International Journal of Radiation Oncology*Biology*Physics, 2016
Purpose/Objective(s): Recently, national consensus guidelines have recommended either whole-brain... more Purpose/Objective(s): Recently, national consensus guidelines have recommended either whole-brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) as primary treatment options for patients with multiple brain metastases. This is supported by retrospective data suggesting comparable survival among patients with multiple brain metastases independent of lesion number. However, the treatment-related costs and economic implications of lesion number have yet to be demonstrated. We hypothesized that patients with multiple brain metastases incur greater costs compared to those with a single metastasis. Materials/Methods: A retrospective cohort study of patients diagnosed with brain metastasis between 2009 and 2014 at a single tertiary care institution was conducted. Patients were divided into 3 cohorts according to the number of metastases at presentation (1, 2-4, and 5). Costs were estimated from the payer's perspective using Medicare cost-to-charge ratios. Total, cancer-specific, and brain metastasis-specific costs were collected through December 2015. The primary outcome was cumulative cancer-specific costs incurred following brain metastasis diagnosis. Unadjusted cost data were compared with Wilcoxon rank-sum tests. Logtransformed multivariable linear regression was used to adjust for differences in pathology, comorbidity index, age, systemic disease, performance status and upfront therapy among cohorts. Results: At presentation, 489 patients were diagnosed with 1,191 brain metastases: 236 patients (48%) were diagnosed with a single metastasis, while 63 (13%) were diagnosed with 5. The most common upfront therapies were SRS alone (58%) and WBRT alone (15%). 12-month distant intracranial failure was 31%, 50%, and 56% (p<0.01) among patients with 1, 2-4, and 5 metastases. Median overall survival among the cohorts was 16, 13, and 11 months, respectively (p<0.01). Cost data were collected for a median of 10 months after diagnosis of brain metastasis. Cumulative and monthly brain metastasis-specific costs
andomized trials have conclusively shown higher rates of chronic graft-versus-host disease with f... more andomized trials have conclusively shown higher rates of chronic graft-versus-host disease with filgrastim-stimulated apheresis peripheral blood as a donor source than unstimulated bone marrow. The Canadian Blood and Marrow Transplant Group conducted a phase 3 study of adults who received either filgrastim-stimulated apheresis peripheral blood or filgrastim-stimulated bone marrow from human leukocyte antigen-identical sibling donors. Because all donors received the identical filgrastim dosing schedule, this study allowed for a controlled evaluation of the impact of stem cell source on development of chronic graft-versus-host disease. One hundred and twenty-one evaluable filgrastim-stimulated apheresis peripheral blood and filgrastim-stimulated bone marrow patient donor products were immunologically characterized by flow cytometry and tested for their association with acute and chronic graft-versus-host disease within 2 years of transplantation. The immune populations evaluated included, regulatory T cells, central memory and effector T cells, interferon γ positive producing T cells, invariate natural killer T cells, regulatory natural killer cells, dendritic cell populations, macrophages, and activated B cells and memory B cells. When both filgrastim-stimulated apheresis peripheral blood and filgrastimstimulated bone marrow were grouped together, a higher chronic graftversus-host disease frequency was associated with lower proportions of CD56 bright natural killer regulatory cells and interferon γ-producing T helper cells in the donor product. Lower CD56 bright natural killer regulatory cells displayed differential impacts on the development of extensive chronic graft-versus-host disease between filgrastim-stimulated apheresis CD56 bright natural killer regulatory cells in filgrastim primed donor blood or marrow products regulate chronic graft-versus-host disease: the Canadian Blood and Marrow Transplant Group randomized 0601 study results
Inflammatory bowel disease can impact on a patient's ability to maintain normal physical and ment... more Inflammatory bowel disease can impact on a patient's ability to maintain normal physical and mental function, and fulfil their social, family and work roles. Aspects of disability in IBD have received little attention. To develop, validate and apply a questionnaire directed towards evaluating these disease aspects. A literature review on disability in IBD was undertaken, and opinion about aspects of disability to measure was sought from six IBD-specialised gastroenterologists. A questionnaire was developed, and IBD patients completed the new disability questionnaire, the SF-36 and the short-IBD (SIBDQ -10 point). A subgroup of patients completed the questionnaire again 4 weeks later. Healthy volunteers were studied as a control group. A total of 116 IBD out-patients were approached, of whom 81 (52 Crohn's disease and 28 ulcerative colitis) participated. Nineteen patients were re-evaluated at 4 weeks. Twenty-five controls were studied. All subscales demonstrated good Cronbach's alpha reliability and reproducibility. There was a significant inverse correlation between the disability score and the SIBDQ and between the disability score and the SF36 and a positive correlation with the Crohn's Disease Activity Index (CDAI) (all P < 0.001). Disability differed between ulcerative colitis and controls, but not between active and inactive disease. The new disability questionnaire is sensitive for detecting disability, is reliable and reproducible, and correlates with disease activity in Crohn's disease, but not ulcerative colitis. Further prospective testing is now needed in the longer term, larger patient populations and in different countries and ethnicities.
Background The kidney disease questionnaire is a tool constructed to measure knowledge of hemodia... more Background The kidney disease questionnaire is a tool constructed to measure knowledge of hemodialysis patients on topics related chronic kidney disease and renal transplantation. Aim The aim s of the study were the translation and cultural adaptation in the Greek language of t h e translation and cultural adaptation of the Kidney Disease Questionnaire. Methodology The process included the forward and back translation of the questionnaire as well as its cultural adaptation according to World Health Organization guidelines. The questionnaire was translated from the source language (English) to the target language (Greek) by three independent translators. Next another person who had a very good command of both languages made the back translation of the questionnair e. The translation produced has not any important difference to the original one. T h en the questionnaire was pilot tested on 10 hemodialysis patients who approved the cultural adaptation and then a s emantic validation wa...
