Longitudinal Serum Protein Analysis of Women with a High Risk of Developing Breast Cancer Reveals Large Interpatient Versus Small Intrapatient Variations:First Results from the TESTBREAST Study

The prospective, multicenter TESTBREAST study was initiated with the aim of identifying a novel panel of blood-based protein biomarkers to enable early breast cancer detection for moderate-to-high-risk women. Serum samples were collected every (half) year up until diagnosis. Protein levels were longitudinally measured to determine intrapatient and interpatient variabilities. To this end, protein cluster patterns were evaluated to form a conceptual basis for further clinical analyses. Using a mass spectrometry-based bottom-up proteomics strategy, the protein abundance of 30 samples was analyzed: five sequential serum samples from six high-risk women; three who developed a breast malignancy (cases) and three who did not (controls). Serum samples were chromatographically fractionated and an in-depth serum proteome was acquired. Cluster analyses were applied to indicate differences between and within protein levels in serum samples of individuals. Statistical analyses were performed using ANOVA to select proteins with a high level of clustering. Cluster analyses on 30 serum samples revealed unique patterns of protein clustering for each patient, indicating a greater interpatient than intrapatient variability in protein levels of the longitudinally acquired samples. Moreover, the most distinctive proteins in the cluster analysis were identified. Strong clustering patterns within longitudinal intrapatient samples have demonstrated the importance of identifying small changes in protein levels for individuals over time. This underlines the significance of longitudinal serum measurements, that patients can serve as their own controls, and the relevance of the current study set-up for early detection. The TESTBREAST study will continue its pursuit toward establishing a protein panel for early breast cancer detection

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Lessons from the Field. Caregivers supporting marginalized people receiving social service support from street outreach workers

Objective In this Lesson from the Field, we examine changes in the burden experienced by caregivers of persons who experience homelessness associated with lack employment, employability or education, and mental health challenges when the care recipient receives support from an outreach professional known as a social street worker (herein identified as worker). In addition, we focus on caregivers' perception of change in the quality of their relationship with the person for whom they care and whether the caregivers receive support from the worker. Background In the Netherlands, due to the transformation toward a participation society, persons living in compromised circumstances must increasingly rely on caregivers for support and shelter instead of relying on services, such as support from social community teams. Methods Workers provided by a Dutch organization covering the northwest of the Netherlands gained the consent of their clients to contact the clients' caregivers. Caregivers were invited to participate in the research and completed consent. A total of 111 caregivers of persons receiving support from workers completed surveys. Results Caregivers who had more contact with the worker worried less about the person for whom they provided care. No changes were found regarding tension between caregivers and the person for whom they cared. Most caregivers (73%) perceived positive changes in the quality of the relationship with the person for whom they provided care, and 52% received support from the worker. Conclusion Most carers did not perceive changes in their burden, but did perceived positive changes in the quality of the relationship with the person for whom they cared and received support themselves. Implications Our study underpins the need to recognize the caregiver's burden of caregivers who support marginalized people, to connect with these caregivers, and to support them