ABSTRACT
PURPOSE: There is a lack of systematic solutions to manage supportive care issues in racial/ethnic minorities (REM) receiving treatment for cancer. We developed and implemented an electronic patient-reported outcome (ePRO)-driven symptom management tool led by oncology pharmacists in a majority-minority cancer center located in Southern California. This study was designed to evaluate the implementation outcomes of our multilevel intervention. METHODS: This was a prospective, pragmatic, implementation study conducted between July 2021 and June 2023. Newly diagnosed adult patients with cancer receiving intravenous anticancer therapies completed symptom screening using ePRO that consists of the Patient-Reported Outcomes Measurement Information System measures at each infusion visit during the study. ePRO results were presented to an oncologist pharmacist for personalized symptom management and treatment counseling. The RE-AIM framework was used to guide implementation outcomes. Differences in symptom trajectories and clinical outcomes between groups were tested using generalized estimating equations. RESULTS: We screened 388 patients of whom 250 were enrolled (acceptance rate: 64.4%), with 564 assessments being completed. The sample consisted of non-Hispanic White (NHW, 42.4%), Hispanic/Latinx (H/L, 30.8%), and non-Hispanic Asian (20.4%), with one (21.6%) of five participants preferring speaking Spanish. Compared with NHW, H/L participants had greater odds of reporting mild to severe pain interference (odds ratio [OR], 1.91 [95% CI, 1.18 to 3.08]; P = .008) and nausea and vomiting (OR, 2.08 [95% CI, 1.21 to 3.58]; P = .008), and higher rates of urgent care utilization (OR, 1.92 [95% CI, 1.04 to 3.61]; P = .04) within 30 days. Nausea and vomiting (n = 131, 23.2%), pain (n = 91, 16.1%), and fatigue (n = 72, 12.8%) were most likely to be intervened, with 90% of the participants expressing satisfaction across all visits. CONCLUSION: Our multilevel ePRO-driven intervention led by oncology pharmacists helps facilitate symptom assessments and management and potentially reduce health disparities among REM.
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PURPOSE: Gastrointestinal (GI) symptoms are common among breast cancer patients undergoing chemotherapy, negatively impacting treatment outcomes and quality of life. Evidence points to inflammatory processes as the underlying cause of chemotherapy-associated GI symptoms. Relatedly, omega-3 (n-3) has been linked to anti-inflammatory processes. The primary objective of this study was to examine the associations between baseline n-3, baseline inflammatory markers and GI symptom progression in early-stage breast cancer patients receiving chemotherapy. METHODS: In this secondary analysis of a prospective cohort study, we analyzed baseline levels of inflammatory biomarkers (measured using a Luminex bead-immunoassay) and plasma levels of DHA, EPA, and FFA (measured using enzyme-linked immunosorbent assay). GI symptoms were assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire in Cancer Patients (EORTC QLQ-C30) symptom scale scores at baseline (T1) and at least 6 weeks after, during chemotherapy (T2). Inferential statistics were used to analyze associations between the variables of interest. RESULTS: The analysis included 31 female breast cancer patients (mean age ± SD = 50.5 ± 8.8; 89.6% receiving anthracycline-based chemotherapy). Higher levels of docosahexaenoic acid (DHA) and interleukin-8 (IL-8) predicted increases in appetite loss. Similarly, higher IL-8 predicted worsened nausea and vomiting. CONCLUSION: Baseline IL-8 and DHA predicted GI symptom progression in early-stage breast cancer patients undergoing chemotherapy. Future studies are required to evaluate how therapeutic intervention targeting these biomarkers may mitigate gastrointestinal symptoms in cancer patients.
Subject(s)
Breast Neoplasms , Gastrointestinal Diseases , Humans , Female , Breast Neoplasms/drug therapy , Interleukin-8 , Quality of Life , Prospective Studies , Gastrointestinal Diseases/chemically induced , Biomarkers , Surveys and QuestionnairesABSTRACT
BACKGROUND: Community service providers (CSPs) play an integral role in the health care of low-income Hispanic or Latinx (HL) communities. CSPs have high-stress frontline jobs and share the high-risk demographics of their communities. Relational savoring (RS) has been associated with lower cardiovascular reactivity and psychosocial benefits, with particular promise among HL participants. In this study, we aim to identify RS's potential in promoting CSPs' cardiometabolic health and, in so doing, having broader impacts on the community they serve. OBJECTIVE: This randomized controlled waitlist study aims to examine the effect of an RS intervention on (1) CSPs' cardiometabolic health (cardiometabolic risk factors and outcomes) and (2) CSPs' threats to leaving the workforce. METHODS: We will recruit a sample of 80 CSPs from community health agencies serving low-income HL populations. Participating CSPs will be randomized into an experimental or a waitlist control. Participants will complete 1 or 2 baseline assessment batteries (before the intervention), depending on the assigned group, and then complete 2 more assessment batteries following the 4-week RS intervention (after the intervention and at a 3-mo follow-up). The RS intervention consists of guided reflections on positive moments of connection with others. Electrocardiogram data will be obtained from a wearable device (Polar Verity Sense or Movisens) to measure heart rate variability. The primary outcome is cardiometabolic health, consisting of cardiometabolic risk (obtained from heart rate variability) and cardiometabolic health behaviors. The secondary outcomes include CSPs' threats to leaving the workforce (assessed via psychological well-being), intervention acceptability, and CSPs' delivery of cardiometabolic health programming to the community (exploratory). Analyses of covariance will be used to examine the effects of RS on cardiometabolic health and on CSPs' threats to leaving the workforce, comparing outcomes at baseline, postintervention, and at follow-up across participants in the experimental versus waitlist group. RESULTS: The study has been approved by the University of California, Irvine, Institutional Review Board and is currently in the data collection phase. By May 2023, 37 HL CSPs have been recruited: 34 have completed the baseline assessment, 28 have completed the 4 intervention sessions, 27 have completed the posttreatment assessment, and 10 have completed all assessments (including the 3-mo follow-up). CONCLUSIONS: This study will provide valuable information on the potential of RS to support cardiometabolic health in HL CSPs and, indirectly, in the communities they serve. TRIAL REGISTRATION: ClinicalTrials.gov NCT05560893; https://clinicaltrials.gov/study/NCT05560893. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51427.
