Women with breast cancer, listening to the unheard voices: A qualitative study

Objective: This is a descriptive qualitative study with the aim of examining experiences of women diagnosed with breast cancer. Method(s): The semi-structured interviews were conducted in the oncology clinic in Al Basheer Hospital in Jordan and included 15 women. Result(s): Several themes were identified such as knowledge before and after diagnosis, side effects of treatment, social and economic problems, lockdown and financial challenges in corona pandemic, coping strategies, and disclosure issues. Appropriate knowledge concerning causes of breast cancer, and side effects of administered drugs were lacking. Additionally, women were not comfortable telling others about their breast cancer diagnosis and considered it a private issue. During the COVID-19 pandemic, they faced many difficulties reaching hospitals, financial struggles, and inability to meet with their loved ones during lockdown. Conclusion(s): This study revealed the diversity of personalities and unique disposition of women regarding all the topics covered in the interviews. These differences should be considered in the support provided to these patients. Copyright © 2023 by Author/s and Licensed by Modestum.

Implementing a dedicated COVID-19 post intensive care unit follow-up clinic to improve the follow-up of patients in a district general hospital

In May 2020, the British Thoracic Society published guidance [1] detailing follow-up for patients discharged from the intensive care unit (ICU) with a diagnosis of acute COVID-19 infection. It advised that patients receive an outpatient follow-up review within 42 days of hospital discharge and a chest radiograph (CXR) within 84 days. We noted that our service was not meeting this standard of care and undertook a quality-improvement project. Methods An initial retrospective analysis of patients discharged between 30 March and 31 May 2020 was undertaken (Phase 1). Data collected included patient demographics, hospital stay, follow-up waiting times and ongoing symptoms (using the C19-YRS (COVID-19 Yorkshire Rehabilitation Scale)). Based on this, we developed a business case to fund a dedicated weekly clinic. After approval, regular telephone clinics started in December 2020. Phase 2 analysed data from patients discharged between 5 October 2020 and 31 March 2021. Results For Phase 1 (n = 23), 8% of patients received an appointment on time, with a mean wait of 111.2 days (SD = 58.9);30.4% of patients received a CXR on time, waiting a mean of 107.1 days (SD = 45). Most common ongoing symptoms were psychological distress (32%), fatigue (19%) and respiratory symptoms (19%). Ten per cent of CXRs showed residual changes. Phase 2 (n = 39) showed a reduction in waiting time to 47.5 days (SD = 12.5), resulting in 62% of patients being followed up on time. The wait for CXRs reduced to 48.1 days (SD = 26), and 80% were on time. The three major symptoms were respiratory (28%), fatigue (22%) and psychological distress (11%);44% of patients showed residual changes on their CXR. Discussion The introduction of a dedicated follow-up service for ICU patients suffering acute COVID-19 reduced waiting times for outpatient review and CXR, aligning our service more closely to national standards of care. Although the three most reported ongoing symptoms remained unchanged, psychological distress reduced and respiratory symptoms increased in Phase 2. The increase in residual changes on CXR reflected this. Improved psychological outcomes may have resulted from improved ICU care, or may have reflected the accelerated nature of the first pandemic period, which included more lockdown measures. The increase in residual changes on CXR in Phase 2 was probably a consequence of the shorter period between discharge and receiving a CXR: a longer time interval ismore likely to demonstrate a greater resolution of opacities.

Identification of Fine-Grained Location Mentions in Crisis Tweets

Identification of fine-grained location mentions in crisis tweets is central in transforming situational awareness information extracted from social media into actionable information. Most prior works have focused on identifying generic locations, without considering their specific types. To facilitate progress on the fine-grained location identification task, we assemble two English tweet crisis datasets and manually annotate them with specific location types. The first dataset contains tweets from a mixed set of crisis events, while the second dataset contains tweets from the global COVID-19 pandemic. We investigate the performance of state-of-the-art deep learning models for sequence tagging on these datasets, in both in-domain and cross-domain settings. © European Language Resources Association (ELRA), licensed under CC-BY-NC-4.0.

