Face and content validity of a holistic assessment questionnaire to assess cancer-related fatigue after breast cancer.

Background and objective: Cancer-related fatigue (CRF) affects the quality of life after breast cancer. In a previous study, we developed a 72-item questionnaire that assesses CRF from a holistic point of view; named the Holistic Assessment of CRF (HA-CRF) questionnaire. The current study assessed the face and content validity of the HA-CRF questionnaire. Methods: Using a mixed-method approach, ten breast cancer survivors (BCS) did a cognitive walkthrough of the HA-CRF via an app followed by a semi-structured interview about relevancy and essentiality (qualitative). In addition, ten health care professionals (HCPs) assessed the relevancy, clarity, and essentiality of each item via a questionnaire (quantitative). Results: BCS indicated minor textual improvement for four items and six items were not completely clear. The app was considered easy to use and the HC-CRF was on average completed in 18 minutes. The HA-CRF questionnaire provided openness about fatigue and gave the feeling of being heard. The items were helpful and induced self-awareness. HCPs indicated 71% of items being very clear or minor revisions proposed by the minority, with 64% of items being essential and 92% considered relevant. Conclusions: The HA-CRF showed good face and excellent content validity. Further research is needed to assess its ability to monitor in daily life.

Development of machine learning models to predict cancer-related fatigue in Dutch breast cancer survivors up to 15 years after diagnosis.

PURPOSE: To prevent (chronic) cancer-related fatigue (CRF) after breast cancer, it is important to identify survivors at risk on time. In literature, factors related to CRF are identified, but not often linked to individual risks. Therefore, our aim was to predict individual risks for developing CRF. METHODS: Two pre-existing datasets were used. The Nivel-Primary Care Database and the Netherlands Cancer Registry (NCR) formed the Primary Secondary Cancer Care Registry (PSCCR). NCR data with Patient Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship (PROFILES) data resulted in the PSCCR-PROFILES dataset. Predictors were patient, tumor and treatment characteristics, and pre-diagnosis health. Fatigue was GP-reported (PSCCR) or patient-reported (PSCCR-PROFILES). Machine learning models were developed, and performances compared using the C-statistic. RESULTS: In PSCCR, 2224/12813 (17%) experienced fatigue up to 7.6 ± 4.4 years after diagnosis. In PSCCR-PROFILES, 254 (65%) of 390 patients reported fatigue 3.4 ± 1.4 years after diagnosis. For both, models predicted fatigue poorly with best C-statistics of 0.561 ± 0.006 (PSCCR) and 0.669 ± 0.040 (PSCCR-PROFILES). CONCLUSION: Fatigue (GP-reported or patient-reported) could not be predicted accurately using available data of the PSCCR and PSCCR-PROFILES datasets. IMPLICATIONS FOR CANCER SURVIVORS: CRF is a common but underreported problem after breast cancer. We aimed to develop a model that could identify individuals with a high risk of developing CRF, ideally to help them prevent (chronic) CRF. As our models had poor predictive abilities, they cannot be used for this purpose yet. Adding patient-reported data as predictor could lead to improved results. Until then, awareness for CRF stays crucial.

A holistic profile for cancer-related fatigue for women with breast cancer - a qualitative study.

Objective: Cancer- related fatigue (CRF) is one of the most reported long-term effects after breast cancer and severely impacts quality of life. To come towards optimal treatment of multidimensional CRF, the first step is to use a holistic approach to develop a holistic patient profile including the patient's experience and impact of CRF on their life. Methods and measures: Four semi- structured focus groups with twenty- seven breast cancer patients and fourteen interviews with healthcare professionals (HCPs) were held. Reflexive thematic analysis was used to define (sub)themes for the holistic patient profile. The themes of the interviews and focus groups were compared for validity. Results: Breast cancer patients and HCPs described the same five major themes, consisting of experience of CRF, impact and consequences, coping, personality, and CRF treatment. Experience of CRF consists of cognitive, emotional, and physical aspects. Impact and consequences include work, family, partner relation, social contact and hobbies, body, and misunderstanding. Coping consists of twelve (mal)adaptive strategies. Personality and CRF treatment were summarised as themes. Conclusions: A first holistic patient profile was introduced for CRF for breast cancer. This profile can be conceptualized into a questionnaire to collect information for personalized treatment recommendations and monitoring of CRF over time.

IgG Stimulates the Formation of Neutrophil Extracellular Traps and Modifies Their Structure.

