Prevalence and correlates of anxiety and depressive symptoms after Spontaneous Coronary Artery Dissection (SCAD): a cross-sectional study.

AIMS: Spontaneous coronary artery dissection (SCAD) is recognised as a particularly stressful cause of heart attack. However few studies have documented the prevalence of post-SCAD anxiety and depressive symptoms, or identified patients most at risk. This study documents the prevalence and correlates of post-SCAD anxiety and depressive symptoms. METHOD AND RESULTS: 310 (95% women) SCAD survivors were recruited by the Victor Chang Cardiac Research Institute from a database of 433 SCAD survivors. Participants completed an online questionnaire to gather demographic, medical and psychosocial information, including the Generalised Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Bivariate and multivariate analyses were undertaken to identify the significant demographic, psychosocial and medical correlates of post-SCAD anxiety and depressive symptoms. Time between SCAD and questionnaire completion varied from 2 months to 18 years (mean = 5.5 years; SD = 3.5 years). Rates of anxiety and depressive symptoms were 20.7% (GAD-7 ≥ 10) and 20.9% (PHQ-9 ≥ 10) respectively, and did not vary by time since event. In bivariate analyses, correlates (p < .05) of anxiety and depressive symptoms were absence of a close confidante, financial strain, mental health diagnosis pre-SCAD, comorbid obesity, not being in paid employment (anxiety only), younger age (depression only), and not knowing another SCAD survivor (depression only). Variables retained in multivariate models were absence of a close confidante, financial strain, not being in paid employment, mental health diagnosis pre-SCAD (depression only), and younger age (depression only). CONCLUSION: This study demonstrated that over one in four SCAD survivors experience either anxiety or depressive symptoms after SCAD, and identified those who may need additional support in their psychological recovery.

Correction: Psychosocial and lifestyle impacts of spontaneous coronary artery dissection: A quantitative study.

[This corrects the article DOI: 10.1371/journal.pone.0296224.].

Evaluation of short-term hair follicle storage conditions for maintenance of RNA integrity.

Hair follicles provide an easily accessible tissue for interrogating gene expression for multiple purposes in mammals. RNAlater® is a liquid storage solution that stabilises and preserves cellular RNA, eliminating the need to immediately process or freeze tissue specimens. The manufacturer advises storage of samples at 2-8°C overnight before transfer to -20°C. This study aimed to evaluate RNA integrity in hair follicle samples collected from horses, stabilized in RNAlater®, and stored under three short-term storage conditions. Mane hair samples complete with follicles were collected from four horses at a single time point. Approximately 15 hairs were placed in each of three 2 mL tubes containing 0.75ml RNAlater® solution. Test group A was stored at 4°C for 24-h, then decanted and stored at -20°C. Test groups B and C were stored at 4°C and 19°C (room temperature) respectively for 7 days, then decanted and stored at -20°C. RNA was isolated from all samples and RNA quantity and quality were measured. One-way ANOVA revealed no difference in RNA concentration (A:516 +/-125 ng/ml, B:273+/-93 ng/ml, C:476+/-176 ng/ml;P = 0.2) or quality (A:9.5 +/-0.19, B:9.8+/-0.09, C:9.2+/-0.35 RIN; P = 0.46) between the test groups. There were no group differences in mean Cycle Threshold values from qPCR validation assays confirming high-quality template cDNA. The results suggest that storage of hair follicles for one week in RNAlater® at cool or room temperature conditions will not compromise RNA integrity and will permit extended transport times from remote sampling locations without the need for freezing.

Prevention and Management of Osteoradionecrosis in Patients With Head and Neck Cancer Treated With Radiation Therapy: ISOO-MASCC-ASCO Guideline.

PURPOSE: To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients with cancer. METHODS: The International Society of Oral Oncology-Multinational Association for Supportive Care in Cancer (ISOO-MASCC) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials and observational studies, published between January 1, 2009, and December 1, 2023. The guideline also incorporated systematic reviews conducted by ISOO-MASCC, which included studies published from January 1, 1990, through December 31, 2008. RESULTS: A total of 1,539 publications were initially identified. There were 487 duplicate publications, resulting in 1,052 studies screened by abstract, 104 screened by full text, and 80 included for systematic review evaluation. RECOMMENDATIONS: Due to limitations of available evidence, the guideline relied on informal consensus for some recommendations. Recommendations that were deemed evidence-based with strong evidence by the Expert Panel were those pertaining to best practices in prevention of ORN and surgical management. No recommendation was possible for the utilization of leukocyte- and platelet-rich fibrin or photobiomodulation for prevention of ORN. The use of hyperbaric oxygen in prevention and management of ORN remains largely unjustified, with limited evidence to support its practice.Additional information is available at www.asco.org/head-neck-cancer-guidelines.

