Use Of Medical Intervention Research Articles

Phantosmia during proton radiation and differences in frequency of phantosmia rates based on proton craniospinal irradiation technique for pediatric brain tumor patients.

Unusual olfactory perception, often referred to as "phantosmia" or "cacosmia" has been reported during brain radiotherapy (RT), but is infrequent and does not typically interfere with the ability to deliver treatment. We seek to determine the rate of phantosmia for patients treated with proton craniospinal irradiation (CSI) and identify any potential clinical or treatment-related associations. We performed a retrospective review of 127 pediatric patients treated with CSI, followed by a boost to the brain for primary brain tumors in a single institution between 2016 and 2021. Proton CSI was delivered with passive scattering (PS) proton technique (n=53) or pencil beam scanning technique (PBS) (n=74). Within the PBS group, treatment delivery to the CSI utilized a single posterior (PA) field (n=24) or two posterior oblique fields (n=50). We collected data on phantom smell, nausea/vomiting, and the use of medical intervention. Our cohort included 80 males and 47 females. The median age of patients was 10years (range: 3-21). Seventy-one patients (56%) received concurrent chemotherapy. During RT, 104 patients (82%) developed worsening nausea, while 63 patients (50%) reported episodes of emesis. Of those patients who were awake during CSI (n=59), 17 (29%) reported phantosmia. In the non-sedated group, we found a higher rate of phantosmia in patients treated with PBS (n=16, 42%) than PS (n=1, 4.7%) (p=.002). Seventy-eight patients (61%) required medical intervention after developing nausea/vomiting or phantosmia during RT. Two patients required sedation due to the malodorous smell during CSI. We did not find any significant difference in nausea/vomiting based on treatment technique. Proton technique significantly influenced olfactory perception with greater rates of phantosmia with PBS compared to PS. Prospective studies should be performed to determine the cause of these findings and determine techniques to minimize phantosmia during radiation therapy.

The distress of one‐dimensional fertility in an African family

AbstractSeveral Euro‐American approaches to couple and family therapy have been instrumental in promoting successful practice of couple and family therapy in continental Africa. This article, however, describes one instance in which an African couple's distress of one‐dimensional fertility could not be resolved by drawing solely from the Euro‐American family therapy tradition. One‐dimensional fertility is defined as a crisis that arises in conditions of sonlessness or daughterlessness in a marriage, that is, in situations where there are only male or female children born to the marriage. The use of medical intervention through the prescription of drugs often worsens rather than enhances the psychological well‐being of couples who suffer from the distress of one‐dimensional fertility. Therefore, it is considered beneficial to encourage the development and recognition of psychological literature that suggests what to be done to control such a distress without recourse to the use of medication or the complicated and sensitive procedure of in vitro fertilisation. The article suggests that the leading intervention package for attending to the challenge of couples with the distress of one‐dimensional fertility entails the exercise of inducting them into the principles and practice of the fertility awareness‐based method of family planning known as the billings ovulation method that is in harmony with the African cultural perspective.

RONC-14. Olfactory Perception During Proton Radiation and Differences in Frequency of Olfactory Perceptions Based on Proton Craniospinal Irradiation Technique for Pediatric Brain Tumor Patients.

