Differences in Circulating Extracellular Vesicle and Soluble Cytokines in Older Versus Younger Breast Cancer Patients With Distinct Symptom Profiles.

Because extracellular vesicle (EV)-associated cytokines, both encapsulated and surface bound, have been associated with symptom severity, and may vary over the lifespan, they may be potential biomarkers to uncover underlying mechanisms of various conditions. This study evaluated the associations of soluble and EV-associated cytokine concentrations with distinct symptom profiles reported by 290 women with breast cancer prior to surgery. Patients were classified into older (≥60 years, n = 93) and younger (< 60 years, n = 197) cohorts within two previously identified distinct symptom severity profiles, that included pain, depressive symptoms, sleep disturbance, and fatigue (i.e., High Fatigue Low Pain and All Low). EVs were extracted using ExoQuick. Cytokine concentrations were determined using Luminex multiplex assay. Mann Whitney U test evaluated the differences in EV and soluble cytokine levels between symptom classes and between and within the older and younger cohorts adjusting for Karnofsky Performance Status (KPS) score, body mass index (BMI), and stage of disease. Partial correlation analyses were run between symptom severity scores and cytokine concentrations. Results of this study suggest that levels of cytokine concentrations differ between EV and soluble fractions. Several EV and soluble pro-inflammatory cytokines had positive associations with depressive symptoms and fatigue within both age cohorts and symptom profiles. In addition, in the older cohort with High Fatigue Low Pain symptom profile, EV GM-CSF concentrations were higher compared to the All Low symptom profile (p < 0.05). Albeit limited by a small sample size, these exploratory analyses provide new information on the association between cytokines and symptom profiles of older and younger cohorts. Of note, unique EV-associated cytokines were found in older patients and in specific symptom classes. These results suggest that EVs may be potential biomarker discovery tools. Understanding the mechanisms that underlie distinct symptom class profiles categorized by age may inform intervention trials and offer precision medicine approaches.

Extracellular vesicle associated and soluble immune marker profiles of psychoneurological symptom clusters in men with prostate cancer: an exploratory study.

Psychoneurological symptom clusters are co-occurring and interrelated physiological symptoms that may include cancer-related fatigue, pain, depressive symptoms, cognitive disturbances, and sleep disturbances. These symptoms are hypothesized to share a common systemic proinflammatory etiology. Thus, an investigation of systemic immune biomarkers is an important approach to test this hypothesis. Here, we investigated the associations between extracellular vesicle (EV)-associated and soluble cytokines with immune markers and symptom clusters in men with non-metastatic prostate cancer. This observational study included 40 men with non-metastatic prostate cancer at the start (T1) of external beam radiation therapy (EBRT) and 3 months post treatment (T2), as well as 20 men with non-metastatic prostate cancer on active surveillance (AS) seen at one time point. Collected questionnaires assessed patient-reported fatigue, sleep disturbances, depressive symptoms, and cognitive fatigue. In total, 45 soluble and EV-associated biomarkers in plasma were determined by multiplex assays. Principal component analysis (PCA) was used to identify psychoneurological symptom clusters for each study group and their time points. Bivariate correlation analysis was run for each identified PCA cluster with the concentrations of EV-associated and soluble cytokines and immune markers. Both EV-associated and soluble forms of RANTES significantly correlated with the symptom cluster for EBRT at T1, whereas, at T2, soluble IFNα2, IL-9, and IL-17 correlated with the corresponding symptom cluster. For the AS group, soluble survivin correlated with psychoneurological symptoms. Linking specific inflammatory cytokines with psychoneurological symptom clusters in men receiving prostate cancer treatment can enhance understanding of the underlying mechanisms of this phenomenon and aid in developing targeted interventions.

Hypertension in military veterans is associated with combat exposure and combat injury.

BACKGROUND: Although the long-term effects of combat injury are not well understood, there is emerging concern that exposure to combat environments and subsequent injury may increase the risk of hypertension through changes in inflammatory responses, psychological stress and mental health, and health behaviors. METHODS: Data from the Millennium Cohort Study and the Department of Defense Trauma Registry were used to identify combat-exposed and combat-injured participants. Incident hypertension diagnoses were ascertained from the Millennium Cohort survey. The associations between combat exposure/injury and hypertension risk was estimated using multivariable complementary log-log survival models. RESULTS: The final analysis sample consisted of 38 734 participants. Of these, 50.8% deployed but were not exposed to combat, 48.6% deployed and were exposed to combat, and 0.6% had combat injury. Overall prevalence of hypertension was 7.6%. Compared with participants who deployed but did not experience combat (mild exposure), elevated odds of hypertension were observed among those who experienced combat but not wounded (moderate exposure; AOR, 1.28; 95% CI, 1.19-1.38) and those wounded in combat (high exposure; AOR, 1.46; 95% CI, 1.07-2.00). Sleep duration of less than 4 h (AOR, 1.21; 95% CI, 1.03-1.43), sleep duration of 4-6 h (AOR, 1.16; 95% CI, 1.05-1.29), posttraumatic stress disorder (AOR, 1.54; 95% CI, 1.26-1.87), and overweight (AOR, 1.77; 95% CI, 1.61-1.95) and obese (AOR, 2.77; 95% CI, 2.45-3.12) status were also associated with higher odds of hypertension. CONCLUSION: Results support the hypotheses that combat exposure increases hypertension risk and that combat injury exacerbates this risk.

