Predictors of health-related quality of life after non-catastrophic injury sustained in a road traffic crash

BackgroundHealth-related quality of life (HRQoL) is an important patient-reported outcome that warrants greater attention in individuals who sustained a non-catastrophic injury in a road traffic crash. Additional robust data on HRQoL outcomes after a non-catastrophic injury are needed to effectively identify potential targets for studies of tertiary prevention of poor recovery after a crash.ObjectiveWe assessed the association between non-catastrophic road traffic crash injuries and HRQoL and factors that independently affect long-term HRQoL.MethodsIn this inception cohort study, injured participants (≥ 17 years old) were identified from various sources including hospital emergency departments by a medical examination by a registered healthcare professional in New South Wales (Australia) and followed up after 12 months. HRQoL was measured by the European Quality of Life–5 Dimensions (EQ-5D-3L) and Medical Outcomes Survey Short Form 12 items (SF-12). A range of socio-demographic, pre-injury health, psychological, and injury-related factors were considered potential predictors of HRQoL in regression analyses.ResultsAmong 2019 individuals identified, 1201 (59.5%) were followed up after 12 months. HRQoL significantly improved between baseline and 12-month follow-up: EQ-5D-3L summary score (0.41-unit difference); SF-12 physical component summary score (PCS; 13.6-unit difference) and mental component summary score (MCS; 3.5-unit difference). Over 12 months, HRQoL score was lower for people claiming compensation than others (P < 0.0001). Key predictors of better 12-month EQ-5D-3L summary score and visual analogue scale score for pain were age, not claiming compensation, reduced body mass index, less pain severity, less pain-related disability, and less general psychological distress. Significant predictors of SF-12 PCS score were injury to the neck (P = 0.02) or head or face (P = 0.01), being a driver or passenger at the time of the crash (P < 0.0001), hospital admission (P < 0.0001) and pain severity (P < 0.0001). Baseline variables associated with 12-month SF-12 MCS scores were head or face injury (P = 0.02), pre-injury health (P = 0.04), pre-injury psychological conditions (P = 0.04), trauma-related distress (P = 0.0002) and general psychological distress (P < 0.0001).ConclusionsA wide spectrum of biopsychosocial factors contribute to HRQoL after a road traffic crash injury. These epidemiological data are potentially important because they could identify potential targets for studies of tertiary prevention of persistently poor HRQoL after such an injury.     

Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit

AimTo describe our experience using extracorporeal cardiopulmonary resuscitation (ECPR) in resuscitating children with refractory cardiac arrest in the intensive care unit (ICU) and to describe hospital survival and neurologic outcomes after ECPR.MethodsA retrospective chart review of a consecutive case series of patients requiring ECPR from 2001 to 2006 at Arkansas Children's Hospital. Data from medical records was abstracted and reviewed. Primary study outcomes were survival to hospital discharge and neurological outcome at hospital discharge.ResultsDuring the 6-year study period, ECPR was deployed 34 times in 32 patients. 24 deployments (73%) resulted in survival to hospital discharge. Twenty-eight deployments (82%) were for underlying cardiac disease, 3 for neonatal non-cardiac (NICU) patients and 3 for paediatric non-cardiac (PICU) patients. On multivariate logistic regression analysis, only serum ALT (p-value = 0.043; OR, 1.6; 95% confidence interval, 1.014–2.527) was significantly associated with risk of death prior to hospital discharge. Blood lactate at 24 h post-ECPR showed a trend towards significance (p-value = 0.059; OR, 1.27; 95% confidence interval, 0.991–1.627). The Hosmer–Lemeshow tests (p-value = 0.178) suggested a good fit for the model. Neurological evaluation of the survivors revealed that there was no change in PCPC scores from a baseline of 1–2 in 18/24 (75%) survivors.ConclusionsECPR can be used successfully to resuscitate children following refractory cardiac arrest in the ICU, and grossly intact neurologic outcomes can be achieved in a majority of cases.     

