An evaluation of a therapeutic radiographer led "sexual care after radiotherapy" clinic.

INTRODUCTION: Changes to sexuality and intimacy are a common consequence of a cancer diagnosis and treatment. Difficulties with sexual functioning and body image have been reported in over 50% of those treated for pelvic malignancies or breast cancer. The provision of sexual care support after radiotherapy is not adequately addressed by oncology professionals yet patients who have the opportunity to discuss sexual issues experience reduced sexual morbidity. This paper describes the evaluation and patient satisfaction of a novel and innovative clinic led by therapeutic radiographers for the management of sexual dysfunction. METHOD: Quantitative data was collected from NHS Friends and Family Test (FFT) patient questionnaires to assess how patients rated the service on a scale from not likely to extremely likely to recommend the service. A qualitative, thematic analysis of the comments provided insight into patient satisfaction and experience. RESULTS: Overall, 33 patients attended the clinic from 2019 to 2020. An 82% return rate of FFT questionnaire's showed 94% of patients were extremely likely and 6% were likely to recommend the service. Three emergent themes were the quality of information provision, the conduct of the staff member and the consultation experience. Patients stated that they were given a range of solutions and many cited a better understanding of their sexual issues. CONCLUSION: Sexual function is an important component of quality of life and sexual dysfunction can cause on-going distress, interfering with recovery. This clinic offers an opportunity to discuss issues and provides an important mechanism of support for patients to live with and beyond their cancer diagnosis. IMPLICATIONS FOR PRACTICE: Oncology professionals should receive training and education to raise sexual issues with their patients and ensure relevant services are provided.

Barriers and facilitators to treatment participation by adolescents in a community mental health clinic.

An estimated 40-60% of children in mental health treatment drop out before completing their treatment plans, resulting in increased risk for ongoing clinical symptoms and functional impairment, lower satisfaction with treatment, and other poor outcomes. Research has focused predominately on child, caregiver, and family factors that affect treatment participation in this population and relatively less on organizational factors. Findings are limited by focus on children between 3 and 14 years of age and included only caregivers' and/or therapists' perspectives. The purpose of this descriptive qualitative study was to identify organizational factors that influenced participation in treatment, with special attention to factors that contributed to dropout in adolescents. The sample included 12 adolescent-caregiver dyads drawn from two groups in a large public mental health provider database. Analysis of focus group interview data revealed several perceived facilitators and barriers to adolescent participation in treatment and provided several practical suggestions for improving treatment participation. Implications of the findings for psychiatric mental health nurses and other clinicians who provide services to families of adolescents with mental health concerns are discussed.

Assess, compare and enhance the status of Persons with Multiple Sclerosis (MS) in Europe: a European Register for MS.

OBJECTIVES: Persons with multiple sclerosis (PwMS) experience health-related quality of life (HRQoL) problems greatly differing across Europe, and the European Union (EU) faces deep inequalities in MS management from country to country. Through the establishment of a European MS Register (EUReMS), an effective action is proposed to improve the overall knowledge on MS and support effective intervention programmes at EU and national political level. EUReMS aims to achieve consensus on its mission and vision, to define existing data providers, to develop models driving future MS health policies and research, to develop an information technology (IT) infrastructure for a data set, to develop a European shared governance and to secure providers' data provision into EUReMS. MATERIALS AND METHODS: EUReMS is meant to build on a minimum set of core data from existing national and regional population-based MS registries and from PwMS' perspectives. EUReMS' main partner is the European MS Platform (EMSP) acting in collaboration with associated and collaborating European partners. RESULTS: EUReMS was launched in July 2011. A Consensus Statement on purposes, vision, mission and strategies was produced in December 2011, and a comprehensive survey on existing MS data collections in Europe has been performed, and the EUReMS data mask is currently being discussed. CONCLUSIONS: EUReMS will represent a tool to provide up to date, comparable and sustainable MS data through an effective and credible register, which will encourage extensive knowledge building of MS, more equitable policies and higher standards in MS treatment and services.

Breathing exercises for asthma: a randomised controlled trial.

