Exploring differences in symptomatic adverse events assessment between nurses and physicians in the clinical trial setting.

A cross-sectional study was performed at Hebei Medical University Fourth Affiliated Hospital from April to July 2020 to explore the difference and consistency between nurses and physicians in terms of symptomatic adverse event (AE) assessment. The Common Terminology Criteria for Adverse Events (CTCAE) was utilized by nurses and physicians to assess patients' symptomatic AEs. Patients self-reported their AEs utilizing the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Four nurses and three physicians were enrolled to assess patients' symptomatic AEs. Given the same AEs, nurses tended to detect more AEs than physicians, and the differences were statistically significant (P < 0.001). The toxicity grade reported by nurses and physicians showed no difference for all AEs, except for fatigue (χ2 = 5.083, P = 0.024). The agreement between nurses and patients was highest compared to the agreement between nurses versus physicians and physicians versus patients. The differences in symptomatic AE assessment can lead to different symptom management. Thus, it is important to establish a collaborative approach between nurses and physicians to ensure continuity in care delivery.

Health Education and Nursing Needs of Breast Cancer Patients With Totally Implantable Venous Access Ports at Different Stages.

Context: The totally implantable venous access port (TIVAP) is an intravenous-infusion device, with a lower complication rate than other such devices. If patients fail to maintain the catheter, however, complications can still occur. Patients' needs may vary by the period of the port's use. Objective: The study intended to explore the differences in the needs of breast-cancer (BC) patients with TIVAPs for health education and nursing care at different periods of the port's use and to determine the kinds of targeted health education that can improve patients' quality of life. Design: The research team designed a questionnaire that the participants completed. Setting: The study took place at the Breast Center at the Fourth Hospital of Hebei Medical University in Shijiazhuang, China. Participants: Participants were 442 BC patients at the hospital between March and June 2020, who had TIVAPs at different stages. Groups: The study included three groups: (1) the preoperative group-participants in the preoperative period prior to the TIVAP implantation after they had signed a consent; (2) the chemotherapy group-participants in the chemotherapy period during the TIVAP's use for chemotherapy-agent transfusion, and (3) the maintenance group-participants in the maintenance period during which the TIVAD was in place but wasn't being used. Outcome Measures: The research team analyzed the results from the questionnaires, categorizing them as: (1) methods of knowledge acquisition, (2) methods of distribution of knowledge, (3) needs of participants in the different groups, and (4) distribution of symptoms among the groups. Results: Compared to other methods, the nursing staff was the main source that participants used to access the TIVAP-related information at different periods: preoperative group (79.6%), chemotherapy group (90.7%), and maintenance group (90.2%).The differences between the periods were statistically significant (P = .00). A traditional mode of education-the medical staff's explanations-was the most common in all groups: preoperative group (79.6%), chemotherapy group (83.3%), and (3) maintenance group (80.7%). Patients wanted new modes of receiving information: talks, a poster, and a medical system. TIVAP patients paid different amounts of attention to educational contents at the different stages (χ2 = 29.816, P = .00). Conclusions: BC patients' needs for health education and nursing vary at different stages when using TIVAPs. Nurses are the main source of knowledge about TIVAP in different periods for BC patients, and the nurses should obtain multidisciplinary health knowledge to enhance the benefits of the education for patients. The current education for patient is traditional, and hospitals need to implement new modes of education such as medical systems and network platforms, lectures, and posters for health education.

Clinicians versus patients subjective adverse events assessment: based on patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE).