Abstract BACKGROUND: Unusual olfactory perception has been reported during brain radiation treatments but is infrequent and does not typically interfere with the ability to deliver treatment or cause notable distress. Methods: We performed a retrospective review of 127 pediatric patients treated with proton radiation therapy (PRT) for primary brain tumors in a single institution between 2016-2021. Patients received PRT to the brain as part of craniospinal irradiation (CSI) followed by a boost to the brain. Proton CSI was delivered with 3D-CRT protons (n=53) or pencil beam scanning technique (PBS) (n=74). Within the PBS group, treatment delivery to the CSI utilized a single PA field (n=24) or two posterior oblique fields (n=50). We collected data on abnormal olfactory sensations, nausea/vomiting, and the use of medical intervention for those symptoms. Results: Our cohort included 80 males and 47 females. The median age of patients was 10 years old (range, 3 – 21). Seventy-one patients received concurrent chemotherapy. Prior to PRT, 31 patients were nauseous. During the radiation course, 104 patients developed worsening nausea while 63 patients reported emesis. Four patients vomited while receiving radiation. Seventeen patients reported olfactory perceptions during CSI. We found a higher rate of olfactory perception in patients treated with PBS (n=16, 22%) than 3D-CRT (n=1, 2%) (p=0.001) and, within the PBS group, patients treated with a single PA field (n=11, 46%) than two oblique fields (n=5, 10%) (p=0.002). Seventy-eight patients required intervention including addition of anti-emetic or anti-anxiety medication. Two patients required sedation due to the malodorous smell during CSI. We did not find any significant difference in nausea/vomiting based on treatment technique. Conclusions: PBS and PBS technique influence olfactory perceptions but not the occurrence of the rate of nausea/vomiting. Further studies should be performed to validate these findings and determine techniques to minimize unpleasant olfactory perceptions.

RADT-34. OLFACTORY PERCEPTION DURING PROTON RADIATION AND DIFFERENCES IN FREQUENCY OF OLFACTORY PERCEPTIONS BASED ON PROTON CRANIOSPINAL IRRADIATION TECHNIQUE FOR PEDIATRIC BRAIN TUMOR PATIENTS

Abstract BACKGROUND Unusual olfactory perception has been reported during brain radiation treatments but is infrequent and does not typically interfere with the ability to deliver treatment or cause notable distress. METHODS We performed a retrospective review of 127 pediatric patients treated with proton radiation therapy (PRT) for primary brain tumors in a single institution between 2016-2021. Patients received PRT to the brain as part of craniospinal irradiation (CSI) followed by a boost to the brain. Proton CSI was delivered with 3D-CRT protons (n=53) or pencil beam scanning technique (PBS) (n=74). Within the PBS group, treatment delivery to the CSI utilized a single PA field (n=24) or two posterior oblique fields (n=50). We collected data on abnormal olfactory sensations, nausea/vomiting, and the use of medical intervention for those symptoms. RESULTS Our cohort included 80 males and 47 females. The median age of patients was 10 years old (range, 3 – 21). Seventy-one patients received concurrent chemotherapy. Prior to PRT, 31 patients were nauseous. During the radiation course, 104 patients developed worsening nausea while 63 patients reported episodes of emesis. Four patients vomited while receiving radiation. Seventeen patients reported olfactory perceptions during CSI. We found a higher rate of olfactory perception in patients treated with PBS (n=16, 22%) than 3D-CRT (n=1, 2%) (p=0.001) and, within the PBS group, patients treated with a single PA field (n=11, 46%) than two oblique fields (n=5, 10%) (p=0.002). Seventy-eight patients required intervention including addition of anti-emetic or anti-anxiety medication. Two patients required sedation due to the malodorous smell during CSI. We did not find any significant difference in nausea/vomiting based on treatment technique. CONCLUSIONS PBS and PBS technique influence olfactory perceptions but not the occurrence of the rate of nausea/vomiting. Further studies should be performed to validate these findings and determine techniques to minimize unpleasant olfactory perceptions.

Humanisation in pregnancy and childbirth: A concept analysis.

To undertake a concept analysis of humanisation in pregnancy and childbirth. Humanisation in pregnancy and childbirth has historically been associated with women who do not require medical intervention. However, the increasing recognition of the importance of emotional and mental health and the physical outcome of pregnancy has meant that there is a need to identify clinical attributes and behaviours that contribute to a positive emotional outcome. Failure to support and protect the emotional health of the woman in pregnancy and childbirth can have effects on the long-term mental health of the mother and the long-term physical and mental health of the child. Concept Analysis METHODS: Eight-step method of concept analysis proposed by Walker and Avant. Defining attributes include being a protagonist, human being interaction and benevolence. Antecedents identified were a recognition of women's rights, birth models, professional competence and the environment. Consequences were identified for women and healthcare professionals: for women, increased feelings of confidence, satisfaction of the experience and safety; and for healthcare professionals, increased satisfaction and confidence in their job and increased esteem in their profession. Humanisation of pregnancy and childbirth now encompasses all women regardless of care pathway. Humanisation does not obstruct the prioritisation of life-saving procedures or the use of medical intervention where required. Women who are able to identify their rights when accessing maternity care will be better equipped to ensure their care planning is individualised. The identification of humanised care practices, attributes and behaviours can support healthcare professionals in the clinical area who wish to identify a pathway of humanised care in pregnancy and birth.

