差异无统计学意义(P>0.05),V-LN组血清总胆固醇[(6.3±0.9)mmol/L]、甘油三酯[(2.0±0.3)mmol/L]、血清补体C3[(0.40±0.16)g/L]、C4[(0.05±0.02)g/L]均低于IMN组[分别为(9.2±1.3)、(3.7±0.5)mmol/L,(0.72±0.06)、(0.12±0.01)g/L](P<0.05),而V-LN组尿红细胞和尿NAG(P<0.05,P<0.01)均高于IMN组;间接免疫荧光显示V-LN及IMN患者肾组织中NEPH1、Nephrin的表达均减弱,但V-LN组的表达减弱不如IMN组明显.结论 足细胞相关蛋白NEPH1、Nephrin表达下降可能参与了LN蛋白尿的发生,其他机制如肾小管上皮细胞的损害可能在V-LN蛋白尿的发生中也起了一定作用.     

The short peritoneal equilibration test in pediatric peritoneal dialysis

The peritoneal equilibration test (PET) is the gold standard method for defining peritoneal membrane permeability and for prescribing peritoneal dialysis (PD) therapy on an individual basis. However, it is laborious, consumes nursing time, and requires many hours to be performed. Therefore, several authors have attempted to validate a short PET protocol, with controversial results. To evaluate the concordance between the 2-h (short) and 4-h (classical) peritoneal equilibrium test, a prospective observational protocol was applied in three PD centers (Mexico, Chile, and Uruguay) between July 1, 2008 and July 31 2009. PET protocol: the night prior to the test, each patient received five exchanges, 1 h each, at the same glucose concentration as previously used. Afterwards, a 2.5% glucose dialysis solution was used for a dwell time of 4 h. Exchange fill volume was 1,100 ml/m² body surface area. The next morning, the 4-h dwell was drained, and Dianeal 2.5% was infused. Three dialysate samples at 0, 2, and 4 h were obtained. A single blood sample was obtained at 120 min. Creatinine D/P and glucose D/D₀ ratios were calculated at hours 0, 2, and 4. Patients were categorized as low, low average, high average, or high transporters according creat D/P and gluc D/D₀ results. Pearson and Kappa test were used for numerical and categorical correlations, respectively, and p?<?0.05 was considered significant. Eighty-seven PET studies were evaluated in 74 patients, 33 males, age 11.1?±?5.05 years old. A positive linear correlation of 92% between 2 and 4-h creat D/P and 80% between 2 and 4-h gluc D/D₀ (p?<?0.001) was founded. The Kappa test showed a significant concordance between creat D/P and gluc D/D₀ categories at 2 and 4 h (p?<?0.001). When analyzing cut-off-value categories, creat D/P was founded to be lower and gluc D/D₀ higher than other experiences. This multicentric prospective study strongly suggests that PET obtained at 2 h and 4 h, based on either creatinine or glucose transport, provides identical characterization of peritoneal membrane transport capacity in PD children.     

Measuring quality of life in oncologic breast surgery: a systematic review of patient-reported outcome measures

Multiple randomized trials demonstrate equivalent survival between BCT and mastectomy, but clinical outcomes research must also evaluate patient satisfaction and quality of life. This review analyzes existing patient-reported outcome (PRO) measures in oncologic breast surgery to assess utility and make recommendations for future research. We performed a systematic literature review to identify PRO measures used in oncologic breast surgery patients. After applying inclusion and exclusion criteria, qualifying instruments were assessed for adherence to international guidelines for health outcomes instrument development and validation. Ten measures underwent development and psychometric evaluation in an oncologic breast surgery population. Five of ten measures (EORTC QLQ BR-23, FACT-B, HBIS, BIBCQ, and BREAST-Q) reported an adequate development and validation process. Three of these 5 measures (EORTC QLQ BR-23, FACT-B, HBIS) focused on non-surgical treatment issues. A fourth instrument (BIBCQ) did not address aesthetic concerns after breast reconstruction. The fifth instrument (BREAST-Q) was developed for use in patients undergoing mastectomy ± reconstruction, but did not address breast-conserving therapy. Overall, two key limitations were noted: 1) surgery-specific issues of breast-conserving surgery patients were not well represented and 2) measures were largely developed without the aid of newer psychometric methods that may improve their clinical utility. Reliable and valid PRO measures in breast cancer patients exist, but even the best instruments do not address all important surgery-specific and psychometric issues of oncologic breast surgery patients. Newer psychometric methods would facilitate development of scales for use in individual patient care as well as group level comparisons.     

输尿管镜下钬激光碎石术的并发症原因分析及对策

目的 探讨输尿管下镜钬激光碎石术并发症的发生原因、处理方法及预防措施. 方法回顾性分析2006年1月-2010年1月307例输尿管镜下钬激光碎石术治疗输尿管结石患者的临床资料.男203例,女104例;平均年龄51.6岁;结石位于输尿管下段133例,中段94例,上段80例.结果 碎石成功率为89.9%(276/307),16例(5.2%)结石移位至肾孟而行体外震波碎石术.操作失败9例(2.9%).输尿管穿孔3例(1%),改开放手术后痊愈.术后严重感染3(1%)例,抗感染治疗后康复. 结论输尿管镜下钬激光碎石术具有高效、安全、创伤小等优点.严格掌握手术适应证,提高术中操作技巧,采用正确的对应措施,能有效地减少并发症.     

原发性肝癌术后复发现状和影响因素分析

目的探讨原发性肝癌术后复发现状和危险因素。方法采用自行制定的自编问卷收集该院2010年2月至2011年2月收治的189例原发性肝癌患者的临床资料,应用SPSS19．0对收集到的数据进行描述性分析和二分类Logistic回归分析以找出原发性肝癌术后复发现状和影响因素,为采取针对性的预防干预措施提供参考依据。结果原发性肝癌患者术后复发率为23．81％。病理切缘残留阳性、术前焦虑情绪、术前抑郁情绪、血管侵犯是原发性肝癌患者复发的危险因素,肿瘤分化程度高是原发性肝癌患者复发保护因素。结论原发性肝癌复发率较高,其发生受多方面因素影响。