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KEYWORDSCancer survivorship, Feasibility study, mHealth, posttraumatic stress, PTSD 1 | BACKGROUND Posttraumatic stress disorder (PTSD) symptoms are common following a cancer diagnosis and treatment; incidence rates range from 20% (early stage) to 80% (recurrent cancer). 1 Persisting symptoms affect 37% of lymphoma survivors more than 7 years after diagnosis and correlate with low quality of life. Non-White and low-income survivors are at highest risk but often lack access to traditional treatments such as office-based cognitive behavioral therapy because of cost and other barriers. 2,3 Mobile technology may be a cost-effective strategy to address cancer survivors' psychosocial needs. Its use is widespread with 68% of Americans owning smartphones in 2015. 4 Among lowincome and African American individuals, 50% and 70% own smartphones, respectively, offering a new platform to reach these populations who experience health care disparities. In recognition of this technology bridge, there is a growing portfolio of psychiatric and behavioral mobile apps that are improving access to solutions for people in need. 5Unfortunately, there are no cancer distress mobile apps available for download; this prompted us to expand our search. One of the US Department of Veterans Affairs (VA) apps, PTSD Coach, reinforces cognitive behavioral therapy messages and is available at no cost via iTunes (iOS) and Google Play (Android). 6 Significant research demonstrates its feasibility, acceptability, and preliminary efficacy among VA patients and community trauma survivors. [6][7][8] Given this, we partnered with the VA to modify PTSD Coach into Cancer Distress Coach (CDC) and revised it following usability testing with 30 cancer survivors.This pilot study aims to evaluate the acceptability, feasibility, and potential efficacy of CDC in improved PTSD, distress symptoms, and self-efficacy to manage symptoms to inform further app development and design of a more rigorous efficacy trial. | METHODS | Participants and proceduresThe Duke University Health System Institutional Review Board approved this study. Eligible patients were approved for contact by their treating physician; examined with lymphoma, breast, or prostate cancer; ≥19 years of age; and had active PTSD symptoms (ie, scored ≥30 on the PTSD Checklist-Specific [PCL-S]). 9 Patients provided informed consent and completed electronic questionnaires.

Outcomes can be challenging to predict in children with mild traumatic brain injury (TBI). Transcranial Doppler (TCD) ultrasound has become an increasingly useful modality in adult and pediatric TBI by measuring blood flow velocities within the circle of Willis. In children with moderate-to-severe TBI, multiple studies have correlated abnormal TCD measurements and poor outcomes. Additionally, TCD has shown value in assessing adults with mild brain injury. To date, there are no studies that correlate TCD findings and outcomes in children with mild TBI. We hypothesize that altered cerebral blood flow after mild TBI is associated with poor functional outcome using the Glasgow Outcome Scale-Extended, Pediatrics (GOS-E Peds). TCD was performed within 24 h of admission on 60 patients at a tertiary Level 1 children's hospital. A secondary analysis was performed on the subgroup of 28 mild TBI patients. GOS-E Peds was measured at the time of hospital discharge and 4-6 weeks post-discharge. Cerebral blood flow velocities did not show correlation with outcome. At discharge, the right-sided Spearman's correlation coefficient was 0.19 (p value = 0.33) and the left-sided was 0.36 (p = 0.06). At follow up the right-sided coefficient was -0.04 (p = 0.84), the left-sided was -0.25 (p = 0.24). Pulsatility index likewise showed no correlation. Right and left-sided correlation at discharge were -0.25 (p = 0.19) and 0.01 (p = 0.96), respectively. At follow up the right side showed 0.004 (p = 0.99), and the left showed 0.18 (p = 0.41). Although our data did not show correlation, it showed that the investigation could feasibly be done in pediatric patients with mild TBI. The study was limited by small sample size and infrequent outcome of interest. Future studies may help define the role of TCD in the large population of mild pediatric TBI patients.

Carpal tunnel syndrome (CTS) is known to develop post-stroke. Median nerve ultrasound (US) is an inexpensive, effective means of screening. In this prospective feasibility study, we compared the ability of the physical exam, the Boston Carpal Tunnel Questionnaire (BCTQ) and median nerve US to screen for carpal tunnel syndrome (CTS) within 72hours of stroke onset. We enrolled 24 consecutive patients. Using US, 19 (79%, p=0.0386) of the 24 patients screened positive for CTS on the paretic side and 20 (83%, p=0.0042) on the nonparetic side. With clinical examination, only 11 out of 24 (46%) screened positive for CTS on the paretic side and 8 (33%) on the nonparetic side. The BCTQ did not predict CTS. US can be an effective screening tool post-stroke. Further research is needed to determine specificity and efficacy compared to electrodiagnostic testing in this population.