Does coping style mediate the relationship between knowledge and psychosocial outcomes in women with atrial fibrillation?

Introduction: In patients affected by atrial fibrillation (AF) disease-specific knowledge and coping style may be associated with psychosocial well-being. This study aimed to determine if coping style (problem-focused, emotion-focused, avoidance-focused) mediated the relationship between patient knowledge and three psychosocial outcomes (anxiety, depression and life satisfaction). Methods: In 2021 a total of 188 women with reported AF, and ages ranging from 18 to 83 years (mean 48.7, sd 15.5 years), completed an online questionnaire consisting of sociodemographic, clinical and AF knowledge questions and psychosocial instruments (Anxiety and depression, the Hospital Anxiety and Depression (HADS) scale; life satisfaction, Satisfaction With Life Scale (SWLS); and coping style (Brief COPE). Using Jamovi statistical software three individual mediational models (for anxiety, depression and life satisfaction) were constructed assessing the direct and indirect relationships between knowledge, coping style and each psychosocial outcome. Age was a covariate in each model. Results: The mediation analyses demonstrated significant direct negative associations between AF knowledge and HADS anxiety and depression and positive associations with SWLS. There were also direct associations between each of the three coping styles and the three psychosocial outcomes. There were significant indirect effects of coping style between AF knowledge and each of the three outcomes confirming partial mediation effects. Discussion: These findings highlight the crucial role of coping style in mediating the association between AF knowledge and psychosocial outcomes. As such, interventions aimed at increasing patient knowledge of AF may be more effective if adaptive problem-solving coping strategies are also demonstrated to these patients. Additionally, modification of maladaptive coping strategies as part of the psychological management of patients with AF is highly recommended.

Equine Headshaking Syndrome: Triggers, Seasonality, and Treatment Efficacy in Australia.

Equine headshaking syndrome is a poorly understood neuropathic pain condition presenting as uncontrollable shaking, flicking, or striking of the head. Therapeutic options are limited, and treatments are only partially successful. Currently, epidemiological information on headshaking in the Southern Hemisphere is lacking. An online survey was circulated to Australian owners of headshaking horses to collect information on triggers, symptoms, seasonality, treatments, and perceived treatment efficacy. The responses (n = 216) showed the mean age at symptom onset as 9.6 (±4.7) years. More geldings were affected than mares (76% vs. 24%), and symptom onset occurred later in geldings compared to mares (10.1 ± 4.7 vs. 7.9 ± 4.0 years; p < 0.01). Bright sunlight, wind, and high pollen were the most commonly reported triggers (61%, 46% and 40%, respectively), and seasonal onset of symptoms was reported by 54% of respondents. In total, 71% of respondents reported using two or more treatments. The most common treatments were supplements (68%), nose nets (63%), light-blocking masks (48%), bodywork (48%) and pharmaceutical compounds (38%). Overall, treatments were considered ineffective by 33% of respondents. The findings were in agreement with surveys from the Northern Hemisphere. Of note was the perception of bright light as a primary trigger, alongside the reported low treatment efficacy of light-blocking masks. Seasonal intensification of symptoms and its relationship to day length merits further exploration.

One Health: Circadian Medicine Benefits Both Non-human Animals and Humans Alike.

