Nevin Manimala

Bone Marrow Transplant. 2023 Sep 7. doi: 10.1038/s41409-023-02094-1. Online ahead of print.

ABSTRACT

Allogeneic hematopoietic cell transplantation (allo-HCT) is curative for myelofibrosis (MF) but assessing risk-benefit in individual patients is challenging. This complexity is amplified in CALR-mutated MF patients, as they live longer with conventional treatments compared to other molecular subtypes. We analyzed outcomes of 346 CALR-mutated MF patients who underwent allo-HCT in 123 EBMT centers between 2005 and 2019. After a median follow-up of 40 months, the estimated overall survival (OS) rates at 1, 3, and 5 years were 81%, 71%, and 63%, respectively. Patients receiving busulfan-containing regimens achieved a 5-year OS rate of 71%. Non-relapse mortality (NRM) at 1, 3, and 5 years was 16%, 22%, and 26%, respectively, while the incidence of relapse/progression was 11%, 15%, and 17%, respectively. Multivariate analysis showed that older age correlated with worse OS, while primary MF and HLA mismatched transplants had a near-to-significant trend to decreased OS. Comparative analysis between CALR- and JAK2-mutated MF patients adjusting for confounding factors revealed better OS, lower NRM, lower relapse, and improved graft-versus-host disease-free and relapse-free survival (GRFS) in CALR-mutated patients. These findings confirm the improved prognosis associated with CALR mutation in allo-HCT and support molecular profiling in prognostic scoring systems to predict OS after transplantation in MF.

PMID:37679647 | DOI:10.1038/s41409-023-02094-1

Surg Endosc. 2023 Sep 7. doi: 10.1007/s00464-023-10369-3. Online ahead of print.

ABSTRACT

BACKGROUND: This retrospective cohort study aims to investigate emergency department (ED) visits and readmission after bariatric surgery among patients with a history of anxiety and/or depression. We predict that patients with a reported history of anxiety and/or depression will have more ED visits in the year following surgery than patients without a history of mental illness.

METHODS: Data were collected from the charts of all consecutive patients who underwent sleeve gastrectomy or gastric bypass surgery between March 2012 and December 2019. Data on baseline body mass index, mental health diagnosis and treatment and emergency department visits and hospital readmissions were retrospectively reviewed over the first year following surgery.

RESULTS: One thousand two hundred ninety-seven patients were originally included in this study and 1113 patients were included in the final analysis. Patients with a history of depression (OR 1.23; 95% CI 0.87-1.73), anxiety (OR 1.14; 95% CI 0.81-1.60), or both (OR 1.17; 95% CI 0.83-1.65) did not have a statistically significant increase in ED visits compared to patients without these disorders. Patients with a history of depression (OR 1.49; 95% CI 0.86-2.61), anxiety (OR 1.45; 95% CI 0.80-2.65) or both (OR 1.47; 95% CI 0.94-2.29) did not have a statistically significant increase in hospital readmissions in the first year after surgery compared to patients without these disorders. Patients treated with a sleeve gastrectomy were readmitted due to postoperative complications less frequently than those treated with other surgeries (OR 0.20; 95% CI 0.05-0.83).

CONCLUSION: Patients with a history of anxiety, depression or both did not have an increased rate of emergency department visits and hospital readmissions within the first year following bariatric surgery. This contradicts current literature and may be due to the multidisciplinary program patients undergo at this study’s home institution.

PMID:37679583 | DOI:10.1007/s00464-023-10369-3

Bull Math Biol. 2023 Sep 7;85(10):97. doi: 10.1007/s11538-023-01202-y.

ABSTRACT

Several safe and effective vaccines are available to prevent individuals from experiencing severe illness or death as a result of COVID-19. Widespread vaccination is widely regarded as a critical tool in the fight against the disease. However, some individuals may choose not to vaccinate due to vaccine hesitancy or other medical conditions. In some sectors, regular compulsory testing is required for such unvaccinated individuals. Interestingly, different sectors require testing at various frequencies, such as weekly or biweekly. As a result, it is essential to determine the optimal testing frequency and identify underlying factors. This study proposes a population-based model that can accommodate different personal decision choices, such as getting vaccinated or undergoing regular tests, as well as vaccine efficacies and uncertainties in epidemic transmission. The model, formulated as impulsive differential equations, uses time instants to represent the reporting date for the test result of an unvaccinated individual. By employing well-accepted indices to measure transmission risk, including the basic reproduction number, the peak time, the final size, and the number of severe infections, the study shows that an optimal testing frequency is highly sensitive to parameters involved in the transmission process, such as vaccine efficacy, disease transmission rate, test accuracy, and existing vaccination coverage. The testing frequency should be appropriately designed with the consideration of all these factors, as well as the control objectives measured by epidemiological quantities of great concern.

