The Impact of a Mobile Support Group on Distress and Physical Activity in Breast Cancer Survivors: Randomized, Parallel-Group, Open-Label, Controlled Trial.

BACKGROUND: While mobile health apps have demonstrated their potential in revolutionizing health behavior changes, the impact of a mobile community built on these apps on the level of physical activity and mental well-being in cancer survivors remains unexplored. OBJECTIVE: In this randomized controlled trial, we examine the effects of participation in a mobile health community specifically designed for breast cancer survivors on their physical activity levels and mental distress. METHODS: We performed a single-center, randomized, parallel-group, open-label, controlled trial. This trial enrolled women between 20 and 60 years of age with stage 0 to III breast cancer, an Eastern Cooperative Oncology Group performance status of 0, and the capability of using their own smartphone apps. From January 7, 2019, to April 17, 2020, a total of 2,616 patients were consecutively screened for eligibility after breast cancer surgery. Overall, 202 patients were enrolled in this trial, and 186 patients were randomly assigned (1:1) to either the intervention group (engagement in a mobile peer support community using an app for tracking steps; n=93) or the control group (using the app for step tracking only; n=93) with a block size of 10 without stratification. The mobile app provides a visual interface of daily step counts, while the community function also provides rankings among its members and regular notifications encouraging physical activity. The primary end point was the rate of moderate to severe distress for the 24-week study period, measured through an app-based survey using the Distress Thermometer. The secondary end point was the total weekly steps during the 24-week period. RESULTS: After excluding dropouts, 85 patients in the intervention group and 90 patients in the control group were included in the analysis. Multivariate analyses showed that patients in the intervention group had a significantly lower degree of moderate to severe distress (B=-0.558; odds ratio 0.572; P<.001) and a higher number of total weekly step counts (B=0.125; rate ratio 1.132; P<.001) during the 24-week period. CONCLUSIONS: Engagement in a mobile app-based patient community was effective in reducing mental distress and increasing physical activity in breast cancer survivors. TRIAL REGISTRATION: ClinicalTrials.gov NCT03783481; https://classic.clinicaltrials.gov/ct2/show/NCT03783481.

Fear of cancer recurrence in South Korean survivors of breast cancer who have received adjuvant endocrine therapy: a cross-sectional study.

Introduction: Fear of cancer recurrence (FCR) is one of the most-prevalent psychological problems among cancer survivors, and younger females who have received endocrine therapy are particularly at risk of high FCR. The aim of this study was to determine the relationship between high FCR and factors related to it in South Korean patients with breast cancer who receive adjuvant endocrine therapy (AET). Methods: This cross-sectional study recruited 326 patients with breast cancer who had received AET. All participants were asked to complete a personal information sheet, the short form of the Fear of Progression Questionnaire, and the Menopause Rating Scale. The factors associated with high FCR were analyzed using association-rule analysis. Results: The mean FCR score was 32.24 (SD = 10.22), and 137 of the 326 (42.0%) patients had high scores (≥34). Hot flushes and sweating (moderate to extremely severe), depressed mood (moderate to extremely severe), irritability (moderate to extremely severe), invasive stage, taking tamoxifen, and being married were associated with high FCR. Conclusion: Since FCR was common in patients with breast cancer who received AET, patients at a greater risk of experiencing FCR must be screened and supported.

Development of a Standardized Curriculum for Nursing Informatics in Korea.

OBJECTIVES: This study explored the current status of nursing informatics education in South Korea and developed a standardized curriculum for it. METHODS: Data were collected in two stages: first, an online survey conducted from December 2020 to February 2021 among 60 nursing schools to analyze the current status of nursing informatics education; and second, a two-round Delphi survey with 15 experts from March to April 2021 to determine the mean and standard deviation of the demand for each learning objective in nursing informatics education. A standardized curriculum proposal was developed based on the results of the two-round Delphi survey. RESULTS: Nursing informatics was most commonly taught in the fourth year (34%), with two credits. The proportion of elective major subjects was high in undergraduate and graduate programs (77.4% and 78.6%, respectively), while the proportion of nursing informatics majors was low (21.4%). The curriculum developed included topics such as nursing information system-related concepts, definitions and components of healthcare information systems, electronic medical records, clinical decision support systems, mobile technology and health management, medical information standards, personal information protection and ethics, understanding of big data, use of information technology in evidence-based practice, use of information in community nursing, genome information usage, artificial intelligence clinical information systems, administrative management systems, and information technology nursing education. CONCLUSIONS: Nursing informatics professors should receive ongoing training to obtain recent medical information. Further review and modification of the nursing informatics curriculum should be performed to ensure that it remains up-to-date with recent developments.