Circadian biology's impact on human physical health and its role in disease development and progression is widely recognized. The forefront of circadian rhythm research now focuses on translational applications to clinical medicine, aiming to enhance disease diagnosis, prognosis, and treatment responses. However, the field of circadian medicine has predominantly concentrated on human healthcare, neglecting its potential for transformative applications in veterinary medicine, thereby overlooking opportunities to improve non-human animal health and welfare. This review consists of three main sections. The first section focuses on the translational potential of circadian medicine into current industry practices of agricultural animals, with a particular emphasis on horses, broiler chickens, and laying hens. The second section delves into the potential applications of circadian medicine in small animal veterinary care, primarily focusing on our companion animals, namely dogs and cats. The final section explores emerging frontiers in circadian medicine, encompassing aquaculture, veterinary hospital care, and non-human animal welfare and concludes with the integration of One Health principles. In summary, circadian medicine represents a highly promising field of medicine that holds the potential to significantly enhance the clinical care and overall health of all animals, extending its impact beyond human healthcare.

Psychosocial and lifestyle impacts of spontaneous coronary artery dissection: A quantitative study.

INTRODUCTION: Recent studies suggest that acute myocardial infarction due to spontaneous coronary artery dissection (SCAD) carries significant psychosocial burden. This survey-based quantitative study builds on our earlier qualitative investigation of the psychosocial impacts of SCAD in Australian SCAD survivors. The study aimed to document the prevalence and predictors of a broad range of psychosocial and lifestyle impacts of SCAD. METHOD: Australian SCAD survivors currently enrolled in the Victor Chang Cardiac Research Institute genetics study were invited to participate in an online survey to assess the psychosocial impacts of SCAD. Participants completed a questionnaire, developed using findings from our earlier qualitative research, which assessed 48 psychosocial and five lifestyle impacts of SCAD. Participants also provided demographic and medical data and completed validated measures of anxiety and depression. RESULTS: Of 433 SCAD survivors invited to participate, 310 (72%) completed the questionnaire. The most common psychosocial impacts were 'shock about having a heart attack' (experienced by 87% respondents), 'worry about having another SCAD' (81%), 'concern about triggering another SCAD' (77%), 'uncertainty about exercise and physical activity' (73%) and 'confusion about safe levels of activity and exertion' (73.0%) and 'being overly aware of bodily sensations' (73%). In terms of lifestyle impacts, the SCAD had impacted on work capacity for almost two thirds of participants, while one in ten had sought financial assistance. The key predictors of psychosocial impacts were being under 50, current financial strain, and trade-level education. The key predictors of lifestyle impacts were being over 50, SCAD recurrence, trade-level education, and current financial strain. All psychosocial impacts and some lifestyle impacts were associated with increased risk of anxiety and/or depression. CONCLUSION AND IMPLICATIONS: This quantitative study extends our previous qualitative investigation by documenting the prevalence of each of 48 psychosocial and five lifestyle impacts identified in our earlier focus group research, and by providing risk factors for greater SCAD impacts. The findings suggest the need for supports to address initial experiences of shock, as well as fears and uncertainties regarding the future, including SCAD recurrence and exercise resumption. Support could be targeted to those with identified risk factors. Strategies to enable SCAD survivors to remain in or return to the paid workforce are also indicated.

Co-designing an online treatment decision aid for men with low-risk prostate cancer: Navigate.

Objectives: To develop an online treatment decision aid (OTDA) to assist patients with low-risk prostate cancer (LRPC) and their partners in making treatment decisions. Patients and methods: Navigate, an OTDA for LRPC, was rigorously co-designed by patients with a confirmed diagnosis or at risk of LRPC and their partners, clinicians, researchers and website designers/developers. A theoretical model guided the development process. A mixed methods approach was used incorporating (1) evidence for essential design elements for OTDAs; (2) evidence for treatment options for LRPC; (3) an iterative co-design process involving stakeholder workshops and prototype review; and (4) expert rating using the International Patient Decision Aid Standards (IPDAS). Three co-design workshops with potential users (n = 12) and research and web-design team members (n = 10) were conducted. Results from each workshop informed OTDA modifications to the OTDA for testing in the subsequent workshop. Clinician (n = 6) and consumer (n = 9) feedback on usability and content on the penultimate version was collected. Results: The initial workshops identified key content and design features that were incorporated into the draft OTDA, re-workshopped and incorporated into the penultimate OTDA. Expert feedback on usability and content was also incorporated into the final OTDA. The final OTDA was deemed comprehensive, clear and appropriate and met all IPDAS criteria. Conclusion: Navigate is an interactive and acceptable OTDA for Australian men with LRPC designed by men for men using a co-design methodology. The effectiveness of Navigate in assisting patient decision-making is currently being assessed in a randomised controlled trial with patients with LRPC and their partners.