“Trying to give birth naturally was out of the question”: Accounting for intervention in childbirth

ProblemStudies of women’s childbirth preferences repeatedly show that natural birth remains highly valued, yet the majority of births involve some form of medical intervention. Reasons for this lack of correspondence have typically been investigated through interviews and focus-groups with women. Relatively little research explores the ways in which women describe their experiences of childbirth outside of such research settings. BackgroundMost maternity services promote woman-centred care, whereby women are encouraged to take active roles in deciding how to give birth. However, recent research indicates that women often report feeling disempowered during labour and birth in hospital settings. AimWe sought to examine how women account for use of medical intervention in hospitals by examining narratives posted on online discussion forums. MethodA thematic analysis of 106 publically available birth stories, sourced using the Internet search terms ‘birth story’, and ‘birth narrative’, was undertaken. FindingsMedical interventions in childbirth were routinely described as unwanted, yet as unavoidable, and two types of account were typically drawn on to explain their use: Protection of the baby/mother; and inflexible hospital policy/practice. We examine these two types of account, focusing on how their design oriented to the discordance between mothers’ reported desires for a natural birth, and their experiences in hospital. ConclusionThe experience of medical intervention in childbirth is routinely oriented to as a matter that requires explanation or account in online birth narratives. Women repeatedly referred to their preference to avoid intervention, but described being unable to do so in hospital.

INCOMPLETE SEX-REASSIGNMENT SURGERY AND PSYCHOSOCIAL FUNCTIONING: A PRELIMINARY STUDY

Sex reassignment surgery is a process which includes a decision to change one’s biological sex through the use of medical intervention. Trans-sexualism is a condition in which a person experiences a discontinuity between their assigned sex and what they feel their core gender is. For example, a person who was identified as “female” at birth, raised as a girl, and has lived being perceived by others as a” woman”, may feel that their core sense of who they are is a closer fit with “male”. If this sense is strong and persistent, this person may decide to take steps to ensure that others perceive them as a man. The impact of gender affirming surgery on interpersonal relationships was studied and presented. The research question was: How does an individual with incomplete sex change surgery experience him/herself in relationships with males and females? The predominant finding was one of a mixed clinical picture wherein although the sex change does bring satisfaction in one area of their lives, it also raises dissatisfaction when it comes to other aspects of their lives. Psychotherapy and surgical intervention are to be considered jointly in order to aid effective integration for individuals considering such an option.

The Association between End-of-Life Care and the Time Interval between Provision of a Do-Not-Resuscitate Consent and Death in Cancer Patients in Korea.

PurposeWe explored the relationship between the use of each medical intervention and the length of time between do-not-resuscitate (DNR) consent and death in Korea.Materials and MethodsA total of 295 terminal cancer patients participated in this retrospective study. Invasive interventions (e.g., cardiopulmonary resuscitation, intubation, and hemodialysis), less invasive interventions (e.g., transfusion, antibiotic use, inotropic use, and laboratory tests), and the time interval between the DNR order and death were evaluated. The subjects were divided into three groups based on the amount of time between DNR consent and death (G1, time interval ≤ 1 day; G2, time interval > 1 day to ≤ 3 days; and G3, time interval > 3 days).ResultsIn general, there were fewer transfusions and laboratory tests near death. Invasive interventions tended to be implemented only in the G1 group. There was also less inotrope use and fewer laboratory tests in the G3 group than G1 and G2. Moreover, the G3 group received fewer less invasive interventions than those in G1 (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.03 to 0.84; 3 days before death, and OR, 0.16; 95% CI, 0.04 to 0.59; the day before death). The frequency of less invasive interventions both 1 and 3 days before death was significantly lower for the G3 group than the G1 (p ≤ 0.001) and G2 group compared to G1 (p=0.001).ConclusionEarlier attainment of DNR permission was associated with reduced use of medical intervention. Thus, physicians should discuss death with terminal cancer patients at the earliest practical time to prevent unnecessary and uncomfortable procedures and reduce health care costs.

