Trait anxiety predicts disease-specific health status in early-stage breast cancer patients

The objectives of this study were to examine the differences in health status (HS) of women with breast cancer (BC) at different moments in time, and between women scoring high and not high on trait anxiety, and to identify possible predictors of HS 6 and 12 months after surgery. Patients (N = 223) completed a trait anxiety questionnaire before diagnosis. Women who received a diagnosis of BC completed a BC-specific HS questionnaire 1, 3, 6 and 12 months after surgery. ANCOVA for repeated measures and multiple regression analysis were used in the analyses. Women scoring high on trait anxiety had significant (P < .005) lower Body image, worse Future perspective and Sexual functioning, and more Side-effects than women who did not score high on trait anxiety. At 6 and 12 months after surgery, the same aspects of HS were predicted by higher trait anxiety scores. Higher scores on trait anxiety resulted in worse scores on four HS domains, indicating that there should be more attention for this group of patients, even before treatment start

Anxious Personality and Breast Cancer: Possible Negative Impact on Quality of Life After Breast-Conserving Therapy

Background Quality of Life (QoL) is an important outcome measure in oncology. To assess the influence of surgical treatment and personality on QoL in women with breast cancer, a longitudinal prospective cohort study was done. Methods Women (n = 222) completed questionnaires concerning QoL (WHOQOL 100) and personality (NEO-FFI and STAI) prior to the diagnosis of breast cancer and 1, 3, 6, and 12 months after diagnosis and treatment. One hundred five women were treated with breast-conserving therapy (BCT) and 117 women underwent mastectomy (MTC). Results The two treatment groups did not differ on overall QoL. At all measurement times the influence of trait anxiety on overall QoL was substantial in the BCT group. Women with a high score on trait anxiety were seven times more likely to have a low overall QoL 1 year after BCT. In the MTC group overall QoL was influenced mainly by neuroticism. Conclusions Personality, especially trait anxiety and neuroticism, determined patients' overall QoL scores. Women with an anxious personality fared worse concerning QoL after breast conserving therap

The effect of a complementary e-learning course on implementation of a quality improvement project regarding care for elderly patients: a stepped wedge trial

<p>Abstract</p> <p>Background</p> <p>Delirium occurs frequently in elderly hospitalised patients and is associated with higher mortality, increased length of hospital stay, functional decline, and admission to long-term care. Healthcare professionals frequently do not recognise delirium, indicating that education can play an important role in improving delirium care for hospitalised elderly. Previous studies have indicated that e-learning can provide an effective way of educating healthcare professionals and improving quality of care, though results are inconsistent.</p> <p>Methods and design</p> <p>This stepped wedge cluster randomised trial will assess the effects of a complementary delirium e-learning course on the implementation of quality improvement initiative, which aims to enhance the recognition and management of delirium in elderly patients. The trial will be conducted in 18 Dutch hospitals and last 11 months. Measurements will be taken in all participating wards using monthly record reviews, in order to monitor delivered care. These measurements will include the percentage of elderly patients who were screened for the risk of developing delirium, use of the Delirium Observation Screening scale, use of nursing or medical interventions, and the percentage of elderly patients who were diagnosed with delirium. Data regarding the e-learning course will be gathered as well. These data will include user characteristics, information regarding use of the course, delirium knowledge before and after using the course, and the attitude and intentions of nurses concerning delirium care.</p> <p>Setting</p> <p>The study will be conducted in internal medicine and surgical wards of eighteen hospitals that are at the beginning stages of implementing the Frail Elderly Project in the Netherlands.</p> <p>Discussion</p> <p>Better recognition of elderly patients at risk for delirium and subsequent care is expected from the introduction of an e-learning course for nurses that is complementary to an existing quality improvement project. This trial has the potential to demonstrate that e-learning can be a vital part of the implementation process, especially for quality improvement projects aimed at complex health issues such as delirium. The study will contribute to a growing body of knowledge concerning e-learning and the effects it can have on knowledge as well as delivered care.</p> <p>Trial registration</p> <p>Netherlands Trial Register (NTR): <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2885">NTR2885</a></p

Delayed and Accelerated Aging Share Common Longevity Assurance Mechanisms

Mutant dwarf and calorie-restricted mice benefit from healthy aging and unusually long lifespan. In contrast, mouse models for DNA repair-deficient progeroid syndromes age and die prematurely. To identify mechanisms that regulate mammalian longevity, we quantified the parallels between the genome-wide liver expression profiles of mice with those two extremes of lifespan. Contrary to expectation, we find significant, genome-wide expression associations between the progeroid and long-lived mice. Subsequent analysis of significantly over-represented biological processes revealed suppression of the endocrine and energy pathways with increased stress responses in both delayed and premature aging. To test the relevance of these processes in natural aging, we compared the transcriptomes of liver, lung, kidney, and spleen over the entire murine adult lifespan and subsequently confirmed these findings on an independent aging cohort. The majority of genes showed similar expression changes in all four organs, indicating a systemic transcriptional response with aging. This systemic response included the same biological processes that are triggered in progeroid and long-lived mice. However, on a genome-wide scale, transcriptomes of naturally aged mice showed a strong association to progeroid but not to long-lived mice. Thus, endocrine and metabolic changes are indicative of “survival” responses to genotoxic stress or starvation, whereas genome-wide associations in gene expression with natural aging are indicative of biological age, which may thus delineate pro- and anti-aging effects of treatments aimed at health-span extension

Cancer or No Cancer:The Influence of Trait Anxiety and Diagnosis on Quality of Life With Breast Cancer and Benign Disease: A Prospective, Longitudinal Study

<p>High trait anxiety (HTA) causes an impaired quality of life (QOL) and fatigue in women with breast cancer (BC) and benign breast disease (BBD). We examined whether the lowered QOL was determined solely by the personality characteristic HTA or by the combination of personality and diagnosis.</p><p>In a prospective longitudinal study, women with BC (n = 152), BBD (n = 205), or gallstone disease (GD) before laparoscopic cholecystectomy (n = 128) were included. Questionnaires concerning trait anxiety (baseline), fatigue, and QOL were completed at baseline and at 6 months. Multivariate linear regression analysis was performed to analyze the predictors for QOL at 6 months.</p><p>At 6 months QOL scores were increased in the GD group, especially in women without HTA. For women without HTA, in the BBD group the scores for fatigue and physical QOL had improved at 6 months, whereas in the BC group physical QOL and fatigue was impaired. Women with HTA scored unfavorably on fatigue and QOL. HTA was the most important factor influencing QOL.</p><p>The course of QOL and fatigue during follow-up were significantly different for each diagnosis. Particularly HTA had a negative impact on QOL and fatigue. Especially the combination HTA and BC caused impaired QOL and fatigue. We recommend identifying women with BC and HTA and offer them a tailor-made follow-up protocol.</p>