Hot flushes and sweating, sleep problems, joint and muscular discomfort, and physical and mental exhaustion in breast cancer survivors during the first 24 months of tamoxifen therapy: a prospective observational study.

Purpose: This study aimed to explore symptom trajectories over 24 months for hot flushes and sweating, sleep problems, joint and muscular discomfort, and physical and mental exhaustion experienced by premenopausal women diagnosed with tamoxifen-treated breast cancer. Methods: A total of 104 patients participated in the study. The menopausal symptoms were examined using the Menopausal Rating Scale at baseline, 3-6, 12, and 18-24 months after initiating tamoxifen. The changes over four time points were analyzed using repeated measures analysis of variance. The chi-square test was used to examine the differences between "no symptom-to-mild" and "moderate-to-extremely severe" 3-6 months after initiating tamoxifen according to the patients' chemotherapy treatment experiences. Results: All menopausal symptoms occurred in > 70% of patients with breast cancer and persisted until 24 months. More than 50% of patients experienced four menopausal symptoms, with at least two at a serious severity level after initiating tamoxifen. Hot flushes and sweating occurred in the highest number of patients, recording high scores. Sleep problems and physical and mental exhaustion exhibited relatively high scores, even before tamoxifen initiation. There were significant changes over four time points in all symptoms. Young patients aged < 40 years experienced more severe sleep problems, and patients who had previously received chemotherapy experienced more severe joint and muscular discomfort. Conclusions: This study's findings may assist in alerting healthcare providers to menopausal symptoms that develop during tamoxifen therapy and the need for early and active intervention to minimize symptom occurrence and distress.

Unmet informatics needs of nurses regarding the use of personal smartphones in the workplace.

AIMS: This study aimed to investigate the differences in practices, policies, and perceptions of nurses regarding work-related utilization of smartphones in acute-care settings. BACKGROUND: Mobile devices utilizing emerging technology are widely used in acute-care settings; however, concerns such as potential distraction, improper use, and negative impact on the nursing image in clinical practice remain valid. METHODS: Nurse managers (n = 8) and nurses (n = 181) were enrolled from eight academic tertiary hospitals that have comprehensive electronic medical record systems and mobile versions. Between October 2018 and February 2019, participants completed a questionnaire designed to explore their use of smartphones. The reporting guide for self-administered surveys of clinicians was applied. RESULTS: Approximately 80% of nurses carried personal smartphones while working, with 70% using their devices for work. The prevalence of work-related smartphone use ranged from 3% to 43% by functionality, which was lower than that estimated by managers. Frequent uses included taking pictures/videos and internet browsing. Nurses were more positive than managers about the benefits of smartphone use and less burdened by related concerns. Novice and junior nurses were more optimistic than senior nurses. Only one hospital had a policy on nurses' use of personal devices at work. CONCLUSION: Two unmet needs in the current clinical information system were identified: information supporting task-related knowledge at the bedside and security of data capture and communication. IMPLICATION FOR NURSING POLICY: The unintended perception gaps between nurses and managers regarding work-related smartphone use can be closed by nursing leadership. Unmet nursing informatics, particularly for information-seeking purposes, can be addressed in the context of quality assurance. Nurse leaders can advocate secure and proper use of smartphones in clinical practice.

Longitudinal Trends in Illness Perception and Depression during Adjuvant Breast Cancer Endocrine Therapy: A Prospective Observational Study.