Background We assessed whether the presence and severity of common cancer symptoms are associated... more Background We assessed whether the presence and severity of common cancer symptoms are associated with the health utility score (hus) generated from the EQ-5D (EuroQol Research Foundation, Rotterdam, Netherlands) in patients with cancer and evaluated whether it is possible pragmatically to integrate routine hus and symptom evaluation in our cancer population.Methods Adult outpatients at Princess Margaret Cancer Centre with any cancer were surveyed cross-sectionally using the Edmonton Symptom Assessment System (esas) and the EQ-5D-3L, and results were compared using Spearman correlation coefficients and regression analyses.Results Of 764 patients analyzed, 27% had incurable disease. We observed mild-to-moderate correlations between each esas symptom score and the hus (Spearman coefficients: –0.204 to –0.416; p < 0.0001 for each comparison), with the strongest associations being those for pain (R = –0.416), tiredness (R = –0.387), and depression (R =-0.354). Multivariable analyses ...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2003
To examine the correlates of therapeutic response of patients with panic disorder presenting with... more To examine the correlates of therapeutic response of patients with panic disorder presenting with palpitations, we hypothesized that therapeutic response would correlate with heart rate variability (HRV) and sleep measures. After a 1-week placebo washout, 27 patients free of structural heart disease and not on cardioactive drugs were randomized in a double-blinded fashion to 4 weeks of treatment with clonazepam (a known antipanic agent) or placebo. We performed standard sleep measures and recorded HRV from 24-hour Holter acquisitions at baseline and end of study. We defined response to therapy as a 50% improvement in the Hamilton Anxiety Rating Scale (HARS) score, confirmed by questionnaires and reaction to sodium lactate infusion. There were 12 responders and 15 nonresponders. Normalization of sleep pattern (including less stage 1 and rapid eye movement [REM] sleep) was observed in both drug and placebo responders (P = 0.011 and P = 0.05, respectively) and in placebo responders alo...
We investigated whether brief supportive-expressive group psychotherapy might reduce illness-indu... more We investigated whether brief supportive-expressive group psychotherapy might reduce illness-induced interference with valued activities and interests (i.e., illness intrusiveness) among women with systemic lupus erythematosus (SLE) in relation to 3 life domains: (1) relationships and personal development (family relationships, other social relationships, self-expression), (2) intimacy (relationship with spouse, sex life), and/or (3) instrumental life (work, finances, active recreation). Women with SLE recruited from 9 rheumatology centers were randomly assigned to receive either usual care (n = 66) or a 12 week brief supportive-expressive group psychotherapy followed by 3 monthly booster sessions (n = 58). Standard instruments assessed disease activity and damage, illness intrusiveness, and psychological distress at 4 measurement occasions: (1) pretreatment, (2) posttreatment, (3) 6 month followup, and (4) 12 month followup. Analysis of covariance, controlling for disease activity ...
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2008
Background:Chronic illnesses are associated with multiple stressors that compromise quality of li... more Background:Chronic illnesses are associated with multiple stressors that compromise quality of life (QOL). Implicit in many of these stressors is the concept of illness intrusiveness: the disruption of lifestyles, activities, and interests due to the constraints imposed by chronic disease and its treatment. The purpose of this study was to examine illness intrusiveness and QOL in epilepsy in patients with different levels of seizure control.Methods:Cross-sectional data were obtained and compared between two groups of patients categorized by presence of seizures: seizure freedom or continued seizures (N=145). Standard instruments measured the following variables: illness intrusiveness, perceived personal control, subjective well-being, and disease specific QOL.Results:Illness intrusiveness varied inversely and significantly with seizure control. Complete seizure freedom, whether achieved by pharmacological or surgical treatment, was associated with the lowest levels of illness intrus...
The underlying factor structure of a subset of 12 items, which comprise the psychosocial subscale... more The underlying factor structure of a subset of 12 items, which comprise the psychosocial subscales of the EORTC QLQ-C30 was explored in a group of women, all with metastatic breast cancer who were participating in a psychosocial intervention study. Two main factors were identified in this exploratory factor analysis, representing “emotional distress” and “functional ability” dimensions. A preliminary assessment of the external validity of the two factor structure was undertaken. The results support the validity of a summative “emotional distress” and “functional ability” score in this sample of patients. The “functional ability” score discriminated well for subgroups defined by clinical status indicators (e.g., performance status, pain, chemotherapy treatment, fatigue). The “emotional distress” subscale discriminated with respect to suffering, fatigue and sleep disturbance. Both subscales converged with related concepts measured by independent instruments, providing support for conv...