We studied the neutrophils and monocytes obtained from 37 patients with various inflammatory diseases such as psoriasis, acute infectious process in the abdominal cavity (acute appendicitis/abscess of the abdominal cavity, and acute cholecystitis), acute pancreatitis, and post-COVID syndrome after mild COVID infection. The number and the morphological structure of neutrophil extracellular traps (NET) as well as the effect of IgG on NET were examined. NET were visualized and counted by fluorescence microscopy with fluorescent dye SYBR Green. All the studied types of inflammation were accompanied by spontaneous formation of NET. After application of IgG, the number of NET doubled, their size increased, and transformation of net-like traps into the cloud forms was observed. The clouds form structure of the network is not capable of capturing pathogens with subsequent retraction, the products of its enzymatic degradation can be the factors of secondary alteration. The study results demonstrate a previously unknown mechanism of infection resistance.

Patient preference attributes in eHealth interventions for cancer-related fatigue: A scoping review.

INTRODUCTION: Cancer-related fatigue (CRF) is one of the most reported long-term effects breast cancer patients experience after diagnosis. Many interventions for CRF are effective, however, not for every individual. Therefore, intervention advice should be adjusted to patients' preferences and characteristics. Our aim was to develop an overview of eHealth interventions and their (preference sensitive) attributes. METHODS: eHealth interventions were identified using a scoping review approach. Eligible studies included breast cancer patients and assessed CRF as outcome. Interventions were categorised as physical activity, mind-body, psychological, 'other' or 'combination'. Information was extracted on various (preference sensitive) attributes, like duration, intensity, peer support and costs. RESULTS: Thirty-five interventions were included and divided over the intervention categories. (Preference sensitive) attributes varied both within and between these categories. Duration varied from 4 weeks to 6 months, intensity from daily to own pace. Peer support was present in seven interventions and costs were known for six. CONCLUSION: eHealth interventions exist in various categories, additionally, there is much variation in (preference sensitive) attributes. This provides opportunities to implement our overview for personalised treatment recommendations for breast cancer patients struggling with CRF. Taking into account patients' preferences and characteristics suits the complexity of CRF and heterogeneity of patients.

An empirical model for educational simulation of cervical dilation in first-stage labor.

BACKGROUND: Several models for educational simulation of labor and delivery were published in the literature and incorporated into a commercially available training simulator (CAE Healthcare Lucina). However, the engine of this simulator does not include a model for the clinically relevant indicators: uterine contraction amplitude and frequency, and cervical dilation. In this paper, such a model is presented for the primigravida in normal labor. METHODS: The conceptual and mathematical models represent oxytocin release by the hypothalamus, oxytocin pharmacokinetics, and oxytocin effect on uterine contractions, cervical dilation, and (positive) feedback from cervical dilation to oxytocin release by the hypothalamus. RESULTS: Simulation results for cervical dilation are presented, together with target data for a normal primigravida. Corresponding oxytocin concentrations and amplitude and frequency of uterine contractions are also presented. CONCLUSION: An original empirical model for educational simulation of oxytocin concentration, uterine contractions, and cervical dilation in first-stage labor is presented. Simulation results for cervical dilation match target data for a normal patient. The model forms a basis for taking into account more independent variables and patient profiles and can thereby considerably expand the range of training scenarios that can be simulated.

Density of tobacco retailers and its association with sociodemographic characteristics of communities across New York.

OBJECTIVE: To examine the association of community median income, race/ethnicity and age with the availability of tobacco products in New York State and six subareas. STUDY DESIGN: Spatial regression analysis applied to licensed tobacco retailer and sociodemographic data in 2009 in New York. METHODS: This study assessed the association between tobacco retailer density and four demographic correlates (percentage African American, percentage Hispanic, percentage aged <18 years and median household income) at the census tract level in New York in 2009. Associations were modelled for New York State and six subareas: Greater New York City/Long Island, New York minus Greater New York City/Long Island (rest of State), the Capital region (containing the city of Albany and surrounding areas), Erie County (containing the city of Buffalo), Monroe County (containing the city of Rochester) and Onondaga County (containing the city of Syracuse). In total, 19,420 licensed tobacco retailers were linked to 4795 residential census tracts. RESULTS: In New York State, residential census tracts with higher proportions of African Americans and Hispanics generally had a significantly higher density of tobacco retailers. Census tracts with a higher percentage of residents aged <18 years and higher median household income generally had a significantly lower density of tobacco retailers. However, these associations were not statistically significant in all areas studied. CONCLUSIONS: Tobacco retailers tend to be more densely distributed in areas characterized by high minority or low-income populations, but these associations were not found in all areas. This may suggest that policy measures to reduce the density of tobacco retailers may be more effective at reducing disparities in tobacco availability and exposure to point-of-sale advertising in some areas than in others.

