Feasibility and Acceptability of a Virtual "Coping with Brain Fog" Intervention for Improving Cognitive Functioning in Young Adults with Cancer.

Purpose: Cancer-related cognitive deficits (CRCDs) are common among young adults (YAs) (ages: 18-39) with cancer and can be debilitating. We aimed to determine the feasibility and acceptability of a virtual Coping with Brain Fog intervention among YAs with cancer. Our secondary aims were to explore the intervention's effect on cognitive functioning and psychological distress. Methods: This prospective feasibility study involved eight weekly, 90-minute virtual group sessions. Sessions focused on psychoeducation on CRCD, memory skills, task management, and psychological well-being. The primary outcomes were feasibility and acceptability of the intervention evaluated through attendance (>60% not missing >2 consecutive sessions) and satisfaction (Client Satisfaction Questionnaire [CSQ] score >20). Secondary outcomes included the following: cognitive functioning (Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog] Scale) and symptoms of distress (Patient-Reported Outcomes Measurement Information System [PROMIS] Short Form-Anxiety/Depression/Fatigue) and participants' experiences using semistructured interviews. Paired t-tests and summative content analysis were used for quantitative and qualitative data analyses. Results: Twelve participants (five male, mean age = 33 years) were enrolled. All but one participant met feasibility criteria of not missing >2 consecutive sessions (11/12 = 92%). The mean CSQ score was 28.1 (standard deviation 2.5). Significant improvement in cognitive function as measured by FACT-Cog Scale was observed postintervention (p < 0.05). Ten participants adopted strategies from the program to combat CRCD, and eight reported CRCD symptom improvement. Conclusion: A virtual Coping with Brain Fog intervention is feasible and acceptable for the symptoms of CRCD among YAs with cancer. The exploratory data indicate subjective improvement in cognitive function, and will inform the design and implementation of a future clinical trial. ClinicalTrials.gov Registration: NCT05115422.

Pan-Canadian Electronic Medical Record Diagnostic and Unstructured Text Data for Capturing PTSD: Retrospective Observational Study.

BACKGROUND: The availability of electronic medical record (EMR) free-text data for research varies. However, access to short diagnostic text fields is more widely available. OBJECTIVE: This study assesses agreement between free-text and short diagnostic text data from primary care EMR for identification of posttraumatic stress disorder (PTSD). METHODS: This retrospective cross-sectional study used EMR data from a pan-Canadian repository representing 1574 primary care providers at 265 clinics using 11 EMR vendors. Medical record review using free text and short diagnostic text fields of the EMR produced reference standards for PTSD. Agreement was assessed with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS: Our reference set contained 327 patients with free text and short diagnostic text. Among these patients, agreement between free text and short diagnostic text had an accuracy of 93.6% (CI 90.4%-96.0%). In a single Canadian province, case definitions 1 and 4 had a sensitivity of 82.6% (CI 74.4%-89.0%) and specificity of 99.5% (CI 97.4%-100%). However, when the reference set was expanded to a pan-Canada reference (n=12,104 patients), case definition 4 had the strongest agreement (sensitivity: 91.1%, CI 90.1%-91.9%; specificity: 99.1%, CI 98.9%-99.3%). CONCLUSIONS: Inclusion of free-text encounter notes during medical record review did not lead to improved capture of PTSD cases, nor did it lead to significant changes in case definition agreement. Within this pan-Canadian database, jurisdictional differences in diagnostic codes and EMR structure suggested the need to supplement diagnostic codes with natural language processing to capture PTSD. When unavailable, short diagnostic text can supplement free-text data for reference set creation and case validation. Application of the PTSD case definition can inform PTSD prevalence and characteristics.

Characterizing primary care patients with posttraumatic stress disorder using electronic medical records: a retrospective cross-sectional study.

BACKGROUND: Posttraumatic stress disorder (PTSD) has significant morbidity and economic costs. This study describes the prevalence and characteristics of patients with PTSD using primary care electronic medical record (EMR) data. METHODS: This retrospective cross-sectional study used EMR data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). This study included 1,574 primary care providers located in 7 Canadian provinces. There were 689,301 patients that visited a CPCSSN provider between 1 January 2017 and 31 December 2019. We describe associations between PTSD and patient characteristics using descriptive statistics, chi-square, and multiple logistic regression models. RESULTS: Among the 689,301 patients included, 8,817 (1.3%, 95% CI 1.2-1.3) had a diagnosis of PTSD. On multiple logistic regression analysis, patients with depression (OR 4.4, 95% CI 4.2-4.7, P < 0.001), alcohol abuse/dependence (OR 1.7, 95% CI 1.6-1.9, P < 0.001), and/or drug abuse/dependence (OR 2.6, 95% CI 2.5-2.8, P < 0.001) had significantly higher odds of PTSD compared with patients without those conditions. Patients residing in community areas considered the most material deprived (OR 2.1, 95% CI 1.5-2.1, P < 0.001) or the most socially deprived (OR 2.8, 95% CI 2.7-5.3, P < 0.001) had higher odds of being diagnosed with PTSD compared with patients in the least deprived areas. CONCLUSIONS: The prevalence of PTSD in Canadian primary care is 1.3% (95% CI 1.25-1.31). Using EMR records we confirmed the co-occurrence of PTSD with other mental health conditions within primary care settings suggesting benefit for improved screening and evidence-based resources to manage PTSD.

