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The aim of this paper is to investigate the effectiveness of physical exercise in managing fatigue during radiotherapy for prostate cancer patients. It explores the impact of various physical exercise regimes and their role in the prevention and management of fatigue to help inform best practice.
A literature search was conducted on OVID Medline database with a follow-up search on google scholar to include relevant references found during the initial search. Relevant systematic reviews and randomised controlled trials (RCTs) arising from this search were reviewed.
There is evidence to support the notion that physical exercise in all its forms is an effective and safe intervention for fatigue management for prostate cancer patients undergoing radiotherapy. Although widely studied, there is limited evidence of fatigue management strategies being clearly implemented into current radiotherapy practice for patients with prostate cancer. This information is essential to enable therapeutic radiographers to educate prostate cancer patients regarding effective exercise strategies and ensure that fatigue is managed optimally.
Further research is required into the optimum physical exercise prescription to reduce radiation-induced fatigue, and standardised best practice guidelines should be developed nationally. A future move toward patient education into physical exercise and wellbeing should be a central component of the therapeutic radiographer role with specialist advice offered by review radiographers, empowering patients to become more physically active during treatment. Therapeutic radiographers have a unique opportunity to educate and promote physical exercise through a holistic wellbeing approach that aims to mitigate fatigue and improve quality of life.
To evaluate the information needs of radiotherapy patients and their families. To explore influential factors regarding information-seeking behaviours. To identify the preferred formats of information and the optimum time for radiotherapy patients to receive information. To assess the implications for clinical practice in satisfying patient information needs.
A Cumulative Index to Nursing and Allied Health Literature database search of literature was undertaken and publications screened for retrieval with 36 qualifying for inclusion in the evaluation.
There was inconclusive evidence exploring the impact that patient age, diagnosis, family background, and educational status had on the information-seeking behaviours and preferences of cancer patients. There is an agreement that there are positive and negative benefits of using different formats of information: verbal, written, virtual, and so on, and ultimately healthcare providers must utilise a combination of information formats to satisfy the information needs and preferences of individual patients. Inconsistent data were found on the optimum time to deliver cancer information to patients and professionals, and therapeutic radiographers should not assume that their information priorities are the same as those of their patients—every patient has unique and individually specific information needs.
The information needs of patients and families are dependent on individual circumstances, and priorities have a tendency to change during the cancer management journey, presenting huge challenges for therapeutic radiographers who are required to regularly reassess and satisfy the varying needs and preferences. More research is needed within the area of information needs and preferences for cancer patients receiving radiotherapy.
The management of breast cancer patients from diagnosis to treatment and beyond can be variable depending on factors including tumour extent and location, histology, genetics, health and wellbeing of the patient as well as personal patient preferences. The therapeutic radiographer’s role is not only vital to ensure safe and accurate radiotherapy delivery but also crucially, as the regular patient interface, they must be fully empowered to engage effectively with all aspects of the patient care pathway. They must be knowledgeable and up to date with evidence-based practices relating to the patient experience including surgery, chemotherapy, endocrine therapy and radiotherapy.
The aim of this paper is to outline the breast cancer management pathway, highlighting the potential side effects that occur as a result of breast radiotherapy treatment and concomitant treatment in order to inform therapeutic radiographers and best practice.
The treatment pathway for breast cancer patients varies greatly depending on a wide range of factors and is very much individualised for each patient. Each treatment modality has its advantages and disadvantages, and all come with a number of side effects that can affect a patient’s daily living. Toxicities can arise during radiotherapy treatment or months after treatment, and education regarding the management of these is essential for effective patient care. Many technological advances in radiotherapy treatment techniques and regimes have the potential to decrease radiation-induced side effects. Despite attempts to standardise clinical guidelines on the use of topical agents and dressings, historical opinions and ideas are still evident in clinical practice. The use of grading systems in radiotherapy tends to only record patients’ physical symptoms and not their holistic wellbeing and emotional needs.
Therapeutic radiographers must ensure that they remain equipped with the skills and knowledge to correctly manage and/or signpost services effectively. This overall outline of the management of patients with breast cancer is designed to help therapeutic radiographers reflect on the current practices and to inspire them, where evidence dictates, to seize opportunities, to explore improvement and to enhance best practice.
Breast cancer patients referred for external beam radiotherapy and who have large and/or pendulous breasts can present positioning and immobilisation challenges. Deep infra-mammary and/or lateral wrap skin folds can occur that can lead to unwanted radiation-induced skin toxicity. The purpose of the study was to evaluate the immobilisation techniques adopted for this subgroup of patients in order to inform best practice.
