Assessing patient–caregiver communication in cancer—a psychometric validation of the Cancer Communication Assessment Tool (CCAT-PF) in a German sample

Purpose

The recently introduced Cancer Communication Assessment Tool (CCAT-PF) measures congruence in patient–caregiver communication and was initially validated in lung cancer patients. Contributing to a greater proportion of the variance in the conflict scores, primary caregivers were hypothesized to experience greater stress. For a detailed understanding of conflicting communication patterns of cancer-affected families, our study aimed for psychometric validation of the CCAT-PF in a sample covering heterogeneous tumor entities.

Methods

Subsequent to a cross-sectional survey of 189 pairs of cancer patients (31 % gastrointestinal, 34 % lung, and 35 % urological) and their caregivers’ exploratory factor analysis with principal component condensation and varimax rotation was conducted (response rate, 74.2 %). Reliability and construct validity were assessed calculating Cronbach’s α and Pearson correlation coefficients for CCAT-P and CCAT-F scales and related constructs, respectively.

Results

Cancer-related communication according to the CCAT-PF can be subdivided into four factors including the scales Disclosure, Limitation of treatment, Family involvement in treatment decisions, and Continuing treatment. Reliability ranged from α?=?.51–.68. The Disclosure scale, describing poor cancer-related communication of the patient, was correlated with patient’s distress (QSC-R10: r?=?.30, p?<?.0001), unmet needs in several areas (SCNS-SF-34: r?=?.25–.32, p?<?.001), and negatively with social/family well-being (FACT: r?=??0.31, p?<?.0001). Higher scores on the scale were significantly associated with considerable decrements in emotional well-being especially for caregivers perceiving patients’ disclosure as problematic.

Conclusions

The Disclosure scale originating from the CCAT-PF emerged as a short, valid, and reliable stand-alone instrument for identifying conflicting communication in patient–caregiver–dyads at risk.     

Leaching and VOC Emission Tests of Polymer Composites Produced from Post-Consumer Waste in Terms of Application in the Construction Sector

One of the existing priorities of the European Union is to search for rational waste management and to keep such waste in the economic cycle, while meeting the highest safety requirements. The paper presents the results of environmental tests of composites based on the polyethylene (rPE) and polypropylene (rPP) matrix and reinforced with cellulose fibres (newsprint, NP). Raw materials were obtained by recycling post-consumer waste such as beverage bottles and newsprint. The composites were tested for their potential use as materials in cladding panels and acoustic barriers. Given that normative documents for these products do not define specific environmental requirements, the composites were tested for the release of dangerous substances, such as anions of inorganic compounds, heavy metals, volatile organic compounds (VOCs), and their impact on the environment. A detailed in-depth analysis of the mechanisms of release of substances (diffusion, dissolution, surface leaching and depletion) from the rPP/NP composite into surface water, groundwater and soil was carried out. In turn, emission of VOCs from the rPE (low-density:high-density (LD:HD)—50:50) and rPE (LD:HD—30:70) composites into indoor air was also carried out. Raw materials in the form of granulates and loose cellulose fibres, used to produce the composites, were also tested for their environmental impact.     

Current pathogenetic aspects of hepatic encephalopathy and noncirrhotic hyperammonemic encephalopathy

Hepatic encephalopathy is a medical phenomenon that is described as a neuropsychiatric manifestation of chronic or acute liver disease that is characterized by psychomotor,intellectual and cognitive abnormalities with emotional/affective and behavioral disturbances.This article focuses on the underlying mechanisms of the condition and the differences between hepatic encephalopathy and noncirrhotic hyperammonemic encephalopathy.Hepatic encephalopathy is a serious condition that can cause neurological death with brain edema and intracranial hypertension.It is assumed that approximately 60%-80% of patients with liver cirrhosis develop hepatic encephalopathy This review explores the complex mechanisms that lead to hepatic encephalopathy.However,noncirrhotic hyperammonemic encephalopathy is not associated with hepatic diseases and has a completely different etiology.Noncirrhotic hyperammonemic encephalopathy is a severe occurrence that is connected with multiple pathogeneses.     

