Optimizing learners on direct care teaching services: A qualitative study of hospitalist clinicians at 26 sites.

Background: Academic medical centers are experiencing rapid clinical growth which has outpaced traditional teaching services. Learners such as medical students, advanced practice provider fellows, and residents may be placed onto direct care teaching services (i.e.

Role function in postmenopausal women during aromatase inhibitor therapy for breast cancer.

Objective: Few studies have examined aromatase inhibitor therapy relating to role function in breast cancer survivors of working age. Our study sought to identify how pre-therapy sociodemographic and health/treatment-related characteristics, as well as patient-reported symptoms measured every six-months, influence role function during 18 months of AI therapy for early-stage breast cancer.

Methods: We performed a secondary analysis of longitudinal study data using linear mixed-effects modeling to examine role physical (RP) and role emotional (RE) functioning measured with the Medical Outcome Study Short Form 36 v2.

Medication-Induced Weight Change Across Common Antidepressant Treatments : A Target Trial Emulation Study.

Background: Antidepressants are among the most commonly prescribed medications, but evidence on comparative weight change for specific first-line treatments is limited.

Objective: To compare weight change across common first-line antidepressant treatments by emulating a target trial.

Design: Observational cohort study over 24 months.

Trends of Antihypertensive Prescription Among US Adults From 2010 to 2019 and Changes Following Treatment Guidelines: Analysis of Multicenter Electronic Health Records.

Background: Guidelines for the use of antihypertensives changed in 2014 and 2017. To understand the effect of these guidelines, we examined trends in antihypertensive prescriptions in the United States from 2010 to 2019 using a repeated cross-sectional design.

Methods And Results: Using electronic health records from 15 health care institutions for adults (20-85 years old) who had ≥1 antihypertensive prescription, we assessed whether (1) prescriptions of beta blockers decreased after the 2014 Eighth Joint National Committee (JNC 8) report discouraged use for first-line treatment, (2) prescriptions for calcium channel blockers and thiazide diuretics increased among Black patients after the JNC 8 report encouraged use as first-line therapy, and (3) prescriptions for dual therapy and fixed-dose combination among patients with blood pressure ≥140/90 mm Hg increased after recommendations in the 2017 Hypertension Clinical Practice Guidelines.

Community Navigation and Supportive Care Experiences of Low-Income Black and Latina Cancer Survivors: Patient and Navigator Perspectives.

Background: Little is known about the role of community-based navigation in supportive care delivery for historically marginalized cancer survivors. The purposes of this study were to evaluate supportive care experiences of low-income, Black and Latina cancer survivors and examine the care role of their community navigator.

Methods: Qualitative evaluation of semi-structured interviews with Black and Latina cancer survivors (n=10) and navigators (n=4) from a community-based organization for low-income women were conducted and analyzed using content analysis.

Complex Care Needs at the End of Life for Seriously Ill Adults With Multiple Chronic Conditions.

Understanding the complex care needs of seriously ill adults with multiple chronic conditions with and without cancer is critical for the delivery of high-quality serious illness and palliative care at the end of life. The objective of this secondary data analysis of a multisite randomized clinical trial in palliative care was to elucidate the clinical profile and complex care needs of seriously ill adults with multiple chronic conditions and to highlight key differences among those with and without cancer at the end of life. Of the 213 (74.

Profiles of Work and Quality of Life among Young Adult Cancer Survivors.

Work ability, or the perception of one's ability to work presently and in the future, may impact quality of life (QOL) among young adult (YA) cancer survivors. Through a convergent mixed methods design, we explored work ability, work-related goals, and QOL among YA hematologic cancer survivors within five years of diagnosis. We described associations at the individual- and microsystem (work)- levels; and compared factors across low and high work ability groups.

Exploration of Relationships Between Symptoms, Work Characteristics, and Quality of Life in Young Adult Hematologic Cancer Survivors.

This study explores relationships between individual, microsystem (work) characteristics, and quality of life (QOL) among young adult (YA; ages 20-39 years at diagnosis) hematologic cancer survivors. Forty YAs who had completed cancer therapy within the past 5 years were recruited through social media and completed an online survey. Poorer QOL was associated with higher levels of depressive symptoms, fatigue, impaired cognitive function, and poorer work ability and financial health (all  < 0.

Financial Toxicity in Adolescents and Young Adults With Cancer: A Concept Analysis.

Background: A cancer diagnosis as an adolescent and young adult (AYA) poses exceptional challenges, including potential greater financial toxicity than older survivors experience who have had more time for career establishment and to build financial assets. Costs to patients have increased more than the past decade; prospects for AYA long-term survival have also increased. A better understanding of what financial toxicity is, how it presents, and the immediate and longer-term implications for AYAs is needed.

Multiple Chronic Conditions among Seriously Ill Adults Receiving Palliative Care.

The objective of this study was to characterize multiple chronic conditions (MCCs) among seriously ill adults receiving palliative care at the end of life. A latent class analysis was conducted to identify latent subgroups of seriously ill older adults based on a baseline Charlson comorbidity index (CCI) measurement, a measure of comorbidity burden, and mortality risk. The three latent subgroups were: (1) low to moderate CCI with MCC, (2) high CCI with MCC, and (3) high CCI and metastatic cancer.