Expanding access to telehealth in Australian cardiac rehabilitation services: a national survey of barriers, enablers, and uptake.

Aims: Cardiac rehabilitation (CR) is traditionally delivered in-person; however, the COVID-19 pandemic provided impetus for alternative offerings such as telehealth. We investigated uptake, barriers, and enablers in a national survey during the pandemic in Australia. Methods and results: We surveyed CR programmes between April and June 2021 using professional association networks. The anonymous online questionnaire addressed programme characteristics, COVID-19 impacts, and barriers to and enablers of telehealth use. Open-text responses were coded and presented as themes. In total, there were responses from 105 programmes (33% response rate). All states and geographical areas were represented. The use of every modality of telehealth care (telephone, video conferencing, text messaging, and web-based) increased significantly during and after COVID with a strong preference for telephone (85% of services). Respondents perceived video (53%) and telephone (47%) formats as safe and effective for delivering CR. The most common barriers to telehealth were difficulties conducting assessments and reduced engagement with patients. Prominent enablers were increased reach and reduced patient barriers to CR access. Conclusion: Telehealth use by CR programmes increased during the peak pandemic period. However, additional support is required to ensure that telehealth services can be maintained. There is considerable potential to increase the reach of CR by embedding telehealth into existing models of care.

Behavioural and psychological telehealth support for people with cardiac conditions: randomized trial of the 'back on track' self-management programme.

AIMS: Behaviour modification and mood management are essential to recovery after a cardiac event. Recent times have seen a major shift to remote delivery of cardiac services. This study assessed behavioural and psychological outcomes of the Back on Track online self-management programme, comparing the programme undertaken alone (self-directed) vs. with telephone support (supported). Relevance for people with depression was also assessed. METHODS AND RESULTS: Participants with cardiac conditions (n = 122) were randomly assigned to self-directed or supported groups and given access to the online programme for 2 months. The programme addressed depression, anxiety, physical activity, and healthy eating. Supported group participants also received two telephone sessions facilitated by a trained counsellor to further enhance their self-management skills and engagement with the online modules. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Active Australia Survey and Diet Quality Tool were administered at baseline, 2, and 6 months. χ2 tests were used to compare self-directed and supported groups. Cochrane's Q tests assessed changes over time in depression, anxiety, and physical activity (PA) and healthy diet guideline achievement. Participants in both groups showed reduced depression rates (self-directed, P < 0.05) and increased PA after programme completion (both groups, P < 0.05). Amongst those classified as depressed at baseline, significantly fewer were classified as depressed over time (P < 0.001) and significantly more were achieving the PA guidelines (P < 0.01) compared to those who were not depressed at baseline. CONCLUSIONS: The Back on Track telehealth programme was effective in assisting with behavioural and emotional recovery after a cardiac event. The programme may be particularly beneficial for those who are depressed early in their recovery period. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12620000102976.

Longitudinal Pattern of Lymphedema and Fibrosis in Patients With Oral Cavity or Oropharyngeal Cancer: A Prospective Study.

PURPOSE: The study aimed to describe the prevalence, severity, and trajectory of internal lymphedema, external lymphedema, and fibrosis in patients with oral cavity or oropharyngeal (OCOP) cancer. METHODS AND MATERIALS: One hundred twenty patients with newly diagnosed OCOP cancer were enrolled in a prospective longitudinal study. Recruitment was conducted at a comprehensive medical center. Participants were assessed pretreatment; at end of treatment; and at 3, 6, 9, and 12 months post-cancer treatment. Validated clinician-reported measures and computed tomography were used to assess the study outcomes. RESULTS: Seventy-six patients who completed the 9- or 12-month assessments were included in this report. Examination of the external lymphedema and fibrosis trajectories revealed that the total severity score peaked between the end of treatment and 3 months posttreatment and then decreased gradually over time but did not return to baseline by 12 months posttreatment (P < .001). The longitudinal patterns of severity scores for patients treated with surgery only or with multimodality therapy were similar. Examination of the internal swelling trajectories revealed that all patients experienced a significant increase in sites with swelling immediately posttreatment. For patients treated with surgery only, swelling was minimal and returned to baseline by 9 to 12 months posttreatment. Patients receiving multimodal treatment experienced a gradual decrease in number of sites with swelling during the 12-month posttreatment period that remained significantly above baseline (P < .05). Computed tomography revealed different patterns of changes in prevertebral soft tissue and epiglottic thickness in the surgery-only and multimodality treatment groups during the 12-month posttreatment period. There were minimal changes in thickness in both regions in the surgery-only group. Patients with multimodal treatment had significant increases in thickness in both regions 3 months posttreatment that remained thicker at 12 months than at baseline (P < .001). CONCLUSIONS: Lymphedema and fibrosis are the common complications of OCOP cancer therapy. Routine assessment, monitoring, and timely treatment of lymphedema and fibrosis are critical.

