Analysis of Oncological Second Opinions in a Certified University Breast and Gynecological Cancer Center Regarding Consensus between the First and Second Opinion and Conformity with the Guidelines.

INTRODUCTION: Oncological second opinions are becoming increasingly important in the era of complex treatments and established certified cancer centers. Oncological guidelines with the highest levels of evidence are available, but these can only be effective to the extent that they are implemented. Therefore, we analyzed the effects of second opinions with regard to their agreement with first opinions and conformity with guidelines. METHODS: In 164 patients with a diagnosis of breast cancer or gynecological malignancy who requested a second opinion, the first and second opinions, established at the interdisciplinary tumor conference, and conformity with the guidelines were evaluated. RESULTS: The first opinion was not in agreement with the guidelines in 34.8% (15.2% diagnosis, 12.8% surgical therapy, 13.4% systemic therapy, and 5.5% radiotherapy), and the recommendations were optimized in the second opinion in 56.7% (28.7% diagnosis, 15.9% surgical therapy, 30.5% systemic therapy, and 8.5% radiotherapy). CONCLUSIONS: Oncological second opinions showed significant effects and one-third of first opinions were not in conformity with the guidelines. In a significant proportion of cases, the existing treatment plan was changed or supplemented to allow modern and individualized treatment approaches.

Analysis of motives and patient satisfaction in oncological second opinions provided by a certified university breast and gynecological cancer center.

PURPOSE: Second opinions in oncology are becoming increasingly important in an era of more complex treatments and a growing demand for information by patients. Therefore, we analyzed their effects and influencing factors like patients' motives, subjective extent of information and satisfaction with communications. METHODS: This prospective study evaluated second opinions for patients with breast cancer or gynecological malignancy. The patients received a questionnaire before and two months after, which inquired expectations, reasons, and satisfaction with the second opinion and the attending physicians. RESULTS: A total of 164 patients were included and the majority had breast cancer (75.0%). Receiving the second opinion made 89.7% feel better informed, their need for information decreased (from 75.3% to 39.2%, P < 0.0001), and satisfaction with doctor-patient communications increased (from 61.9 to 91.8%, P = 0.0002). There were various reasons for requesting a second opinion, e.g., the extremely stressful situation of a cancer diagnosis, hope for change in the treatment recommendation or dissatisfaction with the initial physicians. CONCLUSIONS: Second opinions can lead to significantly greater patient satisfaction, meeting the need for information and leading to better management of patients in the extremely stressful situation of a cancer diagnosis. Doctor-patient communications play a key role.

Quantitative Characterization of the Neuropeptide Level Changes in Dorsal Horn and Dorsal Root Ganglia Regions of the Murine Itch Models.

Chronic itch can be extremely devastating and, in many cases, difficult to treat. One challenge in treating itch disorders is the limited understanding of the multitude of chemical players involved in the communication of itch sensation from the peripheral to the central nervous system. Neuropeptides are intercellular signaling molecules that are known to be involved in the transmission of itch signals from primary afferent neurons, which detect itch in the skin, to higher-order circuits in the spinal cord and brain. To investigate the role of neuropeptides in transmitting itch signals, we generated two mouse models of chronic itch-Acetone-Ether-Water (AEW, dry skin) and calcipotriol (MC903, atopic dermatitis). For peptide identification and quantitation, we analyzed the peptide content of dorsal root ganglia (DRG) and dorsal horn (DH) tissues from chronically itchy mice using liquid chromatography coupled to tandem mass spectrometry. De novo-assisted database searching facilitated the identification and quantitation of 335 peptides for DH MC903, 318 for DH AEW, 266 for DRG MC903, and 271 for DRG AEW. Of these quantifiable peptides, we detected 30 that were differentially regulated in the tested models, after accounting for multiple testing correction (q ≤ 0.1). These include several peptide candidates derived from neuropeptide precursors, such as proSAAS, protachykinin-1, proenkephalin, and calcitonin gene-related peptide, some of them previously linked to itch. The peptides identified in this study may help elucidate our understanding about these debilitating disorders. Data are available via ProteomeXchange with identifier PXD015949.

[Resilience, Fear of Progression and Psychosocial Distress in Patients with Breast Cancer and Gynecological Tumors Seeking a Second Opinion]. / Resilienz, Progredienzangst und psychische Belastungen bei Patientinnen mit Brustkrebs und gynäkologischen Tumoren, die eine ärztliche Zweitmeinung einholen.

PURPOSE: The objective of the study was to find out about psychological distress, fear of progression, and resilience levels in patients with breast cancer and gynecological tumors asking for a second opinion concerning their oncological treatment. METHODS: 158 female cancer patients were assessed for those parameters in a questionnaire survey comprising SOC-13, FoP-Q-SF, and the NCCN distress thermometer. RESULTS: 16.2% of the breast cancer patients and 20.5% of the patients with gynecological tumors suffered from dysfunctional fear of progression, 70.4% of the breast cancer patients and 80.6% of the patients with gynecological tumors were highly distressed. The patients did not differ significantly in their resilience levels from a representative sample of the general population. DISCUSSION: Strong disease-related fear and distress were found in participating patients seeking a second medical opinion. CONCLUSIONS: Further study of the connection between psychological variables and the decision for a second oncological opinion seems crucial concerning implications for doctor-patient-communication.

