Perception of cancer recurrence risk: More information is better

Objective

Breast cancer is the most common cancer among women worldwide. Given the advances in extending survival, the number of recently diagnosed breast cancer patients and longer-term breast cancer survivors is growing. The goals of this study were to better understand (1) perceptions of provider cancer recurrence risk communication, (2) perceived risk of breast cancer recurrence in cancer patients and survivors, and (3) accuracy of perceived risk.

Methods

A survey was conducted on women with a prior breast cancer (n = 141).

Results

Approximately 40% of women perceived that providers had not talked about their breast cancer recurrence risk; although only 1 person reported not wanting a physician to talk to her about her risk. Women were largely inaccurate in their assessments of risk. Greater worry, living in a rural area, and longer time since diagnosis were associated with greater inaccuracy. Women tended to think about distal recurrence of cancer as often of local recurrence.

Conclusions

Perceived risk of breast cancer recurrence was inaccurate, and patients desired more communication about recurrence risk.

Practice implications

Consistent with findings from other studies, greater efforts are needed to improve the communication of cancer recurrence risk to patients. Attention should be paid to those from rural areas and to distal cancer recurrence in women with a previous history of breast cancer.     

Improvement of Statin Utilization in Veterans With Diabetes Through Pharmacy Interventions

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an effort aimed at increasing the use of statins among veterans with diabetes at a Veterans Affairs medical center in New Mexico.     

A novel small molecule approach for the treatment of propionic and methylmalonic acidemias

Propionic Acidemia (PA) and Methylmalonic Acidemia (MMA) are inborn errors of metabolism affecting the catabolism of valine, isoleucine, methionine, threonine and odd-chain fatty acids. These are multi-organ disorders caused by the enzymatic deficiency of propionyl-CoA carboxylase (PCC) or methylmalonyl-CoA mutase (MUT), resulting in the accumulation of propionyl-coenzyme A (P-CoA) and methylmalonyl-CoA (M-CoA in MMA only). Primary metabolites of these CoA esters include 2-methylcitric acid (MCA), propionyl-carnitine (C3), and 3-hydroxypropionic acid, which are detectable in both PA and MMA, and methylmalonic acid, which is detectable in MMA patients only (Chapman et al., 2012). We deployed liver cell-based models that utilized PA and MMA patient-derived primary hepatocytes to validate a small molecule therapy for PA and MMA patients. The small molecule, HST5040, resulted in a dose-dependent reduction in the levels of P-CoA, M-CoA (in MMA) and the disease-relevant biomarkers C3, MCA, and methylmalonic acid (in MMA). A putative working model of how HST5040 reduces the P-CoA and its derived metabolites involves the conversion of HST5040 to HST5040-CoA driving the redistribution of free and conjugated CoA pools, resulting in the differential reduction of the aberrantly high P-CoA and M-CoA. The reduction of P-CoA and M-CoA, either by slowing production (due to increased demands on the free CoA (CoASH) pool) or enhancing clearance (to replenish the CoASH pool), results in a net decrease in the CoA-derived metabolites (C3, MCA and MMA (MMA only)). A Phase 2 study in PA and MMA patients will be initiated in the United States.     

MAPLE Deposition of Macromolecules

Macromolecules are poised to feature prominently as components in organic electronics, medical implants, drug delivery systems, and sensors. A common theme for the role polymers will play in all of these is as a thin film. In all applications, it is paramount to have precise control over film thickness, structure, morphology, surfaces roughness, etc. Here, matrix‐assisted pulsed laser evaporation (MAPLE) is reviewed as a route to processing polymer and other soft matter thin films with control over the above‐mentioned parameters. After briefly discussing the experimental setup and current proposed mechanism of film formation via MAPLE, the use of MAPLE to process thin films is highlighted for use in various technologies and applications. Future directions and challenges for MAPLE processing of thin films are also discussed.

