The philosopher Eugene Gendlin argues that a distinctive mode of reasoning, called experiencing, is necessary for working through personally salient problems such as are encountered in psychotherapy. We review supporting empirical support. It is now possible to consider Gendlin's ideas from a neurological perspective. Work directed at understanding the neurological underpinnings of consciousness and self-related processing, as well as comparative neuroanatomical work, are all consistent with and elucidated by Gendlin's experiencing construct. We argue from this data that the human mind is composed of three interacting systems that are unique to or enhanced in humans compared to other primates. Two are dedicated to "hot and cold" cognition. The most important, least well-studied third system is dedicated to mediating between these forms of cognition. We outline how interactions between these systems define different forms of psychopathology and what they suggest about the structure of the human mind.
Purpose: The purpose of this pilot study was to investigate the impact of an intervention designed to enhance quality of life in newly diagnosed primary brain tumour (PBT) patients. The intervention involved a structured, one time meeting between newly diagnosed PBT patients and trained volunteer "veteran" PBT patients. Methods: Two volunteers met for a single, one-on-one meeting with a total of 10 newly diagnosed PBT patients. A combination of questionnaires and interviews were used to investigate the impact of the intervention for both the new patients and the volunteers. Results: The intervention appeared to be of substantial value for both groups of participants. Analysis revealed that the newly diagnosed patients experienced a range of benefits, including those related to the themes of: increased hope, valued guidance, hearing what it's really like, overcoming aloneness, and receiving a wake up call to what matters. Only relatively minor adverse effects and challenges were reported. Conclusions: The findings provide initial evidence that the developed intervention has the potential to be a safe, useful means of enhancing psycho-social well-being in newly diagnosed PBT patients. Further investigation into the potential of one-to-one, peer support for brain tumour patients is an important research priority.
Introduction: Tumour metastases that involve the scalp are unusual. We report the case of a patient with a lung adenocarcinoma that was metastatic to both the skull and the scalp. Case Report: A 61-year-old female presented with a scalp mass that increased in size from one cm to 10 cm, over a 7-month period. She had a recent history of 20lb weight loss and anorexia. CT scan revealed a soft tissue mass in the left frontal scalp involving the underlying bone and thickening of dura. Magnetic Resonance Imaging (MRI) three months later exhibited rapid growth of the lytic lesion. Bone scan showed no other primary lesions. Intraoperative biopsy specimen displayed histological characteristics of an adenocarcinoma. The patient was pan-scanned and a primary upper lobe lung lesion with extensive hilar lymphadenopathy was identified. She subsequently underwent operative resection of the lesion and cranioplasty. Pathological examination of tumor biopsy showed a moderately differentiated adenocarcinoma characterized by large irregularly shaped acini embedded in a desmoplastic stroma with a mixed acute and chronic inflammatory infiltrate. Mitotic figures were encountered. The neoplastic cells were immunopositive for CK-CAM5.2, CK 7 and TIF-1 (nuclear), and immunonegative for CK 20, features in keeping with adenocarcinoma. Discussion: We describe an unusual case of lung adenocarcinoma that became metastatic to both skull and scalp. The histopathological features and differential diagnosis of such lesions are discussed in the context of the literature. A pilot program at the BC Cancer Agency enlisted trained , experienced primary brain tumour patients (veterans) who had previously completed initial treatment to meet with newly diagnosed brain tumour patients. The veteran patients participated in a training program with a psycho-oncology research clinician, then met with new patients for approximately one hour to answer general questions, provide support and offer information about other available supportive resources for patients and families. Supervision and support were provided to the 2 veterans throughout their meetings with 10 new patients. After the meetings, the new patients and veteran patients responded to questionnaires and exploratory interviews about the benefits and drawbacks of this type of support, resulting in quantitative and qualitative findings concerning the effectiveness of the intervention. There were multiple benefits for new patients and veteran patients alike, and no significant disadvantages for either group. Future directions for research and suggestions for modifications to the intervention are also discussed. Introduction: MGMT promoter methylation is the only confirmed prognostic biomarker for GBM, so determining additional biomarkers is important. We are studying BNIP3 (Bcl-2 Nineteen kDa Interacting Protein), AIF (Apoptosis Inducing Factor), DR5 (Death Receptor 5), and MCL-1 (Myeloid Cell Leukemia Sequence 1). BNIP3 localization to the nucleus confers resistance to temozolomide and represses AIF a...
Conclusion: This pilot study provides a unique mixed quantitative and qualitative understanding of the perceptions of patients with lung cancer and their CGs, and HCPs regarding DNR discussion. Our findings will help further the development of evidence-based guidelines and a broad prospective study that would have important implications for policies and practices around DNR discussions in order to reduce the emotional pain of dying patients, their CGs and HCPs.Purpose/Objective(s): There is abundant evidence and multiple guidelines in support of single fraction (SF) Radiation therapy (RT) for uncomplicated bone metastases (BoM), though a global reluctance to adopt this practice is prevalent. Multiple publications have recently reported on different jurisdictions' rate of SFRT use for BoM. However, it is difficult to interpret these results as the proportion of BoM that are complicated is unknown. We sought to determine the proportion of BoM that are complicated in a population-based RT program in order to act as a potential guide for assessing SFRT utilization rates. In addition, we sought to determine differences in prescribing practices by complicated versus uncomplicated BoM. Materials/Methods: All consecutive patients with BoM treated with RT in 2011 and 2013 were identified in a provincial Canadian cancer registry database. The precise definition of complicated BoM is still debated in literature, and BoM were classified as "complicated" if clinico-radiological features were suggestive of: confirmed fracture and neurological compromise (e.g. spinal cord compression), with or without associated soft tissue mass. Associations between choice of RT fractionation and BoM characterization whether "complicated or not" were confirmed through logistic regression. Results: A total of 6,651 RT courses prescribed to 3,782 patients, with median age of 66 years (range, 18-103 yrs). The most commonly treated skeletal site was spine (56.8%) followed by pelvis (18.2%). Most BoM arose from primary genitor-urinary (26.5%), lung (23.8%), and breast (21.9%) cancers. The incidence of complicated BoM was 32.1%, in decreasing order as a result of an associated soft tissue mass (18.3%), neurological compromise (18.7%), and pathological fracture (6.5%). The most common site of BoM with features of complication was extremity (43.6%), skull (42.7%), and spine (39.2%). Complicated BoM most commonly arose from primary hemato-lymphoid (39.1%), lung (34.2%), gastro-intestinal (32.5%), breast (28.4%), and genitor-urinary (28.4%) cancers. In our program SFRT was prescribed less commonly in complicated versus un-complicated BoM (38.1% vs. 61.4%; p < 0.001), which was confirmed on multivariable analysis (OR 0.40; 95% CI 0.36 e 0.45; p <0.0001). Conclusion: This study found that 32.1% of BoM are complicated by fracture, soft tissue mass, or neurological compromise (i.e. 67.9% were uncomplicated), and that they were less likely to receive SFRT. Given the abundant evidence for SFRT in the setting of un-complicated BoM, and the emerging evidence fo...
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