Patient and radiographer acceptability of prophylactic skin care for breast patients receiving radiotherapy.

INTRODUCTION: This study aimed to: • Address the lack of information surrounding patient preference within radiotherapy skin care. • Identify if prophylactic skin care is the preferred approach of patients and staff. • Establish if patients and staff are accepting of the use of a type of barrier film, such as 3M™ Cavilon™ No Sting Barrier Film. METHODS: Twelve patients undergoing standard whole breast radiotherapy and four staff members who were based mainly on a breast-specific treatment unit were interviewed using semi-structured techniques. The interview transcripts were coded for areas of interest and a thematic map generated using the qualitative data analysis software (NVivo V12, QSR International). RESULTS: One Hundred percent of patients (n = 12) would have preferred a proactive approach to skin care management over the reactive one currently implemented. Staff were also in favour of a proactive approach to skin care with 100% (n = 4) supportive of a trial into the film's effectiveness. Three key themes were identified: • Theme 1: Patient Ownership of Own care - all patients identified they preferred a prophylactic approach and that more specific skin care guidance from healthcare professionals would be beneficial. • Theme 2: Product Practicality - 93% of patients and 100% of staff accepted the product and would be open to the use of it clinically. • Theme 3: Staff Acknowledgement of Skin Care - all staff identified a patient group in need of prophylaxis and that Cavilon No Sting may be a product of interest. CONCLUSION: Patients and staff were in support of prophylactic skin care, both approved of the proposed product. However, there is a significant lack of clinical evidence to support the use of any topical products within radiotherapy skincare due to the lack of high-quality studies. IMPLICATIONS FOR PRACTICE: Changes to skin care practice could be considered due to patient preference in favour of proactive management.

An audit of radiation-induced skin reactions in the inframammary fold; does breast size impact on the severity of the reaction?

INTRODUCTION: Skin toxicity is a clinically significant side effect of external beam radiation; moist desquamation is particularly prevalent for breast patients, mainly in the axilla and inframammary fold (IMF). The aim of this audit was to assess if there is a correlation between patient breast size and the presence and extent of radiotherapy skin reaction in the IMF. METHODS: Between 22/12/2017 and 31/05/2018 forty patients undergoing standard whole breast radiotherapy using 3D planned medial and lateral tangential fields had their skin reaction recorded weekly, whilst on treatment, using the Radiotherapy Oncology Group (RTOG) scoring system. Skin reactions were also documented at three and eight weeks post radiotherapy. A measurement of the patients IMF length and bra size were also noted. Statistical analysis was carried out using IBMÒ SPSS Statistics 24. RESULTS: Six patients presented with grade ≥2 during week three of radiotherapy. The mean IMF length of six patients with adverse reactions 6.1 cm (±3.6 cm). As the length of the IMF increases, severity of skin reactions also increases; a positive correlation was identified between the two at both week three of radiotherapy and three weeks post radiotherapy (r = 0.401, n = 34, p = 0.05 and r = 0.671, n = 29, p = 0.00 respectively). Only one patient displayed grade 2 at eight weeks post radiotherapy (IMF length 7.5 cm). CONCLUSION: The findings from this study would suggest that larger breasted patients do present earlier, and with more severe radiation-induced skin reactions. IMPLICATIONS FOR PRACTICE: Changes to skin care practice could be considered for patients with larger breasts. This could be in the form of more frequent check-ups during treatment or proactive side effect management rather than reactive management.

Atmospheric CH4 oxidation by Arctic permafrost and mineral cryosols as a function of water saturation and temperature.

The response of methanotrophic bacteria capable of oxidizing atmospheric CH4 to climate warming is poorly understood, especially for those present in Arctic mineral cryosols. The atmospheric CH4 oxidation rates were measured in microcosms incubated at 4 °C and 10 °C along a 1-m depth profile and over a range of water saturation conditions for mineral cryosols containing type I and type II methanotrophs from Axel Heiberg Island (AHI), Nunavut, Canada. The cryosols exhibited net consumption of ~2 ppmv CH4 under all conditions, including during anaerobic incubations. Methane oxidation rates increased with temperature and decreased with increasing water saturation and depth, exhibiting the highest rates at 10 °C and 33% saturation at 5 cm depth (260 ± 60 pmol CH4 gdw-1 d-1 ). Extrapolation of the CH4 oxidation rates to the field yields net CH4 uptake fluxes ranging from 11 to 73 µmol CH4  m-2 d-1 , which are comparable to field measurements. Stable isotope mass balance indicates ~50% of the oxidized CH4 is incorporated into the biomass regardless of temperature or saturation. Future atmospheric CH4 uptake rates at AHI with increasing temperatures will be determined by the interplay of increasing CH4 oxidation rates vs. water saturation and the depth to the water table during summer thaw.

Inhibition of lymphocyte protein kinase C by unsaturated fatty acids.

Oleic, arachidonic, eicosapentaenoic and docosahexaenoic acids inhibited lymphocyte protein kinase C activity in the presence of Ca2+, phospholipid and a phorbol ester. Linoleic and alpha-linolenic acids did not affect protein kinase C activity in this way and none of the fatty acids affected protein kinase A activity. These findings indicate direct inhibitory effects of some unsaturated fatty acids upon protein kinase C. Culture of lymphocytes in the presence of oleic, arachidonic, eicosapentaenoic or docosahexaenoic acids resulted in a reduction in protein kinase C activity (by up to 45%). Culture with linoleic or alpha-linolenic acids did not affect protein kinase C activity and none of the fatty acids affected total protein kinase A activity or the percentage in the active form. These results show for the first time that fatty acids have long term effects upon protein kinase C activity, perhaps as a result of altering the rate of turnover of the enzyme. It is suggested that the inhibition of lymphocyte functions caused by unsaturated fatty acids may in part be due to their effect on protein kinase C.

Focus on Trent--community. A seamless service for community care.

In an era of rapid change and development related to community care, Trent Health has been rethinking the region's approach to community nursing services. A task group set up to examine the issues led to the circulation of a consultative document: the responses revealed widespread support for the concept of a joint single service specification as the key to a 'seamless service' within the community. Work continues in Trent to clarify how nurses can contribute to achieving an effective seamless service.