     

Surgical pathology of native valve endocarditis in 310 specimens from 287 patients (1985–2004)

BackgroundFew large studies have documented the clinical and pathologic features of native valve endocarditis (NVE) independently from prosthetic valve endocarditis (PVE).MethodsA retrospective study of medical records of all patients undergoing operation for NVE at Mayo Clinic in Rochester, MN (1985–2004), was performed. Medical records were reviewed from 287 patients for demographics, infecting organism, and comorbidities. Microscopic slides from 310 valves were reviewed for features of infection.ResultsThe study cohort included 287 patients, with age ranging from 9 to 87 years (mean, 54), yielding 310 valves. Most (73%) were from men, and 84% were regurgitant. Risk factors included bicuspid aortic valve (23%), dental manipulation (20%), mitral valve prolapse (18%), diabetes mellitus (16%), and others (< 5% each); in 15%, no risk factor was identified. The four most commonly identified organisms were viridans group streptococci (28%), Staphylococcus aureus (18%), enterococci (9%), and coagulase-negative staphylococci (8%). NVE was histologically active in 58% and healed in 42%, and affected left-sided valves in 94%. It was associated with embolization in 29%, acute heart failure in 29%, and annular abscess in 18%. Men accounted for a higher percentage of aortic NVE than mitral NVE (82% versus 63%, respectively; P=.001). Among 126 valves with active endocarditis, 25% had no microorganisms identified histologically.ConclusionNVE affected men nearly three times as frequently as women. Diabetes mellitus emerged as a prevalent (and previously underrecognized) risk factor for NVE. The most common infecting organisms were streptococci and staphylococci. Microorganisms were identified histologically in the majority of active endocarditis cases.     

Woven Endobridge device for treatment of dissection-related PICA aneurysm

Ruptured vertebrobasilar dissecting aneurysms require urgent, often challenging treatment as they have with a high re-hemorrhage rate within the first 24 hours. The patient is a 57-year-old woman who presented with severe-sudden onset headache. Further work up showed a ruptured dissecting aneurysm of the caudal loop of the posterior inferior cerebellar artery (PICA) with associated narrowing distally, in the ascending limb. The aneurysm was immediately occluded with a Woven Endobridge (WEB) device (MicroVention, Tustin, CA, USA) while flow diversion treatment of the diseased ascending limb was postponed. Follow-up angiography three months later showed complete occlusion of the aneurysm, as well as healing of the diseased distal vessel, obviating the need for further intervention. WEB embolization of a ruptured dissecting posterior circulation aneurysm provided an excellent outcome for this patient.     

Value of Extended Warming in Patients Undergoing Elective Surgery

Perioperative temperature management is imperative for positive surgical outcomes. This study assessed the clinical and wellbeing benefits of extending normothermia by using a portable warming gown. A total of 94 patients undergoing elective surgery were enrolled. They were randomized pre-operatively to either a portable warming gown or the standard warming procedure. The warming gown stayed with patients from pre-op to operating room to postrecovery room discharge. Core temperature was tracked throughout the study. Patients also provided responses to a satisfaction and comfort status survey. The change in average core temperature did not differ significantly between groups (P = 0.23). A nonsignificant 48% relative decrease in hypothermic events was observed for the extended warming group (P = 0.12). Patients receiving the warming gown were more likely to report always having their temperature controlled (P = 0.04) and significantly less likely to request additional blankets for comfort (P = 0.006). Clinical outcomes and satisfaction were improved for patients with extended warming.Key words: Perioperative warming, Hypothermia, Warming gown, Patient warming unitIntra-operative management of core temperature has been shown to reduce postoperative complications including infections, risk of blood transfusions, and length of hospital stay.¹ Core temperature at induction has been demonstrated to be a significant risk for development of perioperative hypothermia.² Research findings in support of avoiding hypothermia (core temperature <36°) during surgery and the impact of lower temperature on patient recovery is well documented.^3,4 These include increased bleeding during surgery, increased infection rates, increased length of stay, as well as, ultimately, a higher mortality rate.^1,5,6Perioperative normothermia has also been shown to reduce postoperative complications.³ Most recently it has been suggested that active warming commencing preoperatively is more effective in achieving normothermic admission temperatures to postanesthesia recovery than warming commenced intra-operatively.⁴ That complications are reduced with preoperative warming is well established. These findings further suggest that extended warming significantly reduces rates of hypothermia over the standard warming just during surgery and at this time, no study has been performed.This study was conducted with three objectives in mind. The first objective was to compare rates of hypothermia (core temp < 36°) recorded intra-operatively in both a standard warming procedure group and an extended perioperative warming group. The second objective was to examine the association between normothermia extension and well-being. The third objective was to describe the costs of extended warming (peri-operative warming gown) and compare it to the standard warming procedure.