The purpose of this study was to assess the incidence, severity, and correlates of acute stress r... more The purpose of this study was to assess the incidence, severity, and correlates of acute stress responses in women undergoing diagnostic mammographic surveillance and to explore the moderating impact of physician support on these symptoms. Methods: Sixty-six female breast cancer outpatients (at least 12 months after diagnosis and primary treatment) and 69 healthy women undergoing mammographic surveillance completed measures of: acute stress response, somatization, trauma history, psychiatric history, social support, and physician satisfaction. Results: Previous cancer, pre-mammography breast complaints, lower income, previous psychiatric medication use, greater instrumental support, greater somatization, greater perceived physician disengagement, and less perceived physician support were all associated with increased stress responses. Among women with a previous cancer diagnosis, those with greater distress reported higher levels of physician support. In contrast, among those without a previous cancer diagnosis, those with greater perceived physician support reported less distress. Conclusions: These findings suggest that cancer-related cues, such as follow-up surveillance, may trigger a sensitizing response in women with a previous cancer diagnosis. The association of distress with physician support may arise from the responsiveness of physicians to identified distress, from increased help-seeking behavior by those who are distressed, or both. The benefit of support provided by health care professionals to those at risk of developing stress response syndromes deserves further study.
Objectives: Suicide rates are elevated in individuals with cancer, although suicidal intention is... more Objectives: Suicide rates are elevated in individuals with cancer, although suicidal intention is not typically assessed in cancer centers. We evaluated in a large comprehensive cancer center the utility of an electronic Distress Assessment and Response Tool (DART), in which suicidal intention is assessed with a single item. Methods: Patients attending cancer clinics completed DART as part of routine care. DART includes measures of physical symptoms, depression, anxiety, social difficulties, and practical concerns. Medical variables were obtained from the Princess Margaret Cancer Registry, the data warehouse of cancer patient statistics. A Generalized Estimating Equation (GEE) model was used to assess factors associated with suicidal intention. Results: Between September 2009 and March 2012, 4822/5461 patients (88.3%) who completed DART consented to the use of their data for research. Amongst the latter, 280 (5.9%) of the 4775 patients who answered the question reported suicidal ideation, which was related to physical and psychological distress, and social difficulties (ps < 0.0001). Amongst those with ideation who responded to the intention question, 20/186 (10.8%) reported suicidal intention. Of respondents with more severe suicidal ideation, 12/49 (24.5%) reported suicidal intention. Using a GEE model, suicidal intention in those with ideation was significantly associated with male sex, difficulty making treatment decisions, and with everyday living concerns. Conclusions: Suicidal ideation is reported on an electronic distress screening tool (DART) by almost 6% of cancer patients, of whom almost 11% report suicidal intention and 33% decline to indicate intention. DART demonstrated utility in identifying patients who may be at highest risk of completed suicide and who require urgent clinical assessment.
Pain, control over treatment, and compliance in dialysis and transplant patients. Pain was survey... more Pain, control over treatment, and compliance in dialysis and transplant patients. Pain was surveyed via structured interview and the McGill Pain Questionnaire in 53 dialysis and 27 transplant patients. Increased patient control over the dialysis procedure was not associated with a reduction in pain though perceived control may have been. Compliance with the dialysis regimen did not predict pain and the validity of the category "dialysis headache" was questioned. Overall, transplant recipients did not report significantly less pain than dialysis patients. Self-reported depression was correlated positively with pain. The clinical implications of these findings are discussed. Les douleurs, le contrôle thérapeutique et l'adaptation chez des malades dialyses et transplantés. Une étude de Ia douleur a eté entreprise chez 53 dialyses et 27 transplantés au cours d'entretiens, et a l'aide d'un questionnaire (McGill Pain Questionnaire). Une plus grande participation du malade a Ia dialyse n'allait pas de pair avec une reduction des douleurs, alors que le contrôle percu peut avoir eu cet effect. Une bonne adaptation a Ia dialyse ne permettait pas de prédire les douleurs, et Ia validité de la classification "céphalées au cours de dialyses" a été remise en question. D'une facon genérale, les transplantés n'indiquaient pas des douleurs significativement inférieures a celles des dialyses. L'état dépressif rapporté par les malades était positivement corrélé avec les douleurs. Les implications cliniques de ces résultats sont discutées. From the patient's point of view, pain control is one of the critical aspects of medical care. Recent research with diverse populations has shown that pain may be one of the basic dimensions of the quality of life of medical patients [11. Despite this, there is very little systematic information concerning pain in end-stage renal disease (ESRD) patients. While clinical impressions strongly suggest that technical advances have greatly reduced the incidence and severity of pain problems for dialysis patients, there is little empirical evidence to support this view. Recent research concerning dialysis pain has focused on limited populations with one specific type of pain [2-4] or has included pain as one of a number of dialysis-related complications [5]. To the authors' knowledge, controlled re-
Cognitive impairment has been documented in uremia with partial improvement after dialysis. Noctu... more Cognitive impairment has been documented in uremia with partial improvement after dialysis. Nocturnal daily hemodialysis (NHD) is a novel dialysis modality with multiple benefits. Previous reports have shown marked improvements in quality of life, cardiac function, resolution of peripheral vascular disease, and reversal of central sleep apnea. We hypothesized that patients maintained on NHD would have better cognitive functioning than those receiving conventional therapy. Using a longitudinal study design, patients were tested at baseline and again after X6 months NHD. At each of the two time points, a battery of 10 neuropsychological tests were used to evaluate three domains of cognitive functioning -attention and working memory skills, psychomotor efficiency and processing speed, and learning efficiency. Clinical subjective symptoms for cognitive functioning and depression were measured using the Patients Assessment of Own Functioning inventory and the Beck Depression Index. Twelve patients (six males, six females) were recruited. Patients were aged 39.673.3 years at the time of first testing. Thirty-three percent were diabetic, with a mean Charlson comorbidity score of 3.572.0. Depression (defined as 416 on the Beck Depression Index score) was not seen in any patient. Over the 6-month period, a 22% reduction in cognitive symptoms (P ¼ 0.01), 7% improvement in psychomotor efficiency and processing speed (P ¼ 0.02), and 32% improvement in attention and working memory (P ¼ 0.04) was seen. Learning efficiency scores were unchanged. NHD may be associated with improved general cognitive efficiency as measured by psychomotor efficiency and attention and working memory.