The Development of a Complex FEP Program at Semmelweis University

Introduction First episode psychosis (FEP) programs target the first 3-5 years after the first manifestation of a psychotic episode. Although follow-up results after 10-15 years are mixed, reported results of the first 5-10 years are promising in improving relapse prevention, functional outcomes and reducing mental health care costs, compared to treatment as usual. Objectives Our objective was to develop the first complex FEP program in Hungary. Methods Male and female inpatients, (age:17-40years), hospitalized due to a first psychotic episode and consenting to participate, were included, since 2019 October. Drug induced psychosis and organic background in the etiology of the psychotic episode were excluded. Duration of the program is 2-3 years, based on the individual needs of the patients. The program provides detailed clinical and neuropsychological examinations, MRI, pharmacotherapy, various psychosocial interventions, and support group for relatives. Results Twenty-eight patients [15 male,13 female, mean age=22,4 (18-40) years] were included. The program has been repeatedly limited by COVID-19 pandemic. Psychiatric control, pharmacotherapy, psychoeducation and supportive therapy, however could be continously provided via telepsychiatry, even during the lockdown. During the first 2 years, 90% of the patients remained in treatment, showed good compliance with pharmacotherapy;10% of the patients were rehospitalized due to relapse. In the presentation, besides clinical experiences, preliminary clinical outcome data will also be presented. Conclusions The first complex FEP program in Hungary, although limited repeatedly by the pandemic, show promising clinical results with low relapse rates and high level of adherence to therapy in the first 2 years after a first psychotic episode.

The impact of COVID-19 on cancer diagnoses in Victoria

Aims: To present the impact of COVID-19 on inpatient cancer care across Victorian health services by comparing the changes in patient and admission numbers for the years 2019-2021. Background(s): The COVID-19 pandemic disrupted cancer care, including delaying diagnoses and treatment, and halting clinical trials.Despite cancer-related services remaining available, utilisation dropped in 2020 due to a range of factors. In 2020, the Victorian Cancer Registry (VCR) recorded 2420 fewer individual diagnoses, a decline of 7%, likely due to COVID-19.1 VCR modelling data shows that the decline in cancer incidence reported in 2020 continued into 2021.2 Methods:Analysis of cancer activity to understand the change in activity between 2019 (pre-COVID-19) and 2020 and 2021 using a subset of cancer-specific patient data from the Victorian Admitted Episode Dataset (VAED). Result(s): Analysis of VAED data shows despite 28290 fewer admissions (-6%) and 16,782 fewer patients (-10%) for patients with both malignant and non-malignant neoplasms in Victoria from 2019 to 2020. The most significant decline in admissions were in May (-23%) and August (-18%)which coincided with COVID lockdowns 1 and 2. In 2021, this trend reversed and admission and patient numbers increased by 8% and 10% respectively when comparing to 2020, but had barely increased when compared to 2019, with lung cancer new admissions down 2.6%. There was growth in admissions mid-year with August having a 29% increase compared to the previous year. October had a slight decrease in admissions (-0.6%) compared to 2020 following 113 days of rolling lockdowns (lockdowns 3-6). Conclusion(s): Previous trends have shown ~4% annual increase in activity however between 2019 and 2021 there was only 2% increase. Our analysismirrors evidence thatCOVID-19 has negatively impacted cancer care which would suggest a surge in activity and late stage cancer diagnoses in 2022.

Lab-on-a-Chip Immunoassay for Prediction of Severe COVID-19 Disease.

Most people infected by the SARS-CoV-2 virus which causes COVID-19 disease experience mild or no symptoms. Severe forms of the disease are often marked by a hyper-inflammatory response known as a cytokine storm. Thus, biomarker tests which can identify these patients and place them on the appropriate treatment regime at the earliest possible phase would help to improve outcomes. Here we describe an automated microarray-based immunoassay using the Fraunhofer lab-on-a-chip platform for analysis of C-reactive protein due to its role in the hyper-inflammatory response.

A Rapid User-Friendly Lab-on-a-Chip Microarray Platform for Detection of SARS-CoV-2 Variants.

Since the original SARS-CoV-2 virus emerged from Wuhan, China, in late December 2019, a number of variants have arisen with enhanced infectivity, and some may even be capable of escaping the existing vaccines. Here we describe a rapid automated nucleic acid microarray hybridization and readout in less than 15 min using the Fraunhofer lab-on-a-chip platform for identification of bacterial species and antibiotic resistance. This platform allows a fast adaptation of new biomarkers enabling identification of different genes and gene mutations, such as those seen in the case the SARS-CoV-2 variants.

Unidirectional Barbed Suture Versus Polyglactin 910 Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy.