PMID:37679577 | DOI:10.1007/s11538-023-01202-y

Arch Gerontol Geriatr. 2023 Aug 31;117:105174. doi: 10.1016/j.archger.2023.105174. Online ahead of print.

ABSTRACT

BACKGROUND & PURPOSE: Pre-stroke impairment of activities of daily living (ADL) is considered a major determinant for functional outcome after stroke. However, findings are based on studies in stroke patients in which pre-stroke information is gathered retrospectively, with inherent risks of selection and recall bias. The objective of this study was to verify the predictive value of pre-stroke ADL with respect to ADL decline in a large prospective cohort of community dwelling older subjects with known vascular risk factors or vascular disease, thereby minimizing selection and recall bias.

METHODS: Within the four-year study follow-up of a cohort including 5,804 community dwelling older subjects from three countries at risk for vascular disease, incident stroke survivors were identified. Incident myocardial infarction (MI) survivors and the remaining study survivors without incident vascular events served as comparison groups. Multivariate logistic regression analyses for each of the aforementioned groups were performed to assess associations between pre-stroke ADL by the Barthel Index (BI) and Instrumental Activities of Daily Living (IADL) scale and risk for ADL decline.

RESULTS: In stroke survivors, neither pre-event BI (n = 230, OR 1.00 (95% CI 0.83-1.23)) nor IADL (OR 1.07 (95% CI 0.94 – 1.20)) predicted risk of post-stroke ADL decline in contrast to ADL decline after MI (n = 443, OR 0.83 (95% CI 0.70-0.98) and 0.87 (95% CI 0.78-0.97) respectively) and the group without vascular events (n = 4336, OR 0.85 (95% CI 0.78-0.92) and 0.87 (95% CI 0.83-0.92) respectively).

CONCLUSIONS: In the present prospective cohort of community dwelling older subjects with known vascular risk factors, pre-stroke ADL measured by BI and IADL scale did not predict post-stroke ADL decline.

PMID:37677863 | DOI:10.1016/j.archger.2023.105174

Clin J Oncol Nurs. 2023 Mar 16;27(2):147-153. doi: 10.1188/23.CJON.147-153.

ABSTRACT

BACKGROUND: Limited English proficiency (LEP) is a limited ability to read, write, speak, and understand English. About 145,000 individuals with LEP will be diagnosed with a new cancer annually, and English remains the dominant language spoken in the U.S. medical system.

OBJECTIVES: The goal of this article is to discuss the issues faced by patients with LEP and cancer who are unable to communicate effectively with oncology providers.

METHODS: This overview used published U.S. government statistics, information from consensus and policy organizations, and clinical studies published between 2017 and 2022.

FINDINGS: Federal laws prohibit discrimination based on immigration status. People with LEP experience delayed cancer diagnoses and often receive inadequate treatment. Patients with LEP often have limited understanding of the medical system and do not receive language-concordant information about their cancer and treatment options.

PMID:37677828 | DOI:10.1188/23.CJON.147-153

Oncol Nurs Forum. 2022 Dec 16;50(1):115-127. doi: 10.1188/23.ONF.115-127.

ABSTRACT

OBJECTIVES: To examine colorectal cancer survivors’ positive psychology and symptom characteristics, and to assess for potential impact of prior trauma on these relationships during acute cancer survivorship.

SAMPLE & SETTING: A cross-sectional study of 117 colorectal cancer survivors was conducted at a National Cancer Institute-designated cancer center.

METHODS & VARIABLES: Participants completed a demographic questionnaire, and the Carver Benefit Finding Scale and Posttraumatic Growth Inventory assessed positive psychology. Descriptive statistics and multiple linear regression analyses were performed.

RESULTS: 49 symptoms were reported and varied based on prior trauma. Significance was found between positive psychology and symptom frequency (p < 0.001); symptoms reported almost daily and daily were inversely related to positive psychology.

IMPLICATIONS FOR NURSING: Nurses should prioritize symptoms; less frequent symptoms improve positive psychology. Early identification of positive changes may promote survivors’ self-awareness and management skills to mitigate adverse symptoms.

PMID:37677795 | DOI:10.1188/23.ONF.115-127

Clin J Oncol Nurs. 2023 Jul 20;27(4):411-417. doi: 10.1188/23.CJON.411-417.

ABSTRACT

BACKGROUND: Older women diagnosed with breast cancer are at risk for malnutrition.