Heroin shortage in Coastal Kenya: A rapid assessment and qualitative analysis of heroin users’ experiences

IntroductionWhile relatively rare events, abrupt disruptions in heroin availability have a significant impact on morbidity and mortality risk among those who are heroin dependent. A heroin shortage occurred in Coast Province, Kenya from December 2010 to March 2011. This qualitative analysis describes the shortage events and consequences from the perspective of heroin users, along with implications for health and other public sectors. MethodsAs part of a rapid assessment, 66 key informant interviews and 15 focus groups among heroin users in Coast Province, Kenya were conducted. A qualitative thematic analysis was undertaken in Atlas.ti. to identify salient themes related to the shortage. ResultsOverall, participant accounts were rooted in a theme of desperation and uncertainty, with emphasis on six sub-themes: (1) withdrawal and strategies for alleviating withdrawal, including use of medical intervention and other detoxification attempts; (2) challenges of dealing with unpredictable drug availability, cost, and purity; (3) changes in drug use patterns, and actions taken to procure heroin and other drugs; (4) modifications in drug user relationship dynamics and networks, including introduction of risky group-level injection practices; (5) family and community response; and (6) new challenges with the heroin market resurgence. ConclusionsThe heroin shortage led to a series of consequences for drug users, including increased risk of morbidity, mortality and disenfranchisement at social and structural levels. Availability of evidence-based services for drug users and emergency preparedness plans could have mitigated this impact.

Seeking more than health: Using medicine for enhancement

The purpose of this essay is to examine some of the ethical concerns raised regarding the use of neuroenhancers. Authors such as Fukuyama and Sandel argue that medical intervention should be limited to treatment of disease, and that enhancement should be outside of the scope of medicine. This commentary will examine the distinction between treatment and enhancement. I shall conclude that it is not a well-drawn distinction and should not be used to provide guidance with regards to the use of psychopharmacological agents for the purpose of cognitive enhancement. I shall further examine whether concepts such as disability and normality could provide a criterion for determining whether enhancement is a permissible use of medical intervention. I conclude that as those concepts are contextually defined, they cannot be used to make principled arguments against enhancement. Finally, I shall review the charge that medicalization of cognitive performance enhancers is not morally permissible. I shall argue that medicalization might have both negative and positive consequences, and decisions about the moral permissibility of medicalization should be made on a case-by-case basis.

Individualised risk estimation and the nature of prevention

Statistical risk models hold substantial promise for the practice of cancer prevention by helping to identify high risk populations and subsequently guide decisions about surveillance, further testing and treatments. They have come under criticism for creating new categories of disease-free but ‘at risk’ individuals. We analysed the debate over the interpretation of risk estimates to assess the importance of these models for the practice of cancer prevention. In particular, we focused on the Gail model for breast cancer risk assessment as a case study, because it is widely used and has been promoted directly to consumers. We describe the critiques that have been offered of the Gail model for individualised risk assessment, such as that classification of a new ‘high risk’ category may increase the use of medical intervention in otherwise healthy individuals. We then analyse the primary methodological limitations of individualised risk models, which are often overlooked in the application of these models and interpretation of their results. In particular, the application of statistical risk models like the Gail model to individuals fails to acknowledge the uncertainty surrounding estimates of individual risk. Moreover, putting the focus of risk management at the individual level minimises the influence of important environmental factors on risk, such as social influences and policies that may impact behaviour or outcomes. Overall, the increasing use of individualised risk estimates for individual decision-making may obscure the fact that successful disease prevention requires intervention on all levels, including the political, social, economic and individual level.

Jewish Views on the Beginnings of Human Life and the Use of Medical Intervention to Produce Children

Ari Z. Zivotofsky and Alan Jotkowitz (2009) present a clear comparative perspective on the views of the Church and Orthodox Judaism regarding two important bioethical issues. The first characterize...