Objective: This prospective study examined sex differences in illness intrusiveness and in baseli... more Objective: This prospective study examined sex differences in illness intrusiveness and in baseline predictors of illness intrusiveness in cardiac patients' I-year postcardiac event. Methods: Patients diagnosed with a myocardial infarction (MI) or unstable angina (UA) completed a baseline questionnaire during their hospitalization (139 men and 104 women). Eighty-one men and 67 women completed the follow-up questionnaire I-year postcardiac event. The questionnaire included measures of illness intrusiveness in three life domains, depressive symptomatology, social support, medical information, risk factors for heart disease, and sociodemographic information. Results: A MANCOVA with the three I1lness Intrusiveness subscales as dependent variables, sex as the betweengroup factor, and partnership status as a covariate found a sex effect for the Intimacy subscale, but not for the Instrumental and the Relationships/Personal Development subscales. Men reported more intrusiveness in the Intimacy domain of their life as compared to women. After controlling for sociodemographic factors and risk
In this study, the authors both developed and validated a self-report mindfulness measure, the To... more In this study, the authors both developed and validated a self-report mindfulness measure, the Toronto Mindfulness Scale (TMS). In Study 1, participants were individuals with and without meditation experience. Results showed good internal consistency and two factors, Curiosity and Decentering. Most of the expected relationships with other constructs were as expected. The TMS scores increased with increasing mindfulness meditation experience. In Study 2, criterion and incremental validity of the TMS were investigated on a group of individuals participating in 8-week mindfulness-based stress reduction programs. Results showed that TMS scores increased following treatment, and Decentering scores predicted improvements in clinical outcome. Thus, the TMS is a promising measure of the mindfulness state with good psychometric properties and predictive of treatment outcome.
Objective-Evaluate the feasibility of implementing a combined in-hospital and home-based exercise... more Objective-Evaluate the feasibility of implementing a combined in-hospital and home-based exercise program in older hemodialysis (HD) patients. Setting-A university hospital HD unit and patients' homes. Participants-A convenience sample of 9 older (>55years) patients undergoing HD.
Always cite the published version, so the author(s) will receive recognition through services tha... more Always cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the TSpace version (original manuscript or accepted manuscript) because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page.
There has been substantial interest in mindfulness as an approach to reduce cognitive vulnerabili... more There has been substantial interest in mindfulness as an approach to reduce cognitive vulnerability to stress and emotional distress in recent years. However, thus far mindfulness has not been defined operationally. This paper describes the results of recent meetings held to establish a consensus on mindfulness and to develop conjointly a testable operational definition. We propose a two-component model of mindfulness and specify each component in terms of specific behaviors, experiential manifestations, and implicated psychological processes. We then address issues regarding temporal stability and situational specificity and speculate on the conceptual and operational distinctiveness of mindfulness. We conclude this paper by discussing implications for instrument development and briefly describing our own approach to measurement.
Sleep complaints are ubiquitous in patients with medical illness. A recent survey of outpatients ... more Sleep complaints are ubiquitous in patients with medical illness. A recent survey of outpatients attending hospital clinics indicated that the vast majority of patients reported sleep disruption concomitant with their condition. The proportion with complaints (> 70%) was more than twice that among control subjects. Doctors rarely ask about sleep problems in the Factors that may indicate a context of medical illness despite the fact that the patient's first complaint disruption of sleep architecture in may be that a particular symptom caused sleep disruption. medically ill patients There are specific reasons for sleep disruptions in patients with medical . Movement arousals (number) illness-for example, people are often deprived of sleep before an 0Feunchgsislesae(eh. operation. Polysomnography has shown that there is a preoperative of sleep) reduction in slow wave sleep and that this is related to the anticipated * Awakenings in first six hours of sleep importance of surgery. The increase in deep sleep that occurs after an (number) operation is thought to facilitate the healing process. * Sleep efficiency ( A variety of sleep variables may be influenced by specific disorders and * Apnoea index particular treatments and each of these effects is likely to differ. A decrease * Leg kicks (total number) in deep (slow wave) sleep, for example, may lead to a sensation of having low energy, whereas repeated interruption of sleep may lead to daytime * Abnormal REM latency * Reduced slow wave sleep corrected for sleepiness. age (% below normal) Drugs may also disrupt sleep architecture by suppressing rapid eye . Total sleep time movement (REM) sleep or by causing a withdrawal effect during the night. * Total sleep time In both cases the drug clearly alters sleep, but the impact on health and * Long awakenings (10 min) recovery may differ. L a. Patterns on electroencephalogram Fatigue is common in several medical conditions. Clinicians, researchers, and patients themselves claim that the fatigue experienced in certain medical conditions differs qualitatively from the experience oftiredness or sleepiness. However, there have been few attempts to separate these states. In this article we provide an overview of the impact of medical disorders on sleep. *Mean (SD) tenderpoint scores are as follows: 3.5 (2-6) in normal people; 16-9 (14-1) in those with chronic fatigue syndrome; 33.0 (11-8) in those with fibromyalgia.
