IntroductionHigh-intensity noninvasive ventilation (NIV) has been shown to improve outcomes in stable chronic obstructive pulmonary disease patients. However, there is insufficient knowledge about whether with this more controlled ventilatory mode optimal respiratory muscle unloading is provided without an increase in patient–ventilator asynchrony (PVA).Patients and methodsTen chronic obstructive pulmonary disease patients on home mechanical ventilation were included. Four different ventilatory settings were investigated in each patient in random order, each for 15 min, varying the inspiratory positive airway pressure and backup breathing frequency. With surface electromyography (EMG), activities of the intercostal muscles, diaphragm, and scalene muscles were determined. Furthermore, pressure tracings were derived simultaneously in order to assess PVA.ResultsCompared to spontaneous breathing, the most pronounced decrease in EMG activity was achieved with the high-pressure settings. Adding a high breathing frequency did reduce EMG activity per breath, while the decrease in EMG activity over 1 min was comparable with the high-pressure, low-frequency setting. With high backup breathing frequencies less breaths were pressure supported (25% vs 97%). PVAs occurred more frequently with the low-frequency settings (P=0.017).ConclusionHigh-intensity NIV might provide optimal unloading of respiratory muscles, without undue increases in PVA.

Background Sexual well-being (SWB) is an important aspect of overall quality of life and should therefore be considered when measuring the effect of breast cancer on daily life. Aim To identify positive and negative predictive factors associated with change in SWB 1 year after diagnosis (T12; hereafter, ∆SWB) and whether SWB changes the year after. Methods All data were derived from an online patient-reported outcome measure that included patients aged >18 years who were treated for breast cancer between October 2015 and March 2022 at the Erasmus University Medical Center. Multivariable linear regression was used to analyze the association between demographic- and disease-specific variables and change in SWB between time of diagnoses (T0) and one year after (T12) (∆SWB). For defining the clinical relevance of ∆SWB, patients were divided into 3 groups based on their SWB score at T12: decreased, stable, and improved. Wilcoxon signed rank test was used to test the difference in SWB between T12 and T24 (2 years after diagnosis) in all 3 groups. Outcomes Outcomes included the associations between demographic- and disease-specific variables and ∆SWB (T0 vs T12) and change in SWB the year after (T12 vs T24). Results An overall 204 patients were included, with a mean age of 51.7 years (SD, 12.8) and a mean SWB score of 64.3 (SD, 20.9) at T0. Body mass index >30 kg/m2 at T0 had a significant negative association (β = −8.369, P = .019) with ∆SWB. Reconstruction (β = 20.136, P < .001) and mastectomy (β = 11.157, P < .001) had a significant positive association with ∆SWB vs lumpectomy. Change in psychological well-being had a significant positive relation to ∆SWB (β = 0.349, P < .001). Patients with decreased SWB at T12 did not improve the year after (P = .376). Clinical Implications By identifying the variables that are associated with decreased SWB during the trajectory of breast cancer treatment and by defining the clinical relevance of decreased SWB, patient groups can be targeted and offered extra support. Strengths and Limitations This study is one of the first to analyze the development of SWB, instead of sexual function, over time in patients with breast cancer, and it uses data over a longer period. However, only one-third of the patients responded to the SWB domains at both time points. Conclusion Type of operation, body mass index >30, and change in psychological well-being were associated with ∆SWB. Patients with decreased SWB 1 year after diagnosis tended not to improve or normalize the year after, indicating that intervention is needed to restore SWB in this specific group.

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Purpose Sexual health is an important contributing factor for health-related quality of life, but research in this domain is scarce. Moreover, normative data are needed to interpret patient-reported outcome measures on sexual health. The aim of this study was to collect and describe normative scores of the Female Sexual Distress Scale (FSDS) and the Body Image Scale (BIS) from the Dutch population and assess the effect of important demographic and clinical variables on the outcome. As the FSDS is also validated in men, we refer to it as SDS. Method Dutch respondents completed the SDS and BIS between May and August 2022. Sexual distress was defined as a SDS score > 15. Descriptive statistics were calculated to present normative data per age group per gender after post-stratification weighting was applied. Multiple logistic and linear regression analyses were conducted to assess the effect of age, gender, education, relationship status, history of cancer and (psychological) comorbidities on SDS and BIS. Results For the SDS 768 respondents were included with a weighted mean score of 14.41 (SD 10.98). Being female (OR 1.77, 95% CI [1.32; 2.39]), having a low educational level (OR 2.02, CI [1.37; 2.39]) and psychological comorbidities (OR: 4.86, 95% CI [2.17; 10.88]) were associated with sexual distress. For the BIS, 696 respondents were included. Female gender (β: 2.63, 95% CI [2.13; 3.13]), psychological comorbidities (β: 2.45, 95% CI [1.43; 3.47]), higher age (β: −0.07, 95% CI [−0.09; −0.05]), and a high educational level (β:−1.21, CI: −1.79 to −0.64) were associated with the non-disease related questions of the Body Image Scale. Conclusion This study provides age- and gender-dependent normative values for the SDS and the non-disease related questions of the BIS. Sexual distress and body image are influenced by gender, education level, relationship status and psychological comorbidities. Moreover, age is positively associated with Body Image.

Objectives The EQ-5D-5L and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) are commonly used Patient-Reported Outcome Measures (PROMs) in breast cancer patients. For utilizing PROMs in research and clinical settings, internal responsiveness is key. Therefore, the aim of this study is to evaluate and compare the internal responsiveness of the EQ-5D-5L and EORTC QLQ-C30 among breast cancer patients during the first-year post-surgery. Methods Effect sizes (ES) and standardized response means (SRM) were calculated for the EQ-5D-5L and EORTC QLQ-C30 between baseline and 6 months post-surgery (delta 1) and between baseline and 12 months post-surgery (delta 2). Delta 1 and 2 of the EQ-5D-5L index and EORTC QLQ-C30 Global Quality of Life scale were compared to the corresponding minimal important clinical difference (MICD). Results In total 333 breast cancer patients treated at the Erasmus MC, who completed the EQ-5D-5L and the EORTC QLQ-C30 at baseline, 6- and 12-months post-surgery were included. The internal responsiveness of both the EQ-5D-5L and the EORTC QLQ-C30 was poor (< 0.05) and larger for delta 1 compared to delta 2. The internal responsiveness of the EQ-5D-5L index was larger than the EORTC QLQ-C30 Global Quality of Life scale and EORTC QLQ-C30 summary score. Conclusions Both the EQ-5D-5L and EORTC QLQ-C30 demonstrate poor internal responsiveness in breast cancer patients at 6- and 12-months post-surgery. Other approaches such as administering PROMs at different intervals or utilizing breast cancer specific PROMs may be considered to improve research and patient-centered healthcare.