Many nineteenth-century theorists viewed triadic distance in terms of common tones and voice-leading proximity, rather than root consonance and mutual diatonic constituency. Audacious Euphony ...reconstructs this view and uses it as the basis for a chromatic model of triadic space, developing geometric representations from blueprints of Euler (1739) and Weitzmann (1853). The model renders coherent many passages of romantic music (e.g. of Schubert, Liszt, Brahms, Chopin, Wagner) that are disjunct from the standpoint of classical tonality. Semantic attributes commonly ascribed to romantic music are theorized as the result of incompatibilities between classical and romantic conceptions of triadic distance. The model generalizes to apply to relations among Tristan-genus seventh chords, due to their structural homologies with triads. At the heart of the approach is the observation that major and minor triads are minimal perturbations of perfectly even augmented triads, and that
this property underlies their status as voice-leading optimizers. Consonant triads are thus overdetermined, as they are also independently the acoustic optimizers of classical theory. Both consonant triads and Tristan-genus seventh chords are homophonous diamorphs, whose syntactic behaviors and semantic qualities require two distinct theories, as well as a third one that reconciles them in a cognitively plausible way. Among the compositions treated analytically in Audacious Euphony are Schubert “Der Doppelgänger” and “Auf dem Fluße”, his sonatas D. 959 and 960, Chopin’s e-minor prelude, fantasy, and g-minor ballade, Schumann’s Dichterliebe, Liszt’s Consolation #3 and organ Kyrie, Rimsky-Korsakov’s Antar, Fauré’s Requiem, Brahms’s 1st and 2nd Symphonies, Wagner’s Parsifal, Bruckner’s 3rd Symphony,
Dvorak’s New World Symphony, and Strauss’s “Frühling.”
Background
The Institute of Medicine recommends that survivorship care plans (SCPs) be included in cancer survivorship care. Our meta‐analysis compares patient‐reported outcomes between SCP and no ...SCP (control) conditions for cancer survivors. Our systematic review examines the feasibility of implementing SCPs from survivors' and health care professionals' perspectives and the impact of SCPs on health care professionals’ knowledge and survivorship care provision.
Methods
We searched seven online databases (inception to April 22, 2018) for articles assessing SCP feasibility and health care professional outcomes. Randomized controlled trials comparing patient‐reported outcomes for SCP recipients versus controls were eligible for the meta‐analysis. We performed random‐effects meta‐analyses using pooled standardized mean differences for each patient‐reported outcome.
Results
Eight articles were eligible for the meta‐analysis (n = 1,286 survivors) and 50 for the systematic review (n = 18,949 survivors; n = 3,739 health care professionals). There were no significant differences between SCP recipients and controls at 6 months postintervention on self‐reported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or self‐efficacy or at 12 months on anxiety, cancer‐specific distress, depression, or satisfaction with follow‐up care. SCPs appear to be acceptable and potentially improve survivors’ adherence to medical recommendations and health care professionals’ knowledge of survivorship care and late effects.
Conclusion
SCPs appear feasible but do not improve survivors’ patient‐reported outcomes. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues, or inappropriate research design of comparative effectiveness studies.
Implications for Practice
Several organizations recommend that cancer survivors receive a survivorship care plan (SCP) after their cancer treatment; however, the impact of SCPs on cancer survivors and health care professionals is unclear. This systematic review suggests that although SCPs appear to be feasible and may improve health care professionals’ knowledge of late effects and survivorship care, there is no evidence that SCPs affect cancer survivors’ patient‐reported outcomes. In order to justify the ongoing implementation of SCPs, additional research should evaluate SCP implementation and the research design of comparative effectiveness studies. Discussion may also be needed regarding the possibility that SCPs are fundamentally ineffective.
This comprehensive systematic review evaluates the effect of survivorship care plans on cancer survivors and health care professionals.
