Cognitive dysfunction in children with brain tumors at diagnosis

Background

Survivors of brain tumors have a high risk for a wide range of cognitive problems. These dysfunctions are caused by the lesion itself and its surgical removal, as well as subsequent treatments (chemo‐ and/or radiation therapy). Multiple recent studies have indicated that children with brain tumors (BT) might already exhibit cognitive problems at diagnosis, i.e., before the start of any medical treatment. The aim of the present study was to investigate the baseline neuropsychological profile in children with BT compared to children with an oncological diagnosis not involving the central nervous system (CNS).

Methods

Twenty children with BT and 27 children with an oncological disease without involvement of the CNS (age range: 6.1–16.9 years) were evaluated with an extensive battery of neuropsychological tests tailored to the patient's age. Furthermore, the child and his/her parent(s) completed self‐report questionnaires about emotional functioning and quality of life. In both groups, tests were administered before any therapeutic intervention such as surgery, chemotherapy, or irradiation. Groups were comparable with regard to age, gender, and socioeconomic status.

Results

Compared to the control group, patients with BTs performed significantly worse in tests of working memory, verbal memory, and attention (effect sizes between 0.28 and 0.47). In contrast, the areas of perceptual reasoning, processing speed, and verbal comprehension were preserved at the time of measurement.

Conclusion

Our results highlight the need for cognitive interventions early in the treatment process in order to minimize or prevent academic difficulties as patients return to school. Pediatr Blood Cancer 2015;62:1805–1812. © 2015 The Authors. Pediatric Blood & Cancer, published by Wiley Periodicals, Inc.     

Bleeding by the numbers: The utility and the limitations of bleeding scores,bleeding prediction tools,and bleeding case definitions

A patient’s history of bleeding, whether spontaneous or in response to challenges, provides important information about both the likelihood of that patient having a biochemically-defined hemostatic defect, and that patient’s risk of future bleeding. Other variables including age, comorbidities and medications influence these probabilities. Scoring systems have been devised in an effort to make the estimates quantitative in specific populations. An example of a bleeding score is the MCMDM1-VWD questionnaire, which was developed to predict the likelihood of a patient having von Willebrand disease. It sums standardized details of the bleeding history, weighted by severity. The HAS-BLED score typifies bleeding prediction tools, developed to predict bleeding during anticoagulant therapy. Although prior bleeding is one item in this score, other comorbidities like hypertension or a history of stroke count for more. A third and related concept is that of bleeding case definitions, which are critical to standardize the reporting of outcomes in trials of antithrombotic agents, and which have entrenched the recognition of different severities of bleeding. We advocate that future efforts should blend some of these features. Information about comorbidities and medication use could refine the interpretation of bleeding events in a bleeding score. So could the introduction of a denominator reflecting the number and duration of challenges to which the patient has been exposed when bleeding might have been expected. More detailed information about the type, frequency and severity of prior bleeding could improve the prognostic power of bleeding prediction tools. More detailed history-based scores might ultimately supersede biochemical testing in many cases.     

Selecting US research-intensive doctoral programs in nursing: Pragmatic questions for potential applicants

Nurses hoping to enter a research intensive doctoral program have a choice of program delivery modes, faculty expertise, and multiple points of entry in addition to the traditional post masters. The American Association of Colleges of Nursing (AACN) lists doctoral programs in nursing in over 300 universities in the United States (U.S.) and Puerto Rico, with most institutions offering more than one type of doctorate. For prospective students who want to maximize their likelihood of significant, sustained scientific impact, identifying research-intensive Doctor of Philosophy (PhD) programs with faculty who have a topic match is key. Embarking on a scientific career requires assessing the curricula and faculty at several institutions. The purpose of this paper is to give prospective students pragmatic guidance in selecting a U.S. research-intensive doctoral program in nursing. We provide a list of published quality indicators in PhD programs as well as potential questions to be addressed to key persons in schools.     

推拿局部镇痛机制的概述

既往对推拿镇痛的研究多集中在脊髓或中枢水平对疼痛的调制方面,而中医经筋疾病的治疗原则是"以痛为腧",在患者的局部给予推拿治疗后,其疼痛往往能够得到减轻或消除,而其局部的某些物质究竟发生了如何的变化值得研究者进行观察,本研究就是探讨推拿手法与局部镇痛物质和致痛物质之间的关系,为中医"以痛为腧"的理论提供客观的依据。     

Intention,beliefs and mood assessed using electronic diaries predicts attendance at cardiac rehabilitation: An observational study

BackgroundCardiac rehabilitationis effective in promoting physical/psychological recovery following acute coronary syndrome. Yet, rates of attendance at outpatient cardiac rehabilitation by eligible patients are low.ObjectivesThis study examined the determinants of attendance at outpatient cardiac rehabilitation in acute coronary syndrome patients following discharge until cardiac rehabilitation commencement.DesignA weekly electronic diary measured cardiac-related cognitions and mood and examined their relation to attendance at outpatient cardiac rehabilitation.SettingsThree United Kingdom National Health Service secondary care settings in two Health Board areas in Scotland.ParticipantsAcute coronary syndrome patients were recruited from March 2012 to June 2013 prior to hospital discharge. Of 488 eligible patients referred for cardiac rehabilitation, 214 consented.MethodsConsecutive patients completed a pre-hospital discharge questionnaire targeting age, diagnosis, social class and smoking history. Acute coronary syndrome patients then completed a weekly electronic diary from the first week of discharge until the start of cardiac rehabilitation. Multilevel structural equation models estimated the effects of initial, i.e. baseline and rate of change in cardiac-related cognition and mood on attendance. Intention to attend cardiac rehabilitation was reflected, log transformed, reported thereafter as “do not intend”. The role of “do not intend” was explored as a mediator of the relationship between cardiac-related cognition and mood on attendance.Results166 participants provided, on average, 5 weeks of diary entries before cardiac rehabilitation commenced. High intention (i.e. low “do not intend”) to attend CR and its rate of increase over time predicted attendance. Low negative emotional representation, high perceived necessity, high confidence in maintaining function, low negative affect, and high positive affect following discharge predicted attendance at cardiac rehabilitation. The rate of change in cardiac-related mood and these cognitions was not predictive. Baseline and rate of change in “do not intend” entirely mediated relationships between a) perceived necessity, b) negative affect and attendance at cardiac rehabilitation.ConclusionsNegative affect in the first weeks following discharge represents the key challenge to a patient maintaining their intention to attend cardiac rehabilitation. Intervention to improve attendance should focus on improving intention to attend following discharge and during recovery by improving patient understanding of cardiac rehabilitation and reducing negative affect.     

Should paramedics use automated external defibrillators? Preliminary data

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