Spiritual dimension of children and adolescents with cancer: an integrative review

OBJECTIVE: To review scientific literature relating to the spiritual dimension of children and adolescents with cancer. METHODS: We conducted an integrative literature review in the LILACS, SciELO, PsycINFO and MEDLINE databases in the period between 1990 to 2011. RESULTS: Twenty-one studies were analyzed and grouped into thematic categories: quality of life and elements of spirituality; alternative and complementary therapies: spirituality as a therapeutic resource; spirituality as a coping strategy and spirituality as an attribute of existential transformations. It was found that spirituality is present at different stages of the disease experience and that its forms of expression may vary, according to age and cognitive development. CONCLUSION: There is a scarcity of specific scales for this age range and a need for scientific production relating to the spiritual dimension of children and adolescents with cancer. Descriptors: Neoplasms; Children; Adolescents; Spirituality

Prevention of skin reactions due to teletherapy in women with breast cancer: a comprehensive review

One of the possible courses of cancer treatment is teletherapy, and one of the most important adverse side effects are skin reactions, an ailment more commonly called radiodermatitis. The main purpose of this study is to analyze knowledge of the evidence about topical products used in the prevention of radiodermatitis, to support care delivery to women with breast cancer during teletherapy. The research method used here is the comprehensive literature review. Four databases were used to select the bibliography. The sample consists of 15 articles. The data shows that, among the topical products analyzed here, Calendula, corticosteroids and Xclair have shown significant protective effects, underlining their actions. The lack of articles published in Brazil highlights the need for further research in this area, seeking better care quality through the use of products with scientifically proven efficiency.

Social Housing e Periferie Urbane: Riqualificazione e tecniche Comunicative

Il campo d’interesse della ricerca è stato l’attuale processo di ricentralizzazione del Social Housing nelle periferie urbane in una parte del contesto internazionale, che sembra stia portando le città a ricrearsi e ripensarsi grazie alla presa di coscienza delle differenze esistenti, rispetto al passato, nei nuovi processi di trasformazione nei quali la città è intesa sia come spazio costruito ma anche sociale. In virtù di quest’ultimi due aspetti complementari della città, oggi, il ruolo della periferia contemporanea sembra essere diversamente interpretato, così come gli interventi di riqualificazione di tipo assistenziale - migliorativo tenderebbero a trasformarne i suoi caratteri alla ricerca del “modello di città”. L’interesse alla tematica è inoltre scaturito dalla constatazione che alla base della crisi dei modelli d’intervento pubblico starebbero sia l’insostenibilità economica ma soprattutto l’errata lettura dei bisogni delle famiglie nella loro specificità e diversità e che in tal senso l’eventuale partecipazione della cittadinanza costituirebbe effettivamente una proposta valida, anche per risolvere la crescente domanda abitativa che si pone a livello mondiale. L’obiettivo della ricerca è stato quello d’analizzare, nel contesto internazionale del Social Housing, le caratteristiche di partecipazione e sussidiarietà che connotano particolarmente gli interventi di riqualificazione destinati a famiglie economicamente carenti, nello specifico analizzando i metodi e gli strumenti atti alla comunicazione partecipativa del progetto in aree urbane periferiche italiane e brasiliane. Nella prima e seconda fase della ricerca è stato svolto, rispettivamente, un lavoro di analisi bibliografica sul tema dell’emergenza casa e sulle nuove politiche abitative di sviluppo urbano ed uno specifico sulla tematica della riqualificazione partecipata del Social Housing in aree della periferia urbana, infine nella terza fase sono stati analizzati i casi di studio prescelti dando rilievo all’analisi delle caratteristiche e requisiti prestazionali delle tecniche partecipative di rappresentazione - comunicazione, più idonee ad influenzare positivamente il suddetto processo.