Paraoxonase 1 (PON1) as a marker of short term death in breast cancer recurrence

ObjectiveTo relate paraoxonase (PON1) activity to survival time and short term death in breast cancer recurrence.Design and methodsPON1 activity was measured by its rate of hydrolysis of two different substrates, paraoxon (PON) and phenylacetate (ARE) in 50 patients with recurrence of breast cancer. Results were compared between patients surviving more than one year after the analysis (22) and those who died within one year (28).ResultsIn a logistic regression analysis, ARE was negatively associated with early death (OR = 0.10 [0.02–0.58], p = 0.0109). PON did not reach significance (OR = 0.43 [0.17–1.11], p = 0.0826). In a multiple logistic regression analysis model, ARE was independently associated with early death (OR = 0.12 [0.02–0.98], p = 0.0476), besides interval time between diagnosis and recurrence (OR = 0.54 [0.27–1.07], p = 0.0781) and undernutrition (OR = 3.95 [0.81–19.19], p = 0.0883).ConclusionParaoxonase is a potential marker of survival in patients with breast cancer recurrence.     

ADD-ASPIRIN: A phase III,double-blind,placebo controlled,randomised trial assessing the effects of aspirin on disease recurrence and survival after primary therapy in common non-metastatic solid tumours

BackgroundThere is a considerable body of pre-clinical, epidemiological and randomised data to support the hypothesis that aspirin has the potential to be an effective adjuvant cancer therapy.MethodsAdd-Aspirin is a phase III, multi-centre, double-blind, placebo-controlled randomised trial with four parallel cohorts. Patients who have undergone potentially curative treatment for breast (n = 3100), colorectal (n = 2600), gastro-oesophageal (n = 2100) or prostate cancer (n = 2120) are registered into four tumour specific cohorts. All cohorts recruit in the United Kingdom, with the breast and gastro-oesophageal cohort also recruiting in India. Eligible participants first undertake an active run-in period where 100 mg aspirin is taken daily for approximately eight weeks. Participants who are able to adhere and tolerate aspirin then undergo a double-blind randomisation and are allocated in a 1:1:1 ratio to either 100 mg aspirin, 300 mg aspirin or a matched placebo to be taken daily for at least five years. Those participants ≥ 75 years old are only randomised to 100 mg aspirin or placebo due to increased toxicity risk.ResultsThe primary outcome measures are invasive disease-free survival for the breast cohort, disease-free survival for the colorectal cohort, overall survival for the gastro-oesophageal cohort, and biochemical recurrence-free survival for the prostate cohort, with a co-primary outcome of overall survival across all cohorts. Secondary outcomes include adherence, toxicity including serious haemorrhage, cardiovascular events and some cohort specific measures.ConclusionsThe Add-Aspirin trial investigates whether regular aspirin use after standard therapy prevents recurrence and prolongs survival in participants with four non-metastatic common solid tumours.     

Effect of a high-intensity interval training on serum microRNA levels in women with breast cancer undergoing hormone therapy. A single-blind randomized trial

BackgroundThe role of microRNAs (miRs) in hormone therapy (HT) is of keen interest in developing biomarkers and treatments for individuals with breast cancer. Although miRs are often moderate regulators under homeostatic conditions, their function is changed more in response to physical activity.ObjectiveThis single-blind randomized trial aimed to explore the effect of high-intensity interval training (HIIT) on serum levels of miRs in individuals with early-stage breast cancer undergoing HT.MethodsHormone receptor-positive women with breast cancer and healthy women were randomly assigned to a healthy control group (n = 15), healthy group with HIIT (n = 15), breast cancer group with HT (HT, n = 26), and breast cancer group with HT and HIIT (HT + HIIT, n = 26). The exercise groups underwent interval uphill walking training on a treadmill 3 times a week for 12 weeks. At the end of the study, we analyzed changes in levels of cancer-related miRs (oncomiRs) and tumour suppressor miRs (TSmiRs) in response to the HT and HIIT.ResultsIn women with breast cancer versus healthy controls, the expression of some oncomiRs was significantly increased — miR-21 (P < 0.001), miR-155 (P = 0.001), miR-221 (P = 0.008), miR-27a (P < 0.001), and miR-10b (P = 0.007) — and that of some TSmiRs was significantly decreased — miR-206 (P = 0.048), miR-145 (P = 0.011), miR-143 (P = 0.008), miR-9 (P = 0.020), and let-7a (P = 0.005). Moreover, HT considerably downregulated oncomiRs and upregulated TSmiRs. HIIT for 12 weeks with HT significantly decreased the expression of the oncomiRs and significantly increased that of the TSmiRs as compared with HT alone.ConclusionsHITT could amplify the decrease and/or increase in expression of miRs associated with HT in women with breast cancer. A prospective trial could determine whether the use of circulating miRs for monitoring treatment can be useful in therapy decisions.Trial registrationIranian Registry of Clinical Trials (No.: IRCT201202289171N1).     