BACKGROUND: The effect of breathing modification techniques on asthma symptoms and objective disease control is uncertain. METHODS: A prospective, parallel group, single-blind, randomised controlled trial comparing breathing training with asthma education (to control for non-specific effects of clinician attention) was performed. Subjects with asthma with impaired health status managed in primary care were randomised to receive three sessions of either physiotherapist-supervised breathing training (n = 94) or asthma nurse-delivered asthma education (n = 89). The main outcome was Asthma Quality of Life Questionnaire (AQLQ) score, with secondary outcomes including spirometry, bronchial hyper-responsiveness, exhaled nitric oxide, induced sputum eosinophil count and Asthma Control Questionnaire (ACQ), Hospital Anxiety and Depression (HAD) and hyperventilation (Nijmegen) questionnaire scores. RESULTS: One month after the intervention there were similar improvements in AQLQ scores from baseline in both groups but at 6 months there was a significant between-group difference favouring breathing training (0.38 units, 95% CI 0.08 to 0.68). At the 6-month assessment there were significant between-group differences favouring breathing training in HAD anxiety (1.1, 95% CI 0.2 to 1.9), HAD depression (0.8, 95% CI 0.1 to 1.4) and Nijmegen (3.2, 95% CI 1.0 to 5.4) scores, with trends to improved ACQ (0.2, 95% CI 0.0 to 0.4). No significant between-group differences were seen at 1 month. Breathing training was not associated with significant changes in airways physiology, inflammation or hyper-responsiveness. CONCLUSION: Breathing training resulted in improvements in asthma-specific health status and other patient-centred measures but not in asthma pathophysiology. Such exercises may help patients whose quality of life is impaired by asthma, but they are unlikely to reduce the need for anti-inflammatory medication.

ArrayExpress--a public database of microarray experiments and gene expression profiles.

UNLABELLED: ArrayExpress is a public database for high throughput functional genomics data. ArrayExpress consists of two parts--the ArrayExpress Repository, which is a MIAME supportive public archive of microarray data, and the ArrayExpress Data Warehouse, which is a database of gene expression profiles selected from the repository and consistently re-annotated. Archived experiments can be queried by experiment attributes, such as keywords, species, array platform, authors, journals or accession numbers. Gene expression profiles can be queried by gene names and properties, such as Gene Ontology terms and gene expression profiles can be visualized. ArrayExpress is a rapidly growing database, currently it contains data from >50,000 hybridizations and >1,500,000 individual expression profiles. ArrayExpress supports community standards, including MIAME, MAGE-ML and more recently the proposal for a spreadsheet based data exchange format: MAGE-TAB. AVAILABILITY: www.ebi.ac.uk/arrayexpress.

ArrayExpress--a public repository for microarray gene expression data at the EBI.

ArrayExpress is a public repository for microarray data that supports the MIAME (Minimum Information About a Microarray Experiment) requirements and stores well-annotated raw and normalized data. As of November 2004, ArrayExpress contains data from approximately 12,000 hybridizations covering 35 species. Data can be submitted online or directly from local databases or LIMS in a standard format, and password-protected access to prepublication data is provided for reviewers and authors. The data can be retrieved by accession number or queried by various parameters such as species, author and array platform. A facility to query experiments by gene and sample properties is provided for a growing subset of curated data that is loaded in to the ArrayExpress data warehouse. Data can be visualized and analysed using Expression Profiler, the integrated data analysis tool. ArrayExpress is available at http://www.ebi.ac.uk/arrayexpress.

Gas chromatographic-mass spectrometric determination of british anti-lewisite in plasma.