International Journal of Radiation Oncology*Biology*Physics, 2016
Purpose/Objective(s): Recently, national consensus guidelines have recommended either whole-brain... more Purpose/Objective(s): Recently, national consensus guidelines have recommended either whole-brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) as primary treatment options for patients with multiple brain metastases. This is supported by retrospective data suggesting comparable survival among patients with multiple brain metastases independent of lesion number. However, the treatment-related costs and economic implications of lesion number have yet to be demonstrated. We hypothesized that patients with multiple brain metastases incur greater costs compared to those with a single metastasis. Materials/Methods: A retrospective cohort study of patients diagnosed with brain metastasis between 2009 and 2014 at a single tertiary care institution was conducted. Patients were divided into 3 cohorts according to the number of metastases at presentation (1, 2-4, and 5). Costs were estimated from the payer's perspective using Medicare cost-to-charge ratios. Total, cancer-specific, and brain metastasis-specific costs were collected through December 2015. The primary outcome was cumulative cancer-specific costs incurred following brain metastasis diagnosis. Unadjusted cost data were compared with Wilcoxon rank-sum tests. Logtransformed multivariable linear regression was used to adjust for differences in pathology, comorbidity index, age, systemic disease, performance status and upfront therapy among cohorts. Results: At presentation, 489 patients were diagnosed with 1,191 brain metastases: 236 patients (48%) were diagnosed with a single metastasis, while 63 (13%) were diagnosed with 5. The most common upfront therapies were SRS alone (58%) and WBRT alone (15%). 12-month distant intracranial failure was 31%, 50%, and 56% (p<0.01) among patients with 1, 2-4, and 5 metastases. Median overall survival among the cohorts was 16, 13, and 11 months, respectively (p<0.01). Cost data were collected for a median of 10 months after diagnosis of brain metastasis. Cumulative and monthly brain metastasis-specific costs
andomized trials have conclusively shown higher rates of chronic graft-versus-host disease with f... more andomized trials have conclusively shown higher rates of chronic graft-versus-host disease with filgrastim-stimulated apheresis peripheral blood as a donor source than unstimulated bone marrow. The Canadian Blood and Marrow Transplant Group conducted a phase 3 study of adults who received either filgrastim-stimulated apheresis peripheral blood or filgrastim-stimulated bone marrow from human leukocyte antigen-identical sibling donors. Because all donors received the identical filgrastim dosing schedule, this study allowed for a controlled evaluation of the impact of stem cell source on development of chronic graft-versus-host disease. One hundred and twenty-one evaluable filgrastim-stimulated apheresis peripheral blood and filgrastim-stimulated bone marrow patient donor products were immunologically characterized by flow cytometry and tested for their association with acute and chronic graft-versus-host disease within 2 years of transplantation. The immune populations evaluated included, regulatory T cells, central memory and effector T cells, interferon γ positive producing T cells, invariate natural killer T cells, regulatory natural killer cells, dendritic cell populations, macrophages, and activated B cells and memory B cells. When both filgrastim-stimulated apheresis peripheral blood and filgrastimstimulated bone marrow were grouped together, a higher chronic graftversus-host disease frequency was associated with lower proportions of CD56 bright natural killer regulatory cells and interferon γ-producing T helper cells in the donor product. Lower CD56 bright natural killer regulatory cells displayed differential impacts on the development of extensive chronic graft-versus-host disease between filgrastim-stimulated apheresis CD56 bright natural killer regulatory cells in filgrastim primed donor blood or marrow products regulate chronic graft-versus-host disease: the Canadian Blood and Marrow Transplant Group randomized 0601 study results
Inflammatory bowel disease can impact on a patient's ability to maintain normal physical and ment... more Inflammatory bowel disease can impact on a patient's ability to maintain normal physical and mental function, and fulfil their social, family and work roles. Aspects of disability in IBD have received little attention. To develop, validate and apply a questionnaire directed towards evaluating these disease aspects. A literature review on disability in IBD was undertaken, and opinion about aspects of disability to measure was sought from six IBD-specialised gastroenterologists. A questionnaire was developed, and IBD patients completed the new disability questionnaire, the SF-36 and the short-IBD (SIBDQ -10 point). A subgroup of patients completed the questionnaire again 4 weeks later. Healthy volunteers were studied as a control group. A total of 116 IBD out-patients were approached, of whom 81 (52 Crohn's disease and 28 ulcerative colitis) participated. Nineteen patients were re-evaluated at 4 weeks. Twenty-five controls were studied. All subscales demonstrated good Cronbach's alpha reliability and reproducibility. There was a significant inverse correlation between the disability score and the SIBDQ and between the disability score and the SF36 and a positive correlation with the Crohn's Disease Activity Index (CDAI) (all P < 0.001). Disability differed between ulcerative colitis and controls, but not between active and inactive disease. The new disability questionnaire is sensitive for detecting disability, is reliable and reproducible, and correlates with disease activity in Crohn's disease, but not ulcerative colitis. Further prospective testing is now needed in the longer term, larger patient populations and in different countries and ethnicities.
Background The kidney disease questionnaire is a tool constructed to measure knowledge of hemodia... more Background The kidney disease questionnaire is a tool constructed to measure knowledge of hemodialysis patients on topics related chronic kidney disease and renal transplantation. Aim The aim s of the study were the translation and cultural adaptation in the Greek language of t h e translation and cultural adaptation of the Kidney Disease Questionnaire. Methodology The process included the forward and back translation of the questionnaire as well as its cultural adaptation according to World Health Organization guidelines. The questionnaire was translated from the source language (English) to the target language (Greek) by three independent translators. Next another person who had a very good command of both languages made the back translation of the questionnair e. The translation produced has not any important difference to the original one. T h en the questionnaire was pilot tested on 10 hemodialysis patients who approved the cultural adaptation and then a s emantic validation wa...