Diagnostic accuracy in Family Medicine residents using a clinical decision support system (DXplain): a randomized-controlled trial.

BACKGROUND: Clinical reasoning is an essential skill in physicians, required to address the challenges of accurate patient diagnoses. The goal of the study was to compare the diagnostic accuracy in Family Medicine residents, with and without the use of a clinical decision support tool (DXplain http://www.mghlcs.org/projects/dxplain). METHODS: A total of 87 first-year Family Medicine residents, training at the National Autonomous University of Mexico (UNAM) Postgraduate Studies Division in Mexico City, participated voluntarily in the study. They were randomized to a control group and an intervention group that used DXplain. Both groups solved 30 clinical diagnosis cases (internal medicine, pediatrics, gynecology and emergency medicine) in a multiple-choice question test that had validity evidence. RESULTS: The percent-correct score in the Diagnosis Test in the control group (44 residents) was 74.1±9.4 (mean±standard deviation) whereas the DXplain intervention group (43 residents) had a score of 82.4±8.5 (p<0.001). There were significant differences in the four knowledge content areas of the test. CONCLUSIONS: Family Medicine residents have appropriate diagnostic accuracy that can improve with the use of DXplain. This could help decrease diagnostic errors, improve patient safety and the quality of medical practice. The use of clinical decision support systems could be useful in educational interventions and medical practice.

[Teacher's perfomance assessment in Family Medicine specialization]. / Evaluación del desempeño docente en la especialización de Medicina Familiar.

BACKGROUND: In Mexico there is no systematic evaluation of teachers in medical specialties. It is difficult to identify appropriate teaching practices. The lack of evaluation has limited the recognition and improvement of teaching. The objective of this study was to analyze feedback from students about teaching activities of teachers-tutors responsible for the specialization course in family medicine, and evaluate the evidence of reliability and validity of the instrument applied online. METHODS: It was an observational and cross-sectional study. Seventy eight teachers of Family Medicine of medical residency were evaluated by 734 resident´s opinion. The anonymous questionnaire to assess teaching performance by resident's opinion and it is composed of 5 dimensions using a Likert scale. Descriptive and inferential statistics (t test, one-way ANOVA and factor analysis) were used. RESULTS: Residents stated that teaching performance is acceptable, with an average of 4.25 ± 0.93. The best valued dimension was "Methodology" with an average of 4.34 ± .92 in contrast to the "assessment" dimension with 4.16 ± 1.04. CONCLUSION: Teachers of specialization in family medicine have acceptable performance by resident's opinion. The online assessment tool meets the criteria of validity and reliability.

Introducción: en México no hay una evaluación sistemática del desempeño docente en las especializaciones médicas, lo que reduce la posibilidad de identificación de prácticas educativas adecuadas, su mejora y reconocimiento. El estudio pretende analizar la opinión de los residentes acerca de las actividades docentes de los profesores-tutores responsables del curso de especialización en medicina familiar, y valorar la fiabilidad y validez del instrumento aplicado en línea. Método: estudio observacional y transversal, la población de estudio fueron setenta y ocho profesores titulares de medicina familiar de la residencia médica de la Facultad de Medicina de la Universidad Nacional Autónoma de México evaluados por 734 residentes. Se utilizó un cuestionario anónimo de evaluación del desempeño docente por opinión del residente, integrado por 37 enunciados y 5 dimensiones con una escala de respuesta tipo Likert. Se utilizó estadística descriptiva e inferencial (t de Student, ANOVA de un factor y análisis factorial). Resultados: los residentes opinaron que el desempeño docente en general es aceptable, con una media de 4.25 ± 0.93, la dimensión con mayor puntaje fue la de metodología con 4.34 ± 0.92 en contraste con la dimensión de evaluación con la menor media de 4.16 ± 1.04. Conclusiones: los profesores de la especialización tienen un desempeño aceptable según la opinión de los residentes. El instrumento de evaluación en línea reúne los criterios de validez y confiabilidad.