Latent Class Analysis of Symptom Burden Among Seriously Ill Adults at the End of Life.

Background: Serious illness is characterized by high symptom burden that negatively affects quality of life (QOL). Although palliative care research has highlighted symptom burden in seriously ill adults with cancer, symptom burden among those with noncancer serious illness and multiple chronic conditions has been understudied. Latent class analysis is a statistical method that can be used to better understand the relationship between severity of symptom burden and covariates, such as the presence of multiple chronic conditions.

Survivors' Dilemma: Young Adult Cancer Survivors' Perspectives of Work-Related Goals.

Background: Young adult cancer survivors have significant work-related challenges, including interruptions to education and employment milestones, which may affect work-related goals (WRGs). The study purpose was to explore posttreatment perspectives of WRGs in a sample of young adult hematologic cancer survivors.

Methods: This qualitative descriptive study used social media to recruit eligible cancer survivors (young adults working or in school at the time of cancer diagnosis).

An integrative review: Women's psychosocial vulnerability in relation to paid work after a breast cancer diagnosis.

Aim: The aim of this integrative review was to explore psychosocial vulnerabilities in women after a breast cancer diagnosis that are related to their paid work.

Design: The review methodology was guided by Whittemore and Knafl. The Mehnert Cancer Survivorship and Work Model provided a lens through which to view vulnerability in working women with a focus on facilitating interventions to improve both recovery and work outcomes.

Trends in the Evaluation and Management of Back Pain in Emergency Departments, United States, 2007-2016.

Objective: Back pain is one of the most common pain syndromes in the United States, but there has been limited recent description of the role of emergency departments (EDs) in caring for patients with back pain. We investigated trends in the evaluation and management of back pain in U.S.

Limb Volume Changes and Activities of Daily Living: A Prospective Study.

Breast cancer-related lymphedema (BCRL) limits the movements of patients' limbs, which leads to a diminished ability to achieve essential activities of daily living (ADLs). The purpose of this study was to examine the associations between limb volume changes from the baseline before breast cancer surgery and self-reported difficulty in performing ADLs at 12 months following cancer surgery. We hypothesized that a positive association existed between limb volume changes from the baseline and self-reported difficulty in performing ADLs at 12 months following breast cancer surgery.

An Adapted Conceptual Model Integrating Palliative Care in Serious Illness and Multiple Chronic Conditions.

Objective: Seriously ill adults with multiple chronic conditions (MCC) who receive palliative care may benefit from improved symptom burden, health care utilization and cost, caregiver stress, and quality of life. To guide research involving serious illness and MCC, palliative care can be integrated into a conceptual model to develop future research studies to improve care strategies and outcomes in this population.

Methods: The adapted conceptual model was developed based on a thorough review of the literature, in which current evidence and conceptual models related to serious illness, MCC, and palliative care were appraised.

Exploratory Study of Associations Between DNA Repair and Oxidative Stress Gene Polymorphisms and Cognitive Problems Reported by Postmenopausal Women With and Without Breast Cancer.

Purpose: Women with breast cancer report varying frequencies of cognitive problems during adjuvant systemic therapy. This variability suggests latent subgroups. Therefore, we identified latent subgroups of self-reported cognitive problems among postmenopausal women with and without breast cancer.

Trajectories of Cognitive Function and Associated Phenotypic and Genotypic Factors in Breast Cancer.

Objectives: This study identified women with unique trajectories of executive function, concentration, and visual working memory before and during adjuvant therapy for breast cancer, and examined phenotypic and genotypic predictors associated with subgroups.

Sample & Setting: 399 postmenopausal women, of whom 288 were women with early-stage breast cancer and 111 were women without breast cancer, matched on age and years of education to the women with breast cancer, and all at an urban cancer center.

Methods & Variables: A repeated-measures design was used; assessments occurred before adjuvant therapy and every six months post-therapy initiation.

The association between pre-treatment occupational skill level and mood and symptom burden in early-stage, postmenopausal breast cancer survivors during the first year of anastrozole therapy.

Purpose: Previous research has explored occupational activity of breast cancer survivors but has not examined the influence of occupational level on symptoms prospectively. The purpose of this study was to examine the relationship between occupational classification and changes in mood and symptom burden for postmenopausal breast cancer survivors during the first year of anastrozole therapy.

Methods: This was an exploratory secondary analysis in 49 postmenopausal women receiving anastrozole therapy for early-stage breast cancer.

Trajectories of self-reported cognitive function in postmenopausal women during adjuvant systemic therapy for breast cancer.

Objective: In a sample of 368 postmenopausal women, we (1) determined within-cohort and between-cohort relationships between adjuvant systemic therapy for breast cancer and self-reported cognitive function during the first 18 months of therapy and (2) evaluated the influence of co-occurring symptoms, neuropsychological function, and other covariates on relationships.

Methods: We evaluated self-reported cognitive function, using the Patient Assessment of Own Functioning Inventory (PAOFI), and potential covariates (e.g.

Gender Differences in Predictors of Quality of Life at the Initiation of Radiation Therapy.

Purpose/objectives: To evaluate gender differences in quality of life (QOL), demographic, clinical, and symptom characteristics.


Design: Prospective, observational.


Setting: Two radiation oncology departments in northern California.