This study aimed to identify the changes in the illness perceptions and depression of women with breast cancer, undergoing AET, at three time points (i.e., before initiating AET, 3 months follow-up, and 12 months follow-up). We investigated the interaction effects of their demographic and clinical characteristics on illness perception changes over time. Furthermore, factors including the patient's characteristics and illness perceptions associated with depressive symptoms 1 year after starting AET were explored. Illness perception and depressive symptoms were assessed with the brief illness perception questionnaire and the Center for Epidemiologic Studies Depression Scale, in a prospective study of 150 women. The changes in illness perceptions and depression between the three time points were analyzed using repeated measures ANOVA. The factors associated with depressive symptoms were identified using regression analysis. Illness perception improved overall over the 12 months. However, more patients perceived their illness as chronic, experienced more symptoms, and developed negative beliefs that treatment could not control their disease. Patients' depressive symptoms decreased significantly. Depression at the baseline, cancer stage, and the perception of personal control were highly associated with depression after 12 months. These findings suggest that healthcare providers should offer appropriate interventions to patients, for managing symptoms, having a positive belief that treatment can control their disease, and preventing long-term depressive symptoms.

Causal Attributions in Breast Cancer Patients Planning to Undergo Adjuvant Endocrine Therapy.

The aim of this study was to explore causal attributions among Korean breast cancer patients who were planning to undergo adjuvant endocrine therapy (AET) as well as the relationships between patient demographic and clinical characteristics and their causal attributions. Causal attributions were assessed with an open-ended response item, which asked patients to list what they thought were the three most important causal factors of their illness. The relationships between patient characteristics and causal attributions were determined through univariate analysis, and the relationships between causal attributions were obtained using social network analysis. A total of 299 participants provided 707 responses. Stress, diet, and exercise were believed to be the three most likely causes of breast cancer. There were no significant differences between causal attributions and the age, education level, marital status, or cancer stage of patients. However, there were differences in the associations between personality, genetics, and reproductive history and patient-identified causal attributions according to the patients' family history of cancer. Patients with a family history of cancer were more likely to believe that personality and genetics/family history were causes of breast cancer compared to patients without such a history. Therefore, it is necessary to educate patients to perceive stress and lifestyle-related factors as modifiable causal factors in order to have a positive effect on their adherence to AET.

Beliefs and attitudes toward endocrine therapy in patients with hormone receptor-positive breast cancer.

Patients' beliefs about medications are important predictors of medication adherence; however, the relationship between patient beliefs and adjuvant endocrine therapy (AET) adherence in patients with breast cancer remains unclear. In this study, we aimed to determine the association between patient beliefs and adherence to AET. Self-reported questionnaires covering necessity beliefs (NB), concerns beliefs (CB), and adherence were completed by 210 Korean patients with breast cancer. The rate of nonadherence was determined by calculating necessity-concern (N-C) differentials and attitudinal subgroup analysis. Multivariate logistic regression analysis was performed to determine the independent impact of patient beliefs on nonadherence. Nonadherence (Morisky Medication Adherence Scale < 8) was reported in 74.3% (n = 156) of patients and predicted by a negative balance regarding AET [odds ratio (OR) = 0.89; 95% confidence interval (CI): 0.83-0.96] and strong concerns about AET such as those in the Ambivalent (OR = 5.41; 95% CI: 1.84-15.92) and Skeptical (OR = 3.48, 95% CI: 1.14-10.65) subgroups. Patient beliefs are significantly associated with adherence to AET in Korean patients with breast cancer. NB, CB, and N-C differentials may be useful intervention targets to improve medication adherence.

Perception of interprofessional education and educational needs of students in South Korea: A comparative study.

Due to the recent emphasis on the importance of interprofessional education (IPE) in healthcare fields, interest in IPE introduction is increasing in South Korea. The purpose of this study was to examine the differences in perceptions of medical, nursing, and pharmacy students regarding IPE. Also, the study aimed at identifying the priority rankings of educational needs by analyzing the differences between students' perceptions of the importance level and the present level for each interprofessional competency. A cross-sectional study was carried out using a survey. A total of 1,500 questionnaires were distributed, of which 1,084 were returned (response rate, 72.3%). The participants were 559 medical, 393 nursing, and 96 pharmacy students. The questionnaire comprised items on the students' perception of IPE and their interprofessional competency. The questionnaire comprised 12 items on their IPE perception and 9 items on their interprofessional competency. These items were developed by examining the content validity by medical educational specialists and conducting a factor analysis for verification. Data were analyzed using the t-test and ANOVA, and Borich's formula was used to calculate the rank of educational needs.89.6% did not know the meaning of IPE. The difference in students' perception of IPE was not significant by grade. Further, the level of IPE perception was higher for female than male students and for students who knew the meaning of IPE than those who did not. The nursing students' perception of the importance, preference, and effectiveness of IPE was the highest, whereas medical students' perception was the lowest. All students perceived their present level to be lower than the importance level for each interprofessional competency. Interprofessional communication skills (6.791) were highly necessary for students. These results will serve as baseline information for developing IPE programs in South Korea.