OBJECTIVES: This article aims to evaluate the relationships among cancer stage, pain, functional status, depression, and malnutrition, and to determine whether these symptoms predict nutritional status.

METHODS: This cross-sectional study included women (N = 72) aged 70 years or older diagnosed with breast cancer at an academic medical center in the midwestern United States. The Timed Up and Go Test, Activities of Daily Living Scale, Numeric Pain Rating Scale, Geriatric Depression Scale, and Mini Nutritional Assessment were used. Demographic characteristics were evaluated using descriptive statistics. Bivariate and point-biserial correlations and linear regressions were used.

FINDINGS: Participants’ Mini Nutritional Assessment scores were significantly related to cancer stage, pain, depression, and Activities of Daily Living Scale scores.

PMID:37677771 | DOI:10.1188/23.CJON.411-417

Oncol Nurs Forum. 2023 Aug 17;50(5):665-670. doi: 10.1188/23.ONF.665-670.

ABSTRACT

OBJECTIVES: To examine the relationships among family caregiver burden and workplace productivity and activity impairment among home hospice family caregivers of individuals with cancer who worked while providing end-of-life caregiving.

SAMPLE &AMP; SETTING: Baseline data from a longitudinal study of communication between hospice providers and hospice family caregivers were used for this secondary analysis.

METHODS &AMP; VARIABLES: Working family caregivers with complete workplace productivity and activity impairment data were included in this analysis (N = 30). Demographic data, caregiver burden, and workplace productivity and activity impairment were examined with descriptive statistics, correlation analysis, and hierarchical linear regressions.

RESULTS: Hospice family caregivers were primarily White, female, married, and employed full-time. Caregiver burden levels were significantly positively associated with activity impairment, presenteeism, and work productivity loss. These relationships remained statistically significant when controlling for age.

IMPLICATIONS FOR NURSING: Hospice and oncology nurses can support working hospice family caregivers by assessing for burden and associated workplace challenges, as well as by providing referrals for respite and community resources.

PMID:37677767 | DOI:10.1188/23.ONF.665-670

Oncol Nurs Forum. 2023 Jun 15;50(4):461-473. doi: 10.1188/23.ONF.461-473.

ABSTRACT

OBJECTIVES: To evaluate differences in the severity of global, cancer-specific, and cumulative life stress, resilience, and common neuropsychological symptoms among four subgroups of patients with distinct chemotherapy-induced nausea (CIN) profiles.

SAMPLE &AMP; SETTING: Adult patients with cancer (N = 1,343) receiving chemotherapy.

METHODS &AMP; VARIABLES: Patients completed stress, resilience, and neuropsychological symptom severity measures. The Memorial Symptom Assessment Scale was used to assess CIN occurrence six times over two cycles of chemotherapy. Parametric and nonparametric statistics were used to evaluate differences among subgroups of patients with distinct CIN profiles.

RESULTS: The high class had significantly higher levels of global, cancer-specific, and cumulative life stress; significantly higher levels of depression, anxiety, sleep disturbance, morning and evening fatigue, and pain; and lower levels of morning and evening energy and cognitive dysfunction.

IMPLICATIONS FOR NURSING: Clinicians need to evaluate CIN occurrence across each cycle of chemotherapy and assess patients for various types of stress and common neuropsychological symptoms.

PMID:37677748 | DOI:10.1188/23.ONF.461-473

Oncol Nurs Forum. 2023 Jun 15;50(4):449-457. doi: 10.1188/23.ONF.449-457.

ABSTRACT

OBJECTIVES: To describe area deprivation, anxiety, depression, relative dose intensity of first-line metastatic breast cancer (MBC) treatment, and survival in Black and White women who had died from triple-negative MBC, including interaction analysis.

SAMPLE &AMP; SETTING: This cohort study drew from a database of women who had died from MBC (N = 53).

METHODS &AMP; VARIABLES: Descriptive statistics, independent t tests, analysis of variance, and Mann-Whitney U tests were used, and effect sizes were calculated.

RESULTS: Compared with White women, Black women reported higher anxiety and depression at MBC baseline. Black women living in areas of higher deprivation experienced shorter overall survival than White women living in similar areas (9.9 months versus 24.6 months). These results were not statistically significant, likely because of a small sample size, but were clinically meaningful.

IMPLICATIONS FOR NURSING: Black and low-income women with breast cancer experience inferior survival as compared with White and higher-income women. Newer explanatory models for racial disparity in cancer outcomes include the assessment of neighborhood deprivation. White women may be less affected by their neighborhood, even when living in areas of greater deprivation influencing cancer outcomes. This merits further exploration.

PMID:37677747 | DOI:10.1188/23.ONF.449-457