Background The national prevalence and patterns of food allergy (FA) in the United States are not well understood. Objective We developed nationally representative estimates of the prevalence of and ...demographic risk factors for FA and investigated associations of FA with asthma, hay fever, and eczema. Methods A total of 8203 participants in the National Health and Nutrition Examination Survey 2005-2006 had food-specific serum IgE measured to peanut, cow's milk, egg white, and shrimp. Food-specific IgE and age-based criteria were used to define likely FA (LFA), possible FA, and unlikely FA and to develop estimates of clinical FA. Self-reported data were used to evaluate demographic risk factors and associations with asthma and related conditions. Results In the United States, the estimated prevalence of clinical FA was 2.5% (peanut, 1.3%; milk, 0.4%; egg, 0.2%; shrimp, 1.0%; not mutually exclusive). Risk of possible FA/LFA was increased in non-Hispanic blacks (odds ratio, 3.06; 95% CI, 2.14-4.36), males (1.87; 1.32-2.66), and children (2.04; 1.42-2.93). Study participants with doctor-diagnosed asthma (vs no asthma) exhibited increased risk of all measures of food sensitization. Moreover, in those with LFA, the adjusted odds ratio for current asthma (3.8; 1.5-10.7) and an emergency department visit for asthma in the past year (6.9; 2.4-19.7) were both notably increased. Conclusion Population-based serologic data on 4 foods indicate an estimated 2.5% of the US population has FA, and increased risk was found for black subjects, male subjects, and children. In addition, FA could be an under-recognized risk factor for problematic asthma.
Cancer patients can experience a number of reproductive complications as a result of cancer treatment and may benefit from reproductive preventative health strategies. A Reproductive Survivorship ...Patient Reported Outcome Measure (RS-PROM) is not currently available but could assist patients address reproductive concerns.
To develop and test the acceptability, feasibility and appropriateness of a RS-PROM tool to be used to assess reproductive needs of cancer survivors aged 18-45 years.
We reviewed the outcomes of a recently published audit of reproductive care provided in our cancer survivorship clinic to identify gaps in current service provided and used this along with available validated reproductive measures, to develop this pilot RS-PROM. Survivors aged 18-45 years either attending the SCH survivorship clinic over a 1-year period or participants on the Australasian Oncofertility Registry (AOFR) who had agreed to be contacted for future research studies were asked to complete the RS-PROM and a questionnaire on the acceptability, feasibility and appropriateness of content included.
One-hundred and fifty patients participated (61.3% females). Median age at cancer diagnosis was 24.5 years (range: 2-45 years). Eighty percent of participants reported the length of the RS-PROM was "just right", 92% agreed they would not mind completing the RS-PROM and 92.7% were willing to answer all questions, with 97% agreeing that the RS-PROM would be an important tool in addressing difficult sexual/reproductive topics concerning with healthcare professionals.
The large majority of survivors participating in our pilot study found the RS-PROM to be an acceptable, feasible and useful tool to assist discussions of their sexual and reproductive health concerns and experiences with their clinical team.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Worldwide advances in treatment and supportive care for children and adolescents with cancer have resulted in a increasing population of survivors growing into adulthood. Yet, this population is at ...very high risk of late occurring health problems, including significant morbidity and early mortality. Unique barriers to high-quality care for this group include knowledge gaps among both providers and survivors as well as fragmented health-care delivery during the transition from paediatric to adult care settings. Survivors of childhood and adolescent cancer are at risk for a range of late-occuring side-effects from treatment, including cardiac, endocrine, pulmonary, fertility, renal, psychological, cognitive, and socio-developmental impairments. Care coordination and transition to adult care are substantial challenges, but can be empowering for survivors and improve outcomes, and could be facilitated by clear, effective communication and support for self-management. Resources for adult clinical care teams and primary care providers include late-effects surveillance guidelines and web-based support services.