Trajectory of fear of cancer recurrence and beliefs and rates of medication adherence in patients with breast cancer.

OBJECTIVE: This study examined the growth trajectory of fear of cancer recurrence (FCR) and its predictors, and the association of that trajectory with the beliefs and rates of medication adherence in patients with breast cancer. METHODS: Two hundred and ten patients with breast cancer undergoing adjuvant endocrine therapy in a university hospital in Seoul, Korea, were followed up five times over 18 months following surgery, and data from the final 162 patients were analyzed. RESULTS: Latent class growth analysis identified three classes. Classes 1 (38.31%) and 2 (39.89%) showed low and moderate FCR levels, respectively, with a decreasing trend over time. Class 3 (21.80%) showed a high FCR level with an initially decreasing but increasing trend afterward s. Lower education and unemployed status were associated with the high FCR class. Higher depression was more associated with the moderate FCR class than the low FCR class. Higher emotional representation was more associated with the high FCR class than with low FCR class, and greater illness comprehension was more associated with the moderate FCR class than with the high FCR class. Both necessity and concerns about medication were the highest in the high FCR class. However, self-reported medication adherence rates did not significantly differ between the classes. CONCLUSIONS: A high level of FCR appears to persist over time, and given its association with greater concerns about medication, monitoring and management of FCR throughout the cancer trajectory.

The effectiveness of interprofessional education programs for medical, nursing, and pharmacy students.

PURPOSE: This study is to develop an interprofessional education (IPE) program for medical, nursing, and pharmacy students and to analyze the effectiveness. METHODS: Subjects consisted of 116 students (41 medical, 46 nursing, and 29 pharmacy students) enrolled in their final year. Subjects were randomly assigned to either the intervention group or the control group, with 58 in each group. A pretest-posttest control group design was used. The program was operated for a single day, and consisted of small-group activities and role-play. We utilized the following tools: Perceptions towards Interprofessional Education (PIPE), Self-Efficacy for Interprofessional Experiential Learning (SEIEL), and Perception towards Interprofessional Competency (PIC). We used t-test and analysis of covariance for analysis. RESULTS: The PIPE tool revealed that the scores of the intervention group were significantly higher than those of the control group (p=0.000). The result was the same when the scores were categorized into the groups medical students (p=0.001), nursing students (p=0.000), and pharmacy students (p=0.005). The SEIEL study also indicated the intervention group scored significantly higher than the control group (p=0.000). However, pharmacy students did not reveal significant (p=0.983). The intervention group scored significantly higher than the control group in the PIC. A concluding survey of the intervention group indicated that most students were satisfied with the IPE program. CONCLUSION: We hope this study will provide useful information for designing and improving IPE programs in other universities.

Perceptions of the interprofessional education of the faculty and the level of interprofessional education competence of the students perceived by the faculty: a comparative study of medicine, nursing, and pharmacy.

PURPOSE: This study will compare differences in perception of interprofessional education (IPE) in the faculty of medicine, nursing, and pharmacy. It will also analyze differences in the level of importance of IPE competences and the present competence levels of their students perceived by the faculty. METHODS: The study included 115 participants from the faculty of medicine, 31 from nursing, and 23 from pharmacy. The surveys contained 21 questions on their perceptions of IPE, and perception on the nine competences of IPE. The results were analyzed using analysis of variance and χ2 analysis, and the Borich coefficient was calculated to identify the educational order of priority from the competence levels of their student of IPE. RESULTS: Participants of 14.8% responded that they were aware of IPE, 95.8% responded that they did not have experience in IPE, and 95.8% responded that IPE was necessary. Among the subfactors of perception of IPE, the faculty of medicine had significantly lower perceptions of the importance, effectiveness, and support of IPE (p<0.001). The present competence levels of their students were significantly lower (p<0.001) than the level of importance of IPE competences perceived by the faculty, and its perception was at its lowest in the faculty of medicine. The needs assessment of the IPE program was in the order of communication skills (10.210), conflict-solving skills (10.114), problem-solving skills (9.319), empathy skills (9.110), and collaborative leadership (8.624) among the nine competences. CONCLUSION: This study will contribute to providing basic data needed to develop faculty development programs on IPE and IPE programs for their students.