Background We assessed whether the presence and severity of common cancer symptoms are associated... more Background We assessed whether the presence and severity of common cancer symptoms are associated with the health utility score (hus) generated from the EQ-5D (EuroQol Research Foundation, Rotterdam, Netherlands) in patients with cancer and evaluated whether it is possible pragmatically to integrate routine hus and symptom evaluation in our cancer population.Methods Adult outpatients at Princess Margaret Cancer Centre with any cancer were surveyed cross-sectionally using the Edmonton Symptom Assessment System (esas) and the EQ-5D-3L, and results were compared using Spearman correlation coefficients and regression analyses.Results Of 764 patients analyzed, 27% had incurable disease. We observed mild-to-moderate correlations between each esas symptom score and the hus (Spearman coefficients: –0.204 to –0.416; p < 0.0001 for each comparison), with the strongest associations being those for pain (R = –0.416), tiredness (R = –0.387), and depression (R =-0.354). Multivariable analyses ...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2003
To examine the correlates of therapeutic response of patients with panic disorder presenting with... more To examine the correlates of therapeutic response of patients with panic disorder presenting with palpitations, we hypothesized that therapeutic response would correlate with heart rate variability (HRV) and sleep measures. After a 1-week placebo washout, 27 patients free of structural heart disease and not on cardioactive drugs were randomized in a double-blinded fashion to 4 weeks of treatment with clonazepam (a known antipanic agent) or placebo. We performed standard sleep measures and recorded HRV from 24-hour Holter acquisitions at baseline and end of study. We defined response to therapy as a 50% improvement in the Hamilton Anxiety Rating Scale (HARS) score, confirmed by questionnaires and reaction to sodium lactate infusion. There were 12 responders and 15 nonresponders. Normalization of sleep pattern (including less stage 1 and rapid eye movement [REM] sleep) was observed in both drug and placebo responders (P = 0.011 and P = 0.05, respectively) and in placebo responders alo...
We investigated whether brief supportive-expressive group psychotherapy might reduce illness-indu... more We investigated whether brief supportive-expressive group psychotherapy might reduce illness-induced interference with valued activities and interests (i.e., illness intrusiveness) among women with systemic lupus erythematosus (SLE) in relation to 3 life domains: (1) relationships and personal development (family relationships, other social relationships, self-expression), (2) intimacy (relationship with spouse, sex life), and/or (3) instrumental life (work, finances, active recreation). Women with SLE recruited from 9 rheumatology centers were randomly assigned to receive either usual care (n = 66) or a 12 week brief supportive-expressive group psychotherapy followed by 3 monthly booster sessions (n = 58). Standard instruments assessed disease activity and damage, illness intrusiveness, and psychological distress at 4 measurement occasions: (1) pretreatment, (2) posttreatment, (3) 6 month followup, and (4) 12 month followup. Analysis of covariance, controlling for disease activity ...
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2008
Background:Chronic illnesses are associated with multiple stressors that compromise quality of li... more Background:Chronic illnesses are associated with multiple stressors that compromise quality of life (QOL). Implicit in many of these stressors is the concept of illness intrusiveness: the disruption of lifestyles, activities, and interests due to the constraints imposed by chronic disease and its treatment. The purpose of this study was to examine illness intrusiveness and QOL in epilepsy in patients with different levels of seizure control.Methods:Cross-sectional data were obtained and compared between two groups of patients categorized by presence of seizures: seizure freedom or continued seizures (N=145). Standard instruments measured the following variables: illness intrusiveness, perceived personal control, subjective well-being, and disease specific QOL.Results:Illness intrusiveness varied inversely and significantly with seizure control. Complete seizure freedom, whether achieved by pharmacological or surgical treatment, was associated with the lowest levels of illness intrus...
The underlying factor structure of a subset of 12 items, which comprise the psychosocial subscale... more The underlying factor structure of a subset of 12 items, which comprise the psychosocial subscales of the EORTC QLQ-C30 was explored in a group of women, all with metastatic breast cancer who were participating in a psychosocial intervention study. Two main factors were identified in this exploratory factor analysis, representing “emotional distress” and “functional ability” dimensions. A preliminary assessment of the external validity of the two factor structure was undertaken. The results support the validity of a summative “emotional distress” and “functional ability” score in this sample of patients. The “functional ability” score discriminated well for subgroups defined by clinical status indicators (e.g., performance status, pain, chemotherapy treatment, fatigue). The “emotional distress” subscale discriminated with respect to suffering, fatigue and sleep disturbance. Both subscales converged with related concepts measured by independent instruments, providing support for conv...