Frontal and anterior temporal hypometabolism post chemoradiation in head and neck cancer: A real-world PET study.

BACKGROUND AND PURPOSE: Adverse neurological effects after cancer therapy are common, but biomarkers to diagnose, monitor, or risk stratify patients are still not validated or used clinically. An accessible imaging method, such as fluorodeoxyglucose positron emission tomography (FDG PET) of the brain, could meet this gap and serve as a biomarker for functional brain changes. We utilized FDG PET to evaluate which brain regions are most susceptible to altered glucose metabolism after chemoradiation in patients with head and neck cancer (HNCa). METHODS: Real-world FDG PET images were acquired as standard of care before and after chemoradiation for HNCa in 68 patients. Linear mixed-effects voxelwise models assessed changes after chemoradiation in cerebral glucose metabolism quantified with standardized uptake value ratio (SUVR), covarying for follow-up time and patient demographics. RESULTS: Voxelwise analysis revealed two large clusters of decreased glucose metabolism in the medial frontal and polar temporal cortices following chemoradiation, with decreases of approximately 5% SUVR after therapy. CONCLUSIONS: These findings provide evidence that standard chemoradiation for HNCa can lead to decreased neuronal glucose metabolism, contributing to literature emphasizing the vulnerability of the frontal and anterior temporal lobes, especially in HNCa, where these areas may be particularly vulnerable to indirect radiation-induced injury. FDG PET shows promise as a sensitive biomarker for assessing these changes.

Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study.

AIMS: To examine healthcare professional's knowledge about assessment and management of sleep disorders for cardiac patients and to describe the barriers to screening and management in cardiac rehabilitation settings. DESIGN: A qualitative descriptive study. Data were collected via semi-structured interviews. METHODS: In March 2022, a total of seven focus groups and two interviews were conducted with healthcare professionals who currently work in cardiac rehabilitation settings. Participants included 17 healthcare professionals who had undertaken cardiac rehabilitation training within the past 5 years. The study adheres to the consolidated criteria for reporting qualitative research guidelines. An inductive thematic analysis approach was utilized. RESULTS: Six themes and 20 sub-themes were identified. Non-validated approaches to identify sleep disorders (such as asking questions) were often used in preference to validated instruments. However, participants reported positive attitudes regarding screening tools provided they did not adversely affect the therapeutic relationship with patients and benefit to patients could be demonstrated. Participants indicated minimal training in sleep issues, and limited knowledge of professional guidelines and recommended that more patient educational materials are needed. CONCLUSION: Introduction of screening for sleep disorders in cardiac rehabilitation settings requires consideration of resources, the therapeutic relationship with patients and the demonstrated clinical benefit of extra screening. Awareness and familiarity of professional guidelines may improve confidence for nurses in the management of sleep disorders for patients with cardiac illness. IMPACTS: The findings from this study address healthcare professionals' concerns regarding introduction of screening for sleep disorders for patients with cardiovascular disease. The results indicate concern for therapeutic relationships and patient management and have implications for nursing in settings such as cardiac rehabilitation and post-cardiac event counselling. REPORTING METHOD: Adherence to COREQ guidelines was maintained. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution as this study explored health professionals' experiences only.

Incidence and impacts of post-cardiac event mental health problems.