Web sites selling cigarettes: how many are there in the USA and what are their sales practices?

OBJECTIVES: To estimate the number and geographic location of web sites selling cigarettes in the USA, and to examine their sales and marketing practices. METHODS: Comprehensive searches were conducted using four keyword terms and five popular internet search engines, supplemented by sites identified in a news article. Over 1800 sites were examined to identify 88 internet cigarette vendors. MEASURES: Trained raters examined the content of each site using a standardised coding instrument to assess geographic location, presence of warnings, products sold, and promotional strategies. SETTING: USA. RESULTS: Internet cigarette vendors were located in 23 states. Nearly half (n = 43) were located in New York state, and many were in tobacco producing states with low cigarette excise taxes. Indian reservations housed 49 of the 88 sites. Only 28.4% of sites featured the US Surgeon General's health warnings and 81.8% featured minimum age of sale warnings. Nearly all sites (96.6%) sold premium or value brand cigarettes, 21.6% sold duty-free Marlboros, and 8.0% sold bidis. Approximately one third featured special promotional programmes. CONCLUSIONS: Internet cigarette vendors present new regulatory and enforcement challenges for tobacco control advocates because of the difficulty in regulating internet content and because many vendors are on Indian reservations.

Working with licensed cosmetologists to promote health: results from the North Carolina BEAUTY and Health Pilot Study.

BACKGROUND: Beauty salons are located in all communities and represent a promising channel for delivering health promotion programs. No previous salon-based health promotion program has assessed the needs, interests, and preferences of licensed cosmetologists about sharing health information with their clients. METHODS: Licensed cosmetologists in one town completed a mailed survey assessing (1) health topics typically discussed with clients, (2) interest in delivering messages about beauty and health, and (3) preferred methods for learning about and sharing health information with their clients. RESULTS: The average cosmetologist sees 47 clients per week and spends 30-60 min per appointment. Eighty-two percent report that they are interested in talking about health with their clients. Most cosmetologists already discuss a wide range of health topics with their clients and are most comfortable discussing healthy eating (65.3%), physical activity (63.3%), and dieting (63.3%). Cosmetologists preferred reading pamphlets (55.1%) and watching educational videos (46.9%) to learn about beauty and health. Distributing pamphlets (69.4%), talking with clients (61.2%), and placing posters/mirror stickers in the salons (59.2%) were the methods cosmetologists most preferred for sharing health information with their clients. CONCLUSIONS: Licensed cosmetologists are in a unique position to serve as "natural helpers" by delivering health messages to their clients and reinforcing those messages over time. Partnerships with licensed cosmetologists should be developed to deliver salon-based health promotion programs.

Pulmonary tumor embolism presenting as infarcts on computed tomography.

Pulmonary tumor embolism is a rare cause of respiratory failure in patients with cancer and is only infrequently diagnosed during life. Chest radiographs are usually normal. Dilated and beaded peripheral pulmonary arteries may be present on computed tomography scans. The authors describe an unusual case of pulmonary tumor embolism presenting on computed tomography scans as bilateral, peripheral, wedge-shaped opacities. On autopsy, these opacities corresponded to areas of pulmonary infarction.

Saquinavir, an HIV protease inhibitor, is transported by P-glycoprotein.

Saquinavir, a peptidomimetic HIV protease inhibitor, has been shown to be effective in reducing patient viral load and reducing mortality. In this report we investigated whether saquinavir is a substrate for the multidrug resistance transporter P-glycoprotein (P-gp), which may reduce the effective intracellular concentration of the drug. G185 cells, which highly express P-gp, are resistant to saquinavir-mediated cytotoxicity, and co-administration of cyclosporine reversed this resistance. Saquinavir and saquinavir mesylate inhibited basolateral to apical transport of the fluorescent dye rhodamine 123 in a polarized epithelial transport assay, a result that suggests competition of these drugs for the P-gp transporter. Finally, we measured specific, directional transport of saquinavir and saquinavir mesylate in an epithelial monolayer model. Transport in the basolateral to apical direction was 3-fold greater than apical to basolateral flux for both saquinavir and saquinavir mesylate and was blocked by co-incubation with the established P-gp reversal agents cyclosporine and verapamil. These data provide evidence that saquinavir is a substrate for the P-gp transporter and suggest that this protein may affect intracellular accumulation of the drug and contribute to its poor oral bioavailability.