Introduction and objective Laparoscopic suturing of the vaginal cuff and knotting is the most challenging step in total laparoscopic hysterectomy (TLH) and requires surgical skill. The objective of this study was to compare the efficacy and safety of unidirectional barbed suture (V-LocTM 180; Covidien, Mansfield, MA) with the conventional polyglactin 910 suture (coated Vicryl; Covidien) for vaginal cuff closure in patients with benign uterine diseases undergoing total laparoscopic hysterectomy. Methods  A prospective observational study was carried out at the department of obstetrics and gynecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, for two years. A total of 109 patients with benign uterine diseases planned for TLH were included in the study. Laparoscopic vaginal cuff closure was performed with the unidirectional barbed suture (V-Loc) in 44 patients and with the standard polyglactin 910 suture (Vicryl) in 65 patients. The primary outcome measure was vaginal cuff closure time. Secondary outcome measures included total operative time, blood loss, average number of stitches, postoperative pain perception, duration of hospital stay, vaginal cuff-related complications, and dyspareunia. Results Demographic variables and baseline characteristics were similar in both groups except for body mass index (BMI). The mean vaginal cuff closure time was significantly less in the V-Loc group (8.84 ± 2.18 min) than in the Vicryl group (11.66 ± 1.74 min) (p = <0.01). Mean operative time was comparable in both groups (V-Loc group - 109.36±33.02 and Vicryl group - 108.49±40.48; p = 0.91). Other intraoperative parameters, such as blood loss and number of stitches in cuff closure, and postoperative characteristics, such as pain score, duration of hospital stay, vaginal cuff-related complications (vault cuff dehiscence, hematoma, or abscess), and dyspareunia, were comparable in both the groups. Conclusions The unidirectional barbed suture significantly reduces vaginal cuff closure time. It is a safe, effective, and well-tolerated alternative to conventional Vicryl suture for vaginal cuff closure in TLH without increasing the risk of postoperative vaginal complications particularly where affordability is not an issue and resources are accessible.

Locus of control moderates the association of COVID-19 stress and general mental distress: results of a Norwegian and a German-speaking cross-sectional survey.

BACKGROUND: An internal locus of control (LoC I) refers to the belief that the outcome of events in one's life is contingent upon one's actions, whereas an external locus of control (LoC E) describes the belief that chance and powerful others control one's life. This study investigated whether LoC I and LoC E moderated the relationship between COVID-19 stress and general mental distress in the general population during the early months of the COVID-19 pandemic. METHODS: This cross-sectional survey study analysed data from a Norwegian (n = 1225) and a German-speaking sample (n = 1527). We measured LoC with the Locus of Control-4 Scale (IE-4), COVID-19 stress with a scale developed for this purpose, and mental distress with the Patient Health Questionnaire 4 (PHQ-4). Moderation analyses were conducted using the PROCESS macro for SPSS. RESULTS: The association between COVID-19 stress and general mental distress was strong (r = .61 and r = .55 for the Norwegian and the German-speaking sample, respectively). In both samples, LoC showed substantial moderation effects. LoC I served as a buffer (p < .001), and LoC E exacerbated (p < .001) the relation between COVID-19 stress and general mental distress. CONCLUSIONS: The data suggest that the COVID-19 pandemic is easier to bear for people who, despite pandemic-related strains, feel that they generally have influence over their own lives. An external locus of control, conversely, is associated with symptoms of depression and anxiety. The prevention of mental distress may be supported by enabling a sense of control through citizen participation in policy decisions and transparent explanation in their implementation.

Current state of diagnostic, screening and surveillance testing methods for COVID-19 from an analytical chemistry point of view.

Since December 2019, we have been in the battlefield with a new threat to the humanity known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this review, we describe the four main methods used for diagnosis, screening and/or surveillance of SARS-CoV-2: Real-time reverse transcription polymerase chain reaction (RT-PCR); chest computed tomography (CT); and different complementary alternatives developed in order to obtain rapid results, antigen and antibody detection. All of them compare the highlighting advantages and disadvantages from an analytical point of view. The gold standard method in terms of sensitivity and specificity is the RT-PCR. The different modifications propose to make it more rapid and applicable at point of care (POC) are also presented and discussed. CT images are limited to central hospitals. However, being combined with RT-PCR is the most robust and accurate way to confirm COVID-19 infection. Antibody tests, although unable to provide reliable results on the status of the infection, are suitable for carrying out maximum screening of the population in order to know the immune capacity. More recently, antigen tests, less sensitive than RT-PCR, have been authorized to determine in a quicker way whether the patient is infected at the time of analysis and without the need of specific instruments.

Recent advances in lab-on-a-chip technologies for viral diagnosis.

The global risk of viral disease outbreaks emphasizes the need for rapid, accurate, and sensitive detection techniques to speed up diagnostics allowing early intervention. An emerging field of microfluidics also known as the lab-on-a-chip (LOC) or micro total analysis system includes a wide range of diagnostic devices. This review briefly covers both conventional and microfluidics-based techniques for rapid viral detection. We first describe conventional detection methods such as cell culturing, immunofluorescence or enzyme-linked immunosorbent assay (ELISA), or reverse transcription polymerase chain reaction (RT-PCR). These methods often have limited speed, sensitivity, or specificity and are performed with typically bulky equipment. Here, we discuss some of the LOC technologies that can overcome these demerits, highlighting the latest advances in LOC devices for viral disease diagnosis. We also discuss the fabrication of LOC systems to produce devices for performing either individual steps or virus detection in samples with the sample to answer method. The complete system consists of sample preparation, and ELISA and RT-PCR for viral-antibody and nucleic acid detection, respectively. Finally, we formulate our opinions on these areas for the future development of LOC systems for viral diagnostics.