Interaction of common sequence variants and selected risk factors in determination of HDL cholesterol levels

ObjectivesThe aim of our study was to assess the association of common sequence variants, and selected interactions, with HDL-c plasma levels.Design and methodsWe analysed 743 individuals (340 men and 403 women) with high mean triglyceride and LDL-c levels. The association of five polymorphic sites (ABCA1 g.1051G>A, APOA1 g.­75G>A, CETP g.­629C>A, HNF1A g.102A>C, and LIPG g.584C>T), apoE isoforms and selected interactions with HDL-c levels were evaluated using linear regression models.ResultsAfter adjusting for triglycerides, sex, and BMI the only genotype with a statistically significant effect on HDL-c levels (p-value = 0.004) was the CETP promoter variant. Further, linear regression model with interactions included indicated possible interplay between APOA1 genotype and menopause (p-value = 0.002) and ABCA1 and APOE isoforms (p-value = 0.017) on HDL-c plasma concentration.ConclusionsOur study indicated that not only the CETP variant but also apoE isoforms and menopause could operate as potent modulators of HDL-c concentrations.     

(Re)organisation of the somatosensory system after early brain lesion: A lateralization index fMRI study

ObjectiveTo evaluate the relationship between neural (re)organization of the somatosensory cortex and impairment of sensory function (2-point discrimination [2PD]) in individuals with unilateral cerebral palsy.MethodsWe included 21 individuals with unilateral cerebral palsy. 2PD thresholds were evaluated on thumb pads, and activation of the somatosensory cortex was recorded by functional MRI (fMRI) during passive movements of the affected hand. A lateralization index (LI) was calculated for the primary sensory (S1) and secondary sensory (S2) cortices and the correlation between the LI and 2PD thresholds was analysed.ResultsWe found a significant negative correlation between the 2PD thresholds and the S2 LI (r = −0.5, one-tailed P-value = 0.01) and a trend towards a negative correlation with the S1 LI (r = −0.4, one-tailed P-value = 0.05).ConclusionHigh levels of activation in the contralesional hemisphere were associated with high levels of sensory impairment in individuals with unilateral cerebral palsy. The interhemispheric (re)organization of the somatosensory system may not effectively compensate for somatosensory impairment.     

Clinical significance of Stratifin,ERα and PR promoter methylation in tumor and serum DNA in Indian breast cancer patients

Objectives:The objective of this study was to determine the concordance of promoter methylation of stratifin, ERα and PR in tumor and circulating DNA in breast cancer patients and their association with clinicopathological parameters and disease prognosis.Design and methods:Methylation specific PCR were carried out to investigate the promoter methylation status of stratifin, ERα and PR in tumor and circulating DNA in 100 breast cancer patients in a prospective study. The effect of promoter methylation on protein expression was evaluated by immunohistochemistry.Results:Significant association was observed between promoter methylation of stratifin in tumors (61%) and paired sera (56%) (r = 0.78; p ≤ 0.001). Loss of stratifin expression was observed in 47% tumors and was associated with poor overall survival (p = 0.05). Significant correlation was observed between methylation status of ERα with PRB (p < 0.0001, OR = 20.8, 95% CI = 7.4–58.0) and stratifin (p = 0.003, OR = 2.0, 95% CI = 0.8–4.4).Conclusion:This study underscores the potential utility of serum DNA methylation of these genes as surrogate for tumor DNA methylation as a promising tool for cancer diagnosis.     

