Listening to the HysterSisters: A Retrospective Keyword Frequency Analysis of Conversations About Hysterectomy Recovery.

BACKGROUND: In the postoperative period, individual patient experiences vary widely and are based on a diverse set of input variables influenced by all stakeholders in and throughout the surgical process. Although clinical research has primarily focused on clinical and administrative datasets to characterize the postoperative recovery experience, there is increasing interest in patient-reported outcome measures (PROMs). The growth of online communities in which patients themselves participate provides a venue to study PROMs directly. One such forum-based community is HysterSisters, dedicated to helping individuals through the experience of hysterectomy, a major surgery which removes the uterus. The surgery can be performed by a variety of methods such as minimally invasive approaches or the traditional abdominal approach using a larger incision. The community offers support for "medical and emotional issues [...] from diagnosis, to treatment, to recovery." Users can specify when and what type of hysterectomy they underwent. They can discuss their shared experience of hysterectomy and provide, among other interactions, feedback, reassurance, sympathy, or advice, thus providing a unique view into conversations surrounding the hysterectomy experience. OBJECTIVE: We aimed to characterize conversations about hysterectomy recovery as experienced by users of the HysterSisters online community. METHODS: A retrospective keyword frequency analysis of the HysterSisters Hysterectomy Recovery forum was performed. RESULTS: Within the Hysterectomy Recovery forum, 33,311 unique users declared their hysterectomy date and type and posted during the first 12 weeks postsurgery. A taxonomy of 8 primary symptom groups was created using a seed list of keywords generated from a term frequency analysis of these threads. Pain and bleeding were the two most mentioned symptom groups and account for almost half of all symptom mentions (19,965/40,127). For symptoms categories such as pain and hormones and emotions, there was no difference in the proportion of users mentioning related keywords, regardless of the type of hysterectomy, whereas bleeding-related or intimacy-related keywords were mentioned more frequently by users undergoing certain minimally invasive approaches when compared with those undergoing abdominal hysterectomy. Temporal patterns in symptom mentions were noted as well. The majority of all posting activity occurred in the first 3 weeks. Across all keyword groups, individuals reporting minimally invasive procedures ceased forum use of these keywords significantly earlier than those reporting abdominal hysterectomy. Peaks in conversation volume surrounding particular symptom categories were also identified at 1, 3, and 6 weeks postoperatively. CONCLUSIONS: The HysterSisters Hysterectomy Recovery forum and other such forums centered on users' health care experience can provide novel actionable insights that can improve patient-centered care during the postoperative period. This study adds another dimension to the utility of social media analytics by demonstrating that measurement of post volumes and distribution of symptom mentions over time reveal key opportunities for beneficial symptom-specific patient engagement.

Twitter 101 and beyond: introduction to social media platforms available to practicing hematologist/oncologists.

Social media utilizes specific media platforms to allow increased interactivity between participants. These platforms serve diverse groups and purposes including participation from patients, family caregivers, research scientists, physicians, and pharmaceutical companies. Utilization of these information outlets has increased with integration at conferences and between conferences with the use of hashtags and "chats". In the realm of the "e-Patient" it is key to not underestimate your audience. Highly technical information is just as useful as a basic post. With growing use, social media analytics help track the volume and impact of content. Additionally, platforms are leveraging each other for uses, including Twitter, blogs, web radio, and recorded video and images. We explore information on social media resources and applications from varying perspectives. While these platforms will evolve over time, or disappear with new platforms taking their place, it is apparent they are now a part of the everyday experience of oncology communication.

Novel phase I study combining G1 phase, S phase, and G2/M phase cell cycle inhibitors in patients with advanced malignancies.

PURPOSE: Cancer is a manifestation of aberrant cellular proliferation, and the cell cycle is one of the most successfully drugged targets in oncology. No prior study has been reported that simultaneously targets the 3 principal cell cycle phases populated by proliferating cells--G1, S, and G2/M. METHODS: Temsirolimus (G1 inhibitor), topotecan (S inhibitor), and bortezomib (G2/M inhibitor) were administered in combination to patients with advanced malignancies using a 3+3 dose escalation schedule to assess the safety and establish the maximum tolerated dose (primary endpoints) of this cell cycle targeting approach. An in silico pharmacodynamic model using established effects of each of these agents on the cell cycle was used to validate the regimen and to guide the dosing regimen. RESULTS: Sixty-two subjects were enrolled. The most common adverse events and dose-limiting toxicities were cytopenias, consistent with the cell cycle targeting approach employed. All cytopenias resolved to baseline values upon holding study drug administration. The maximum tolerated dose was temsirolimus 15 mg/kg IV D1, 8, 15; topotecan 2.8 mg/m(2) IV D1, 8; and bortezomib 0.6 mg/m2 IV D1, 4, 8, 11 [DOSAGE ERROR CORRECTED] of a 21-day cycle. In silico modeling suggests the regimen induces cell population shifts from G2/M and S phases to G1 phase and the quiescent G0 phase. Eighteen percent of subjects (11/62) achieved partial response (n = 2, serous ovarian and papillary thyroid) or stable disease for > 6 months (n = 9). CONCLUSION: Combining drugs with inhibitory activity of G1 phase, S phase, and G2/M phase is safe and warrants further evaluation.

Simulating the shaping of the fastigial deep nuclear saccade command by cerebellar Purkinje cells.

Early lesion and physiological studies established the key contributions of the cerebellar cortex and fastigial deep nuclei in maintaining the accuracy of saccades. Recent evidence has demonstrated that fastigial oculomotor region cells (FORCs) provide commands that are critical both for driving and braking saccades. Modeling studies have largely ignored the mechanisms by which the FORC activity patterns, and those of the Purkinje cells (PCs) that inhibit them, are produced by the mossy fiber (MF) inputs common to both. We have created a hybrid network of integrate-and-fire and summation units to model the circuitry between PCs, FORCs, and MFs that can account for all observed PC and FORC activity patterns. The model demonstrates that a crucial component of FORC activity may be due to the rebound depolarization intrinsic to FORC neurons that, like the MF-driven activity of FORCs, is also shaped by PC inhibition and disinhibition. The model further demonstrates that the shaping of the FORC saccade command by PCs can be adaptively modified through plausible learning rules based on cerebellar long-term depression (LTD) and long-term potentiation (LTP), which are guided by climbing fiber (CF) input to PCs that realistically indicates only the direction (but not the magnitude) of saccade error. These modeling results provide new insights into the adaptive control by the cerebellum of the deep nuclear saccade command.

Sparse cerebellar innervation can morph the dynamics of a model oculomotor neural integrator.

The oculomotor integrator is a brainstem neural network that converts velocity signals into the position commands necessary for eye-movement control. The cerebellum can independently adjust the amplitude of eye-movement commands and the temporal characteristics of neural integration, but the percentage of integrator neurons that receive cerebellar input is very small. Adaptive dynamic systems models, configured using the genetic algorithm, show how sparse cerebellar inputs could morph the dynamics of the oculomotor integrator and independently adjust its overall response amplitude and time course. Dynamic morphing involves an interplay of opposites, in which some model Purkinje cells exert positive feedback on the network, while others exert negative feedback. Positive feedback can be increased to prolong the integrator time course at virtually any level of negative feedback. The more these two influences oppose each other, the larger become the response amplitudes of the individual units and of the overall integrator network.