An Assessment of Physical Activity Data Collected via a Smartphone App and a Smart Band in Breast Cancer Survivors: Observational Study.

BACKGROUND: Although distress screening is crucial for cancer survivors, it is not easy for clinicians to recognize distress. Physical activity (PA) data collected by mobile devices such as smart bands and smartphone apps have the potential to be used to screen distress in breast cancer survivors. OBJECTIVE: The aim of this study was to assess data collection rates of smartphone apps and smart bands in terms of PA data, investigate the correlation between PA data from mobile devices and distress-related questionnaires from smartphone apps, and demonstrate factors associated with data collection with smart bands and smartphone apps in breast cancer survivors. METHODS: In this prospective observational study, patients who underwent surgery for breast cancer at Asan Medical Center, Seoul, Republic of Korea, between June 2017 and March 2018 were enrolled and asked to use both a smartphone app and smart band for 6 months. The overall compliance rates of the daily PA data collection via the smartphone walking apps and wearable smart bands were analyzed in a within-subject manner. The longitudinal daily collection rates were calculated to examine the dropout pattern. We also performed multivariate linear regression analysis to examine factors associated with compliance with daily collection. Finally, we tested the correlation between the count of daily average steps and distress level using Pearson correlation analysis. RESULTS: A total of 160 female patients who underwent breast cancer surgeries were enrolled. The overall compliance rates for using a smartphone app and smart bands were 88.0% (24,224/27,513) and 52.5% (14,431/27,513), respectively. The longitudinal compliance rate for smartphone apps was 77.8% at day 180, while the longitudinal compliance rate for smart bands rapidly decreased over time, reaching 17.5% at day 180. Subjects who were young, with other comorbidities, or receiving antihormonal therapy or targeted therapy showed significantly higher compliance rates to the smartphone app. However, no factor was associated with the compliance rate to the smart band. In terms of the correlation between the count of daily steps and distress level, step counts collected via smart band showed a significant correlation with distress level. CONCLUSIONS: Smartphone apps or smart bands are feasible tools to collect data on the physical activity of breast cancer survivors. PA data from mobile devices are correlated with participants' distress data, which suggests the potential role of mobile devices in the management of distress in breast cancer survivors. TRIAL REGISTRATION: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966.

Exercise Promotion and Distress Reduction Using a Mobile App-Based Community in Breast Cancer Survivors.

Physical activity (PA) enhancement and mental distress reduction are important issues in cancer survivorship care. Mobile technology, as an emerging method for changing health behaviors, is gaining attention from many researchers. This study aimed to investigate the effect of a mobile app-based community on enhancing PA and decreasing distress in breast cancer survivors. We conducted a non-randomized, prospective, interventional study that had a mobile community-later arm and mobile community-first arm. With an Android smartphone app (WalkON®), daily walk steps and weekly distress scores using app-based Distress Thermometer (DT) questionnaires were collected from participants for about 12 weeks. To examine the difference in weekly step counts before and during the community activity, we used a paired t-test method. For a comparative analysis, we referred to a previous prospective observational study without a mobile community intervention that had the same setting as the present study. After propensity score matching (PSM), multivariable regression modeling with difference-in-difference (DID) was performed to estimate the effect of the mobile app-based community on PA and mental distress. From January to August 2018, a total of 64 participants were enrolled in this study. In the univariate analysis, after participation in the mobile community, the participants showed a significant increase in total weekly steps (t = -3.5341; P = 0.00208). The mean of the differences was 10,408.72 steps. In the multivariate analysis after PSM, the mobile community significantly increased steps by 8,683.4 per week (p value <0.0001) and decreased DT scores by 0.77 per week (p value = 0.009) in the mixed effect model. In the two-way fixed effect model, the mobile community showed a significant increase in weekly steps by 8,723.4 (p value <0.0001) and decrease in weekly DT by 0.73 (p value = 0.013). The mobile app-based community is an effective and less resource-intensive tool to increase PA and decrease distress in breast cancer survivors. Trial Registration: NCT03190720, NCT03072966.

Evaluation of the Korean version of the self-assessment of nursing informatics competencies scale.