Summary Quality-of-life and psychosocial oncology studies that have low participation might have less precision, less statistical power, and can have non-response bias. In this systematic Review, we ...searched MEDLINE, Embase, and PsycInfo, for paediatric studies published in 2010–15 and adults studies published 2014–15. Studies were eligible if they were original studies published in a peer-reviewed journal; recruited children (aged 0–18 years at diagnosis) with cancer or their parents, or adult patients with cancer; and assessed psychosocial outcomes, including quality of life, depression, anxiety, wellbeing, distress, coping, or adjustment as a primary or secondary outcome. We assessed participation reporting quality, calculated percentages of participation achieved, and measured the influence of study design and participant characteristics. We reviewed 311 studies including a total of 87 240 adults, children, and parents. Mean participation across studies was more than 70% (paediatric participation was 72% and adult participation was 74%). Many studies did not report data essential for the assessment of participation, especially for non-respondents. Studies using a longitudinal cohort design had higher participation than randomised trials. In paediatric studies, recruitment of participants at diagnosis, face to face, and with the use of short questionnaires yielded higher participation. Other study design characteristics (method of data collection, who enrolled the participants, and incentives) and patient characteristics (cancer type, patient or parent age, and sex) did not affect participation in either paediatric or adult studies. Researchers can use these data to improve reporting quality and make evidence-based choices to maximise participation in future studies.
Effective communication is challenging in childhood cancer, where decisions carry unpredictable and life‐threatening implications. We aimed to describe patients' experiences of communicating with ...clinicians during treatment of childhood cancer. A systematic review of qualitative studies to April 2019 was performed. Eligible studies included patients diagnosed with cancer at age ≤ 18 years and reported their perspectives of communicating with clinicians during treatment of childhood cancer. Data were extracted from primary studies for thematic synthesis. From 101 articles across 25 countries involving 1870 participants who were diagnosed with cancer between ages 3 to 18 years, we identified 6 themes: 1) rendered invisible and powerless (displaced and undermined by adult authority; betrayed and distrustful; feeling neglected; helpless and intimidated; disempowered by lack of information); 2) fear and worry for the future (paralyzed by devastating news; uncertainty, anticipation, and dread; broaching intimate and private topics); 3) burdened with responsibility (pressured and unprepared; balancing external expectations; protecting hope); 4) therapeutic patient-provider relationships (emotional support and encouragement; validated personhood and companionship); 5) safety in trust (truthfulness and transparency; prepared by awareness and understanding; reassured by reliable expertise; depending on adults for protection and difficult decisions; security in expressing opinions and needs); and 6) empowerment and assertive agency (right to individual knowledge and choice; control over own life; partnership and respect; enhancing capacity for self‐management). During treatment of childhood cancer, patients gain a sense of respect, safety, and control when they feel clinicians address their information and developmental needs. However, communication that is perceived to be parent‐centered can be disempowering. Promoting child agency and partnership may improve care and outcomes for children with cancer.
Communication in childhood cancer is particularly challenging; however, most studies focus on familial or physician perspectives rather than those of the child patients. Through a thematic synthesis of 101 articles including 1870 participants, this qualitative review captures child and adolescent experiences, needs, and preferences for communicating with clinicians during childhood cancer to improve strategies for shared decision making.
Highlights • CIPN is common and can be long lasting. • Characteristics and natural history of neuropathy are specific to the chemotherapy agent. • Significant variation in incidence may be due to ...challenges in clinical assessment. • Risk factors for CIPN may be disease, treatment or patient related. • Standardised age-appropriate assessment protocols are essential for future research.
Genes encoding TRK are oncogenic drivers in multiple tumour types including infantile fibrosarcoma, papillary thyroid cancer and high-grade gliomas (HGG). TRK fusions have a critical role in ...tumourigenesis in 40% of infant HGG. Here we report the first case of a TRK fusion-driven HGG treated with larotrectinib-the first selective pan-TRK inhibitor in clinical development. This 3-year-old girl had failed multiple therapies including chemotherapy and radiotherapy. Tumour profiling confirmed an ETV6-NTRK3 fusion. Treatment with larotrectinib led to rapid clinical improvement with near total resolution of primary and metastatic lesions on MRI imaging. This is the first report of a TRK fusion glioma successfully treated with a TRK inhibitor.
Childhood cancer survivor (CCS) numbers are increasing as a result of advances in both treatment and supportive care. This positive outcome is tempered by the recognition of a high burden of chronic ...health conditions. Here, we review the nutritional concerns of CCS, including dietary habits after treatment and the factors during treatment that may contribute to chronic health conditions. Dietary interventions that have been conducted in CCS will be summarized along with focused goals of these interventions. We will also address the need to leverage these interventions to reduce the risk of chronic disease in CCS.
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