Ravenna e i piu' significativi centri dell'Impero. Il mosaico parietale tra V e VI secolo: Revisione critica

Tra il V ed il VI secolo, la città di Ravenna, per tre volte capitale, emerge fra i più significativi centri dell’impero, fungendo da cerniera tra Oriente e Occidente, soprattutto grazie ai mosaici parietali degli edifici di culto, perfettamente inseriti in una koinè culturale e artistica che ha come comune denominatore il Mar Mediterraneo, nel contesto di parallele vicende storiche e politiche. Rispetto ai ben noti e splendidi mosaici ravennati, che insieme costituiscono senza dubbio un unicum nel panorama artistico dell’età tardoantica e altomedievale, nelle decorazioni musive parietali dei coevi edifici di culto dei diversi centri dell’impero d’Occidente e d’Oriente, e in particolare in quelli localizzati nelle aree costiere, si possono cogliere divergenze, ma anche simmetrie dal punto di vista iconografico, iconologico e stilistico. Sulla base della letteratura scientifica e attraverso un poliedrico esame delle superfici musive parietali, basato su una metodologia interdisciplinare, si è cercato di chiarire l’articolato quadro di relazioni culturali, ideologiche ed artistiche che hanno interessato e interessano tuttora Ravenna e i vari centri della tarda antichità, insistendo sulla pluralità, sulla complessità e sulla confluenza di diverse esperienze artistiche sui mosaici di Ravenna. A tale scopo, i dati archeologici e artistici sono stati integrati con quelli storici, agiografici ed epigrafici, con opportuni collegamenti all’architettura, alla scultura, alle arti decorative e alle miniature, a testimonianza dell’unità di intenti di differenti media artistici, orientati, pur nella diversità, verso le medesime finalità dogmatiche, politiche e celebrative. Si tratta dunque di uno studio di revisione e di sintesi sui mosaici parietali mediterranei di V e VI secolo, allo scopo di aggiungere un nuovo tassello alla già pur vasta letteratura dedicata all’argomento.

Chickenpox is not always benign: postvaricella purpura fulminans requires prompt and aggressive treatment

We present 2 patients, who were admitted owing to rapidly progressing purpuric lesions due to postvaricella purpura fulminans, a coagulopathy leading to life- or limb-threatening thrombosis caused by a severe transient autoimmune protein S deficiency. Laboratory results were being consistent with disseminated intravascular coagulation secondary to protein S deficiency; treatment with fresh frozen plasma, intravenous immunoglobulins, and prednisone was started. In our experience, a prompt therapy may limit the course and the extent of the disease. We present a review of the topic with supporting literature for the therapeutic options. Therefore, we should be reminded that purpura fulminans is a rare but severe complication of chickenpox, which demands quick action.

A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery

A systematic literature review was conducted to assess the effectiveness of, compliance with, and critical factors for the implementation of safety checklists in surgery.

A nurse is a nurse? A systematic review of the effectiveness of specialised nursing in breast cancer

The effectiveness of specialised nursing in breast cancer has received limited attention. This systematic literature review aims at (i) presenting and discussing role models of specialised nursing in the area of breast cancer and (ii) suggesting avenues for future research in this field. The ten studies included in the review differ with respect to the roles of specialised nurses as well as the measured outcome variables; thus, the comparability and generalisability of results are limited. Nevertheless, the review indicates that specialised nursing in breast cancer may contribute to improved physical and psycho-social well-being. In view of the limited comparability, the authors call for (i) a more uniform definition of models of specialised nursing in breast cancer care, as well as (ii) rigorous confirmatory studies to evaluate their effectiveness. These two aspects are pivotal in providing a reliable basis for future health care strategies.

Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies

STUDY DESIGN: Systematic literature review. OBJECTIVE: To evaluate the safety and efficacy of vertebroplasty and kyphoplasty using the data presented in published clinical studies, with respect to patient pain relief, restoration of mobility and vertebral body height, complication rate, and incidence of new adjacent vertebral fractures. SUMMARY OF BACKGROUND DATA: Vertebroplasty and kyphoplasty have been gaining popularity for treating vertebral fractures. Current reviews provide an overview of the procedures but are not comprehensive and tend to rely heavily on personal experience. This article aimed to compile all available data and evaluate the clinical outcome of the 2 procedures. METHODS: This is a systematic review of all the available data presented in peer-reviewed published clinical trials. The methodological quality of included studies was evaluated, and data were collected targeting specific standard measurements. Where possible, a quantitative aggregation of the data was performed. RESULTS: A large proportion of subjects had some pain relief, including 87% with vertebroplasty and 92% with kyphoplasty. Vertebral height restoration was possible using kyphoplasty (average 6.6 degrees ) and for a subset of patients using vertebroplasty (average 6.6 degrees ). Cement leaks occurred for 41% and 9% of treated vertebrae for vertebroplasty and kyphoplasty, respectively. New fractures of adjacent vertebrae occurred for both procedures at rates that are higher than the general osteoporotic population but approximately equivalent to the general osteoporotic population that had a previous vertebral fracture. CONCLUSIONS: The problem with stating definitely that vertebroplasty and kyphoplasty are safe and effective procedures is the lack of comparative, blinded, randomized clinical trials. Standardized evaluative methods should be adopted.