Posttraumatic stress disorder (PTSD) is a mental health disorder with symptoms presenting after having experienced or witnessed a traumatic event. PTSD symptoms continue for more than 1 month after the event and negatively impact the health and social wellbeing of an individual. Primary care, including family doctors, nurse practitioners, and community paediatricians, are often the first point of healthcare for an individual. This study found that PTSD is diagnosed and managed in primary care. Patients with PTSD had comorbidities, substance use, and visited their primary care provider more frequently. Additionally, patients with PTSD often live in a community area that is experiencing high material and social deprivation. The presence of PTSD in primary care suggests the need for new and additional evidence-based resources to assist in managing this complex condition.

Characterizing posttraumatic stress disorder in primary care using electronic medical records: a retrospective cohort study.

Context: Posttraumatic stress disorder (PTSD) is a chronic mental health disorder associated with significant morbidity and economic cost. Primary care providers are frequently involved in the ongoing management of patients experiencing PTSD, as well as related comorbid conditions. Despite recognized need to enhance PTSD management in primary care settings, knowledge regarding its prevalence in these settings is limited. Objective: To apply a validated case definition of PTSD to electronic medical records (EMRs) of family physicians and nurse practitioners participating in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Study Design: Retrospective cross-sectional study. Dataset: This study accessed de-identified EMR from 1,574 primary care providers participating in the CPCSSN. Population Studied: The study population included all patients with at least one visit to a primary care provider participating in the CPCSSN between January 1, 2017 and December 31, 2019 (N = 689,301). Outcome Measures: We identified patients with PTSD and described associations between PTSD and patient characteristics (including sex, age, geography, depression, anxiety, medical comorbidities, substance use and social and material deprivation) using multivariable logistic regression models. Results: Among the 689,301 patients meeting inclusion criteria, 8,213 (1.2%) had a diagnosis of PTSD. Patients with PTSD were significantly more likely to reside in an urban location (84.9% vs. 80.4%; p-value <.0001) and have one or more comorbid conditions (90.8% vs. 70.2%; p-value <.0001). On multivariable logistic regression analysis, patients with depression (OR 4.8; 95%CI 4.6-5.1) and anxiety (OR 2.2; 95%CI 2.1-2.3) had increased odds of having PTSD compared to patients without depression or anxiety. Patients with alcohol (OR 1.8; 95%CI 1.6-1.9) and drug (OR 3.1; 95%CI 2.9-3.3) use disorders had significantly higher odds of PTSD compared to patients without these disorders. Patients in the most deprived neighborhoods based on census data had 4.2 times higher odds of have PTSD (95%CI 3.2-5.43) compared to patients in the least deprived areas. Conclusions: This is the first study to describe PTSD prevalence in a large Canadian sample of primary care patients using an EMR-based case definition. Characterizing patients with PTSD in primary care may improve disease surveillance and inform the interdisciplinary care required to manage PTSD symptoms.

Enhanced Protection Against Diarrhea Among Breastfed Infants of Nonsecretor Mothers.

Diarrhea is a major cause of infant mortality. Being a "nonsecretor" (having an inactive fucosyltransferase-2 gene) protects against diarrhea by inhibiting enteric infections. Breastfeeding also protects against diarrhea; however, the impact of maternal secretor status is unknown. In the ALSPAC cohort (N = 4971), we found that breastfeeding by nonsecretor mothers was especially protective against diarrhea, which could inform new prevention strategies.

F2-isoprostanes in Fish mucus: A new, non-invasive method for analyzing a biomarker of oxidative stress.

F2-isoprostanes (F2-isoPs) are a reliable biomarker class for oxidative stress in vivo in animals. These compounds are traditionally measured in matrices like liver and plasma, however social and environmental pressures warrant the development of non-lethal and non-invasive methods to assess animal health. Therefore, this study aimed to develop a high-performance liquid chromatography tandem mass spectrometry (HPLC-ESI-MS/MS) method to separate and detect F2-isoPs in fish mucus. The method was developed and validated for four native F2-isoP isomers using Northern pike mucus (Esox lucius). Linearity was observed between 5 and 1000 pg/µL. The limits of detection of the four F2-IsoP isomers ranged from 0.63 to 2.0 ng/g. Recoveries ranged from 78 to 95%, and matrix effects were small (<10%). The between-day and within-day repeatability for all target analytes was lower than 20% RSD. Endogenous F2-isoPs were measured in the pike mucus (5.3-28.8 ng/g). A preliminary study of baseline F2-isoP concentrations in lake trout (Salvelinus namaycush) captured from five lakes at the IISD-Experimental Lakes Area in Northwestern Ontario, Canada, was also conducted to test the interspecies applicability of the method. Endogenous F2-isoPs were quantified in lake trout (6.3-132 ng/g). Lake trout samples displayed large variability within and between the different lakes, which suggests sampling methods may require adjustment for this species. This work developed a sensitive analytical method for measuring F2-isoPs in fish mucus, however several further studies are required to determine its ability to accurately measure oxidative stress in fish species.