Supportive care for patients with breast cancer by using an interactive app during neoadjuvant chemotherapy : a randomized controlled trial

Background: Patients with breast cancer undergoing neoadjuvant chemotherapy are often treated as outpatients and experience several distressing symptoms and concerns over a long period, which must be managed at home. Routine use of patient reported outcomes facilitates communication with the healthcare of what needs the patient may have. To support patients with cancer during treatment, the use of mHealth has shown promising results in reducing symptoms and improving quality of life. Aim: To evaluate how an interactive app for reporting and managing symptoms provides supportive care in patients with breast cancer during neoadjuvant chemotherapy. Methods: Through the app patients report symptoms daily as well as write free text messages. The reports are monitored and responded to by a contact nurse at the clinic. Further, the patients have access to self-care advice and can view their reported symptoms in graphs. This randomized controlled trial was conducted according to the Medical Research Council’s framework for complex interventions. In Study I, the patients were randomized to an intervention group (n = 74), who used the app during treatment in combination with standard care, and to a control group (n = 75), who received standard care alone. Both groups answered questionnaires regarding symptoms and healthrelated quality of life before start of treatment and two weeks after end of treatment, to evaluate if the intervention had any effects on the patients’ symptoms and health-related quality of life. Study II investigated the patients’ engagement in using the app. Logged data from the patient’s app usage (n = 74) and predictors of usage were analyzed. Telephone interviews were conducted with the patients about how they perceived using the app during treatment. In Study III, face-to-face interviews were conducted three months after end of neoadjuvant chemotherapy with patients from both groups (n = 40) about perceptions of care during treatment with or without using the app. Results: In Study I, patients who used the app during treatment perceived less prevalence of symptoms and symptom distress and better emotional functioning two weeks after end of treatment compared with the patients in the control group. In Study II, the adherence to reporting in the app was 83%. The components included in the app, such as self-care advice and graphs, were used by most of the patients. Higher age predicted fewer free text messages sent. The app was considered easy to use with a relevant content, which facilitated support for symptom management and own monitoring of symptoms as well as having a close, continuous, and interactive contact with the contact nurse. In Study III, results showed that most of the patients, whether they had used the app or not, were satisfied with the care during the treatment. The patients who had used the app perceived it as an added value for support as they were provided easy access to information and communication regarding experienced symptoms with the contact nurse. Moreover, Interaktor facilitated performing self-care by using the self-care advice and promoted own participation in care. Conclusions: This thesis shows that patients with breast cancer can receive supportive care by using an app such as Interaktor during neoadjuvant chemotherapy. By facilitating interaction and communication with the contact nurse, symptoms can be identified and managed in a timely manner as well as enhancing patients’ participation in their own care

Forholdet mellom arbeidsgivers styringsrett og arbeidstakers særskilte rettsvern ved varsling, jf. aml. § 2 A-4. I hvilken grad innebærer det særskilte rettsvernet ved varsling i aml. § 2 A-4 en innskrenkning av arbeidsgivers styringsrett?

MasteroppgaveJUS399MAJURMAJUR-

The requirements of a specialist breast centre

Abstract This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.Peer reviewe

A Fast and Reliable Method for Simultaneous Waveform, Amplitude and Latency Estimation of Single-Trial EEG/MEG Data

The amplitude and latency of single-trial EEG/MEG signals may provide valuable information concerning human brain functioning. In this article we propose a new method to reliably estimate single-trial amplitude and latency of EEG/MEG signals. The advantages of the method are fourfold. First, no a-priori specified template function is required. Second, the method allows for multiple signals that may vary independently in amplitude and/or latency. Third, the method is less sensitive to noise as it models data with a parsimonious set of basis functions. Finally, the method is very fast since it is based on an iterative linear least squares algorithm. A simulation study shows that the method yields reliable estimates under different levels of latency variation and signal-to-noise ratioÕs. Furthermore, it shows that the existence of multiple signals can be correctly determined. An application to empirical data from a choice reaction time study indicates that the method describes these data accurately

Corticosteroids and regional variations in thickness of the human cerebral cortex across the lifespan