A survey aimed to identify the current clinical practice in radiotherapy centres throughout the United Kingdom and Ireland was undertaken. The email survey was distributed with support of the Radiotherapy Services Managers group.
Twenty-six of the 74 radiotherapy centres responded to the survey. Responses demonstrated that supine positioning with or without additional immobilisation was preferable. Of the eight different immobilisation techniques identified, patients positioned supine on a breast board wearing a bra was the most common. Only two of the centres reported using a prone technique.
Immobilisation and reproducibility are key for successful external beam radiotherapy particularly when advanced treatment techniques are being employed. No single technique gained widespread acceptance as the optimum for the effective immobilisation of patients with large and/or pendulous breasts. Further evaluative research in the form of a multi-centre trial is warranted in order to clearly establish the most effective immobilisation methods/devices for this ever expanding, subgroup of cancer patients.
To evaluate the use of exercise in managing fatigue in breast cancer patients undergoing adjuvant radiotherapy. To explore the effectiveness of different exercise practices and explore how optimum management of fatigue might be achieved.
A CINAHL (Cumulative Index to Nursing and Allied Health Literature) database search of literature was undertaken and publications screened for retrieval with 24 qualifying for inclusion in the review.
There is evidence to support various forms of exercise including aerobic, resistance, alternative and combination exercise in the management of fatigue in early stage breast cancer patients undergoing adjuvant radiotherapy. The benefits of exercise for patients with later stage and metastatic disease is less clear and there is a lack of published research related to this category of patient.
Exercise is considered a safe, non-pharmacological intervention for early stage breast cancer patients receiving adjuvant radiotherapy. Further investigation is required into optimum exercise interventions and the effectiveness and viability of supervised and unsupervised models. Patient centred tailored advice and guidance needs to be developed and effectively promoted by therapeutic radiographers in order for patients to fully realise the benefit.
Radiotherapy clinical trials are at the forefront of modern-day prostate cancer patient management. Patients are reviewed during treatment by clinical oncologists or competent on-treatment review radiographers to minimise treatment toxicities. Clinical Research Radiographers (CRRs) routinely monitor and gather research data from patients participating in clinical trials.
The aim of this article is to evaluate the effectiveness of the CRR undertaking the on-treatment review of clinical trial patients.
An experienced CRR within the Northern Ireland Cancer Trials Network was supervised by a clinical oncologist to undertake the role of the on-treatment review of patients receiving radiotherapy for prostate cancer. The CRR explored published literature and compiled this written evaluation as part of their advanced practice learning.
The supervising clinical oncologist verified, following the planned period of supervised practice and academic study, that the CRR was competent to fulfil the role. Evidence of the beneficial synergistic impact of co-joining the roles was experienced at first hand during the undertaking of supervised practice.
Co-joining the roles and responsibilities of the CRR and the on-treatment review radiographer enhanced the quality of care offered to the patients participating in clinical trials.
New drugs against Trypanosoma brucei, the causative agent of Human African Trypanosomiasis, are urgently needed to replace the highly toxic and largely ineffective therapies currently used. The trypanosome alternative oxidase (TAO) is an essential and unique mitochondrial protein in these parasites and is absent from mammalian mitochondria, making it an attractive drug target. The structure and function of the protein are now well characterized, with several inhibitors reported in the literature, which show potential as clinical drug candidates. In this review, we provide an update on the functional activity and structural aspects of TAO. We then discuss TAO inhibitors reported to date, problems encountered with in vivo testing of these compounds, and discuss the future of TAO as a therapeutic target.
Unions and employers have historically been able to resolve labor disputes through a negotiated grievance and arbitration process. Until a 2009 decision of the Supreme Court, it was not clear if this process could be used for statutory employment claims of individual employees represented by unions. That decision suggested an affirmative answer to the question but raised issues of fairness to represented employees when unions declined to go to arbitration. Terry Meginniss and Paul Salvatore report on the “Protocol” they have negotiated and on their clients’ behalf administer in the commercial building industry of New York City for precisely such cases.