ABSTRACT
Resumen: El edema pulmonar por mal de altura es una entidad no cardiogénica que se debe a hipoxia hipobárica y falta de adaptación pulmonar en los pacientes que retornan a altitudes mayores de 2.500 m luego de haber permanecido a nivel del mar por varios días. Esta entidad, frecuente en los niños, debido a sus características anatómicas y fisiológicas, suele ser subdiagnosticada o confundida con otras patologías que cursan con insuficiencia respiratoria. Presentamos el caso de un paciente de sexo masculino, 4 años de edad, atendido en Emergencias por dificultad respiratoria severa por mal de altura.
Abstract: Pulmonary edema by altitude sickness is a non-cardiogenic entity, due to lack of pulmonary adaptation and hypobaric hypoxia in patients who return to altitudes higher than 2,500 meters after staying for several days at sea level. This entity is frequent in children, given their physiological and anatomical characteristics. It tends to be underdiagnosed or confused with other pathologies associated with shortness of breath. We present the case of a four-year-old male patient, who attended the emergency department for severe respiratory distress caused by altitude sickness.
Subject(s)
Humans , Male , Child, Preschool , Pulmonary Edema , Child , Altitude SicknessABSTRACT
Chronic skin lesions constitute a clinical diagnostic challenge. We report the case of a patient whose facial lesion was histopathologically compatible with squamous cell carcinoma and hence programmed for Mohs surgery. However, review of the clinical and epidemiological history led to laboratory diagnosis of cutaneous leishmaniasis, treatment with miltefosine, and complete resolution of the lesion.
Subject(s)
Antibodies, Protozoan/analysis , Carcinoma, Squamous Cell/diagnosis , Leishmania guyanensis/isolation & purification , Leishmaniasis, Cutaneous/diagnosis , Skin Neoplasms/diagnosis , Antiprotozoal Agents/therapeutic use , Carcinoma, Squamous Cell/pathology , Diagnosis, Differential , Female , Humans , Leishmania guyanensis/immunology , Leishmaniasis, Cutaneous/drug therapy , Leishmaniasis, Cutaneous/parasitology , Leishmaniasis, Cutaneous/pathology , Middle Aged , Mohs Surgery , Phosphorylcholine/analogs & derivatives , Phosphorylcholine/therapeutic use , Skin Neoplasms/pathology , Treatment OutcomeABSTRACT
Esta investigación se orienta hacia a la descripción e interpretación acerca de lo que siente, piensa, dice y hace el alumnado de magisterio de educación infantil en su formación inicial. Para llevar a cabo esta investigación he combinado distintos instrumentos de recogida de informaciones: observación participante, grupos de discusión, diario de campo, entrevistas individuales y documentos del alumnado. Propongo que se continúe investigando para conducir a la formación hacia la posibilidad de vivir la complejidad, la incertidumbre y la tensión de la vida real en contextos educativos naturales y que se amplíe la reflexión de la formación inicial
This research aims to describe and interpret what the student of physical education whose area of study is teaching feels, thinks, says and does in his/her initial training. Different instruments were used to collect information: participant observation, panel groups, individual interviews, in-depth interviews and the student's autobiographies. I propose at the end of the paper that we continue investigating in this area the possibility of living the complexity, uncertainty and tension of real life in educational settings and in this way broaden the reflection of initial training
Esta investigação descreve e a interpreta o que sente, pensa, diz e faz o aluno (a) de magistério especialidade educação física em sua formação inicial. Foram utilizados diferentes instrumentos de coleta de informações: observação participante, grupos de discussão, entrevistas individuais, entrevistas em profundidade e documentos dos alunos. Proponho que se continue investigando com a possibilidade de viver a complexidade, a incerteza e a tensão da vida real em contextos educativos e que se amplie a reflexão da formação inicial
