Relating information needs to the cancer experience: 1. Information as a key coping strategy

Information-seeking behaviour is a strategy that many people use as a means of coping with, and reducing stress, throughout their cancer experience. The importance of providing information to people with cancer and many of the problems encountered with its provision have been well documented. Individuals frequently express dissatisfaction with the information given to them and experience difficulty in retaining and processing information. Lack of information may well lead to increased problems with anxiety and coping. This paper reviews and explores the literature associated with the information needs of people with cancer and the use of information as a coping strategy. The review forms part of a phenomenological study, conducted to explore the important issues for people with cancer that arose out of their cancer experience. Much of the literature discusses information-giving from the viewpoint of healthcare professionals rather than from the viewpoint of users and concentrates solely on information needs relating to the disease and its medical treatment. There is scant reference to the need for information on other issues such as available financial and community resources, or coping strategies.     

Comparison of pregnancy outcomes in Dutch kidney recipients with and without calcineurin inhibitor exposure: a retrospective study

Within pregnancies occurring between 1986 and 2017 in Dutch kidney transplant recipients (KTR), we retrospectively compared short-term maternal and foetal outcomes between patients on calcineurin inhibitor (CNI) based (CNI+) and CNI-free immunosuppression (CNI−). We identified 129 CNI+ and 125 CNI− pregnancies in 177 KTR. Demographics differed with CNI+ having higher body mass index (P = 0.045), shorter transplant-pregnancy interval (P < 0.01), later year of transplantation and -pregnancy (P < 0.01). Serum creatinine levels were numerically higher in CNI+ in all study phases, but only reached statistical significance in third trimester (127 vs. 105 µm ; P < 0.01), where the percentual changes from preconceptional level also differed (+3.1% vs. −2.2% in CNI−; P = 0.05). Postpartum both groups showed 11–12% serum creatinine rise from preconceptional level. Incidence of low birth weight (LBW) tended to be higher in CNI+ (52% vs. 46%; P = 0.07). Both groups showed equal high rates of preterm delivery. Using CNIs during pregnancy lead to a rise in creatinine in the third trimester but does not negatively influence the course of graft function in the first year postpartum or direct foetal outcomes. High rates of preterm delivery and LBW in KTR, irrespective of CNI use, classify all pregnancies as high risk.     

The effectiveness of interventions for preventing injuries in the construction industry: a systematic review

BACKGROUND: Occupational injury rates among construction workers are the highest among the major industries. A number of injury-prevention interventions have been proposed, yet the effectiveness of these is uncertain. Thus a systematic review evaluating the effectiveness of interventions for preventing occupational injuries among construction workers was conducted. METHODS: Seven databases were searched, from the earliest available dates through June 2006, for published findings of injury prevention in construction studies. Acceptable study designs included RCTs; controlled before-after studies; and interrupted time series (ITS). Effect sizes of similar interventions were pooled into a meta-analysis in January 2007. RESULTS: Of 7522 titles found, four ITS studies and one controlled ITS study met the inclusion criteria. The overall methodologic quality was low. No indications of publication bias were found. Findings from a safety-campaign study and a drug-free-workplace study indicated that both interventions significantly reduced the level and the trend of injuries. Three studies that evaluated legislation did not decrease the level (ES 0.69; 95% CI=-1.70, 3.09) and made the downward trend (ES 0.28; 95% CI=0.05, 0.51) of injuries less favorable. CONCLUSIONS: Limited evidence was found for the effectiveness of a multifaceted safety campaign and a multifaceted drug program, but no evidence was found that legislation is effective to prevent nonfatal or fatal injuries in the construction industry.     

