Procainamide-Provoked Brugada Pattern in a Patient Presenting with New-Onset Atrial Fibrillation or Flutter: When Does it Matter?

BACKGROUND: Brugada syndrome (BrS) is an inherited disease that can lead to sudden cardiac death. Medications, such as antidysrhythmics, and fevers can unmask or induce the Brugada pattern on an electrocardiogram (ECG). This case report highlights a patient who developed drug-induced Brugada type I pattern after a procainamide infusion for the treatment of new-onset atrial fibrillation (AF) or flutter and discusses the implications for this incidental but potentially lethal finding. CASE REPORT: We report a case of a young man who presented to the emergency department (ED) with new-onset AF with rapid ventricular response that began within 12 h of presentation. ED treatments included a crystalloid IV fluid bolus, diltiazem pushes, synchronized electrical cardioversion, and a procainamide infusion. After the procainamide infusion, the patient developed ECG findings consistent with Brugada pattern. Both the AF and Brugada pattern resolved spontaneously within 24 h. The patient was discharged without implantable cardioverter defibrillator placement due to presumed isolated procainamide-induced Brugada pattern and lack of concerning features, such as inducible dysrhythmia during electrophysiology study, family history of sudden death, and history of syncope. The patient was counseled to follow-up with genetics and avoid BrS-inducing medications. WHY SHOULD AN EMERGENCY PHYSICIANS BE AWARE OF THIS?: Procainamide, an option for the treatment of AF in the ED, can provoke Brugada pattern. If encountered, it is important to recall that some patients may not be diagnosed with BrS if determined to be low risk according to the Shanghai criteria. All patients should be referred to cardiology for further evaluation.

Polyarticular Septic Arthritis Secondary to Septic Thrombophlebitis of the Brachiocephalic Vein: A Rare Case Report.

BACKGROUND: Polyarticular septic arthritis (PASA) accounts for approximately 15% of all septic arthritides and is rare in immunocompetent adults. Even with appropriate therapy PASA's mortality rate is nearly 50%. CASE REPORT: We report a rare presentation of PASA caused by idiopathic septic thrombophlebitis of the brachiocephalic vein in an immunocompetent adult female patient who presented with symptoms of right clavicular, left wrist, and right hip pain associated with fevers. Methicillin-sensitive Staphylococcus aureus was isolated in blood cultures and joint aspiration of one of the affected hips. Transesophageal echocardiogram was negative for valvular vegetations and computed tomography chest with contrast revealed thrombi in the brachiocephalic and subclavian veins extending to the superior vena cava. It also showed bilateral pulmonary nodules consistent with septic pulmonary emboli. No clear precipitant for the underlying septic thrombophlebitis was identified. Management was conservative, with systemic anticoagulation and IV antibiotics. The patient's symptoms improved, and she was discharged to subacute rehabilitation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early diagnosis and treatment of PASA in the emergency department is imperative to reducing overall morbidity and mortality associated with this condition. To the best of our knowledge, this is the only case report of idiopathic septic thrombophlebitis of the subclavian vein causing PASA in an immunocompetent adult.

eHealth Activity among African American and White Cancer Survivors: A New Application of Theory.

eHealth is a promising resource for cancer survivors and may contribute to reducing racial disparities in cancer survivorship. This research applies the Unified Theory of Acceptance and Use of Technology (UTAUT) to examine eHealth activity among African American (AfAm) and White cancer survivors. In a population-based sample of AfAm and White survivors (n = 300), a Poisson regression tested whether UTAUT constructs (facilitating conditions, social influence, perceived ease of use, perceived usefulness) and beliefs about security/trustworthiness of eHealth were associated with the number of eHealth activities respondents had used. To test whether the effects varied across racial groups, interactions between each of these five facets and survivor race were included in the model. The model adjusted for demographic characteristics, cancer history, and internet access and use. Across racial groups, facilitating conditions (IRR = 1.44, 95%CI [1.17, 1.77]) and perceived usefulness (IRR = 1.16, 95%CI [1.08, 1.24]) were associated with increased eHealth activity. A marginally significant interaction between race and perceived ease of use (IRR = 1.17, 95%CI [0.99, 1.39]) indicated this perception was associated with decreased eHealth activity for White but not AfAm survivors. A significant interaction between race and perceived security/trustworthiness (IRR = 1.16, 95%CI [1.02, 1.32]) indicated this perception was associated with increased eHealth activity for AfAm but not White survivors. Social influence was not associated with eHealth use for either group (IRR = 1.07, 95%CI [0.98, 1.16]). Interventions targeting attitudes about eHealth may encourage its adoption and use. Furthermore, eHealth tools intended for use among AfAm cancer survivors should ensure they are secure and emphasize trustworthiness to intended users.