Assessment of platelet activation and phagocytic activity in gastric cancer patients

AIM: To assess the activation of platelets and their phagocytic activity in the course of gastric cancer. METHODS: Forty-three gastric cancer patients were recruited to the study. The patients were divided into 3 groups depending on tumor stage. Group E included 6 patients with early gastric cancer; group A included 18 patients with locally advanced cancer; and group M included 19 patients with metastatic cancer. The investigations were performed twice, prior to surgery and 12-14 d afterwards. RESULTS: The platelet count and the level of sP-selectin were found to increase with the disease progression. The level of sP-selectin was lowest in early cancer and was observed to increase after surgery in all the study patients. Irrespective of tumor stage, a statistically significant decrease was noted in the percentage of phagocytizing platelets and in the phagocytic index in gastric cancer patients as compared to healthy subjects. Despite increased platelet count and stimulation of thrombocytopoiesis, the phagocytic functions of blood platelets were markedly impaired. Tumor development seems to impair metabolic processes. CONCLUSION: A decreasing phagocytic activity can promote both inflammatory processes and cancer growth.     

The use of methotrexate and arterial embolization to avoid surgery in a case of cervical pregnancy

Objective: To describe the management of a case of cervical ectopic pregnancy (EP).

Design: Case report.

Setting: University-affiliated teaching hospital.

Patient(s): A 26-year-old woman, gravida 4, para 0-1-2-0, with the diagnosis of a cervical EP.

Intervention(s): Systemic methotrexate (MTX) and arterial embolization.

Result(s): A cervical EP was diagnosed by ultrasonography. The patient was treated with systemic MTX. Vaginal bleeding began 4 days later and was treated with arterial embolization, thus eliminating the need for surgical intervention. The pregnancy resolved and the patient has resumed normal menstruation and again is attempting pregnancy.

Conclusion(s): Arterial embolization can be used to avoid surgical intervention in cases of cervical EP in which hemorrhage occurs after treatment with chemotherapy.     

Ultrastructure of Lactobacillus fermentum during early and late growth phases and during thiamine deficiency

Thin sections of exponentially growing and stationary-phase cells of L. fermentum from thiamine sufficient and thiamine deficient media were studied by electron microscopy. Compared to the exponential-phase cells the stationary-phase cells from both types of media had thicker cell walls and cross walls and fewer and smaller granules of storage material. Exponential-phase, thiamine deficient cells had rather thin cell walls and small mesosomes.     

Prevention of murine experimental allergic encephalomyelitis: cooperative effects of cyclosporine and 1 α, 25-(OH)2D3

The hormone 1 α,25-dihydroxyvitamin D₃ (1,25(OH)₂D₃) has immune modulatory activities in vitro and in vivo, and can prevent or delay the onset of experimental or spontaneous autoimmune diseases. At therapeutical doses, however, hypercalcemic side effects are found. The present experiments examined the effects of combined treatment with subtherapeutic doses of cyclosporine A (CsA) and 1,25(OH)₂D₃ on the evolution of experimental autoimmune encephalomyelitis (EAE) in SJL mice. 1,25(OH)₂D₃ at 5 μg/kg body weight (given by i.p. injection every 2 days) prevented the appearance of paralysis in 70% of the treated mice. The treatment with 1,25(OH)₂D₃ at 2 μg/kg/2 days alone had less substantial protective effects (22% disease-free animals versus 5% in the control group). However, when this subtherapeutic dose was associated to treatment with a daily dose of CsA (2 or 5 mg/kg/day), which by itself was subtherapeutic (24 and 50% disease-free animals, respectively), the association of both drugs led to near-total protection (86% disease-free animals when combined with the highest dose of CsA). When an alternate day administration schedule (CsA at 10 mg/kg and 1,25(OH)₂D₃ at 2 μg/kg, each given on alternate days from day −3 to +19 after disease induction) was used, all treated mice were completely protected clinically and histologically. The two drugs also showed additive effects on serum osteocalcin and urinary calcium and desoxypyridinoline excretion, but not on serum calcium concentration. Our experiments demonstrate that 1,25(OH)₂D₃ might be a potential dose-reducing agent for CsA in immunosuppressive therapy.