British anti-Lewisite (BAL) (2,3-dimercapto-1-propanol) is a potential therapeutic compound when used against the effects of cutaneous sulfur mustard, and a method for its determination in plasma has been developed. BAL and the internal standard (IS) ethane dithiol were isolated from plasma samples through solid-phase extraction and then reacted with 1-pentafluoropropionylimidazole, forming stable pentafluoropropionyl derivates that are sensitive to gas chromatographic-mass spectrometric analysis. Examination of concentration versus peak-area ratios of the BAL and IS derivatives demonstrated the method to be linear over a concentration range of 0.48 to 124 ng/mL in plasma when fit to a weighted (1/y2) least-squares regression. Correlation coefficients were 0.9943 to 0.9995 for six runs, and coefficients of variation (CV) were 2.5 to 8.7% over the eight concentrations tested. The intra- and interday accuracy and precision of this method was measured by examining six groups of eight unknown test samples (n = 6). Intraday accuracy, as expressed by percent error, was found to range from -15.4 to 0.21%, whereas the precision, expressed as %CV, was less than 9.8% over all sample concentrations. Interday test unknown sample results were similar in that the accuracy was shown to be -7.1 to 0.4%, and precision was 4.7 to 9.5%. BAL levels in frozen plasma (-70 degrees C) remained constant for more than 14 days with a CV of less than 10% for the eight concentrations tested. The data indicate that the method will provide accurate and precise determination of BAL at concentrations down to approximately 1 ng/mL in plasma. This procedure has been applied to determine preliminary time-concentration profile studies of BAL in the hairless guinea pig.

Breathing exercises for asthma.

BACKGROUND: There is much anecdotal evidence in Eastern and Western literature describing considerable benefits for patients with asthma when treated with breathing interventions. The term 'breathing exercise, training and retraining' has numerous interpretations depending on the nature of the therapy, therapist and cultural background. OBJECTIVES: To assess the evidence for the efficacy of breathing retraining in the treatment of patients with asthma. SEARCH STRATEGY: Trials were searched for in the Cochrane Airways Group trials register, Cochrane Complementary Medicine Field trials register, EMBASE: Physical Medicine & Rehabilitation Field, and Databases of the physiotherapy library of current research, World Congress of Physical Therapy Proceedings (1995) and AMED (Allied & Complementary Medicine Database 1985-2003/4). Hand searching of the Association of Chartered Physiotherapists in Respiratory Care Journals was undertaken. Chartered physiotherapists in the field of respiratory medicine were contacted and appeals made in the 'Physiotherapy' Journal and the Physiotherapy Respiratory Care magazine. Searches were undertaken of bibliographies from the included studies and other appropriate papers. Authors of included studies were contacted for information concerning other relevant trials. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials of breathing retraining in patients of all ages with a diagnosis of asthma. Breathing retraining should be a major component of the treatment intervention. DATA COLLECTION AND ANALYSIS: Two reviewers (EH & FR) independently assessed trial quality and extracted data. Authors of included trials were contacted for additional data. Where possible adverse effects were noted. MAIN RESULTS: Abstracts were identified and 42 full text papers were obtained for assessment and possible inclusion. Thirty five studies were excluded. A total of five studies were included in the original review. Two further studies have been added to this update. Most studies were of small size. Two studies demonstrated significant reductions in rescue bronchodilator use and three studies showed reductions in acute exacerbations, although these were measured in different ways. Two single studies showed significant improvements in quality of life measures. Overall, benefits of breathing exercises were found in isolated outcome measures in single studies. Five studies compared breathing retraining with no active control and two with asthma education control groups. REVIEWER'S CONCLUSIONS: Comparisons and conclusions were difficult to evaluate as treatment interventions and outcome measurements from the seven trials varied considerably. At present therefore no reliable conclusions can be drawn concerning the use of breathing exercises for asthma in clinical practice. However trends for improvement, notably in quality of life measurements, are encouraging and further studies including full descriptions of treatment methods and outcome measurements are required.

Breathing retraining for asthma.

Breathing retraining is used increasingly throughout the world by many patients with asthma in addition to their usual medical care. We undertook a systematic review of the literature in order to determine the effectiveness of breathing retraining in the management of asthma. Six randomised-controlled trials were identified that involved breathing retraining in asthma. Due to the variation in reported trial outcomes, limited reporting of study data and small number of included trials it was not possible to draw any firm conclusions as to its effectiveness. However, outcomes that were reported from individual trials do show that breathing retraining may have a role in the treatment and management of asthma. Further large-scale trials using breathing retraining techniques in asthma are required to address this important issue.

Early dose assessment in criticality accidents.