Age-friendly student senior connection: students' experience in an interprofessional pilot program to combat loneliness and isolation among older adults during the COVID-19 pandemic.

Loneliness and isolation are concerning consequences of social distancing and other stay-at-home orders for older adults globally, amidst the COVID-19 pandemic. To combat loneliness and isolation among older adults residing in California, the Keck School of Medicine collaborated with other health profession schools at the University of Southern California (USC) to create the Age-Friendly Student Senior Connection (AFSSC). A total of 115 interprofessional graduate students were linked with older adults. Students engaged in 30 to 60 minute phone calls with older adults 2 to 5 times per week for 6 weeks. Student preparation included asynchronous video and web-based learning, weekly synchronous de-briefing sessions with a participating faculty member via Zoom, phone, and e-mail support from faculty, and information about resources for older adults. Faculty held weekly meetings throughout the pilot and developed new resources to respond to older adult needs, as reported by students. A total of 102 students completed pre-program and post-program surveys. Preliminary results show statistically significant changes in the reported benefits and outcomes from students participating in the program.

Sexuality After Cancer: A Model for Male Survivors.

INTRODUCTION: For men with cancer, sexual dysfunction is a common issue and has a negative impact on quality of life, regardless of whether he has a partner. In general, sexuality encompasses much more than intercourse; it involves body image, identity, romantic and sexual attraction, and sexual thoughts and fantasies. AIM: Acknowledging that cancer affects multiple physical and psychosocial domains in patients, the authors propose that such changes also inform sexual function for the male survivor. METHODS: An in-depth review of the literature describing alterations to sexual functioning in men with cancer was undertaken. Based on this and the clinical expertise of the authors, a new model was created and is presented. RESULTS: This biopsychosocial model is intended to expand the understanding of male sexuality beyond a purely biomedical model that addresses dysfunction as distinct from the context of a man's life and sexual identity. CONCLUSION: Most data on sexual dysfunction in men with cancer are derived from those with a history of prostate cancer, although other data suggest that men with other types of malignancies are similarly affected. Unfortunately, male sexuality is often reduced to aspects of erection and performance. Acknowledging that cancer affects multiple physical and psychosocial domains in patients, the authors propose that such changes also inform sexual function for the male survivor. This biopsychosocial model might form the basis for interventions for sexual problems after cancer that includes a man and his partner as a complex whole.

Barriers to cancer screening among Orthodox Jewish women.

The increased risk of genetic cancer mutations for Ashkenazi Jews is well known. However, little is known about the cancer-related health behaviors of a subset of Ashkenazi Jews, Orthodox Jews, who are a very religious and insular group. This study partnered with Rabbinical leadership and community members in an Orthodox Jewish community to investigate barriers to cancer screening in this community. Orthodox Jewish women were recruited to participate in focus groups designed to elicit their perspectives on barriers to cancer screening. A total of five focus groups were conducted, consisting of 3-5 members per group, stratified by age and family history of cancer. Focus groups were audio recorded and transcribed. Transcripts were coded using conventional content analysis. The resulting themes identified as barriers to cancer screening were: preservation of hidden miracles, fate, cost, competing priorities, lack of culturally relevant programming, lack of information, and fear. These results provide a unique perspective on barriers to cancer screening in a high risk but understudied population. Findings from this study may serve to inform culturally appropriate cancer education programs to overcome barriers to screening in this and other similar communities.

Breast cancer and sexuality: multi-modal treatment options.

The sexual consequences of breast cancer and its treatments are well known and previously reviewed. Alterations in body image, with or without breast reconstruction, changes in sexual self-esteem and self-efficacy, vulvovaginal atrophy as a result of chemotherapy and/or adjuvant hormone therapy, and loss of libido secondary to dyspareunia and body image issues are common in survivors of breast cancer. Medications that are prescribed for long-term use including those in the class of aromatase inhibitors can have far-reaching implications on quality of life by contributing to vulvar and vaginal atrophic changes. While this is an important issue, there are few widely accepted treatments that have been evaluated for efficacy and safety for these sexual challenges in the breast cancer population. However, progress is being made in finding new and innovative solutions for many of the sexual problems faced by breast cancer survivors and their partners. Many institutions are now compelled to address survivorship concerns and addressing sexuality and intimacy are paramount issues in survivorship care. In this article, we present the evidence for the multimodal approach to the management of sexuality concerns in the breast cancer survivor. Pharmacologic, nonpharmacologic, and psychosocial interventions will be reviewed.