Clinical significance of serum M30 and M65 levels in patients with breast cancer

M30 and M65 are relatively new assays that detect different circulating forms of the epithelial cell structural protein cytokeratin18. The objective of this study was to determine the clinical significance of the serum levels of M30 and M65 in patients with breast cancer. A total of 80 patients with a pathologically confirmed diagnosis of breast cancer were enrolled into the study. Serum M30 and M65 concentrations were determined by the solid-phase sandwich ELISA method. Serum samples were obtained on first admission before any type of treatment. The median age at diagnosis was 52 years, range 30 to 81 years. The baseline serum M30 and M65 levels in patients with metastatic disease were significantly higher than those in the non-metastatic patients (P = 0.017 and P = 0.003, respectively). Moreover, serum M65 level was also elevated in patients with large tumor size (P = 0.02). No correlation was found between these serum assay levels and response to chemotherapy (P > 0.05). However, the significant relationship was found between the serum levels of M30 and M65 (r_s = 0.96, P < 0.001). Neither serum M30 nor serum M65 had significantly effect on survival (P = 0.50, and P = 0.52, respectively). In conclusion, although both serum M30 and M65 levels are elevated in metastatic disease, no predictive and prognostic roles on survival were found in patients with breast cancer.     

Expression of haptoglobin predicts recurrence in head and neck squamous cell carcinoma

BackgroundWe determined whether expression of haptoglobin by head and neck squamous cell carcinoma (HNSCC) cells is associated with prognosis.MethodsWestern blotting was carried out to investigate the expression of haptoglobin in oral cancer cell lines. We study patients with HNSCC without distant metastasis at diagnosis. Correlation between cellular haptoglobin and clinical characteristics of HNSCC was analyzed to assess the prognostic value of cellular haptoglobin level. Kaplan–Meier survival curves and log-rank test were used to evaluate differences in recurrence, distant metastasis, and overall survival rates between patients grouped according to cellular haptoglobin level in cancer tissues. The relationship of haptoglobin expression with survival was assessed using Cox proportional hazard models.ResultsWestern blotting analysis showed that haptoglobin protein was expressed in 4 oral cancer cell lines. The recurrence rate was higher in HNSCC patients with over-expression of haptoglobin (> 50%) (P = 0.045). Over-expression of haptoglobin was also associated with an increased risk for recurrence (hazard ratio [HR] 3.2; 95% confidence interval [CI], 1.127–8.895; P = 0.029) after adjusting for age, gender, disease site, stage, and treatment modality.ConclusionsAltogether, the data presented show that cellular expression of haptoglobin is closely related to recurrence rate in HNSCC patients. The elevated risk of relapse was confirmed in a multivariate analysis. The cellular expression of haptoglobin may be a prognostic factor in HNSCC.     

Evolution of Cancer-Related Symptoms Over an 18-Month Period

ContextPrevious studies have revealed inconsistent findings about the longitudinal evolution of cancer-related symptoms. In addition, the contribution of medical factors (e.g., cancer site, and treatments) in explaining the changes in these symptoms is yet to be established.ObjectivesThis prospective study investigated longitudinal changes of five symptoms (i.e., depression, anxiety, insomnia, fatigue, and pain) in patients scheduled to undergo surgery for cancer (N = 828).MethodsThe patients completed the Hospital Anxiety and Depression Scale, the Insomnia Severity Index, the Multidimensional Fatigue Inventory, and a pain questionnaire at baseline and after 2, 6, 10, 14 and 18 months.ResultsSeveral time changes were statistically significant but effect sizes only revealed one change of a medium magnitude, that is, a reduction of anxiety from T1 to T2 (d = ?0.58). Women with breast or gynecological cancer were the only subgroups to exhibit significant changes (i.e., reduction of a small magnitude of anxiety symptoms from T1 to T2; ds = ?0.27 and ?0.30, respectively). However, numerous differences were found across adjuvant treatments, including greater variations in depression and insomnia scores in the chemotherapy group (ds = ?0.71 to 0.20) and a transient increase in fatigue symptoms in patients receiving “all” adjuvant treatments (ds = ?0.24 to 0.37).ConclusionThe severity of cancer-related symptoms varies during the cancer care trajectory, especially anxiety scores, which importantly decrease during the first few months after the surgery. This study also suggests that treatment regimens better account for individual differences than cancer site in the evolution of symptoms.     