In 2009, the U.S. Supreme Court in 14 Penn Plaza LLC v. Pyett decided that a provision in a collective bargaining agreement (CBA) entered into between an employer and a union that waives the right of covered employees to pursue statutory claims of discrimination in a judicial forum is enforceable, provided that the waiver is both specific and clear and provided that the bargaining agreement creates a sufficient alternative forum for the pursuit of those claims. The Court's holding has been cheered by some and denigrated by others. Those who have welcomed the decision emphasize that (1) the decision authorizes the use of arbitration, a cost-effective and speedy forum, for employers and employees to resolve employment discrimination disputes by a neutral party; (2) the decision will have the salutary effect of easing the burden on an already crowded judicial system; and (3) the Court honored the abilities of arbitrators to hear and rule on these matters.
The Supreme Court's ruling left open a vexing question, however. In Pyett, the employees argued that the bargaining agreement's arbitration provision provided the union with the exclusive right to determine whether to bring their discrimination claim to arbitration. They asserted that, because the union had declined to bring the claim to arbitration, they had to be afforded the opportunity to pursue the claim in court; otherwise the mandatory arbitration provision would have effectively extinguished altogether their right to vindicate the protections guaranteed by the statute. The Court did not decide this issue.
Epidemiological evidence regarding the association between carbohydrate intake, glycaemic load (GL) and glycaemic index (GI) and risk of ovarian cancer has been mixed. Little is known about their impact on ovarian cancer risk in African-American women. Associations between carbohydrate quantity and quality and ovarian cancer risk were investigated among 406 cases and 609 controls using data from the African American Cancer Epidemiology Study (AACES). AACES is an ongoing population-based case–control study of ovarian cancer in African-Americans in the USA. Cases were identified through rapid case ascertainment and age- and site-matched controls were identified by random-digit dialling. Dietary information over the year preceding diagnosis or the reference date was obtained using a FFQ. Multivariable logistic regression models were used to estimate odds ratios and 95 % CI adjusted for covariates. The OR comparing the highest quartile of total carbohydrate intake and total sugar intake v. the lowest quartile were 1·57 (95 % CI 1·08, 2·28; Ptrend=0·03) and 1·61 (95 % CI 1·12, 2·30; Ptrend<0·01), respectively. A suggestion of an inverse association was found for fibre intake. Higher GL was positively associated with the risk of ovarian cancer (OR 1·18 for each 10 units/4184 kJ (1000 kcal); 95 % CI 1·04, 1·33). No associations were observed for starch or GI. Our findings suggest that high intake of total sugars and GL are associated with greater risk of ovarian cancer in African-American women.
The Bovine Respiratory Disease Coordinated Agricultural Project (BRD CAP) is a 5-year project funded by the United States Department of Agriculture (USDA), with an overriding objective to use the tools of modern genomics to identify cattle that are less susceptible to BRD. To do this, two large genome wide association studies (GWAS) were conducted using a case:control design on preweaned Holstein dairy heifers and beef feedlot cattle. A health scoring system was used to identify BRD cases and controls. Heritability estimates for BRD susceptibility ranged from 19 to 21% in dairy calves to 29.2% in beef cattle when using numerical scores as a semi-quantitative definition of BRD. A GWAS analysis conducted on the dairy calf data showed that single nucleotide polymorphism (SNP) effects explained 20% of the variation in BRD incidence and 17–20% of the variation in clinical signs. These results represent a preliminary analysis of ongoing work to identify loci associated with BRD. Future work includes validation of the chromosomal regions and SNPs that have been identified as important for BRD susceptibility, fine mapping of chromosomes to identify causal SNPs, and integration of predictive markers for BRD susceptibility into genetic tests and national cattle genetic evaluations.
As a firm prepares for initial public offering, the Securities and Exchange Commission mandates that top managers must record risks to their firms’ survival or performance in the prospectus. More specifically we propose that external risk factors (market risks, legal risks, and government regulations risks) have a more negative effect on investor optimism and initial public offering valuation, while internal risk factors (management risks, operational risks, technical risks) have a more negative effect on post-initial public offering long-term firm survival. This study illustrates a major gap between risk factors that investors initially focus on and the true determinants of long-term success.
Religious participation or belief may predict better mental health but most research is American and measures of spirituality are often conflated with well-being.
To examine associations between a spiritual or religious understanding of life and psychiatric symptoms and diagnoses.
We analysed data collected from interviews with 7403 people who participated in the third National Psychiatric Morbidity Study in England.