Sexuality After Cancer as an Unmet Need: Addressing Disparities, Achieving Equality.

One extremely important and often neglected aspect of cancer care is sexuality. Sexuality is inherently a human trait, and this does not cease to be true after a cancer diagnosis. Multiple domains comprise sexuality, and all are at risk from cancer and its treatment. Despite the importance of sexual health, it still represents an unmet need in the United States and internationally. The disparities in meeting the sexual health needs of women with cancer extend beyond issues related to genitourinary symptoms of menopause and sexual pleasure; we propose that it extends toward the needs of sexual and gender minorities. Therefore, we focus on the delivery of sexual health care for people with cancer with an emphasis on women, women in low- and middle- income countries, and marginalized sexual and gender minorities.

Feasibility, Acceptability, and Clinical Significance of a Dyadic, Web-Based, Psychosocial and Physical Activity Self-Management Program (TEMPO) Tailored to the Needs of Men with Prostate Cancer and Their Caregivers: A Multi-Center Randomized Pilot Trial.

BACKGROUND: Prostate cancer is the most common cancer diagnosis among men. Family caregivers (often female spouses) play a key role in ensuring patients' needs are met, frequently assuming their role with no formal training, which can contribute to a high burden. The purpose of this study was to pilot TEMPO-the first dyadic, Tailored, wEb-based, psychosocial and physical activity self-Management PrOgram for men with prostate cancer and their caregivers. METHODS: 49 men with prostate cancer and their caregivers were randomized to TEMPO or usual care. Baseline and follow-up questionnaires were completed to assess feasibility, acceptability, and clinical significance. A priori benchmarks for these outcomes were set. Thirteen exit interviews were conducted to further explore acceptability. RESULTS: Feasibility benchmarks were met with the exception for recruitment with on average 6.1 dyads recruited/month (benchmark: 8 dyads/month). Benchmarks of acceptability focused on attrition (<25%) and system usability, which were met. Using the strict criteria for adherence of 100% of the module viewed and participants spending at least 15 min on the module, 45% of participants were adherent. The clinical significance on anxiety and quality of life was supported for caregivers, and mostly supported for the men with prostate cancer. CONCLUSION: This pilot trial was successful, with minor modifications needed prior to a large trial.

A longitudinal family-level model of Arab Muslim adolescent behavior problems.

Arab-American Muslim adolescents in immigrant families face a number of challenges that put them at risk for behavior problems. This study of Arab-American Muslim Adolescents and their relatively recent immigrant mothers tested a longitudinal family-level model of adolescent behavior problems. Mother-adolescent dyads (N = 530) completed measures of maternal and adolescent stressors, active and avoidance coping, and social support; maternal distress; quality of mother-child relationship; and adolescent behavior problems at Time 1 and approximately 18 months later. The youth were between the ages of 11 and 15 years at Time 1 and 48.7% were girls. Longitudinal analyses were conducted using latent change modeling with change scores from Time 1 and Time 2 data. Social support facilitated active coping for both mothers and adolescents. Although maternal avoidance coping mediated maternal stressors and its effect on maternal distress, maternal stressors and maternal distress were not related to adolescent behavior problems. The only factor mitigating the effects of adolescent stressors on adolescent behavior problems was the quality of the mother-child relationship. These findings suggest that adolescents are insulated from maternal stress and distress as long as there is a good mother-child relationship.

Keeping your eye on the process: body image, older women, and countertransference.

Research on body image and older women has grown in the past decade. However, there is a gap in the literature regarding body image, older women, and countertransference. This article provides 7 case examples of racially and ethnically diverse women over 60, drawn from MSW student and agency staff supervision, and participant feedback from a national conference on aging workshop. Themes related to loss and grief, adult daughter and aging mother issues, incest, anger, disability, personality disorders, phobic reactions, and shame are discussed. Recommendations and implications for social work practice, education and research are provided.

Smartphone apps for cancer: A content analysis of the digital health marketplace.