PURPOSE: Adverse events (AEs) assessment by clinicians is a standard practice in a clinical setting. However, studies have found clinicians tend to report fewer AEs, especially subjective AEs. We aimed to explore the difference of subjective AEs assessment between clinicians and patients based on PRO-CTCAE, and to discuss the necessity of incorporating patient into the evaluation of AEs. METHODS: Between April and July 2019, two different questionnaires with the same subjective AEs were given to patients and clinicians in the Day Chemotherapy ward of Breast Center in the Fourth Hospital of HeBei Medical University. Patients completed a Simplified Chinese version of PRO-CTCAE, including six common subjective AEs of chemotherapy: nausea, vomiting, diarrhea, fatigue, pain, and constipation. Clinicians completed the common terminology criteria for adverse events (CTCAE) with the same AEs. General information of enrolled patients and results from the questionnaires were collected and analyzed. RESULTS: 384 paired questionnaires were collected. Clinicians reported less subjective AEs than patients, and the general agreement between patients and clinicians was poor. When considering the grade difference, we utilize weighted kappa coefficient to analysis, and agreement between patients and clinicians was poor (k < 0.4) regardless of the frequency, the severity and interfering with daily life of AEs, and the most discrepancies were within one point. Patients tended to grade severer than the clinician. CONCLUSIONS: The results of this study showed that there were differences between clinicians and patients in subjective adverse events evaluation. Patient reporting of symptoms can be used as a supplementary method to incorporate the current approach to monitor subjective AEs, to improve the timeliness and accuracy of clinical evaluation of subjective AEs.

Dissipation behavior, residue distribution and dietary risk assessment of cyromazine, acetamiprid and their mixture in cowpea and cowpea field soil.

BACKGROUND: Cyromazine and acetamiprid are widely applied as pesticides in agriculture, causing increasing concerns about their residues in crops. In this study, cyromazine, acetamiprid and their mixture were applied to cowpea to investigate their degradation dynamics and perform a dietary risk assessment. RESULTS: The dissipation behavior of cyromazine and acetamiprid in the single- and mixed-pesticide groups followed first-order kinetics, with a linear correlation coefficient of 0.910 to 0.987. The half-lives of cyromazine and acetamiprid were 1.56-11.18 days in the four different matrices. The half-life of cyromazine in the mixed-pesticide group was similar to or even shorter than that in the single-pesticide group. The highest levels of cyromazine and acetamiprid in cowpea occurred with a preharvest interval of 7 days and after two or three applications. These levels are below the maximum residue limits recommended by the Chinese Ministry of Agriculture for cyromazine and acetamiprid in cowpea. The risk quotient of cyromazine and acetamiprid ranged from 0.0018 to 0.0418, and the national estimated short-term intake values of the cyromazine and acetamiprid were far below the acute reference dose as recommended by the European Food Safety Authority. CONCLUSION: These results suggest that the use of cyromazine and acetamiprid and a cyromazine-acetamiprid mixture in cowpea is safe under the Good Agricultural Practices for Chinese fields, and the use of a cyromazine-acetamiprid mixture affords even better results than the application of cyromazine alone. Moreover, the residue dynamics information will support the label claims for the application of cyromazine, acetamiprid and a cyromazine-acetamiprid mixture to cowpea fruit. © 2020 Society of Chemical Industry.

Polycyclic aromatic hydrocarbons in surface sediment from Yangpu Bay, China: Distribution, sources and risk assessment.

The study investigated the occurrence of polycyclic aromatic hydrocarbons (PAHs) in the surface sediment from eleven sites in Yangpu Bay, China in December 2013 (winter) and July 2014 (summer). The 16 US EPA priority PAHs were found in the range of 1583.2-5701.7 ng/g dry weights with an average of 3134.7 ± 1241.3 ng/g in winter and ranged from 2161.8 to 4527.2 ng/g with an average of 3016.6 ± 748.0 ng/g in summer, respectively. The concentrations of the PAHs tended to be relatively high in comparison with other areas from the literatures. The identification using molecular indices analysis indicated that the PAHs originated mainly from pyrogenic and petrogenic sources in most of the sites. According to principle component analysis-multiple linear regression (PCA/MLR) for their source apportionment, the main sources of PAHs were vehicle emissions, petroleum products and biomass combustion. The risk assessment using international sediments quality guidelines and sediments quality criteria indicated that several PAHs, such as Nap, Flu, Phe, Ace, Acy and BghiP in most of the sites would potentially affect organisms in Yangpu Bay.