Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Background The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions.Methods This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting.Findings Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey.Conclusions The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.Subject terms: Breast cancer, Surgical oncology, Health care economics, Quality of life, Health policy     

The size-weight illusion in visual form agnosic patient DF

ABSTRACT

The size-weight illusion is a perceptual illusion where smaller objects are judged as heavier than equally weighted larger objects. A previous informal report suggests that visual form agnosic patient DF does not experience the size-weight illusion when vision is the only available cue to object size. We tested this experimentally, comparing the magnitudes of DF’s visual, kinesthetic and visual-kinesthetic size-weight illusions to those of 28 similarly-aged controls. A modified t-test found that DF’s visual size-weight illusion was significantly smaller than that of controls (z_cc = ?1.7). A test of simple dissociation based on the Revised Standardized Difference Test found that the discrepancy between the magnitude of DF’s visual and kinesthetic size-weight illusions was not significantly different from that of controls (z_dcc = ?1.054), thereby failing to establish a dissociation between the visual and kinesthetic conditions. These results are consistent with previous suggestions that visual form agnosia, following ventral visual stream damage, is associated with an abnormally reduced size-weight illusion. The results, however, do not confirm that this reduction is specific to the use of visual size cues to predict object weight, rather than reflecting more general changes in the processing of object size cues or in the use of predictive strategies for lifting.     

Automated classification of depression from structural brain measures across two independent community‐based cohorts

Major depressive disorder (MDD) has been the subject of many neuroimaging case–control classification studies. Although some studies report accuracies ≥80%, most have investigated relatively small samples of clinically‐ascertained, currently symptomatic cases, and did not attempt replication in larger samples. We here first aimed to replicate previously reported classification accuracies in a small, well‐phenotyped community‐based group of current MDD cases with clinical interview‐based diagnoses (from STratifying Resilience and Depression Longitudinally cohort, ‘STRADL’). We performed a set of exploratory predictive classification analyses with measures related to brain morphometry and white matter integrity. We applied three classifier types—SVM, penalised logistic regression or decision tree—either with or without optimisation, and with or without feature selection. We then determined whether similar accuracies could be replicated in a larger independent population‐based sample with self‐reported current depression (UK Biobank cohort). Additional analyses extended to lifetime MDD diagnoses—remitted MDD in STRADL, and lifetime‐experienced MDD in UK Biobank. The highest cross‐validation accuracy (75%) was achieved in the initial current MDD sample with a decision tree classifier and cortical surface area features. The most frequently selected decision tree split variables included surface areas of bilateral caudal anterior cingulate, left lingual gyrus, left superior frontal, right precentral and paracentral regions. High accuracy was not achieved in the larger samples with self‐reported current depression (53.73%), with remitted MDD (57.48%), or with lifetime‐experienced MDD (52.68–60.29%). Our results indicate that high predictive classification accuracies may not immediately translate to larger samples with broader criteria for depression, and may not be robust across different classification approaches.     

Couple relationship quality and offspring attachment security: a systematic review with meta-analysis

This paper provides a meta-analytic examination of strength and direction of association between parents’ couple relationship quality and early childhood attachment security (5 years and under). A comprehensive search of four EBSCOhost databases, Informit, Web of Science, and grey literature yielded 24 studies meeting eligibility criteria. Heterogeneity of the couple quality construct and measurement was marked. To disaggregate potentially differentially acting factors, we grouped homogeneous studies, creating two predictor variables defined as “positive dyadic adjustment” and “inter-parental conflict”. Associations of each construct with offspring attachment security were examined in two separate meta-analyses. Inter-parental conflict was inversely associated (8 studies, k = 17, r = ?0.28, CI = [?0.39 to ?0.18]), and dyadic adjustment was not associated with offspring attachment security (5 studies, k = 12, r = 0.14, CI = [?0.03 to 0.32]). The study supports finer distinctions of couple relationship constructs and measurement in developmental research, assessment, and intervention.     

Outcome of respiratory intensive care for the elderly

We followed 1018 patients admitted consecutively to a multidisciplinary respiratory ICU (RICU), with special attention to patients aged 75 yr and over. The elderly had a higher RICU (11/49) and in-hospital (21/49) mortality than younger patients. The 28 survivors of hospitalization had a lower acute physiology score (APS) than nonsurvivors on admission (16.1 +/- 7.8 vs. 21.8 +/- 8.9, respectively), indicating less severe illness. The quality of long-term survival (12 to 24 months) was assessed using an open-ended questionnaire. Eighteen hospital survivors were alive at the time of follow-up and the quality of life was deemed satisfactory by 10 of 13 patients who were living independently. Only two of 28 survivors had been transferred to nursing home care, and two were in acute care hospitals. We conclude most elderly patients discharged from the RICU consider their lifestyle satisfactory and are not a large drain on community health care resources. Further studies of the screening process which determines RICU admission are necessary, because unimodal criteria such as age and APS after admission were not of prognostic value.     

