Re-irradiation in Paediatric Tumours of the Central Nervous System: National Guidelines from the Swedish Workgroup of Paediatric Radiotherapy.

There is a lack of clinical protocols for re-irradiation in paediatric central nervous system (CNS) tumours. To fill this void, the Swedish Workgroup of Paediatric Radiotherapy (SBRTG) compiled national guidelines on re-irradiation in paediatric CNS tumours (diffuse intrinsic pontine glioma, ependymoma, germinoma and medulloblastoma). These have been in clinical practice since 2019 in all paediatric radiotherapy centres in Sweden. Since the implementation, the guidelines have been complemented with a yearly review on clinical outcome and toxicities in all paediatric patients treated according to the guidelines. This article presents the Swedish national guidelines on re-irradiation in paediatric CNS tumours.

Physiological changes associated with routine nursing procedures in critically ill are common: an observational pilot study.

BACKGROUND: Nursing procedures that are routinely performed in the intensive care unit (ICU) are assumed to have minimal side effects. However, these procedures may sometimes cause physiological changes that negatively affect the patient. We hypothesized that physiological changes associated with routine nursing procedures in the ICU are common. METHODS: A clinical observational study of 16 critically ill patients in a nine-bed mixed university hospital ICU. All nursing procedures were observed, and physiological data were collected and subsequently analyzed. Minor physiological changes were defined as minimal changes in respiratory or circulatory variables, and major physiological changes were marked as hyper/hypotension, bradycardia/tachycardia, bradypnea/tachypnea, ventilatory distress, and peripheral blood oxygen desaturation. RESULTS: In the 16 patients, 668 procedures generated 158 major and 692 minor physiological changes during 187 observational hours. The most common procedure was patient position change, which also generated the majority of the physiological changes. The most common major physiological changes were blood oxygen desaturation, ventilatory distress, and hypotension, and the most common minor changes were arterial pressure alteration, coughing, and increase in respiratory rate. CONCLUSION: In this pilot study, we examined physiological changes in connection with all regular routine nursing procedures in the ICU. We found that physiological changes were common and sometimes severe.

Change in smoking habits after having been screened for abdominal aortic aneurysm.

OBJECTIVES: To study smoking habits among men with abdominal aortic aneurysm at screening at 65 years of age, and during follow-up, as a base-line study to evaluate future interventions. DESIGN: Nested case-control study. PATIENTS AND METHODS: Between 2006 and 2011, 8150 65-year-old men (compliance 85%) were screened for AAA in Uppsala County, Sweden. Among 292 men with an aortic diameter of at least 25 mm, 77 were active smokers at the time of screening. At follow-up of smoking habits in 2012, 53 men (69%) participated in this study, 28 had an AAA of at least 30 mm and 25 a sub-aneurysmal aorta (SAA) 25-29 mm at baseline. For each case, one control was randomly selected, all active smokers with aortic diameter less than 25 mm at baseline, matched for age and year of screening. Telephone interviews were performed at a median 34 months (range: 4-67) after screening. RESULTS: Men with AAA had hypertension more often than controls (68% vs. 23%, p < .001). Men with AAA and SAA reported more smoking years than controls (p = .017). Cessation rate among patients with AAA did not differ significantly compared with men with an aorta less than 30 mm (29% vs. 15%, p = .159), but they had reduced their consumption of cigarettes/day significantly more than men with SAA and controls (-8.2 vs. -3.0 vs. -4.5, p = .030). Men with AAA recalled having been informed about the importance of smoking cessation at the time of screening more often (p = .031). There was no difference in growth of the AAA between those who continued, and those who quit smoking (2.03 vs. 2.01 mm/year, p = .982), but the study was not powered to study AAA growth. CONCLUSIONS: Although counselling in a normal healthcare setting had some effect, the results indicate a need to tailor interventions to further increase smoking cessation rates among men diagnosed with both AAA and SAA.

Is doctors' ability to identify cancer patients' worry and wish for information related to doctors' self-efficacy with regard to communicating about difficult matters?

The aims were to investigate whether: (A) doctors' ability to identify patients' worry about prognosis/wish for information about disease and treatment is related to doctors' self-efficacy with regard to communicating about difficult matters and patients' satisfaction with a consultation/hope to live a good life in spite of the disease; and (B) patients and doctors agree on how much worry/wish for information a patient experiences/wishes. Sixty-nine patients with carcinoid and 11 doctors participated. Ability to identify worry/wish for information was estimated by posing questions to doctors/patients concerning how much worry/information a patient experienced/wished during a consultation. Doctors' self-efficacy was measured by nine questions, patients' satisfaction and hope by two questions. When doctors show good ability to identify wish for information, they report higher self-efficacy (t = 3.5, d.f. = 67, P < 0.001) than when they show less good ability. Patients finding the consultation very satisfying meet doctors reporting higher self-efficacy than patients finding the consultation satisfying (t = 2.26, d.f. = 65, P < 0.05). Doctors fail to identify patients who report less worry/wish more information than the average patient. The findings underscore the importance of further enhancing doctors' self-efficacy with regard to communicating about difficult matters and ability to identify patients who are less worried/wish more information than the average patient.