International audienceExposures to life stressors accumulate across the lifespan, with possible impact on brain health. Little is known, however, about the mechanisms mediating age-related changes in brain structure. We use a lifespan sample of participants (n = 21 251; 4–97 years) to investigate the relationship between the thickness of cerebral cortex and the expression of the glucocorticoid- and the mineralocorticoid-receptor genes (NR3C1 and NR3C2, respectively), obtained from the Allen Human Brain Atlas. In all participants, cortical thickness correlated negatively with the expression of both NR3C1 and NR3C2 across 34 cortical regions. The magnitude of this correlation varied across the lifespan. From childhood through early adulthood, the profile similarity (between NR3C1/NR3C2 expression and thickness) increased with age. Conversely, both profile similarities decreased with age in late life. These variations do not reflect age-related changes in NR3C1 and NR3C2 expression, as observed in 5 databases of gene expression in the human cerebral cortex (502 donors). Based on the co-expression of NR3C1 (and NR3C2) with genes specific to neural cell types, we determine the potential involvement of microglia, astrocytes, and CA1 pyramidal cells in mediating the relationship between corticosteroid exposure and cortical thickness. Therefore, corticosteroids may influence brain structure to a variable degree throughout life

Toward Defining the Preclinical Stages of Alzheimer's Disease: Recommendations from the National Institute on Aging-Alzheimer's Association Workgroups on Diagnostic Guidelines for Alzheimer's Disease

The pathophysiological process of Alzheimer's disease (AD) is thought to begin many years before the diagnosis of AD dementia. This long "preclinical" phase of AD would provide a critical opportunity for therapeutic intervention; however, we need to further elucidate the link between the pathological cascade of AD and the emergence of clinical symptoms. The National Institute on Aging and the Alzheimer's Association convened an international workgroup to review the biomarker, epidemiological, and neuropsychological evidence, and to develop recommendations to determine the factors which best predict the risk of progression from "normal" cognition to mild cognitive impairment and AD dementia. We propose a conceptual framework and operational research criteria, based on the prevailing scientific evidence to date, to test and refine these models with longitudinal clinical research studies. These recommendations are solely intended for research purposes and do not have any clinical implications at this time. It is hoped that these recommendations will provide a common rubric to advance the study of preclinical AD, and ultimately, aid the field in moving toward earlier intervention at a stage of AD when some disease-modifying therapies may be most efficacious

Cathelicidin-like Helminth Defence Molecules (HDMs) Absence of Cytotoxic, Anti-microbial and Anti-protozoan Activities Imply a Specific Adaptation to Immune Modulation

Host defence peptides (HDPs) are expressed throughout the animal and plant kingdoms. They have multifunctional roles in the defence against infectious agents of mammals, possessing both bactericidal and immune-modulatory activities. We have identified a novel family of molecules secreted by helminth parasites (helminth defence molecules; HDMs) that exhibit similar structural and biochemical characteristics to the HDPs. Here, we have analyzed the functional activities of four HDMs derived from Schistosoma mansoni and Fasciola hepatica and compared them to human, mouse, bovine and sheep HDPs. Unlike the mammalian HDPs the helminth-derived HDMs show no antimicrobial activity and are non-cytotoxic to mammalian cells (macrophages and red blood cells). However, both the mammalian- and helminth-derived peptides suppress the activation of macrophages by microbial stimuli and alter the response of B cells to cytokine stimulation. Therefore, we hypothesise that HDMs represent a novel family of HDPs that evolved to regulate the immune responses of their mammalian hosts by retaining potent immune modulatory properties without causing deleterious cytotoxic effects. © 2013 Thivierge et al

Brain structural differences between 73- and 92-year olds matched for childhood intelligence, social background, and intracranial volume

Fully characterizing age differences in the brain is a key task for combating aging-related cognitive decline. Using propensity score matching on 2 independent, narrow-age cohorts, we used data on childhood cognitive ability, socioeconomic background, and intracranial volume to match participants at mean age of 92 years (n = 42) to very similar participants at mean age of 73 years (n = 126). Examining a variety of global and regional structural neuroimaging variables, there were large differences in gray and white matter volumes, cortical surface area, cortical thickness, and white matter hyperintensity volume and spatial extent. In a mediation analysis, the total volume of white matter hyperintensities and total cortical surface area jointly mediated 24.9% of the relation between age and general cognitive ability (tissue volumes and cortical thickness were not significant mediators in this analysis). These findings provide an unusual and valuable perspective on neurostructural aging, in which brains from the 8th and 10th decades of life differ widely despite the same cognitive, socioeconomic, and brain-volumetric starting points