Patient participation in multidisciplinary tumor conferences in breast and gynecological cancer care: How patient-centered is the communication?

OBJECTIVE: Patients' participation is part of patient-centeredness, but it is so far unclear whether providers in multidisciplinary tumor conferences (MTCs) with patient participation communicate in a patient-centered way. Our aim is to explore (a) to what extent providers ask questions to breast and gynecological cancer patients during case discussion in MTCs, (b) how providers respond to patients' expressions of emotions during case discussions, and (c) which patient- and context-related characteristics and responses are associated with patients' trust in the treatment team after the case discussion. METHODS: This observational study included survey data and audio recordings of MTCs with patient participation at three breast and gynecological cancer centers. Providers' questions to patients and responses to patients' emotional expressions were coded using the Verona Coding Definitions of Emotional Sequences. The response can be explicitly or non-explicitly related to the emotion and space-reducing or space-providing. Multiple linear regression analysis was used to determine associations between providers' responses, patient- and context-related characteristics, and patients' trust in the treatment team after the case discussion. RESULTS: We analyzed 82 case discussions (77 breast, 5 breast and gynecological cancer patients). Providers asked a total of 646 questions, of which 86% were polar (yes/no). Providers gave 303 responses to a total of 230 emotional expressions by patients. Non-explicit responses were associated with more trust when they were space-providing, but with less trust when space-reducing. CONCLUSIONS: The frequency of providers' closed questions and space-reducing responses to emotions shows that patient-centered communication rarely takes place in MTCs with patient participation.

An evaluation of the risk of airborne transmission of COVID-19 on an inter-city train carriage.

Experiments were conducted in an UK inter-city train carriage with the aim of evaluating the risk of infection to the SARS-CoV-2 virus via airborne transmission. The experiments included in-service CO2 measurements and the measurement of salt aerosol concentrations released within the carriage. Computational fluid dynamics simulations of the carriage airflow were also used to visualise the airflow patterns, and the efficacy of the HVAC filter material was tested in a laboratory. Assuming an infectious person is present, the risk of infection for a 1-h train journey was estimated to be 6 times lower than for a full day in a well-ventilated office, or 10-12 times lower than a full day in a poorly ventilated office. While the absolute risk for a typical journey is likely low, in the case where a particularly infectious individual is on-board, there is the potential for a number of secondary infections to occur during a 1-h journey. Every effort should therefore be made to minimize the risk of airborne infection within these carriages. Recommendations are also given for the use of CO2 sensors for the evaluation of the risk of airborne transmission on train carriages.

Parent/Caregiver Experiences of a CAMHS ADHD Assessment Pathway: A Qualitative Service Evaluation.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by impulsivity, inattention, and hyperactivity. Although the literature has explored the parental impact of living with a child diagnosed with ADHD, less is known about the ADHD assessment journey for children and the parental experiences of this. A recent service evaluation suggested that exploring parental perceptions of a child's ADHD assessment pathway could be beneficial in understanding experiences, gathering ideas for future service development, and collecting service user feedback. AIMS AND OBJECTIVE: The aims were to (a) explore the broad experiences of parents/caregivers accessing the ADHD assessment pathway for their child and (b) explore experiences of remote appointments during the assessment process in consideration of the COVID-19 pandemic. METHODS: Twelve parents of children who had experienced an ADHD assessment within a CAMHS pathway participated in a telephone-based semi-structured interview. This involved gathering experiences of the CAMHS ADHD pathway from a parental perspective. The evaluation implemented a qualitative design. Qualitative data was analyzed through thematic analysis. RESULTS: Results revealed seven main themes. Regarding general experiences of the pathway, parent/caregiver interview responses indicated a sense of relief, feeling understood, and the service being child-focused during the assessment. Difficulties were highlighted within the themes, such as long waiting lists impacting on the child and parent as well as lengthy assessments. In reference to COVID-19 and remote/telephone appointments, interview responses indicated some positives of having remote appointments, such as comfort and convenience. Thus, the strengths of face-to-face communication were highlighted.

