A multidisciplinary rehabilitation programme for cancer cachexia improves quality of life.

OBJECTIVES: Patients with cancer cachexia have severely impaired quality of life (QoL). Multidisciplinary, multimodal treatment approaches have potential for stabilising weight and correcting other features of this syndrome, but the impact on QoL is unknown. METHODS: A retrospective analysis of QoL in patients with advanced cancer, referred for the management of cachexia by a specialised multidisciplinary clinic (The McGill Cancer Nutrition Rehabilitation Program clinic at the Jewish General Hospital (CNR-JGH)). QoL was assessed at visits 1-3 using a dedicated QoL tool for cachexia, and the change in QoL was calculated for each patient. The correlation between clinical features and QoL at baseline and subsequent change in QoL was analysed, to determine what factors predict improvements in QoL during the CNR-JGH intervention. RESULTS: 374 patients assessed at visit 1 with mean weight loss of 10.2% over the preceding 6 months. Baseline QoL scores were severely impaired but clinically important improvements were observed over visits 1-3 to the CNR-JGH clinic. Improvements in QoL were not determined by baseline characteristics and were similar in all patient subgroups. However, those patients who gained weight and increased their 6 min walk test (6MWT) had the greatest improvements in QoL. CONCLUSIONS: Improving management of all facets of the cancer cachexia syndrome, including poor QoL, remains a priority. The multimodal approach to management of cancer cachexia offered by the CNR-JGH results in clinically important improvements in QoL. All patients who are able to receive this type of intervention have similar potential to improve their QoL, but the greatest benefits are seen in those who gain weight and improve their 6MWT.

Family Perspectives of Traumatically Brain-Injured Patient Pain Behaviors in the Intensive Care Unit.

Behavioral scales allow for the pain assessment of vulnerable critically ill patients who are unable to self-report. However, validity of the use of such scales is limited in traumatic brain injury patients with an altered level of consciousness as a result of the different way that these patients express pain. Family participation is considered as an important component of pain assessment for those unable to self-report, but research in this area is minimal so far. This study aimed to describe what behaviors family caregivers deemed relevant to pain for patients with a traumatic brain injury with an altered level of consciousness in the intensive care unit. Using a mixed-method descriptive design, semistructured interviews were conducted and behaviors' relevance was quantitatively rated by seven family caregivers of nonverbal patients with traumatic brain injury in the intensive care unit of a tertiary trauma center in Montreal, Canada. Family caregivers were able to provide rich descriptions of a number of behaviors they observed in their loved ones that were perceived to be relevant indicators of pain, such as muscle tension and key facial expressions and body movements. Several factors influenced how behaviors were interpreted by family, including personal medical beliefs and intimate knowledge of the patient's history. The pain behaviors determined by family caregivers can be useful in the pain assessment process of traumatic brain injury patients with an altered level of consciousness. Their input could also be helpful in further development of pain assessment tools.

The feasibility and acceptability of neuromuscular electrical stimulation to improve exercise performance in patients with advanced cancer: a pilot study.

BACKGROUND: To determine the feasibility and acceptability of lower limb neuromuscular electrical stimulation (NMES) as a home-based exercise therapy in patients with cancer who could not attend hospital-based exercise training. METHODS: A single-arm prospective pilot study of NMES, applied daily to both quadriceps muscles for six weeks. Participants were recruited from patients referred to a hospital-based multi-disciplinary supportive care team specializing in treatment of patients with nutritional depletion and functional decline. RESULTS: Of the 15 participants who underwent baseline testing, 10 (67%) completed the study and only one (7%) withdrew because of discomfort due to NMES treatment. 7/10 (70%) of participants used NMES at least three times a week for the duration of the study. Use of NMES did not lead to significant improvements in physical performance tests. CONCLUSIONS: NMES is a feasible and acceptable intervention for home use in patients with cancer, poor performance status and metastatic disease. However, whether NMES is an effective strategy to stabilize or improve physical performance in such patients is not proven.

Alzheimer's disease dietary supplements in websites.

Consumer demand for health information and health services has rapidly evolved to capture and even propel the movement to online health information seeking. Seventeen percent (52 million) of health information internet users will look for information about memory loss, dementia and Alzheimer's disease (AD) (Fox Pew Internet & American life project: Online health search. Report. Pew Research Center. http://pewinternet.org/Reports/2006/Online-Health-Search-2006.aspx 2006, Pew Research Center. http://pewinternet.org/Reports/2011/HealthTopics.aspx 2011). We examined the content of the 25 most frequently retrieved websites marketing AD dietary supplements. We found that the majority of websites and their products claimed AD-related benefits, including improvement and enhancement of function, treatment for AD, prevention of AD, maintenance of function, delayed progression of AD, and decreased symptoms. Supplements were described as effective, natural, powerful or strong, dependable and pure or of high quality. Peer reviewed references to proper scientific studies were infrequent on websites. Statements highlighting the risks of dietary supplements were as common as statements mitigating or minimizing these risks. Different strategies were used to promote supplements such as popular appeals and testimonials. Further enforcement of relevant policy is needed and preparation of clinicians to deal with requests of patients and caregivers is indicated.

First reproductive experience persistently affects spatial reference and working memory in the mother and these effects are not due to pregnancy or 'mothering' alone.

Pregnancy and motherhood are life-altering events that result in a number of hormonal, neural and behavioral changes in the mother. Motherhood has been shown to influence spatial learning and memory performance of the mother. In turn new research has shown that reproductive experience (number of times pregnant and mothered) plays a significant role on spatial learning and memory performance. How long these changes persist after weaning and the role of pregnancy and/or mothering on these changes have yet to be fully investigated. The present study aimed to determine whether enhanced spatial working and/or reference memory in the mother is evident long after weaning and whether these effects are due, in part, to pregnancy or 'mothering' alone. Five groups of age-matched rats: multiparous, primiparous, nulliparous, pregnant-only and sensitized rats were tested approximately 1 month after weaning/pup-exposure, or 55 days after birth, on the spatial working/reference version of the radial arm maze. Results show that regardless of error type (reference or working memory errors), primiparous rats make fewer errors compared to multi- and nulli-parous rats, with a trend to enhanced memory compared to sensitized rats. In addition, pregnant-only rats completed the task on significantly fewer days than primiparous, multiparous, nulliparous and sensitized rats. Clearly the combination of first pregnancy and first mothering experience has a significant impact on hippocampus-dependent learning and memory performance in the mother.