OBJECTIVE: The purpose of this study was to examine the state of smartphone applications for cancer intended for the general public with a focus on interactive features, content sources, and application developer affiliations. The level of health provider involvement in screening or appraising application content was also assessed. METHODS: A total of 123 apps were identified for analysis from two major mobile application marketplaces (Apple iTunes = 40; Google Play = 83). Application characteristics were collected, analyzed, and reported. These included the mobile platform, cost, application developer affiliation, date of last update, purpose of application, content sources, and interactive features. RESULTS: In the study sample, 50% of the applications focused on general information for cancer (62/123). Next, this was followed by applications for breast cancer (15%, 19/123) and skin cancer (7%, 8/123). Only 10% of application descriptions (12/123) identified sources for application content. Interactive features included the ability to monitor symptoms, side effects, treatments, and chronic pain (20%, 25/123). Only 3% of the applications (4/123) stated content had been evaluated by health providers. CONCLUSIONS: This study contributes an updated analysis of applications for cancer available in the digital health marketplace. The findings have implications for information quality and supportive resources for cancer care. More transparent information about content sources, organizational affiliations, and level of health provider oversight in screening application content is warranted. Recommendations for improving the quality of cancer applications are also offered.

Acceptability and Usefulness of a Dyadic, Tailored, Web-Based, Psychosocial and Physical Activity Self-Management Program (TEMPO): A Qualitative Study.

Caregivers of men with prostate cancer report high burden, and there is a need to develop cost-effective programs to support them in their roles. This study reports on the acceptability of a dyadic, Tailored, wEb-based, psychosocial and physical activity (PA) self-Management PrOgram called TEMPO. TEMPO was accessed by a convenience sample of 19 men with prostate cancer and their caregivers (n = 18), as well as six health care professionals (HCPs). User feedback was gathered via semi-structured qualitative interviews. Data were analyzed using thematic analysis. Most dyads were satisfied with TEMPO, particularly with the dyadic feature of TEMPO, the focus on goal setting to integrate self-management, and the extensive health library. The patients and caregivers motivated each other as they worked through TEMPO. Most goals to achieve during TEMPO pertained to increasing PA, followed by learning physical symptom management. One unanticipated benefit of TEMPO for the dyads was improved communication. HCPs agreed that TEMPO was a novel approach to online cancer self-management and they echoed the benefits reported by dyads. Key suggestions for improving TEMPO were to reduce repetition, tailor content, add more exercise ideas, and have more printing options. This study provides a strong foundation on which to plan a larger trial.

It Has Always Been About Relationships.

Since the beginning of my nursing career in South Africa, for me, it has always been about relationships. I was three years older than my classmates in nursing school and was married before I graduated, so my social life was separate, but I made friends and enjoyed listening to their dating successes and woes. One of my instructors lived down the road from me, and we spent many an evening talking about nursing. She had worked in Canada's North, and I remember her telling me that it was so cold that her contact lenses froze. Little did I anticipate that, one day, I too would move to Canada (the cold certainly has been a persistent issue for me). In many ways, she was a mentor-although I didn't realize it at the time-and she was certainly an inspiration.

Social Media and Scholarly Publication: What Is the Connection?

A recent post on The Scholarly Kitchen website got me thinking about the role of social media in my professional life. I have young adult children who keep me in the loop about social trends to some extent. They instructed me to join Facebook many years ago and, since then, I have remembered friends' and relatives' birthdays with much greater success. I joined Twitter and, for a time, had a personal as well as professional account. It was difficult to keep those separate, and I eventually stopped tweeting on the personal account. I only use my professional one now and with greater circumspect (no politics and fewer complaints about hotels and airlines). I have an Instagram account where I follow many chefs, winemakers, and artists, and I enjoy the beautiful images that they post.

CE: Obesity-Related Cancer in Women: A Clinical Review.

: There is mounting evidence that obesity is linked to numerous types of cancer that affect both sexes. But the incidence of obesity-related cancers is particularly high among women. Obesity is implicated not only in the development of cancer, but also in cancer recurrence, treatment complications, and poor patient outcomes. Nurses, particularly those caring for women, should be aware of these associations so they may provide effective patient teaching about preventing cancer and mitigating its adverse effects. The author discusses the role of obesity in the development and recurrence of cancer in women; describes weight loss interventions that may reduce cancer risk in overweight or obese patients; and suggests interviewing techniques to help nurses sensitively address the topic of overweight and obesity with their female patients.

The Copyright Issue.

Do you remember the first (or 40th) time you received notification that a manuscript you submitted to a journal was accepted? Did you dance around your office, yell so loudly that the person in the office next door came to check on you, and/or immediately post the news to Facebook and Twitter to ensure that your success would be broadcast to all your friends and relatives? And did you then download the required forms and merrily sign them before scanning or faxing them back to the journal? Like many of you, I have done all of the above.

Storytelling: How We Learn.

The best conference presentations tell a story with an interesting introduction, details in the middle, and a conclusion that leads to new research, questions or answers about practice, and perhaps further research on the topic. So, too, do journal articles, and this publication is dependent on the rigors of quality research to tell stories about our patients and their experiences and make suggestions on how we can effect change.