Early estimation of dose is useful in the medical evaluation of severe radiation accidents. In a prior publication, lymphocyte depletion kinetics were shown to follow an exponential decline for gamma accidents in which the average whole-body dose was in the range 50 cGy < D < 8-10 Gy. In that study, the depletion rate constant was linearly related to dose, within the statistical variation of the historical hematological data. This simple technique has now been extended to include analysis of various types of criticality accidents (liquid process; water moderated systems; metallic systems). Lymphocyte depletion in high-level mixed gamma/neutron accidents is found to be approximately equal, at a given effective dose, to that for gamma accidents. This universality would indicate a neutron RBE for human lymphocytes close to unity. Furthermore, the technique appears to be insensitive to the shape of gamma and neutron spectra, therefore making it especially robust for initial, approximate dose estimation.

Breathing exercises for asthma.

BACKGROUND: There is much anecdotal evidence in Eastern and Western literature describing considerable benefits for patients with asthma when treated with breathing interventions. The term 'breathing exercise or training' has numerous interpretations depending on the nature of the therapy, therapist and cultural background. OBJECTIVES: The objective of this review was to assess the evidence for the effectiveness of breathing re-training in the treatment of patients with asthma. SEARCH STRATEGY: Trials were searched for in the Cochrane Airways Group trials register, Cochrane Complementary Medicine Field trials register, EMBASE: Physical Medicine & Rehabilitation Field, and Databases of the physiotherapy library of current research, World Congress of Physical Therapy Proceedings (1995) and AMED (Allied & Alternative Medicine). Hand searching of the Association of Chartered Physiotherapists in Respiratory Care Journals was undertaken. Chartered physiotherapists in the field of respiratory medicine were contacted and appeals made in the 'Physiotherapy' Journal and the Physiotherapy Respiratory Care magazine. SELECTION CRITERIA: Randomised or quasi randomised controlled trials of breathing re-training in patients of all ages with a diagnosis of asthma. Breathing re-training should be a major component of the treatment intervention. DATA COLLECTION AND ANALYSIS: Two reviewers (EH & FR) independently assessed trial quality and extracted data. Study authors were contacted for additional information. Information on adverse effects was collected from the included trials where possible. MAIN RESULTS: Abstracts were identified and 32 full text papers were obtained for assessment and possible inclusion of studies in the review. Twenty seven papers were excluded. A total of five papers were included in this review. Most were small. One large study (106 patients) showed an improvement in PEFR and reduction in rescue bronchodilator use. Otherwise benefit of breathing exercises was found in isolated outcome measures in single small studies. REVIEWER'S CONCLUSIONS: No reliable conclusions can be drawn concerning the use of breathing exercises for asthma in clinical practice.

A physical map of 30,000 human genes.

A map of 30,181 human gene-based markers was assembled and integrated with the current genetic map by radiation hybrid mapping. The new gene map contains nearly twice as many genes as the previous release, includes most genes that encode proteins of known function, and is twofold to threefold more accurate than the previous version. A redesigned, more informative and functional World Wide Web site (www.ncbi.nlm.nih.gov/genemap) provides the mapping information and associated data and annotations. This resource constitutes an important infrastructure and tool for the study of complex genetic traits, the positional cloning of disease genes, the cross-referencing of mammalian genomes, and validated human transcribed sequences for large-scale studies of gene expression.

Early dose assessment following severe radiation accidents.

Early treatment of victims of high level acute whole-body x-ray or gamma exposure has been shown to improve their likelihood of survival. However, in such cases, both the magnitude of the exposure and the dosimetry profile(s) of the victim(s) are often not known in detail for days to weeks. A simple dose-prediction algorithm based on lymphocyte kinetics as documented in prior radiation accidents is presented here. This algorithm provides an estimate of dose within the first 8 h following an acute whole-body exposure. Early lymphocyte depletion kinetics after a severe radiation accident follow a single exponential, L(t) = L(o)e(-k(D¿t), where k(D) is a rate constant, dependent primarily on the average dose, D. Within the first 8 h post-accident, K(D) may be calculated utilizing serial lymphocyte counts. Data from the REAC/TS Radiation Accident Registry were used to develop a dose-prediction algorithm from 43 gamma exposure cases where both lymphocyte kinetics and dose reconstruction were felt to be reasonably reliable. The inverse relationship D(K) may be modeled by a simple two parameter curve of the form D = a/(1 + b/K) in the range 0 < or = D < or = 15 Gy, with fitting parameters (mean +/- SD): a = 13.6 +/- 1.7 Gy, and b = 1.0 +/- 0.20 d(-1). Dose estimated in this manner is intended to serve only as a first approximation to guide initial medical management.