Seguimiento de egresados de la especialidad en Medicina Familiar y el grado de satisfacción de sus empleadores / Follow-Up of Family Medicine Graduates and Degree of Satisfaction of Their Employers

Introducción: el proceso de globalización de la atención a la salud, la educación, la tecnología y las nuevas formas de organización del trabajo, exigen a los países generar mecanismos de evaluación a sus sistemas educativos. Objetivo: conocer el nivel de satisfacción de los empleadores de unidades médicas con relación al desempeño profesional de los médicos egresados Programa de especialización en medicina familiar para médicos generales del Instituto Mexicano del Seguro Social, de la Facultad de Medicina de la Universidad Nacional Autónoma de México. Métodos: estudio observacional, descriptivo y transversal. Se aplicó un cuestionario por profesores de la Subdivisión de Medicina Familiar, de la Facultad de Medicina de la Universidad Nacional Autónoma de México, que constó de 10 preguntas dirigidas a los directivos de las unidades médicas donde trabajaban (antes y después de la especialización), los egresados del Programa de Especialización en Medicina Familiar para Médicos Generales, relacionadas con el grado de satisfacción de las autoridades con el trabajo desempeñado por los médicos egresados de la especialización bajo la modalidad de capacitación en servicio. Resultados: los resultados generales muestran alta satisfacción de los directivos en cuanto al desempeño profesional de los médicos egresados. Conclusiones: para los empleadores, de Especialización en Medicina Familiar para Médicos Generales, produce una alta satisfacción el desempeño profesional de los egresados(AU)

Objective: Know the level of satisfaction of medical units' employers with respect to professional performance of family medicine graduates from the specialization programs for general practitioner of the Mexican social-security, Medical Faculty Institute of the Autonomous National University from Mexico. Methods: An observational, descriptive study was conducted at the Faculty of Medicine of the National Autonomous University of Mexico. A questionnaire of 10 questions was applied to managers of medical units, related to the satisfaction of the authorities with the work performed by doctors specializing graduates in the form of in-service training where graduates worked, before and after specialization, within the specialization program in Family Medicine for General Practitioners. Results: The general results evidence high satisfaction of the executives as to the professional performance of the graduate doctors. Conclusions: High satisfaction is produced by the professional performance of Family Medicine graduates, to the employers(AU)

Análisis de la videograbación como estrategia educativa en la especialidad de medicina familiar en México / Analysis of video recording as an educational strategy in the family medicine specialty in Mexico

Objetivo: incrementar la adquisición de competencias profesionales en los estudiantes de médicina familiar ubicados mayoritariamente en sedes académicas cuya supervisión y asesoría resulta difícil, por distancia, ubicación geográfica y turno laboral. Métodos: se creó un grupo de expertos integrado por nueve profesores que incluyó a tres especialistas en medicina familiar, dos terapeutas familiares, un subespecialista en orientación familiar, un maestro en educación médica, un psiquiatra y una psicóloga. Su misión fue desarrollar un instrumento piloto, que permitiera apreciar la práctica profesional de los médicos a través de los videos. Finalmente, se decidió valorar cinco dimensiones: 1. Imagen personal y profesional, 2. Imagen del consultorio, 3. Comunicación verbal y no verbal, 4. Práctica clínica y 5. Abordaje familiar. Se describen cada una de las dimensiones valoradas. Resultados: se obtuvo una herramienta valiosa para el proceso de enseñanza aprendizaje en medicina familiar, que permitió mejorar las habilidades y destrezas del médico en el abordaje del paciente y la familia así como el asesoramiento del profesor al alumno en el desarrollo de las habilidades clínicas y las actitudes en la consulta cotidiana. Conclusiones: la herramienta presentada es una estrategia educativa que busca finalmente, incrementar las capacidades del médico familiar para que pueda otorgar una mejor atención al paciente y su familia

Objective: to increase the acquisition of professional competences in those family medicine students who are mostly located in academic institutions and are difficult to be supervised and advised, due to distance, geographic location and work shifts. Methods: a group of experts made up of nine professors including three family medicine specialists, two family therapists, a family counseling specialist, a medical education professor, a psychiatrist and a psychologist was created. The mission of this group was to develop a pilot instrument that allows observing the professional practice of the physicians through videos. Finally, five dimensions were chosen to be assessed: 1- personal and professional image, 2- the physician's office image, 3- verbal and non-verbal communication, 4-Clinical practice and 5-Family approach. All these assessed dimensions were described in the paper. Results: a valuable tool for the teaching/learning process was obtained. It allowed improving the abilities and dexterities of the physician in dealing with the patient and the family, as well as the possibilities of the professor for giving advice to the student in terms of development of clinical abilities and individual attitudes in the daily medical work. Conclusions: the tool described in this paper is an educational strategy aimed at increasing the capacities of the family physicians to provide better care to their patients and families