The purpose of this study was to assess the incidence, severity, and correlates of acute stress r... more The purpose of this study was to assess the incidence, severity, and correlates of acute stress responses in women undergoing diagnostic mammographic surveillance and to explore the moderating impact of physician support on these symptoms. Methods: Sixty-six female breast cancer outpatients (at least 12 months after diagnosis and primary treatment) and 69 healthy women undergoing mammographic surveillance completed measures of: acute stress response, somatization, trauma history, psychiatric history, social support, and physician satisfaction. Results: Previous cancer, pre-mammography breast complaints, lower income, previous psychiatric medication use, greater instrumental support, greater somatization, greater perceived physician disengagement, and less perceived physician support were all associated with increased stress responses. Among women with a previous cancer diagnosis, those with greater distress reported higher levels of physician support. In contrast, among those without a previous cancer diagnosis, those with greater perceived physician support reported less distress. Conclusions: These findings suggest that cancer-related cues, such as follow-up surveillance, may trigger a sensitizing response in women with a previous cancer diagnosis. The association of distress with physician support may arise from the responsiveness of physicians to identified distress, from increased help-seeking behavior by those who are distressed, or both. The benefit of support provided by health care professionals to those at risk of developing stress response syndromes deserves further study.
Objectives: Suicide rates are elevated in individuals with cancer, although suicidal intention is... more Objectives: Suicide rates are elevated in individuals with cancer, although suicidal intention is not typically assessed in cancer centers. We evaluated in a large comprehensive cancer center the utility of an electronic Distress Assessment and Response Tool (DART), in which suicidal intention is assessed with a single item. Methods: Patients attending cancer clinics completed DART as part of routine care. DART includes measures of physical symptoms, depression, anxiety, social difficulties, and practical concerns. Medical variables were obtained from the Princess Margaret Cancer Registry, the data warehouse of cancer patient statistics. A Generalized Estimating Equation (GEE) model was used to assess factors associated with suicidal intention. Results: Between September 2009 and March 2012, 4822/5461 patients (88.3%) who completed DART consented to the use of their data for research. Amongst the latter, 280 (5.9%) of the 4775 patients who answered the question reported suicidal ideation, which was related to physical and psychological distress, and social difficulties (ps < 0.0001). Amongst those with ideation who responded to the intention question, 20/186 (10.8%) reported suicidal intention. Of respondents with more severe suicidal ideation, 12/49 (24.5%) reported suicidal intention. Using a GEE model, suicidal intention in those with ideation was significantly associated with male sex, difficulty making treatment decisions, and with everyday living concerns. Conclusions: Suicidal ideation is reported on an electronic distress screening tool (DART) by almost 6% of cancer patients, of whom almost 11% report suicidal intention and 33% decline to indicate intention. DART demonstrated utility in identifying patients who may be at highest risk of completed suicide and who require urgent clinical assessment.
Pain, control over treatment, and compliance in dialysis and transplant patients. Pain was survey... more Pain, control over treatment, and compliance in dialysis and transplant patients. Pain was surveyed via structured interview and the McGill Pain Questionnaire in 53 dialysis and 27 transplant patients. Increased patient control over the dialysis procedure was not associated with a reduction in pain though perceived control may have been. Compliance with the dialysis regimen did not predict pain and the validity of the category "dialysis headache" was questioned. Overall, transplant recipients did not report significantly less pain than dialysis patients. Self-reported depression was correlated positively with pain. The clinical implications of these findings are discussed. Les douleurs, le contrôle thérapeutique et l'adaptation chez des malades dialyses et transplantés. Une étude de Ia douleur a eté entreprise chez 53 dialyses et 27 transplantés au cours d'entretiens, et a l'aide d'un questionnaire (McGill Pain Questionnaire). Une plus grande participation du malade a Ia dialyse n'allait pas de pair avec une reduction des douleurs, alors que le contrôle percu peut avoir eu cet effect. Une bonne adaptation a Ia dialyse ne permettait pas de prédire les douleurs, et Ia validité de la classification "céphalées au cours de dialyses" a été remise en question. D'une facon genérale, les transplantés n'indiquaient pas des douleurs significativement inférieures a celles des dialyses. L'état dépressif rapporté par les malades était positivement corrélé avec les douleurs. Les implications cliniques de ces résultats sont discutées. From the patient's point of view, pain control is one of the critical aspects of medical care. Recent research with diverse populations has shown that pain may be one of the basic dimensions of the quality of life of medical patients [11. Despite this, there is very little systematic information concerning pain in end-stage renal disease (ESRD) patients. While clinical impressions strongly suggest that technical advances have greatly reduced the incidence and severity of pain problems for dialysis patients, there is little empirical evidence to support this view. Recent research concerning dialysis pain has focused on limited populations with one specific type of pain [2-4] or has included pain as one of a number of dialysis-related complications [5]. To the authors' knowledge, controlled re-
Cognitive impairment has been documented in uremia with partial improvement after dialysis. Noctu... more Cognitive impairment has been documented in uremia with partial improvement after dialysis. Nocturnal daily hemodialysis (NHD) is a novel dialysis modality with multiple benefits. Previous reports have shown marked improvements in quality of life, cardiac function, resolution of peripheral vascular disease, and reversal of central sleep apnea. We hypothesized that patients maintained on NHD would have better cognitive functioning than those receiving conventional therapy. Using a longitudinal study design, patients were tested at baseline and again after X6 months NHD. At each of the two time points, a battery of 10 neuropsychological tests were used to evaluate three domains of cognitive functioning -attention and working memory skills, psychomotor efficiency and processing speed, and learning efficiency. Clinical subjective symptoms for cognitive functioning and depression were measured using the Patients Assessment of Own Functioning inventory and the Beck Depression Index. Twelve patients (six males, six females) were recruited. Patients were aged 39.673.3 years at the time of first testing. Thirty-three percent were diabetic, with a mean Charlson comorbidity score of 3.572.0. Depression (defined as 416 on the Beck Depression Index score) was not seen in any patient. Over the 6-month period, a 22% reduction in cognitive symptoms (P ¼ 0.01), 7% improvement in psychomotor efficiency and processing speed (P ¼ 0.02), and 32% improvement in attention and working memory (P ¼ 0.04) was seen. Learning efficiency scores were unchanged. NHD may be associated with improved general cognitive efficiency as measured by psychomotor efficiency and attention and working memory.