Mobile health and supervised rehabilitation versus mobile health alone in breast cancer survivors: Randomized controlled trial

BackgroundSurvival rates in cancer are increasing exponentially, with a corresponding increase/influence in disability-adjusted life-years. Efforts should be made to explore the optimal balance between unsupervised/distance-based and supervised/onsite approaches to cancer care.ObjectiveThis study aimed to compare the clinical efficacy of the BENECA mobile Health (mHealth) lifestyle application combined with a supervised rehabilitation program (BENECA and supervised rehabilitation) versus the BENECA mHealth lifestyle application alone on quality of life (QoL) and functional outcomes of breast cancer survivors.MethodsThis randomized controlled trial included 80 survivors of breast cancer diagnosed at stage I–IIIA, who completed adjuvant therapy and were overweight or obese at diagnosis. Participants were randomly allocated (ratio 1:1, 3 waves) to BENECA mHealth and rehabilitation for 2 months (n = 40) or BENECA mHealth and usual care (BENECA mHealth alone; n = 40). Participants completed a questionnaire at baseline (T1), 8-weeks post-intervention (T2) and 6-month follow-up (T3). The primary outcome was QoL assessed with the EORT QLQ-C30. Secondary outcomes included upper-limb functionality and body composition. Statistical (between-group analyses of covariance) and clinical effects were analyzed by intention to treat.ResultsBoth groups showed improved outcomes, but global QoL was significantly better with BENECA mHealth and rehabilitation than BENECA mHealth alone (mean difference, 12.76; 95% confidence interval 4.85; 20.67; P = 0.004), with a moderate-to-large effect size (d = 72). The proportion of participants reporting reliable clinical improvement on global QoL at T2 was higher with BENECA mHealth and rehabilitation than BENECA mHealth alone (57.5% vs 26.3%, P = 0.008). Improvement in subjective and objective upper-limb functionality was also higher with BENECA mHealth and rehabilitation.ConclusionsThe BENECA mHealth lifestyle application with a supervised rehabilitation program had a statistically and clinically significant effect on QoL and upper-limb functionality in breast cancer survivors and is a unique and important promising new approach.     

Breast cancer follow up: A randomised controlled trial comparing point of need access versus routine 6-monthly clinical review

AimTo examine a model of care for breast cancer patients based on the concept of point of need access and investigate the effectiveness of this model compared to routine 6-monthly clinical reviews.DesignA parallel randomised controlled trial was used to examine point of need access to specialist care via the nurse specialist, compared to routine hospital based 6-monthly clinical review at year two post breast cancer diagnosis. A total of 237 patients were recruited to the study.MethodsOutcome measures at baseline, 9 and 18 months included psychological morbidity using the GHQ12 questionnaire, quality of life using the FACT-B plus endocrine subscale, fear and isolation. An analysis of covariance was used to detect changes over time. Recurrences and methods of detection were recorded as secondary outcome measures.ResultsTwo hundred and fourteen patients completed the study. Overall patients were not exposed to risks of increased psychological morbidity (p = 0.767) or decline of quality of life (p = 0.282) when routine review was discontinued and no significant differences were detected during an 18-month period. Patients not receiving regular review did not feel isolated, and at the end of 18 months did not wish to return to 6-monthly clinical reviews. The presentation of recurrences and short symptom history demonstrate that the recurrences observed were unlikely to have been detected at a routine visit.ConclusionsPoint of need access is acceptable to the majority of patients. Although a third of patients may wish to maintain a regular review, patient choice is important. Findings suggest that after 2 years following the diagnosis of breast cancer there is no evidence to support the view that regular clinical review improves psychological morbidity or quality of life. Patients do not appear to be compromised in terms of early detection of recurrence. Point of need access can be provided by suitably trained specialist nurses and provides a fast, responsive management system at a time when patients really need it.     

