Understanding the information needs of women with rheumatoid arthritis concerning pregnancy, post-natal care and early parenting: A mixed-methods study

© 2015 Ackerman et al. Background: Although women with rheumatoid arthritis (RA) face a number of challenges in negotiating the journey to parenthood, no studies have explored the information needs of women with RA in relation to their childbearing years. This study aimed to determine the need for (and preferred mode/s of delivery of) information regarding pregnancy, post-natal care and early parenting among women with RA. Methods: Interviews and focus groups were conducted with 27 women with RA who were pregnant in the last 5 years, currently pregnant or planning pregnancy. Verbatim transcripts were analysed using both inductive and deductive approaches. Two validated instruments were used to quantify information needs and preferences: the Educational Needs Assessment Tool (ENAT, range 0-156, higher scores indicate higher educational needs) and the Autonomy Preference Index (API, range 0-100, higher scores indicate stronger preferences). Results: Lack of information about medication safety, access to physical/emotional support services and practical strategies for coping with daily challenges related to parenting were the most prominent of the six key themes identified. Rheumatologists were the primary source for information regarding treatment decisions while arthritis consumer organisations were perceived as critical 'resource hubs'. There was strong preference for information delivered electronically, especially among rural participants. Quantitative outcomes supported the qualitative findings; on average, participants reported high educational needs (mean ENAT score 97.2, SD 30.8) and API scores indicated that desire for information (mean 89.8, SD 5.6) was greater than the need for involvement in treatment decision-making (mean 68.4, SD 8.2). Conclusions: Many women with RA struggle to find adequate information on pregnancy planning, pregnancy and early parenting in relation to their chronic condition, and there is a clear need to develop accessible information that is consumer-focused and evidence-based. Although most participants trusted their rheumatologist as their primary information source, there was consistent demand for more information, particularly regarding the safety of RA medications during pregnancy and breastfeeding, and the importance of learning from other women's personal experiences was strongly emphasised

New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients

<p>Abstract</p> <p>Background</p> <p>Current practice is to perform a completion axillary lymph node dissection (ALND) for breast cancer patients with tumor-involved sentinel lymph nodes (SLNs), although fewer than half will have non-sentinel node (NSLN) metastasis. Our goal was to develop new models to quantify the risk of NSLN metastasis in SLN-positive patients and to compare predictive capabilities to another widely used model.</p> <p>Methods</p> <p>We constructed three models to predict NSLN status: recursive partitioning with receiver operating characteristic curves (RP-ROC), boosted Classification and Regression Trees (CART), and multivariate logistic regression (MLR) informed by CART. Data were compiled from a multicenter Northern California and Oregon database of 784 patients who prospectively underwent SLN biopsy and completion ALND. We compared the predictive abilities of our best model and the Memorial Sloan-Kettering Breast Cancer Nomogram (Nomogram) in our dataset and an independent dataset from Northwestern University.</p> <p>Results</p> <p>285 patients had positive SLNs, of which 213 had known angiolymphatic invasion status and 171 had complete pathologic data including hormone receptor status. 264 (93%) patients had limited SLN disease (micrometastasis, 70%, or isolated tumor cells, 23%). 101 (35%) of all SLN-positive patients had tumor-involved NSLNs. Three variables (tumor size, angiolymphatic invasion, and SLN metastasis size) predicted risk in all our models. RP-ROC and boosted CART stratified patients into four risk levels. MLR informed by CART was most accurate. Using two composite predictors calculated from three variables, MLR informed by CART was more accurate than the Nomogram computed using eight predictors. In our dataset, area under ROC curve (AUC) was 0.83/0.85 for MLR (n = 213/n = 171) and 0.77 for Nomogram (n = 171). When applied to an independent dataset (n = 77), AUC was 0.74 for our model and 0.62 for Nomogram. The composite predictors in our model were the product of angiolymphatic invasion and size of SLN metastasis, and the product of tumor size and square of SLN metastasis size.</p> <p>Conclusion</p> <p>We present a new model developed from a community-based SLN database that uses only three rather than eight variables to achieve higher accuracy than the Nomogram for predicting NSLN status in two different datasets. </p

The Effect of Cognitive Behavior Therapy on Anxiety Reduction of First Normal Vaginal Delivery

Introduction: Anxiety has an impressive effect on normal vaginal delivery. Since no study has been conducted in this regard, this research is designed to determine the effect of cognitive behavior therapy on the reduction of anxiety at first normal vaginal delivery. Methods: A semi-experimental study was carried out on 40 nulliparous women with six months age of pregnancy and without abortion and infertility background. After the completion of testimonial, the rate of anxiety was evaluated by Beck anxiety inventory. Then the participants were randomly divided into two groups (20 persons in each group). The experimental group received ten sessions of individual cognitive behavior therapy. The test was carried out again a week before delivery and twenty days after it. The data analysis was accomplished by SPSS16 and Co-variance analysis test. Results: At first the average of anxiety score in the experimental group was 34.16, in post test. 8.68 and in follow up test 7.79 and, thus the difference was meaningful(p<0.01), whereas in the control group, this score, at first, was 34.05, in post test 34.53 and in follow up test 26.89, which did not show any meaningful difference. Conclusions: Consequently the cognitive behavior therapy causes to decrease the anxiety with enduring effect at first normal vaginal delivery. Therefore, this treatment is proposed to reduce the anxiety of first delivery women

Professional Medical English: Course book for higher education students, specialty 222 Medicine of higher educational institution institutions of IV level of accreditation

The course book is intended for students of higher education in the specialty 222 Medicine of the second year of study in accordance with the requirements of the Professional English Language program. The purpose of the course book is to form a foreign language communicative competence in the field of professional terminology in higher education medical students. The course book consists of 30 chapters organized according to the thematic principle. Each section contains a text, a thematic explanatory dictionary, a system of lexical and grammatical exercises of a communicative orientation and a case history. When compiling the exercises of a communicative orientation and a case history. When compiling the course book, authentic text materials were used. The course book can be used in postgraduate education courses, as well as for self-improvement of the professional English Language level by practicing doctors