Pilot randomized trial of an electronic symptom monitoring intervention for hospitalized patients with cancer.

BACKGROUND: Hospitalized patients with cancer experience a high symptom burden, which is associated with poor health outcomes and increased health care utilization. However, studies investigating symptom monitoring interventions in this population are lacking. We conducted a pilot randomized trial to assess the feasibility and preliminary efficacy of a symptom monitoring intervention to improve symptom management in hospitalized patients with advanced cancer. PATIENTS AND METHODS: We randomly assigned patients with advanced cancer who were admitted to the inpatient oncology service to a symptom monitoring intervention or usual care. Patients in both arms self-reported their symptoms daily (Edmonton Symptom Assessment System and Patient Health Questionnaire-4). Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily team rounds. The primary end point of the study was feasibility. We defined the intervention as feasible if >75% of participants hospitalized >2 days completed >2 symptom reports. We observed daily rounds to determine whether clinicians discussed and developed a plan to address patients' symptoms. We used regression models to assess intervention effects on patients' symptoms throughout their hospitalization, readmission risk, and hospital length of stay (LOS). RESULTS: Among 150 enrolled patients (81.1% enrollment), 94.2% completed >2 symptom reports. Clinicians discussed 60.4% of the symptom reports and developed a plan to address the symptoms highlighted by the symptom reports 20.8% of the time. Compared with usual care, intervention patients had a greater proportion of days with lower psychological distress (B = 0.12, P = 0.008), but no significant difference in the proportion of days with improved Edmonton Symptom Assessment System-physical symptoms (B = 0.07, P = 0.138). Intervention patients had lower readmission risk (hazard ratio = 0.68, P = 0.224), although this difference was not significant. We found no significant intervention effects on hospital LOS (B = 0.16, P = 0.862). CONCLUSIONS: This symptom monitoring intervention is feasible and demonstrates encouraging preliminary efficacy for improving patients' symptoms and readmission risk.ClinicalTrials.gov identifier NCT02891993.

Factors associated with depression and anxiety symptoms in family caregivers of patients with incurable cancer.

BACKGROUND: Family caregivers (FCs) are critically important for patients with cancer, yet they may experience psychological distress related to caregiving demands. We sought to describe rates of depression and anxiety in FCs of patients with incurable cancer and identify factors associated with these symptoms to determine those at greatest risk for psychological distress. PATIENTS AND METHODS: We performed a cross-sectional analysis of baseline data from a randomized trial of early palliative care. We assessed depression and anxiety using the Hospital Anxiety and Depression Scale in patients within 8 weeks of diagnosis of incurable lung or gastrointestinal cancer and their FCs. We also assessed patients' quality of life (Functional Assessment of Cancer Therapy-General), coping strategies (Brief COPE), and their report of the primary goal of their cancer treatment. We used linear regression with purposeful selection of covariates to identify factors associated with FC depression and anxiety symptoms. RESULTS: We enrolled 78.6% (n = 275) of potentially eligible FCs. The majority were female (69.1%) and married to the patient (66.2%). While the proportion of FCs and patients reporting depression did not differ (16.4% versus 21.5%, P = 0.13), FCs were more likely to report anxiety compared with patients (42.2% versus 28.4%, P < 0.001). Patients' use of acceptance coping was associated with lower FC depression (B = -0.42, P < 0.001), while emotional support coping was associated with higher FC depression (B = 0.69, P = 0.001) and lower FC anxiety (B = -0.70, P < 0.001). Patient report that their primary goal of their treatment was to 'cure my cancer' was associated with higher FC depression (B = 0.72, P = 0.03). CONCLUSIONS: Patients with incurable cancer and their FCs report high levels of depression and anxiety symptoms. We demonstrated that patients' coping strategies and prognostic understanding were associated with FC depression and anxiety symptoms, underscoring the importance of targeting these risk factors when seeking to address the psychological distress experienced by FCs.

Investigation into the bacterial pollution levels at various sites along the Diep and Plankenburg river systems, 3 Western Cape, South Africa.