Dysrhythmia management content in ADN and BSN curricula

BACKGROUND: The purposes of this study were to compare nurse educators' perceptions of the importance of selected dysrhythmia management competencies for the graduates of associate degree in nursing (ADN) and baccalaureate of science in nursing (BSN) programs, and to compare what related content is taught at the ADN and BSN level for dysrhythmia management. METHOD: A quantitative, nonexperimental design with a mailed survey was used to compare how nurse educators perceive the importance of dysrhythmia competencies in selected ADN and BSN programs in the states of Illinois and Iowa, and to determine what related content is taught. RESULTS: A total of 33 ADN and 24 BSN programs returned the survey for a 58.2% (57 of 98) response rate. Results indicated that ADN and BSN faculty in Illinois and Iowa perceived that selected dysrhythmia management content is important and that such content is currently provided at both the ADN and BSN level. CONCLUSIONS: Health care institutions can have confidence that new graduates from either educational preparation have had dysrhythmia management content and can expand their level of expertise.     

Nurses' opportunistic interventions with patients in relation to smoking

AIM: This paper reports a study exploring nurses' provision of opportunistic health education on smoking for hospital patients. BACKGROUND: Smoking cessation guidelines recommend assessment of patients' smoking habits and provision of smoking cessation advice when possible, and highlight the importance of the role of nurses in health promotion and health education. In the past, nurses have been criticized for lack of knowledge, skills and confidence in relation to health education and the perception that it is additional to, rather than integrated with, nursing care. METHODS: A qualitative case study design was selected to explore the health education practice of 12 nurses working in acute wards in three general hospitals in Scotland. Data were collected in 2000 through non-participant observation, semi-structured interviews and the use of a radio-microphone to record nurse-patient interactions. The data analysis was guided by four key elements of health education practice: 'the teachable moment', 'readiness to learn', 'the provision of health information' and 'oral communication'. FINDINGS: Smoking was part of the nurses' agenda, as most recognized opportunities to introduce health education on smoking during nursing care, suggesting a tentative move towards the integration of health education with nursing care. Evidence from patients' interactions indicated ample opportunity for nurses to provide smoking-related health information. However, the content of nurses' interactions on smoking was variable, with some limited by poor communication skills and inadequate knowledge of smoking and smoking cessation. The context of the interactions was also important in understanding some of the restrictions on conversational progress. CONCLUSIONS: Nurses require the knowledge and skills to perform a health education role, and the inclusion of smoking cessation guidelines in nursing curricula would contribute to this. Where patients are in hospitals for short periods of time, opportunistic health education on smoking needs to be introduced as the basis for more specialist intervention.     

Eosin B as a novel antimalarial agent for drug-resistant Plasmodium falciparum

4',5'-Dibromo-2',7'-dinitrofluorescein, a red dye commonly referred to as eosin B, inhibits Toxoplasma gondii in both enzymatic and cell culture studies with a 50% inhibitory concentration (IC(50)) of 180 microM. As a non-active-site inhibitor of the bifunctional T. gondii dihydrofolate reductase-thymidylate synthase (DHFR-TS), eosin B offers a novel mechanism for inhibition of the parasitic folate biosynthesis pathway. In the present study, eosin B was further evaluated as a potential antiparasitic compound through in vitro and cell culture testing of its effects on Plasmodium falciparum. Our data revealed that eosin B is a highly selective, potent inhibitor of a variety of drug-resistant malarial strains, with an average IC(50) of 124 nM. Furthermore, there is no indication of cross-resistance with other clinically utilized compounds, suggesting that eosin B is acting via a novel mechanism. The antimalarial mode of action appears to be multifaceted and includes extensive damage to membranes, the alteration of intracellular organelles, and enzymatic inhibition not only of DHFR-TS but also of glutathione reductase and thioredoxin reductase. In addition, preliminary studies suggest that eosin B is also acting as a redox cycling compound. Overall, our data suggest that eosin B is an effective lead compound for the development of new, more effective antimalarial drugs.