BACKGROUND: Acute cardiac events confer an increased risk of mental health problems, which compromise physical recovery and increase the risk of recurrence and premature mortality. OBJECTIVE: This paper provides an overview of the nature, prevalence, predictors and impacts of post-cardiac event mental health problems, and outlines the benefits of mental health screening, effective treatments for mental health problems and the role of general practitioners (GPs) in the identification and management of mental health problems in cardiac patients. DISCUSSION: Post-event mental health problems are common, yet gaps exist in their identification and management in acute inpatient, cardiac rehabilitation and primary care settings. Effective screening tools and treatment options are available and have been shown to improve not only mental health, but also cardiovascular outcomes. GPs are well placed to contribute to the identification and management of post-event mental health problems provided they are equipped with adequate information about treatment and referral options.

Molecular signature incorporating the immune microenvironment enhances thyroid cancer outcome prediction.

Genomic and transcriptomic analysis has furthered our understanding of many tumors. Yet, thyroid cancer management is largely guided by staging and histology, with few molecular prognostic and treatment biomarkers. Here, we utilize a large cohort of 251 patients with 312 samples from two tertiary medical centers and perform DNA/RNA sequencing, spatial transcriptomics, and multiplex immunofluorescence to identify biomarkers of aggressive thyroid malignancy. We identify high-risk mutations and discover a unique molecular signature of aggressive disease, the Molecular Aggression and Prediction (MAP) score, which provides improved prognostication over high-risk mutations alone. The MAP score is enriched for genes involved in epithelial de-differentiation, cellular division, and the tumor microenvironment. The MAP score also identifies aggressive tumors with lymphocyte-rich stroma that may benefit from immunotherapy. Future clinical profiling of the stromal microenvironment of thyroid cancer could improve prognostication, inform immunotherapy, and support development of novel therapeutics for thyroid cancer and other stroma-rich tumors.

Increased microglia activation in late non-central nervous system cancer survivors links to chronic systemic symptomatology.

Prolonged inflammatory expression within the central nervous system (CNS) is recognized by the brain as a molecular signal of "sickness", that has knock-on effects to the blood-brain barrier, brain-spinal barrier, blood-cerebrospinal fluid barrier, neuro-axonal structures, neurotransmitter activity, synaptic plasticity, neuroendocrine function, and resultant systemic symptomatology. It is concurred that the inflammatory process associated with cancer and cancer treatments underline systemic symptoms present in a large portion of survivors, although this concept is largely theoretical from disparate and indirect evidence and/or clinical anecdotal reports. We conducted a proof-of-concept study to link for the first time late non-CNS cancer survivors presenting chronic systemic symptoms and the presence of centralized inflammation, or neuroinflammation, using TSPO-binding PET tracer [11 C]-PBR28 to visualize microglial activation. We compared PBR28 SUVR in 10 non-CNS cancer survivors and 10 matched healthy controls. Our data revealed (1) microglial activation was significantly higher in caudate, temporal, and occipital regions in late non-central nervous system/CNS cancer survivors compared to healthy controls; (2) increased neuroinflammation in cancer survivors was not accompanied by significant differences in plasma cytokine markers of peripheral inflammation; (3) increased neuroinflammation was not accompanied by reduced fractional anisotropy, suggesting intact white matter microstructural integrity, a marker of neurovascular fiber tract organization; and (4) the presentation of chronic systemic symptoms in cancer survivors was significantly connected with microglial activation. We present the first data empirically supporting the concept of a peripheral-to-centralized inflammatory response in non-CNS cancer survivors, specifically those previously afflicted with head and neck cancer. Following resolution of the initial peripheral inflammation from the cancer/its treatments, in some cases damage/toxification to the central nervous system occurs, ensuing chronic systemic symptoms.

Patients' perspective of quality-of-care and its correlation to quality-of-life following spontaneous coronary artery dissection.