This study sought to investigate and compare bacterial contamination levels at six different sites along the Diep and Plankenburg river systems in the Western Cape, South Africa. Surface water and sediment samples were collected monthly from the six selected sampling sites along both river courses between January 2014 and December 2014 and were evaluated for bacterial contaminants. Microbial isolation, characterisation and identification were done using conventional techniques (serial dilution, Gram staining, and biochemical testing) and molecular identification techniques (polymerase chain reaction and DNA sequencing). A total of 19 bacterial isolates belonging to the genera Raoultella, Bacillus, Pseudomonas, Klebsiella, Escherichia, Enterobacter, Exiguobacterium, Acinetobacter, Serratia, Aeromonas, Staphylococcus and Citrobacter were isolated from the surface water and sediment samples at the end of the survey. Higher microbial load was obtained from sediment samples compared to surface water samples. Seasonal variation was also observed in terms of microbial counts. Higher microbial counts were obtained during summer sampling time compared to winter sampling time. The most contaminated site was located on Plankenburg River with average bacterial counts ranging between 3.1 × 10(5)-6.9 × 10(8) CFU/ml and 3.9 × 10(6)-2.88 × 10(9) CFU/ml from surface water and sediment, respectively, recorded at this site during winter and summer. Although lower microbial counts were recorded along the Diep River course, most of the bacterial counts recorded along both rivers exceeded the acceptable maximum limits for river water.

Prognostic understanding, quality of life and mood in patients undergoing hematopoietic stem cell transplantation.

Little is known about how patients undergoing hematopoietic stem cell transplantation (HCT) and their family caregivers (FC) perceive their prognosis. We examined prognostic understanding in patients undergoing HCT and their FC and its relationship with quality of life (QOL) and mood. We conducted a longitudinal study of patients (and FC) hospitalized for HCT. We used a questionnaire to measure participants' prognostic understanding and asked the oncologists to estimate patients' prognosis prior to HCT. We assessed QOL and mood weekly and evaluated the relationship between prognostic understanding, and QOL and mood using multivariable linear mixed models. We enrolled 90 patients undergoing (autologous (n=30), myeloablative (n=30) or reduced intensity allogeneic (n=30)) HCT. About 88.9% of patients and 87.1% of FC reported it is 'extremely' or 'very' important to know about prognosis. However, 77.6% of patients and 71.7% of FC reported a discordance and more optimistic prognostic perception compared to the oncologist (P<0.0001). Patients with a concordant prognostic understanding with their oncologists reported worse QOL (ß=-9.4, P=0.01) and greater depression at baseline (ß=1.7, P=0.02) and over time ((ß=1.2, P<0.0001). Therefore, Interventions are needed to improve prognostic understanding, while providing patients with adequate psychological support.

The application of bioremediation: reduction of metal concentrations in river water and COD in distillery effluent.

The major aim of this study was to evaluate and develop artificial bioremediation systems to reduce or remove metal pollutants from contaminated river water and to decrease the chemical oxygen demand (COD) in distillery effluent. Metals were extracted using the nitric acid digestion method, and the concentrations determined using inductively coupled plasma-atomic emission spectrometry. A decrease in metal concentrations was observed for most of the metals analysed in the river water after being pumped through the bioreactor system for approximately two weeks, e.g. Al concentration decreased from 0.75mg.l(-1) to 0.18mg.l(-) and for Ni, from 0.19mg.l(-1) to 0 mg.l(-l). In addition, the COD counts decreased from 2255 mg.l(-1) to a final value of < 150 mg.l(-1) in the distillery effluent. It could thus be concluded that the bioreactor system decreased the COD and metal concentrations in the distillery effluent as well as the river water, respectively. A bioreactor is being evaluated on-site at a wine cellar to reduce COD and will be constructed at a site along the Plankenbrug River.

Effect of exogenous insulin on meal patterns and stomach emptying in the spiny mouse.

Male adult spiny mice (Acomys cahirinus) were acutely challenged with a single dose of regular insulin or saline vehicle SC; either food intake, meal frequency and meal duration, or stomach emptying were then measured. Meal frequency, as well as amount eaten, was significantly higher over a 6-hr period following both 10 and 30 U/kg of insulin than following vehicle injection. Meal duration remained essentially the same across all conditions. When 30 U/kg of insulin was administered either 15 min prior to, or immediately after, a solid food meal, stomach emptying (as measured by dry weight of recovered stomach contents) was accelerated relative to vehicle controls. These data are generally consistent with and extend the comparative literature suggesting a possible link between rate of stomach emptying and insulin-induced hyperphagia in some species.