Shared-Decision-Making Experiences in Breast Cancer Care with and without Patient Participation in Multidisciplinary Tumor Conferences: A Mixed-Methods-Study.

Purpose: This study aimed (1) to analyze patients' perceived shared decision-making (SDM) experiences over 4 weeks between patients participating or not in multidisciplinary tumor conferences (MTCs) and (2) to analyze the association of patients' active participation in and organizational variables of MTCs with patients' perceived SDM experience directly after MTC. Patients and Methods: From the N=317 patients, this observational study included patient surveys, observations, and audio transcripts from MTCs with (N=82) and without (N=145) patient participation in six breast and gynecologic cancer centers. We performed t tests for within- and between-group comparisons and linear regression with "patients' perceived SDM experiences in MTC" as the dependent variable. Results: Patients' perceived SDM experiences increased at 4 weeks after MTC (p<0.001) with lower perceived SDM experiences for participating versus nonparticipating patients (p<0.001). Linear regression showed that the organizational variable "round table seating arrangement" was significantly associated with higher perceived SDM experiences compared with a theater or U-shape arrangement (beta=-0.38, p=0.043; beta=-0.69, p=0.010) directly after MTC. Conclusion: Results provide first insights into patients' perceived SDM experiences in MTCs. SDM in MTCs is associated with organizational variables of MTCs. A round table seating arrangement in MTCs with patient participation seems important for patients' perceived SDM experiences. The relatively low perceived SDM experiences of participating patients directly after MTC indicates room for improvement, eg concerning patient-centered communication.

Questions and emotional expressions from patients and companions while participating in multidisciplinary tumor conferences in breast and gynecological cancer centers.

OBJECTIVE: To investigate (a) how many questions and negative emotions (cues/concerns) breast and/or gynecologic cancer patients and companions express during their case discussion in multidisciplinary tumor conferences (MTCs), (b) with which topics the emotions are linked, and (c) which patient- and context-related characteristics determine patients' communicative behavior. METHODS: This observational study included audio/video recordings of MTCs with patient participation in three breast and gynecological cancer centers. Using the Verona Coding Definitions of Emotional Sequences, patients' and companions' questions and negative emotions expressed were analyzed. Multiple regression analyses were used to determine associations between communicative behavior and patient- and context-related characteristics. RESULTS: We identified 607 questions and 230 cues/concerns expressed by patients/companions in 82 case discussions in MTCs. The number of questions was significantly associated with the hospital. In case discussions with patients who had need for psychological support and who were accompanied, more questions were asked by patients/companions. CONCLUSION: The results show that active patient participation does not depend only on patient characteristics, but also on the hospital setting. PRACTICE IMPLICATIONS: If cancer centers want to enable patient participation in MTCs, they must define the role of the patient before. Subsequently, conditions must be created to enable this role expectation.

Cytopathic and non-cytopathic bovine viral diarrhoea virus biotypes affect fluid phase uptake and mannose receptor-mediated endocytosis in bovine monocytes.

We have used non-cytopathic (ncp) and cytopathic (cp) bovine viral diarrhoea viruses (BVDV) to determine how the two biotypes affect mannose receptor (MR)-mediated endocytosis and fluid phase uptake in bovine monocytes. We have demonstrated that endocytosis in uninfected monocytes after 1 h of culture was mediated by the MR and fluid phase uptake, and after 24 h of culture it was mediated via fluid phase uptake only. Both cp and ncp BVDV affected the mechanisms of antigen uptake in monocytes. Endocytosis in BVDV infected monocytes, unlike in uninfected cells, was MR-independent and mediated by fluid phase uptake after 1 h of infection. The 24-h-BVDV infection changed the antigen uptake mechanisms to become MR- and fluid phase uptake-dependent. We conclude that antigen uptake, an important antigen presenting cell (APC) function, is affected in the early stage of BVDV infection during the first 24 h, with both BVDV biotypes, cp and ncp, having similar effects on monocyte antigen uptake in cattle. By influencing the early antigen uptake function of APC, BVDV might disrupt the function of monocytes as professional APC and contribute to the specific immunotolerance to BVDV.