From long range mapping to sequence-ready contigs on human chromosome 6.

Our aim is to construct physical clone maps covering those regions of chromosome 6 that are not currently extensively mapped, and use these to determine the DNA sequence of the whole chromosome. The strategy we are following involves establishing a high density framework map of the order of 15 markers per Megabase using radiation hybrid (RH) mapping. The markers are then used to identify large-insert genomic bacterial clones covering the chromosome, which are assembled into sequence-ready contigs by restriction enzyme fingerprinting and sequence tagged site (STS) content analysis. Contig gap closure is performed by walking experiments using STSs developed from the end sequences of the clone inserts.

A gene map of the human genome.

The human genome is thought to harbor 50,000 to 100,000 genes, of which about half have been sampled to date in the form of expressed sequence tags. An international consortium was organized to develop and map gene-based sequence tagged site markers on a set of two radiation hybrid panels and a yeast artificial chromosome library. More than 16,000 human genes have been mapped relative to a framework map that contains about 1000 polymorphic genetic markers. The gene map unifies the existing genetic and physical maps with the nucleotide and protein sequence databases in a fashion that should speed the discovery of genes underlying inherited human disease. The integrated resource is available through a site on the World Wide Web at http://www.ncbi.nlm.nih.gov/SCIENCE96/.

An integrated YAC map of the human X chromosome.

The human X chromosome is associated with a large number of disease phenotypes, principally because of its unique mode of inheritance that tends to reveal all recessive disorders in males. With the longer term goal of identifying and characterizing most of these genes, we have adopted a chromosome-wide strategy to establish a YAC contig map. We have performed > 3250 inter Alu-PCR product hybridizations to identify overlaps between YAC clones. Positional information associated with many of these YAC clones has been derived from our Reference Library Database and a variety of other public sources. We have constructed a YAC contig map of the X chromosome covering 125 Mb of DNA in 25 contigs and containing 906 YAC clones. These contigs have been verified extensively by FISH and by gel and hybridization fingerprinting techniques. This independently derived map exceeds the coverage of recently reported X chromosome maps built as part of whole-genome YAC maps.

Physical mapping of chromosome 6: a strategy for the rapid generation of sequence-ready contigs.

The development of radiation hybrid (RH) mapping (Cox et al., 1990) and the availability of large numbers of STS markers, together with extensive bacterial clone resources provided a means to accelerate the process of mapping a human chromosome and preparing bacterial clone contigs ready to sequence. Our aim is to construct physical clone maps covering those regions of chromosome 6 that are not currently extensively mapped, and use these to determine the DNA sequence of the whole chromosome. We report here a strategy which initially involves establishing a high density framework map using RH mapping. The framework markers are then used for the identification of bacterial genomic clones covering the chromosome. The bacterial clones are analysed by restriction enzyme fingerprinting and STS-content analysis to identify sequence-ready contigs. Contig gap closure will also be performed by clone walking.

Supervision: its contributions to treatment efficacy.

The efficacy of supervision in training of psychotherapists is discussed in relation to (a) trainees' attitudes, beliefs, and skills, (b) trainee's performance in the therapist role, (c) interactional process events in supervision and psychotherapy, and, (d) client change. Although investigations to date suggest the potential of supervision for teaching advanced skills of psychotherapy, few studies exist that examine directly the relation of therapist performance and client change to supervision. There are virtually no studies that compare the efficacy of supervision to other training methods. If supervision is to remain an integral part of training, then standardized training manuals, analogous to those in psychotherapy, need to be developed.

Parent and occupational therapist collaboration in the neonatal intensive care unit.

Medical care of infants in the neonatal intensive care unit (NICU) is so complex that professionals have been almost exclusively responsible for providing care to the infants and information to their families. Although federal law now mandates early intervention programs and service providers to include families in decision making and treatment implementation for their children, family-centered care has generally not been implemented in the NICU. This article offers suggestions for occupational therapists from members of the Parent Connection, an NICU parent support group. They state that a therapist can have the greatest effect on an infant's development by helping the parents develop skills to nurture their infant the way that they choose.