Premorbid psychosocial factors are associated with poor health-related quality of life in subjects with new onset of chronic widespread pain – Results from the EPIFUND study

Chronic widespread pain (CWP) is associated with poor health-related quality of life (HRQoL). It is unclear whether pain itself is the cause of poor HRQoL or other factors play a role. We hypothesised that new onset of CWP was associated with poor physical and mental HRQoL but that psychosocial risk markers for CWP onset would explain this relationship. A prospective population-based survey measured pain and psychosocial status at baseline. Subjects free of CWP at baseline were followed up 15 months later, when pain status, threatening life events and HRQoL (SF-12) were assessed. The risk associated with the new onset of CWP and reporting poor SF12-MCS and SF12-PCS was quantified using multinomial logistic regression (relative risk ratios (RRRs) with 95% confidence intervals (95% CI)), adjusted for age and gender. 3000 subjects (77%) free of CWP at baseline participated at follow-up. 2650 subjects (88%) provided full SF-12 and pain data and formed the cohort for this analysis. 9.4% of subjects (n = 248) reported new CWP. New CWP was associated with an increased risk of having the poorest SF12-MCS (RRR = 2.3; 95% CI 1.6–3.2) and SF12-PCS (RRR = 8.0; 95% CI 5.4–11.8) scores. After adjusting for baseline psychosocial status, the relationship between CWP onset and SF12-MCS was attenuated (RRR = 1.2; 95% CI 0.8–1.8), although the association with SF12-PCS remained (RRR = 4.8% CI 3.1–7.47). New onset of CWP is associated with poor mental and physical HRQoL. However, the relationship with mental HRQoL is explained by psychosocial risk markers.     

BCL2L12: A promising molecular prognostic biomarker in breast cancer

ObjectivesBCL2-like 12 (BCL2L12) is a new member of the BCL2 gene family that was discovered and cloned by members of our group and found to be expressed in the mammary gland. Many genes of the BCL2 family were found to be implicated in breast carcinogenesis and to serve as possible prognostic markers. The aim of the present study was the quantification of BCL2L12 mRNA expression in order to assess its value as a prognostic tissue biomarker in breast cancer (BC).Design and methodsBCL2L12 mRNA levels were determined in a statistically significant sample size of cancerous (N = 108) and adjacent non-cancerous (N = 71) breast tissues using a highly sensitive quantitative real-time polymerase chain reaction (qRT-PCR) method. Relative quantification analysis was conducted using the comparative C_T (2^− ΔΔC_T) method, whereas the association between BCL2L12 expression and clinopathological data, disease-free survival (DFS) and overall survival (OS) were estimated by statistical analysis.ResultsBCL2L12 mRNA expression was decreased in malignant samples compared to the histologically normal counterparts (p = 0.012). Significant relationships between BCL2L12 expression and TNM stages (p = 0.009), metastatic potential (p = 0.012), tumor size (p = 0.04) and age (p = 0.024) were observed. Moreover, Kaplan–Meier and Cox univariate analyses indicated that BCL2L12 expression is associated with longer DFS, whereas multivariate analysis pointed out the independent favorable prognostic value of BCL2L12.ConclusionsAccording to our results, BCL2L12 mRNA expression is a favorable prognostic marker of DFS for BC patients, suggesting its possible application as a novel prognostic indicator of this malignancy.     