A influência do delirium no tempo de ventilação mecânica em pacientes críticos: uma revisão sistemática / The influence of delirium in the time of mechanical ventilation in critical patients: a systematic review

O delirium consiste em um estado confusional agudo e de curso flutuante representando uma manifestação da disfunção cerebral que pode estar associado com diferentes manifestações clínicas. Os pacientes com delirium têm sido estudados, pois tem apresentado maior tempo de ventilação mecânica e de internação em unidade de terapia intensiva. O objetivo do estudo foi realizar uma revisão de literatura acerca da influência do delirium no tempo de ventilação mecânica, sedação e na mortalidade de pacientes internados em unidade de terapia intensiva. Foi realizada uma busca por estudos nas bases de dados PubMed e Embase, com os descritores delirium, intensive care unit and mechanical ventilation. Nos resultados foram incluídos oito artigos, um recebeu graduação A e sete receberam graduação B na escala de Oxford. Os principais resultados foram: Os pacientes com delirium apresentaram maior gravidade, maior tempo de ventilação mecânica, maior tempo de sedação e maior mortalidade. Conclui-se que o delirium parece estar associado ao maior tempo da ventilação mecânica, maior dosagem de sedação e de mortalidade nestes pacientes.

Delirium consists of an acute, fluctuating, confusional state, representing a manifestation of cerebral dysfunction that can occur with different clinical manifestations. Patients with delirium have been studied because they have had longer time of mechanical ventilation and hospitalization in the intensive care unit. The objective of the study was to perform a literature review about the influence of delirium on the time of mechanical ventilation, sedation and on the mortality of patients admitted in intensive care units. A search for studies with the keywords delirium, intensive care unit and mechanical ventilation was performed in PubMed and Embase databases. As result eight articles were included, one received level A and seven received level B on the Oxford scale. The main results were: Patients with delirium presented greater severity, longer time of mechanical ventilation, longer sedation time and higher mortality. It is concluded that delirium appears to be associated with longer mechanical ventilation, greater sedation and mortality rates in these patients.

Adaptation and cross-cultural validation of the Brazilian version of the Warwick-Edinburgh mental well-being scale.

OBJECTIVE: the Warwick-Edinburgh mental well-being scale (WEMWBS) was designed to assess the level of mental well-being of a population or specific groups. The scale consists of 14 items covering functional psychological aspects, as well as well-being. The final score is calculated by adding up the response of each item, ranging from 1 to 5, obtaining a result from 14 to 70 points. METHODS: the procedure was developed in accordance with the protocol recommended by the World Health Organization covering translation, back translation, semantic equivalence, expert evaluation of the previous steps, pre-test and final version of the instrument. Following, the final version was applied to a sample of 122 individuals and the data were subjected to descriptive statistical analysis, factor analysis, internal consistency and correlation with other validated instruments. RESULTS: we performed the instrument's adaptation to the Portuguese spoken in Brazil, replacing terms to approximate the language to expressions of everyday life. The final version showed similar results to those from the original version, demonstrated by factor analysis, internal consistency (Cronbach's alpha: 0.89) and positive correlation with instruments validated to the Portuguese language. CONCLUSION: the Brazilian version of the WEMWBS proved to be easy to use and understand, showed high internal consistency and construct validity similar to the original instrument.

Adaptation and cross-cultural validation of the Brazilian version of the Warwick-Edinburgh mental well-being scale / Adaptação e validação transcultural da versão brasileira da escala de bem-estar mental de Warwick-Edinburgh.

Summary Objective: the Warwick-Edinburgh mental well-being scale (WEMWBS) was designed to assess the level of mental well-being of a population or specific groups. The scale consists of 14 items covering functional psychological aspects, as well as well-being. The final score is calculated by adding up the response of each item, ranging from 1 to 5, obtaining a result from 14 to 70 points. Methods: the procedure was developed in accordance with the protocol recommended by the World Health Organization covering translation, back translation, semantic equivalence, expert evaluation of the previous steps, pre-test and final version of the instrument. Following, the final version was applied to a sample of 122 individuals and the data were subjected to descriptive statistical analysis, factor analysis, internal consistency and correlation with other validated instruments. Results: we performed the instrument's adaptation to the Portuguese spoken in Brazil, replacing terms to approximate the language to expressions of everyday life. The final version showed similar results to those from the original version, demonstrated by factor analysis, internal consistency (Cronbach's alpha: 0.89) and positive correlation with instruments validated to the Portuguese language. Conclusion: the Brazilian version of the WEMWBS proved to be easy to use and understand, showed high internal consistency and construct validity similar to the original instrument. .

Resumo Objetivo: a escala de bem-estar mental de Warwick-Edinburgh (EBEMWE) foi desenhada para avaliar o nível de bem-estar mental de uma população em geral ou de grupos específicos. A escala é constituída por catorze itens, abrangendo aspectos funcionais psíquicos, assim como bem-estar. O escore final é calculado pela soma das respostas de cada item, cujo valor varia de 1 a 5, obtendo um resultado total de 14 a 70 pontos. Métodos: o processo foi desenvolvido de acordo com o protocolo da Organização Mundial da Saúde (OMS), abrangendo tradução, retrotradução, equivalência semântica, avaliação de especialistas das etapas anteriores, pré-teste do instrumento e versão final. Na sequência, a versão final foi aplicada em uma amostra de 122 indivíduos, e os dados obtidos foram submetidos a tratamento estatístico descritivo, análise fatorial, avaliação da consistência interna e correlação com outros instrumentos validados. Resultados: realizou-se adequação do instrumento para o português utilizado no Brasil, substituindo termos para aproximar a linguagem às expressões do dia a dia. A versão final apresentou resultados similares à versão original, demonstrados pela análise fatorial, pela consistência interna (alfa de Cronbach: 0,89) e pela correlação positiva com instrumentos validados para a língua portuguesa. Conclusão: a versão brasileira da EBEMWE mostrou-se de fácil aplicação e compreensão, apresentou alta consistência interna e similar validade de construto ao instrumento original. .