Likely consequences of increased patient choice

Likely consequences of increased patient choice

Clinical decisions by vascular surgeons do not maximize patient expected utility

Applied prospectively to patients with peripheral arterial disease, individualized decision analysis promises to improve the surgeon’s ability to maximize the patient’s desired outcome from intervention. A prospective, randomized trial comparing surgical decision analysis to standard decision-making was performed in 206 patients with symptomatic lower extremity arterial disease using individualized probability and utility estimates to predict the optimal management strategy most likely to maximize patient quality of life. Utility assessment was obtained from patients prior to treatment. Estimates of the probability of treatment outcome, intended and actual treatment plans, and assessment of the surgeon’s comfort with the decision (Provider Decision-Process Instrument) were obtained from surgeons before and after decision analysis. Results of decision analysis were provided to surgeons in a randomized manner for half of the patients. Utility values for the patient’s current state of health correlated weakly with the SF36 PCS (r = 0.23) as well as individual health concept scores of BP (r = 0.31), VT (r = 0.25), and SF (r = 0.24), as well as with Walking Impairment Questionnaire (r = −0.20). Patients with severe ischemia more more likely to devalue their current state of health (0.57 vs 0.50, P < 0.01), while patients with a contralateral amputation placed greater value on this intervention (0.53 vs 0.34, P < 0.001). The optimum treatment predicted by decision analysis differed significantly from the surgeon’s initial plan and consisted of bypass for 30% vs 29%, respectively, angioplasty for 28% vs 11%, amputation for 31% vs 6%, and nonoperative management for 34% vs 54% (agreement 50%, kappa 0.28). Randomization to the surgeon aware of the decision model results (n=100) did not alter the surgeon’s verbalized final plan. However, surgeon awareness trended toward greater use of medical intervention vs bypass. Patients for whom the model agreed with the surgeon’s initial plan were less likely to undergo bypass (13% vs 30%, P < 0.01). Greater comfort was seen when the surgeon’s plan agreed with the model, regardless of randomization status (PDPI score 47.5 vs 45.6, P < 0.005). Individualized application of a decision model to patients with peripheral arterial disease suggests that arterial bypass is frequently recommended even when it may not maximize patient expected utility.

Strategies for effectively addressing women’s concerns about the menopause and HRT

HRT has many benefits for postmenopausal women yet acceptance and compliance with therapy is low. This paper sets out some of the main concerns women have regarding HRT and highlights ways that physicians can effectively deal with these concerns. Physicians dealing with women concerned about starting or continuing HRT should conduct patient-centered consultations employing good counseling skills. Dealing effectively with women’s concerns means addressing their attitude to HRT, listening to the patients’ fears in an understanding and non-dismissive way, and focusing on good communication. Common concerns relating to unwanted effects such as bleeding, fear of cancer, weight gain, thrombosis, general systemic effects, and the use of medical intervention generally, can be dealt with if the physician follows the principles for conducting a patient-centered interview. When it comes to decisions about starting and continuing on HRT, it is important that women are treated with understanding, their concerns are taken seriously, and they are given time to air their views and ask questions. Tailoring treatments to individual patients can overcome many of the problems women have with HRT, however it is important that the decision to start HRT, and the most suitable regimen and delivery system to use, be decided in partnership with the patient. This should result in the patient having a better understanding of HRT, and may improve compliance.

Management of encopresis in early adolescence in a medical-psychiatric unit

The aim of this work is to present the role of a medical-psychiatric unit in the treatment of chronic resistant encopresis in adolescence as an effective alternative to the standard approach. Four case reports are presented. The integrative program is based on full patient cooperation and involves separating the patient from the family environment and the use of medical intervention combined with modified behavioral therapy and parental education and guidance. The patient is given full responsibility for the cure. The median full hospital stay for our patients was 2 weeks, and outcome in all cases was complete remission. This experience suggests that chronic resistant encopresis in adolescents requires a different approach from the standard because of the patient’s developmental stage and the often hostile family dynamics. A medical-psychiatric setting provides an excellent management milieu and can lead to a dramatic improvement in this chronic disabling condition.