Of the participants 35% had a religious understanding of life, 19% were spiritual but not religious and 46% were neither religious nor spiritual. Religious people were similar to those who were neither religious nor spiritual with regard to the prevalence of mental disorders, except that the former wereless likely to have ever used drugs (odds ratio (OR)=0.73, 95% CI 0.60-0.88) or be a hazardous drinker (OR=0.81, 95% CI 0.69-0.96). Spiritual people were more likely than those who were neither religious nor spiritual to have ever used (OR = 1.24, 95% CI 1.02-1.49) or be dependent on drugs (OR = 1.77, 95% CI 1.20-2.61), and to have abnormal eating attitudes (OR = 1.46, 95% Cl 1.10-1.94), generalised anxiety disorder (OR =1.50, 95% Cl 1.09-2.06), any phobia (OR = 1.72, 95% CI 1.07-2.77) or any neurotic disorder (OR = 1.37, 95% CI 1.12-1.68). They were also more likely to be taking psychotropic medication (OR = 1.40, 95% CI 1.05-1.86).
People who have a spiritual understanding of life in the absence of a religious framework are vulnerable to mental disorder.
Transgenic volunteer corn is a competitive weed in soybean that decreases soybean yield at densities as low as 0.5 plants m−2, yet the competitive effects of volunteer corn in corn have yet to be quantified in the peer-reviewed literature. In order to quantify competition between volunteer corn and hybrid corn, seed was harvested from transgenic hybrid corn. The seed was then hand-planted at two locations (Lafayette, IN and Wanatah, IN) into 3 by 9 m plots of hybrid corn at five densities: 0 (control), 0.5, 2, 4, and 8 plants m−2. Volunteer corn competition reduced leaf area and biomass of hybrid corn plants. Hybrid corn grain yield at Lafayette, IN, was reduced by 23 and 22% due to competition with volunteer corn growing in densities of 8 plants m−2 in 2010 and 2011, respectively, but when volunteer corn grain yield was combined with the hybrid corn grain yield, there was no reduction in total grain yield. This study demonstrates that the competitive effects on the grain yield of the hybrid corn will be offset by the grain yield of the volunteer plants. However, because the unpredictable locations and densities of volunteer corn plants present challenges to machine harvesting, future studies should examine what proportion of the volunteer crop is actually harvestable.
Systems linking people and nature, known as social-ecological systems, are increasingly understood as complex adaptive systems. Essential features of these complex adaptive systems – such as nonlinear feedbacks, strategic interactions, individual and spatial heterogeneity, and varying time scales – pose substantial challenges for modeling. However, ignoring these characteristics can distort our picture of how these systems work, causing policies to be less effective or even counterproductive. In this paper we present recent developments in modeling social-ecological systems, illustrate some of these challenges with examples related to coral reefs and grasslands, and identify the implications for economic and policy analysis.
Volunteer corn (VC) in hybrid corn has become more prevalent in recent years and can reduce grain yield. Nitrogen (N) management can influence VC interference in corn. Field experiments were established to determine the effects of N fertilizer management and VC interference on hybrid corn growth and grain yield. Treatments consisted of three VC densities (control, 0 plants m−2; low density, 1 plant m−2; high density, 4 plants m−2) and six N fertilizer treatments (0 kg N ha−1, 67 kg N ha−1 at planting, 67 kg N ha−1 at planting + 133 kg N ha−1 at V5 corn growth stage, 67 kg N ha−1 at planting + 133 kg N ha−1 at V10 corn growth stage, 200 kg N ha−1 at V5 corn growth stage, and 200 kg N ha−1 at V10 corn growth stage). The effect of VC on hybrid corn was dependent on N rate. When 200 kg N ha−1 was applied, regardless of application timing, hybrid corn dry weight, hybrid corn N content, and hybrid corn grain yield were reduced by the high VC density. However, when VC grain yield was added to hybrid corn grain yield, VC density did not affect total grain yield. When 0 and 67 kg N ha−1 were applied, neither hybrid corn dry weight nor hybrid corn N content was affected by either VC density, but the high VC density reduced hybrid corn grain yield for both N rates by 19% and total grain yield by 9 and 10%, respectively. Application timing of N fertilizer had no effect on hybrid corn dry weight, N content, or grain yield. However, late N fertilizer applications (200 kg N ha−1 at V10 and 67 kg N ha−1 at planting +133 kg N ha−1 at V10) resulted in greater VC N content, VC grain yield, and total yield. Assuming the harvestability of VC, the ability of a late N treatment (V10) to maximize total grain yield allows growers to use a late N application to reduce the competitive effects of VC in hybrid corn.