BACKGROUND: In order to assess nursing students' informatics competency, we need a comprehensive Korean version scale that reflects the important advances in nursing informatics and can make up for the lack of an existing measure. This study aimed to cross-culturally adapt the Self-Assessment of Nursing Informatics Competencies Scale (SANICS) into Korean (K-SANICS) and verify its validity and reliability with nursing students. METHODS: The design of this study was a methodological approach to translate and evaluate the Korean version tool (K-SANICS). A total of 254 nursing students at four universities in Korea completed a structured questionnaire including background characteristics and the K-SANICS. Reliability and validity of the 30-item K-SANICS were evaluated using Cronbach's α, content validity, factor analysis, and contrasted groups approach. RESULTS: Cronbach's α was .95. Exploratory factor analysis was performed to verify the scale's construct validity, identifying 30 items across six categories: advanced skills for clinical informatics, basic application skills, basic computer skills, roles in nursing informatics, skills for clinical applications, and attitude toward computers in nursing. CONCLUSION: The K-SANICS may be used as a reliable assessment tool of nursing students' nursing informatics competencies. It is expected that the K-SANICS will contribute to establishing, operating, and evaluating nursing informatics curricula and also can be used in a clinical setting.

Relationships between determinants of adjuvant endocrine therapy adherence in breast cancer.

BACKGROUND: Interventions that promote adjuvant endocrine therapy (AET) adherence are critical to improve breast cancer survival. The development of interventions would benefit from a better understanding of the reasons for adherence and the causal relationships of determinants using theoretical or model approaches. The aim of the present study was to identify reasons for AET adherence in breast cancer patients with sequential relationships and inter-relationships. METHODS: A total of 210 participants with estrogen receptor positive breast cancer who received AET completed a questionnaire assessing demographic/medical, psychological, and endocrine therapy (ET)-specific factors. A descriptive analysis was performed to identify meaningful variables. Selected variables were subjected to hierarchical regression and path analyses. The path model was tested and modified based on the research framework and the results of regression weights and model fit. RESULTS: Analysis of sequential effects showed that ET-specific factors contributed the largest proportion of variance (13.4%) to predict AET adherence, followed by psychological factors (4.6%) and demographic/medical factors (3.1%). Analysis of inter-relationships showed that demographic/medical factors such as AET regimen type and cancer stage have direct effects on AET adherence, whereas psychological factors contribute indirectly through the mediating effects of ET-specific factors. CONCLUSION: Assessments and interventions that encompass the patient's medication beliefs, self-efficacy, and depression are needed to promote AET adherence.

Does depression decrease the moderating effect of self-efficacy in the relationship between illness perception and fear of progression in breast cancer?

OBJECTIVE: Fear of progression (FOP) is a prevalent concern among breast cancer patients that affect their adjustment to disease. This study examined whether self-efficacy moderates the effect of illness perception (IP) on FOP and whether the moderating effect of self-efficacy depends on the level of depressive symptoms. METHODS: A cross-sectional survey including brief illness perception questionnaire (BIPQ), FOP short form, general self-efficacy scale, and the center for epidemiologic studies depression scale were administered to 245 patients with breast cancer in Korea. RESULTS: Self-efficacy moderated the negative impact of the patients' perception of chronic timeline and a greater emotional impact of the illness on FOP. However, the moderating effect of self-efficacy of the BIPQ timeline and emotions on FOP depended on level of depressive symptoms. CONCLUSIONS: The findings underscore the importance of considering the IP as determinants of FOP, as well as of self-efficacy and depression as the moderating factors in the relationship between IP and FOP, suggesting the need to enhance self-efficacy and depressive symptoms in order to compensate the negative impact of IP on FOP in breast cancer patients.

Longitudinal patterns and associated factors of postdiagnosis weight changes in Korean breast cancer survivors with normal body mass index.