[Impact of tobacco use on the periodontium--an update (I)--Part 1: Epidemiologic und pathogenetic aspects of tobacco-related periodontal diseases]

This literature review represents the second in a series of articles from the Swiss task force "Smoking--Intervention in the private dental office" on the topic "tobacco use and dental medicine". In this article, the epidemiological background as well as some pathogenetic processes are described and discussed critically for tobacco-related periodontal diseases. Earlier publications confirmed tobacco consumption as a risk factor for periodontal diseases. Over the last few years, oral health research has significantly contributed to the understanding of the mechanisms leading to the deterioration of the hard and soft tissues supporting the teeth. With the recording of the number of cigarettes smoked per day and the amount of years tobacco was used, a dose response relationship was established. Various, potentially significant pathogenic effects of tobacco-related substances may exist on the periodontal tissues, the immune response system or the composition of the oral flora. Moreover, there is reference that tobacco consumption may change the genetically determined susceptibility for periodontal diseases.

Alveolar distraction osteogenesis: a systematic review

This literature review was performed to analyse the outcomes of clinical studies of alveolar distraction osteogenesis (DO) listed by PUBMED between January 1996 and December 2006. A PUBMED search identified 128 articles on alveolar DO. Twenty articles covering 209 cases were analysed, considering location, device and procedural parameters, rate of augmentation, aspect of final implant placement and follow up. The mean latency period was 7.26+/-2.31 days, distraction rate 0.71+/-0.27 mm/day, rate of augmentation 6.88+/-2.52 mm and consolidation period 12.22+/-5.58 weeks. A total of 469 implants were placed and followed post loading for an average of 14.19+/-11.03 months, with a survival rate of 97%. Of the different procedural parameters, only the difference between mean consolidation period for failed (8.10+/-2.51 weeks) and successful (12.43+/-5.62 weeks) implants was statistically significant (P=0.01). Use of DO may be advantageous in terms of the success rate of implants placed in augmented sites, but there is still a lack of sufficient data based on long-term follow up. Future experimental studies should evaluate the application of different methods with a view to shortening the overall treatment period and improving the performance of implants placed in distracted alveolar ridges.

Influence of Mechanical and Thermal Boundary Conditions on Stabilizing/Destabilizing Mechanisms in Evaporating Liquid Films

Liquid films, evaporating or non-evaporating, are ubiquitous in nature and technology. The dynamics of evaporating liquid films is a study applicable in several industries such as water recovery, heat exchangers, crystal growth, drug design etc. The theory describing the dynamics of liquid films crosses several fields such as engineering, mathematics, material science, biophysics and volcanology to name a few. Interfacial instabilities typically manifest by the undulation of an interface from a presumed flat state or by the onset of a secondary flow state from a primary quiescent state or both. To study the instabilities affecting liquid films, an evaporating/non-evaporating Newtonian liquid film is subject to a perturbation. Numerical analysis is conducted on configurations of such liquid films being heated on solid surfaces in order to examine the various stabilizing and destabilizing mechanisms that can cause the formation of different convective structures. These convective structures have implications towards heat transfer that occurs via this process. Certain aspects of this research topic have not received attention, as will be obvious from the literature review. Static, horizontal liquid films on solid surfaces are examined for their resistance to long wave type instabilities via linear stability analysis, method of normal modes and finite difference methods. The spatiotemporal evolution equation, available in literature, describing the time evolution of a liquid film heated on a solid surface, is utilized to analyze various stabilizing/destabilizing mechanisms affecting evaporating and non-evaporating liquid films. The impact of these mechanisms on the film stability and structure for both buoyant and non-buoyant films will be examined by the variation of mechanical and thermal boundary conditions. Films evaporating in zero gravity are studied using the evolution equation. It is found that films that are stable to long wave type instabilities in terrestrial gravity are prone to destabilization via long wave instabilities in zero gravity.