Objective: This prospective study examined sex differences in illness intrusiveness and in baseli... more Objective: This prospective study examined sex differences in illness intrusiveness and in baseline predictors of illness intrusiveness in cardiac patients' I-year postcardiac event. Methods: Patients diagnosed with a myocardial infarction (MI) or unstable angina (UA) completed a baseline questionnaire during their hospitalization (139 men and 104 women). Eighty-one men and 67 women completed the follow-up questionnaire I-year postcardiac event. The questionnaire included measures of illness intrusiveness in three life domains, depressive symptomatology, social support, medical information, risk factors for heart disease, and sociodemographic information. Results: A MANCOVA with the three I1lness Intrusiveness subscales as dependent variables, sex as the betweengroup factor, and partnership status as a covariate found a sex effect for the Intimacy subscale, but not for the Instrumental and the Relationships/Personal Development subscales. Men reported more intrusiveness in the Intimacy domain of their life as compared to women. After controlling for sociodemographic factors and risk
In this study, the authors both developed and validated a self-report mindfulness measure, the To... more In this study, the authors both developed and validated a self-report mindfulness measure, the Toronto Mindfulness Scale (TMS). In Study 1, participants were individuals with and without meditation experience. Results showed good internal consistency and two factors, Curiosity and Decentering. Most of the expected relationships with other constructs were as expected. The TMS scores increased with increasing mindfulness meditation experience. In Study 2, criterion and incremental validity of the TMS were investigated on a group of individuals participating in 8-week mindfulness-based stress reduction programs. Results showed that TMS scores increased following treatment, and Decentering scores predicted improvements in clinical outcome. Thus, the TMS is a promising measure of the mindfulness state with good psychometric properties and predictive of treatment outcome.
Objective-Evaluate the feasibility of implementing a combined in-hospital and home-based exercise... more Objective-Evaluate the feasibility of implementing a combined in-hospital and home-based exercise program in older hemodialysis (HD) patients. Setting-A university hospital HD unit and patients' homes. Participants-A convenience sample of 9 older (>55years) patients undergoing HD.
Always cite the published version, so the author(s) will receive recognition through services tha... more Always cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the TSpace version (original manuscript or accepted manuscript) because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page.
There has been substantial interest in mindfulness as an approach to reduce cognitive vulnerabili... more There has been substantial interest in mindfulness as an approach to reduce cognitive vulnerability to stress and emotional distress in recent years. However, thus far mindfulness has not been defined operationally. This paper describes the results of recent meetings held to establish a consensus on mindfulness and to develop conjointly a testable operational definition. We propose a two-component model of mindfulness and specify each component in terms of specific behaviors, experiential manifestations, and implicated psychological processes. We then address issues regarding temporal stability and situational specificity and speculate on the conceptual and operational distinctiveness of mindfulness. We conclude this paper by discussing implications for instrument development and briefly describing our own approach to measurement.
Sleep complaints are ubiquitous in patients with medical illness. A recent survey of outpatients ... more Sleep complaints are ubiquitous in patients with medical illness. A recent survey of outpatients attending hospital clinics indicated that the vast majority of patients reported sleep disruption concomitant with their condition. The proportion with complaints (> 70%) was more than twice that among control subjects. Doctors rarely ask about sleep problems in the Factors that may indicate a context of medical illness despite the fact that the patient's first complaint disruption of sleep architecture in may be that a particular symptom caused sleep disruption. medically ill patients There are specific reasons for sleep disruptions in patients with medical . Movement arousals (number) illness-for example, people are often deprived of sleep before an 0Feunchgsislesae(eh. operation. Polysomnography has shown that there is a preoperative of sleep) reduction in slow wave sleep and that this is related to the anticipated * Awakenings in first six hours of sleep importance of surgery. The increase in deep sleep that occurs after an (number) operation is thought to facilitate the healing process. * Sleep efficiency ( A variety of sleep variables may be influenced by specific disorders and * Apnoea index particular treatments and each of these effects is likely to differ. A decrease * Leg kicks (total number) in deep (slow wave) sleep, for example, may lead to a sensation of having low energy, whereas repeated interruption of sleep may lead to daytime * Abnormal REM latency * Reduced slow wave sleep corrected for sleepiness. age (% below normal) Drugs may also disrupt sleep architecture by suppressing rapid eye . Total sleep time movement (REM) sleep or by causing a withdrawal effect during the night. * Total sleep time In both cases the drug clearly alters sleep, but the impact on health and * Long awakenings (10 min) recovery may differ. L a. Patterns on electroencephalogram Fatigue is common in several medical conditions. Clinicians, researchers, and patients themselves claim that the fatigue experienced in certain medical conditions differs qualitatively from the experience oftiredness or sleepiness. However, there have been few attempts to separate these states. In this article we provide an overview of the impact of medical disorders on sleep. *Mean (SD) tenderpoint scores are as follows: 3.5 (2-6) in normal people; 16-9 (14-1) in those with chronic fatigue syndrome; 33.0 (11-8) in those with fibromyalgia.
Uploads
Papers by Gerald Devins