AIM: Spontaneous coronary artery dissection (SCAD) is an under-recognised cause of myocardial infarction. We aimed to investigate SCAD survivors' perceptions of their quality-of-care and its relationship to quality-of-life. METHODS AND RESULTS: An anonymous survey was distributed online to SCAD survivors involved in Australian SCAD support groups, with 172 (95.3% female, mean age 52.6 ± 9.2 years) participants in the study. The survey involved assessment of quality-of-life using a standardised questionnaire (EQ-5DTM-3L). Respondents rated the quality-of-care received during their hospital admission for SCAD a median 8/10 [interquartile range (IQR) 7-10]. Respondents ≤50 years versus >50 years were more likely to perceive that their symptoms were not treated seriously as a myocardial infarction (χ2 = 4.127, df = 1, p < 0.05). Participants rated clinician's knowledge of SCAD a median 4/10 (IQR 2-8) and 7/10 (IQR 3-9) for Emergency and Cardiology clinicians, respectively (p < 0.05). The internet was the most selected source (45.4%) of useful SCAD information. The mean EQ-5DTM summary index was 0.79 (population norm 0.87). 47.2% of respondents reported a mental health condition diagnosis, with 36% of these diagnosed after their admission with SCAD. Quality-of-life was significantly associated with perceived quality-of-care: EQ-5DTM index/(1-EQ-5DTM index) increased by 13% for each unit increase in quality-of-care after adjusting for age and comorbidities (p < 0.001). CONCLUSION: While SCAD survivors rated their overall hospital care highly, healthcare providers' knowledge of SCAD was perceived to be poor and, the most common source of SCAD information was the internet. Mental health conditions were common, and a significant association was observed between perceived quality-of-care and SCAD survivors' quality-of-life.

Development of a short form of the Cardiac Distress Inventory.

BACKGROUND: Cardiac distress may be viewed as a persistent negative emotional state that spans multiple psychosocial domains and challenges a patient's capacity to cope with living with their heart condition. The Cardiac Distress Inventory (CDI) is a disease-specific clinical assessment tool that captures the complexity of this distress. In busy settings such as primary care, cardiac rehabilitation, and counselling services, however, there is a need to administer briefer tools to aid in identification and screening. The aim of the present study was to develop a short, valid screening version of the CDI. METHODS: A total of 405 participants reporting an acute coronary event in the previous 12 months was recruited from three hospitals, through social media and by direct enrolment on the study website. Participants completed an online survey which included the full version of the CDI and general distress measures including the Kessler K6, Patient Health Questionnaire-4, and Emotion Thermometers. Relationship of the CDI with these instruments, Rasch analysis model fit and clinical expertise were all used to select items for the short form (CDI-SF). Construct validity and receiver operating characteristics in relation to the Kessler K6 were examined. RESULTS: The final 12 item CDI-SF exhibited excellent internal consistency indicative of unidimensionality and good convergent and discriminant validity in comparison to clinical status measures, all indicative of good construct validity. Using the K6 validated cutoff of ≥ 18 as the reference variable, the CDI-SF had a very high Area Under the Curve (AUC) (AUC = 0.913 (95% CI: 0.88 to 0.94). A CDI-SF score of ≥ 13 was found to indicate general cardiac distress which may warrant further investigation using the original CDI. CONCLUSION: The psychometric findings detailed here indicate that the CDI-SF provides a brief psychometrically sound screening measure indicative of general cardiac distress, that can be used in both clinical and research settings.

Factors associated with quality of life among patients with a newly diagnosed oral cavity and oropharyngeal cancer.

PURPOSE: The objectives of this report were 1) to examine the quality of life (QOL) of patients with a newly diagnosed oral cavity or oropharyngeal (OCOP) cancer; and 2) to examine factors contributing to QOL before cancer treatment. METHODS: The sample included 115 participants with a new diagnosis of OCOP cancer. Participants completed the demographic form, oral cancer disease and treatment form, Hospital Anxiety and Depression Scale (HADS), Brief Health Literacy Screen (BHLS), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Pearson correlations and linear regressions were used for data analysis. RESULTS: Participants had a median global health related QOL score of 66.7 (interquartile range, IQR = 50.0, 83.4) with median scores for the subdomains being generally high (all >80 of possible 100). Anxiety and depression were significantly inversely correlated with all areas of EORTC QOL (r = - 0.48 to -0.78, all p < .001). Multivariable associations were strongest with the physical functioning domain (R = 0.56, p < .001), with younger age, higher income, Stage I/II cancer (compared to Stage III/IV) significant contributors to the multiple correlation (beta > ± 0.20, p < .05). CONCLUSIONS: Health care providers should be attentive to OCOP cancer patients with older age, lower household income, advanced cancer stage, and presence of anxious and/or depressive symptoms for indicators of poor QOL. CLINICIANS SHOULD CONSIDER THE BENEFIT OF: initiating supportive interventions before cancer treatment among OCOP cancer patients with poor QOL.