Characteristics of Advanced Cancer Patients With Cancer-Related Fatigue Enrolled in Clinical Trials and Patients Referred to Outpatient Palliative Care Clinics

ContextLimited published data exist on whether characteristics of patients with advanced cancer enrolled in cancer-related fatigue clinical trials (CCTs) differ from patients in outpatient palliative care clinics (OPCs).ObjectivesThe primary aim of this study was to compare the characteristics of two groups of patients with advanced cancer and moderate-to-severe fatigue: patients in CCTs and patients at an OPC.MethodsWe retrospectively reviewed the records of 337 patients who were enrolled in one of five CCTs for advanced cancer patients at The University of Texas M. D. Anderson Cancer Center as well as the records of 1896 consecutive patients who were referred to our OPC from January 2003 through December 2010. Patients with fatigue scores of ≥4/10 (measured by the Edmonton Symptom Assessment System [ESAS]) were eligible (1252 OPC patients and 337 CCT patients). Patient characteristics, ESAS scores, and survival times were compared using Chi-square tests, Wilcoxon rank sum tests, and the Kaplan-Meier method.ResultsCompared with the CCT patients, OPC patients were more likely to be older (58 vs. 59 years; P = 0.009) and male (38% vs. 52%; P < 0.001). The most common primary cancer type was breast cancer (22%) in the CCT patients and lung cancer (23%) in the OPC patients (P < 0.001). The median ESAS scores in the OPC and CCT groups, respectively, were 6 and 4 for pain (P < 0.001), 7 and 7 for fatigue (P = 0.525), 3 and 2 for depression (P = 0.004), 3 and 2 for anxiety (P < 0.001), 3 and 2 for dyspnea (P < 0.001), and 43 and 32 for the symptom distress score (P < 0.001). The median overall survival times were 17.9 months (95% CI 13.5–22.3 months) in the CCT group and 3.8 months (95% CI 3.5–4.1 months) in the OPC group (P < 0.001).ConclusionBaseline characteristics and overall survival times significantly differed between patients enrolled in the CCT and OPC groups. Therefore, we conclude that the results of CCTs cannot be generalized to patients being treated in OPCs.     

Prognostic Factors of Survival in Patients With Advanced Cancer Admitted to Home Care

ContextData regarding prognostication of life expectancy in patients with advanced cancer are of paramount importance to patients, families, and clinicians. However, data regarding patients followed at home are lacking.ObjectivesThe aim of this study was to evaluate the correlation between various factors recorded at the beginning of home care assistance and survival.MethodsA sample of consecutive patients admitted to two home care programs was surveyed. A preliminary consensus was achieved as to the possible variables easy to be recorded at home. These included age at the time of home care admission, gender, residence, marital status, primary cancer diagnosis, Karnofsky Performance Status (KPS) score, measures of systolic blood pressure and heart rate, cyanosis, use of oxygen, and body temperature. The Edmonton Symptom Assessment System was used to record the intensity of each symptom. Patients were divided into two groups: patients with a survival of less than 10 days (short survival) and patients with a survival of 10 days or more (medium-long survival).ResultsThree hundred seventy-four consecutive patients admitted to home care programs were surveyed, of which 187 were male. The mean ± SD age was 72.1 ± 12.7 years. The mean survival was 56.2 ± 65 days. Mean survival was 71.5 ± 67 days (287 patients) and 5.6 ± 2.7 days (87 patients) in the short and medium-long survival groups, respectively. No association between type of tumor and survival was observed (P = 0.162). Univariate logistic regression analysis revealed that male gender (P = 0.020), older age (P = 0.012), lower KPS scores (P < 0.0005), systolic blood pressure less than 100 mm Hg (P = 0.003), heart rate greater than 100 beats per minute (P = 0.0006), delirium (P = 0.004), the use of oxygen (P = 0.002), intensity of fatigue (P = 0.006), drowsiness (P < 0.0005), anorexia (P < 0.0005), dyspnea (P < 0.0005), poor sense of well-being (P < 0.0005), and distress score (P < 0.0005) were associated with a survival of less than 10 days. Marital status, residence, cognitive function, fever, pain, depression, and anxiety were not found to be significantly correlated with survival. In a multiple logistic regression model, low systolic blood pressure and high heart rate, gender, delirium, use of oxygen, KPS score, drowsiness, anorexia, and dyspnea were significantly correlated with a shorter survival.ConclusionLow systolic blood pressure and high heart rate, male gender, poor KPS score, anorexia, and dyspnea were correlated with a shorter survival. Moreover, patients with low systolic blood pressure and high heart rate, male gender, poor KPS score, and greater intensity of anorexia and dyspnea are more likely to die within one week. The combination of physical symptoms from the Edmonton Symptom Assessment System and other parameters included in this study, which are simple to assess and are repeatable at home, should be further explored in future studies to provide a simple tool for use with patients with advanced cancer admitted to a home care program.     

