Patient-physician agreement on function and pain is associated with long-term outcomes in sarcoma: findings from a longitudinal study.

PURPOSE: We aimed to describe the level of agreement between patients and physicians on the ratings of daily functioning and pain in a cohort of sarcoma patients and assess how (dis)agreement and its change over time predicted patient-reported outcomes in survivorship. METHOD: We performed secondary analysis of longitudinal data from a sarcoma-specialty clinic in Montreal, Canada. Demographics, clinical characteristics and patient-physician agreement were summarized descriptively. Linear mixed models were used to assess the effects of time, baseline agreement, change in agreement over time, interaction of time and change in agreement and 12-month daily functioning, quality of life, and fatigue. RESULTS: Data were available for 806 patients (57.7% male, x̄ = 53.3 years) who completed at least one questionnaire. Patient-physician disagreement was common on the level of function (43.4%) and pain (45.7%). Baseline physician-patient agreement was associated with better 12-month outcomes. Improvement in agreement on function over time was significantly associated with daily functioning (F(2, 212) = 3.18, p = 0.043) and quality of life (F(2, 212) = 3.17, p < 0.044). The pattern was similar though less pronounced for the agreement on pain. CONCLUSIONS: Our study offers novel insights into the importance of patient-physician agreement and communication's role in long-term patient-reported outcomes in sarcoma. IMPLICATIONS FOR CANCER SURVIVORS: The results emphasize the importance of mutual understanding of symptoms and patients' needs and suggest that further consultation in cases of discordance of ratings and opinions might be beneficial for optimal survivorship.

Dynamics of non-communicable disease prevention, diagnosis and control in Lebanon, a fragile setting.

BACKGROUND: Non-communicable diseases (NCD) present an increasing global health challenge, particularly for settings affected by fragility where access to care may be disrupted, and where high-quality continuous care delivery is difficult to achieve. This study documents the complex dynamics of NCD prevention and management in the fragile setting of rural Beqaa, Lebanon. METHODS: Participatory system dynamics methods were used, including 30 semi-structured interviews and three Group Model Building (GMB) workshops. Participants included health care providers offering NCD care, and Lebanese host- and Syrian refugees community members affected by NCDs. RESULTS: Participants across all groups articulated a shared complex understanding of both the structural and direct determinants behind NCD onset. Lebanese and Syrian community members further identified several barriers to health seeking, including restrictions in health coverage, limited availability of services in the Beqaa and perceptions of poor-quality care. Health providers and community members described a health system overtly focused on disease control and overwhelmed by delivery of care to people living with NCD across both communities. CONCLUSION: Participants across all groups agreed on the need for health promotion and primary prevention activities and identified priority interventions in these areas.

Identification and quantitation of human amniotic fluid components using capillary zone electrophoresis.

A capillary electrophoresis method was used to measure albumin, immunoglobulin G (IgG), transferrin, and uric acid in 230 amniotic fluid (AF) samples collected at 15.15+/-0.06 weeks gestation. Species were quantified by external calibration using thiamine as internal standard. All major components were detected within 10 min. Migration time reproducibility was 3.0% relative standard deviation (RSD) and normalized peak areas were 12% RSD or better at 190 nm from 81 measurements of a pooled AF sample. The separation profile was not affected by 10h of storage at room temperature or by 10 freeze-thaw cycles, suggesting that frozen AF samples are suitable for protein biomarker studies.

Second trimester amniotic fluid transferrin and uric acid predict infant birth outcomes.

OBJECTIVE: To establish whether second trimester amniotic fluid protein and/or uric acid concentrations were associated with and predictive of infant birth weight and/or gestational age. METHODS: Second trimester amniotic fluid samples (n = 230) in mothers undergoing age-related amniocentesis for genetic testing were collected and quantified using capillary zone electrophoresis (CZE) for albumin, IgG, transferrin and uric acid. Maternal characteristics (prepregnancy weight and height, parity, ethnicity, smoking status) and infant birth weight, gestational age and gender were obtained from questionnaires and maternal obstetrical chart review. RESULTS: Preterm infants had higher concentrations of second trimester amniotic fluid transferrin than term infants (P = 0.0215). Transferrin was negatively associated with length of gestation, whereas uric acid was positively associated with the gestational age in spontaneous vaginal delivery (SVD) infants. Uric acid was also a significant predictor of the infant birth weight in grams. CONCLUSION: Second trimester amniotic fluid transferrin and uric acid concentrations are related to subsequent birth outcomes and might emerge as biomarkers of early fetal development.