Systematic review of atraumatic splenic rupture

BACKGROUND: Atraumatic splenic rupture (ASR) is an ill defined clinicopathological entity. METHODS: The aim was to characterize aetiological and risk factors for ASR-related mortality in order to aid disease classification and treatment. A systematic literature review (1980-2008) was undertaken and logistic regression analysis employed. RESULTS: Some 632 publications reporting 845 patients were identified. The spleen was normal in 7.0 per cent (atraumatic-idiopathic rupture). One, two or three aetiological factors were found in 84.1, 8.2 and 0.7 per cent respectively (atraumatic-pathological rupture). Six major aetiological groups were defined: neoplastic (30.3 per cent), infectious (27.3 per cent), inflammatory, non-infectious (20.0 per cent), drug- and treatment-related (9.2 per cent) and mechanical (6.8 per cent) disorders, and normal spleen (6.4 per cent). Treatment comprised total splenectomy (84.1 per cent), organ-preserving surgery (1.2 per cent) or conservative measures (14.7 per cent). The ASR-related mortality rate was 12.2 per cent. Splenomegaly (P = 0.040), age above 40 years (P = 0.007) and neoplastic disorders (P = 0.008) were associated with increased ASR-related mortality on multivariable analysis. CONCLUSION: The condition can be classified simply into atraumatic-idiopathic (7.0 per cent) and atraumatic-pathological (93.0 per cent) splenic rupture. Splenomegaly, advanced age and neoplastic disorders are associated with increased ASR-related mortality.

Differences in primary sites of infection between zoonotic and human tuberculosis: results from a worldwide systematic review.

Tuberculosis (TB) is one of the most devastating infectious diseases worldwide. Whilst global burden estimates for M. tuberculosis infection (MtTB) are well established, accurate data on the contribution of zoonotic TB (zTB) caused by M. bovis or M. caprae to human TB are scarce. The association of M. bovis infection with extrapulmonary tuberculosis has been suggested repeatedly, though there is little scientific evidence available to support this relationship. The present study aimed to determine globally the occurrence of extrapulmonary TB and the primary site (i.e. primary body location affected) of zTB in comparison with MtTB, based on previously published reports. A systematic literature review was conducted in 32 different bibliographic databases, selecting reports on zTB written in English, French, German, Spanish or Portuguese. Data from 27 reports from Africa, America, Europe and the Western Pacific Region were extracted for analyses. Low income countries, in Africa and South-East Asia, were highly underrepresented in the dataset. The median proportion of extrapulmonary TB cases was significantly increased among zTB in comparison with data from registries of Europe and USA, reporting mainly MtTB cases (47% versus 22% in Europe, 73% versus 30% in the USA). These findings were confirmed by analyses of eight studies reporting on the proportions of extrapulmonary TB in comparable populations of zTB and MtTB cases (median 63% versus 22%). Also, disparities of primary sites of extrapulmonary TB between zTB and MtTB were detected. Our findings, based on global data, confirm the widely suggested association between zTB and extrapulmonary disease. Different disability weights for zTB and MtTB should be considered and we recommend separate burden estimates for the two diseases.

Illusory predictors: Generalizability of findings in cocaine treatment retention research.

Treatment retention is of paramount importance in cocaine treatment research as treatment completion rates are often 50% or less. Failure to retain cocaine patients in treatment has both significant research and clinical implications. In this paper we qualitatively and quantitatively demonstrate the inconsistency found across analyses of retention predictors in order to highlight the problem. First, a qualitative review of the published literature was undertaken to identify the frequency of predictors studied and their relations to treatment retention. Second, an empirical demonstration of predictor stability was conducted by testing a common set of variables across three similar 12-week cocaine clinical trials conducted by the same investigators in the same research clinic within a five-year period. Results of the literature review indicated inconsistently selected variables of convenience, widely varying statistical procedures, and discrepant findings of significance. Further, quantitative analyses resulted in discrepancies in variables identified as significant predictors of retention among the three studies. Potential sources of heterogeneity affecting the consistency of findings across studies and recommendations to improve the validity and generalizability of predictor findings in future studies are proposed.

Driving ability, mental illness and psychotropic medication in the elderly

Fitness to drive in elderly drivers is most commonly discussed with a focus on cognitive impairment. Therefore, this article is focussing on mental illness and the use of psychotropic drugs in elderly drivers, which can both interfere with fitness to drive. Based on a detailed literature review and on clinical judgement, we propose signposts and "red flags" to judge the individual risks. Health professionals dealing with elderly patients should in particular be aware of the dangers related to cumulative risks and need to inform the patients appropriately. For medico-legal reasons the information provided to patients must be written down in the medical record. Individual counselling is important as fitness to drive is a complex topic.