Effects of two retraining strategies on nursing students’ acquisition and retention of BLS/AED skills: A cluster randomised trial

AimTo determine and compare the effects of two different retraining strategies on nursing students’ acquisition and retention of BLS/AED skills.MethodsNursing students (N = 177) from two European universities were randomly assigned to either an instructor-directed (IDG) or a student-directed (SDG) 4-h retraining session in BLS/AED. A multiple-choice questionnaire, the Cardiff Test, Laerdal SkillReporter^® software and a self-efficacy scale were used to assess students’ overall competency (knowledge, psychomotor skills and self-efficacy) in BLS/AED at pre-test, post-test and 3-month retention-test. GEE, chi-squared and McNemar tests were performed to examine statistical differences amongst groups across time.ResultsThere was a significant increase in the proportion of students who achieved competency for all variables measuring knowledge, psychomotor skills and self-efficacy between pre-test and post-test in both groups (all p-values < 0.05). However, at post-test, significantly more students in the SDG achieved overall BLS/AED competency when compared to IDG. In terms of retention at 3 months, success rates of students within the IDG deteriorated significantly for all variables except ≥70% of chest compressions with correct hand position (p-value = 0.12). Conversely, the proportion of students who achieved competency within the SDG only decreased significantly in ‘mean no flow-time≤5s’ (p-value = 0.02). Furthermore, differences between groups’ success rates at retention-test also proved to be significantly different for all variables measured (all p-values < 0.05).ConclusionThis study demonstrated that using a student-directed strategy to retrain BLS/AED skills has resulted in a higher proportion of nursing students achieving and retaining competency in BLS/AED at three months when compared to an instructor-directed strategy.     

A Web-based self-management exercise and diet intervention for breast cancer survivors: Pilot randomized controlled trial

BackgroundRegular exercise and dietary practices have been shown to affect the health-related quality of life (HRQOL) and survival of breast cancer patients.ObjectiveThe current study aimed to investigate whether the WSEDI was a feasible and primarily effective method for promoting exercise and dietary behaviours for breast cancer patients.DesignA 12-week randomized, controlled trial.SettingOncology outpatient treatment clinics at 3 university hospitals and 1 National Cancer Center in South Korea.ParticipantsFifty-nine breast cancer patients who had received curative surgery and completed primary cancer treatment within 12 months prior to the study and who had been diagnosed with stage 0–III cancers within 2 years prior to the study were recruited.MethodsParticipants were randomly assigned to either the intervention group, which used a Web-based self-management exercise and diet intervention program incorporating transtheoretical model (TTM)-based strategies (n = 29), or to the control group, which used a 50-page educational booklet on exercise and diet (n = 28). The intervention efficacy was measured at the baseline and 12 weeks via a Web-based survey that addressed the promotion of exercise and consumption of 5 servings of fruits and vegetables (F&V) per day, dietary quality, HRQOL, anxiety, depression, fatigue, motivational readiness, and self-efficacy.ResultsThe proportion of subjects who performed at least moderate-intensity aerobic exercise for at least 150 min per week; ate 5 servings of F&V per day; and had overall improvements in dietary quality, physical functioning and appetite loss (HRQOL), fatigue, and motivational readiness was greater in the intervention group than in the control group. The self-efficacy with respect to exercise and F&V consumption was greater in the intervention group than in the control group. A Web-based program that targets changes in exercise and dietary behaviours might be effective for breast cancer survivors if the TTM theory has been used to inform the program strategy, although further research with a larger sample size is required to enable definitive conclusions.