PURPOSE: This study aimed to describe longitudinal patterns of weight changes from diagnosis to within 5 years after diagnosis and investigate factors associated with short- and long-term weight changes among Korean breast cancer survivors with initially normal body mass index (BMI). METHODS: Body weights at diagnosis for 1546 breast cancer survivors were compared with those at 12, 24, 36, 48, and 60 months after diagnosis. Absolute weight change (kg) and relative weight changes (%) were analyzed. Logistic regression was used to identify factors associated with short-term (1 year) and long-term (5 years) weight changes. RESULTS: A significant decrease in mean weight was predominant at 12 months postdiagnosis. In subgroup analysis, the younger age group showed significant weight gains after 36 months. The older age group and chemotherapy (CT) group showed significant weight losses after 24 months. About 40% of weight gainers and 60% of weight losers at 12 months returned to their initial weight by 60 months postdiagnosis. CT and lower educational levels were associated with short-term weight loss and gain, respectively. For long-term changes, age at diagnosis was the sole associated factor. CONCLUSIONS: Korean breast cancer survivors treated with CT mainly experienced postdiagnosis weight loss rather than weight gain. Short-term weight change was independently associated with chemotherapy and educational level. However, long-term weight change was associated with age at diagnosis. Breast cancer survivors with normal BMI may be categorized according to the time-dependent risk for postdiagnosis weight change.

Interaction between body mass index and hormone-receptor status as a prognostic factor in lymph-node-positive breast cancer.

The aim of this study was to determine the relationship between the body mass index (BMI) at a breast cancer diagnosis and various factors including the hormone-receptor, menopause, and lymph-node status, and identify if there is a specific patient subgroup for which the BMI has an effect on the breast cancer prognosis. We retrospectively analyzed the data of 8,742 patients with non-metastatic invasive breast cancer from the research database of Asan Medical Center. The overall survival (OS) and breast-cancer-specific survival (BCSS) outcomes were compared among BMI groups using the Kaplan-Meier method and Cox proportional-hazards regression models with an interaction term. There was a significant interaction between BMI and hormone-receptor status for the OS (P = 0.029), and BCSS (P = 0.013) in lymph-node-positive breast cancers. Obesity in hormone-receptor-positive breast cancer showed a poorer OS (adjusted hazard ratio [HR] = 1.51, 95% confidence interval [CI] = 0.92 to 2.48) and significantly poorer BCSS (HR = 1.80, 95% CI = 1.08 to 2.99). In contrast, a high BMI in hormone-receptor-negative breast cancer revealed a better OS (HR = 0.44, 95% CI = 0.16 to 1.19) and BCSS (HR = 0.53, 95% CI = 0.19 to 1.44). Being underweight (BMI < 18.50 kg/m2) with hormone-receptor-negative breast cancer was associated with a significantly worse OS (HR = 1.98, 95% CI = 1.00-3.95) and BCSS (HR = 2.24, 95% CI = 1.12-4.47). There was no significant interaction found between the BMI and hormone-receptor status in the lymph-node-negative setting, and BMI did not interact with the menopause status in any subgroup. In conclusion, BMI interacts with the hormone-receptor status in a lymph-node-positive setting, thereby playing a role in the prognosis of breast cancer.

Metrics for Electronic-Nursing-Record-Based Narratives: cross-sectional analysis.

OBJECTIVES: We aimed to determine the characteristics of quantitative metrics for nursing narratives documented in electronic nursing records and their association with hospital admission traits and diagnoses in a large data set not limited to specific patient events or hypotheses. METHODS: We collected 135,406,873 electronic, structured coded nursing narratives from 231,494 hospital admissions of patients discharged between 2008 and 2012 at a tertiary teaching institution that routinely uses an electronic health records system. The standardized number of nursing narratives (i.e., the total number of nursing narratives divided by the length of the hospital stay) was suggested to integrate the frequency and quantity of nursing documentation. RESULTS: The standardized number of nursing narratives was higher for patients aged ≥ 70 years (median = 30.2 narratives/day, interquartile range [IQR] = 24.0-39.4 narratives/day), long (≥ 8 days) hospital stays (median = 34.6 narratives/day, IQR = 27.2-43.5 narratives/day), and hospital deaths (median = 59.1 narratives/day, IQR = 47.0-74.8 narratives/day). The standardized number of narratives was higher in "pregnancy, childbirth, and puerperium" (median = 46.5, IQR = 39.0-54.7) and "diseases of the circulatory system" admissions (median = 35.7, IQR = 29.0-43.4). CONCLUSIONS: Diverse hospital admissions can be consistently described with nursing-document-derived metrics for similar hospital admissions and diagnoses. Some areas of hospital admissions may have consistently increasing volumes of nursing documentation across years. Usability of electronic nursing document metrics for evaluating healthcare requires multiple aspects of hospital admissions to be considered.