Performance of plasma free metanephrines measured by liquid chromatography–tandem mass spectrometry in the diagnosis of pheochromocytoma

BackgroundPlasma free metanephrines have proved a highly sensitive biochemical test for the diagnosis of pheochromocytoma. We have developed and validated a simple, LC–MS/MS method to determine plasma metanephrines and compared the diagnostic efficacy of the method with an enzyme immunoassay procedure in 151 patients, 38 with histologically confirmed pheochromocytoma.MethodsOff-line solid phase extraction in a 96-well plate format was used to isolate metanephrines from 100-μL of plasma, followed by rapid separation with hydrophilic interaction chromatography. Mass spectrometry detection was performed in multiple-reaction monitoring mode using a tandem quadrupole mass spectrometer with positive electrospray ionization.ResultsDetection limits were < 0.1 nmol/l with method linearity up to 23.0 nmol/L for normetanephrine (NMN), metanephrine (MN) and 3-methoxytyramine (3-MT). Method comparison with an automated LC–MS/MS yielded Deming regression slopes of r = 0.94 for NMN, r = 0.98 for MN and r = 0.94 for 3-MT. Method comparison with enzyme immunoassay revealed regression slope of r = 1.28 (NMN) and 1.25 (MN) with values approximately 25% lower than LC–MS/MS. Plasma metanephrines by LC–MS/MS identified all 38 patients with phaeochromocytoma compared with 36 cases by immunoassay.ConclusionsPlasma metanephrines measured by LC–MS/MS are a reliable and sensitive test for the biochemical detection of pheochromocytoma.     

Do health-status measures play a role in improving treatment in chronic obstructive pulmonary disease?

During the past few decades, health status has become increasingly important in the clinical research of chronic obstructive pulmonary disease. The use of health-status questionnaires in routine practice can enhance understanding about the impact of the disease on the patient, improve standardisation and increase compliance through increased patient satisfaction. However, before health-status measurement in individual patients can be used in routine practice, questionnaires have to be validated on an individual level. In this article, the authors suggest a new method of assessing this individual validity, to enhance the use of health-status instruments in daily clinical practice, and thus improve treatment in chronic obstructive pulmonary disease.     

Cardiac concomitants of performance monitoring: context dependence and individual differences

Feedback processing is an important aspect of cognitive control and decision-making. Several studies have shown that heart rate slows following feedback that indicates incorrect performance or loss of money. The current study was the first to investigate (1) whether this slowing reflects an evaluation of the valence of the outcome or a system that indicates that the feedback contains informative value, (2) whether the slowing is determined by the value of the outcome relative to the range of possible outcomes, and (3) whether highly anxious individuals have a hypersensitive feedback monitoring system. The results showed that heart rate only slows when the feedback is performance based. The information provided by negative feedback is processed in a context-sensitive manner, suggesting that heart rate slowing following feedback reflects a signal associated with informative value for subsequent performance adjustment. Highly anxious individuals showed larger heart rate slowing in response to feedback indicating high stakes, but they failed to respond to feedback in a context-sensitive manner. These results were interpreted to suggest that anxious individuals are generally more sensitive to performance outcomes. Heart rate changes following informative feedback proved to be a sensitive index of component processes associated with performance monitoring.     

Effects of methylphenidate, desipramine, and L-dopa on attention and inhibition in children with Attention Deficit Hyperactivity Disorder

The objective of this study was to investigate the effects of methylphenidate (MPH) on attention and inhibition in children with Attention Deficit Hyperactivity Disorder (ADHD) and to establish what the relative contributions of the noradrenergic and dopaminergic systems to this effect were. In addition to MPH, two other drugs were administered in order to affect both transmitter systems more selectively, L-dopa (dopamine (DA) agonist) and desipramine (DMI) (noradrenaline (NA) re-uptake inhibitor). Sixteen children with ADHD performed a stop-task, a laboratory task that measures the ability to inhibit an ongoing action, in a double-blind randomized within-subjects design. Each child received an acute clinical dose of MPH, DMI, L-dopa, and placebo; measures of performance and plasma were determined. The results indicated that inhibition performance was improved under DMI but not under MPH or L-dopa. The response-time to the stop-signal was marginally shortened after intake of DMI. MPH decreased omission and choice-errors and caused faster reaction times to the trials without the stop-tone. No effects of L-dopa whatsoever were noted. Prolactin levels were increased and 5-HIAA levels were lowered under DMI relative to placebo. It is suggested that the effects of MPH on attention are due to a combination of noradrenergic and dopaminergic mechanisms. The improved inhibition under DMI could be serotonergically mediated.