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Apoptosis plays an essential role in maintaining cellular homeostasis and preventing cancer progression. Bcl-xL, an anti-apoptotic protein, is an important modulator of the mitochondrial apoptosis pathway and is a promising target for anticancer therapy. In this study, we identified octenidine as a novel Bcl-xL inhibitor through structural feature-based deep learning and molecular docking from a library of approved drugs. The NMR experiments demonstrated that octenidine binds to the Bcl-2 homology 3 (BH3) domain-binding hydrophobic region that consists of the BH1, BH2, and BH3 domains in Bcl-xL. A structural model of the Bcl-xL/octenidine complex revealed that octenidine binds to Bcl-xL in a similar manner to that of the well-known Bcl-2 family protein antagonist ABT-737. Using the NanoBiT protein-protein interaction system, we confirmed that the interaction between Bcl-xL and Bak-BH3 domains within cells was inhibited by octenidine. Furthermore, octenidine inhibited the proliferation of MCF-7 breast and H1299 lung cancer cells by promoting apoptosis. Taken together, our results shed light on a novel mechanism in which octenidine directly targets anti-apoptotic Bcl-xL to trigger mitochondrial apoptosis in cancer cells.

Patient portals (PPs) are robust health IT programs that engage and empower patients in their care. Although PPs can benefit older adults who manage chronic conditions, their use of PPs have been largely overlooked and little training has been provided to them. Previously, our research team developed an older-adult-friendly Theory-based PP eLearning Program (T-PeP) and tested its impact on older adults with chronic conditions. As part of T-PeP, participants used discussion forums. The aim of this study was to explore older adults’ experiences with using PPs, perceived impact of PP on their health, and suggestions for improvement through analysis of discussion posts. A total of 205 posts were subjected to content analysis. Findings from 10 major themes explained older adults’ experiences with PPs and offered suggestions for vendors and healthcare organizations. As U.S. population is aging, older adults must be considered during the development and implementation of health IT programs.

Introduction - Cancer survivors may have physical, psychological, social, spiritual, and financial challenges that require coordinated, comprehensive care. Patient involvement programs that focus on education and health promotion help survivors to manage their symptoms and take better control of their total health. At the University of Maryland, a collaborative group developed the Cancer Survivorship Patient Engagement Toolkit (CaS-PET) which includes survivorship care plans, education on health topics, discussion boards, and ongoing communication between providers and patients using a patient portal. A study was performed to test the feasibility and preliminary impact of the CaS-PET program. Methods - After IRB approval, 30 cancer survivors at the University of Maryland Marlene and Stuart Greenebaum Comprehensive Cancer Center who were within 6 months of completion of active treatment were enrolled in a prospective pilot study of the CaS-PET that used a single group pre-post (3 month) design. The outcome measures included changes in quality of life, fear of recurrence, impact of cancer, dietary and exercise behaviors, and selected cancer symptoms. Participants’ demographic characteristics, internet/patient portal experience, and eHealth literacy was collected at baseline. Results - Among the 30 total participants, 15 (50%) were breast cancer survivors. Of the breast cancer participants, the median age was 57.2±13 years, 66.7% (n=10) were African American, and all were female. 13/15 (86%) participants completed the program and post questionnaires. After the CaS-PET program, participants had improved adherence to treatment (p=0.019), fruit and vegetable consumption (p=0.039), and trend to improved physical activity score (p=0.069). Tests related to psychosocial aspects of health did not show improvement. PrePostTest StatisticP valueAdherence to treatment25.223.2t=-2.7670.019Fruit and veg consumption9.712.4t=2.3110.039Physical Activity total MET5.16.7t=1.9950.069Global distress index0.90.9t=0.1890.853Fear of recurrence15.016.4t=0.8060.435 Discussion - The Cancer Survivorship Patient Engagement Toolkit (CaS-PET) was successfully administered to breast cancer survivors. Improvements in adherence, diet, and a trend towards improved physical activity were noted at the 3 month time point. While measured changes in fear of recurrence, impact of cancer, and symptom burden did not show significant changes, patients reported to investigators positive experiences from the program. Further longitudinal designed studies are needed with a larger sample and across different age groups. Citation Format: Paula Rosenblatt, Lindsey Hertsenberg, Hyojin Son, Mary McQuaige, Kenneth Miller, Eun Shim Nahm. Use of cancer survivorship patient engagement toolkit (CaS-PET) in breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-11.

Caregiving stress is a risk factor for cardiometabolic disease. Therefore, integrating cardiometabolic biomarkers into caregiving research provides a more comprehensive assessment of an individual’s health and response to an intervention. The objective of this study was to examine the effects of a yoga-based stress reduction intervention on stress, psychological outcomes, and cardiometabolic biomarkers in cancer caregivers. This prospective randomized controlled trial enrolled family caregivers of adult patients who underwent an allogeneic HSCT at the National Institutes of Health (NIH) Clinical Center. All subjects received usual care education. Participants in the intervention group received an Iyengar yoga intervention self-administered over six weeks using an audio recording file. The primary outcome was perceived stress (measured using the NIH toolbox Perceived Stress). The secondary outcomes were psychological factors (depression and anxiety measured using PROMIS® Depression and Anxiety), and cardiometabolic biomarkers measured by nuclear magnetic resonance spectroscopy. A total of 50 family caregivers (mean [SD] age, 44.9 [15.2] years; 42 [84.0%] women) were randomized, 25 to the intervention group and 25 to the control group. No group differences were noted in stress, depression, and anxiety. Significant interaction effects between group and time were found in large TRL-P (F(1,43) = 10.16, p = 0.003) and LP-IR (F(1,42) = 4.28, p = 0.045). Post-hoc analyses revealed that the levels of large TRL-P (mean difference = 1.68, CI = [0.86, 2.51], p< .001) and LP-IR (mean difference = 5.67, CI = [1.15, 10.18], p = 0.015) significantly increased over time in the control group but while remained stable in the intervention group (mean difference = -0.15, CI = [-0.96, 0.66], p = 0.718; mean difference = -0.81, CI = [-5.22, 3.61], p = 0.714, respectively). Even when perceptions of psychological distress remain unchanged, incorporating gentle yoga poses and breathing exercises may reduce the risk of cardiometabolic disease in caregivers by inhibiting the development of insulin resistance. Standard lipids of cardiometabolic risk do not appear to be robust enough to detect short-term early changes of cardiometabolic risk in caregivers. Trial registration: ClinicalTrials.gov Identifier: NCT02257853.

A symptom cluster is a group of 2 or more symptoms that occur together and are related to each other. Family caregivers of allogeneic hematopoietic stem cell transplantation (HSCT) recipients experience multiple concurrent symptoms, but the majority of symptom research in this population has focused on assessing and managing individual symptoms. The purpose of this analysis was to determine (1) whether clusters of 5 highly prevalent symptoms (fatigue, sleep disturbance, depression, anxiety, and cognitive impairment) in allogeneic HSCT caregivers could be identified and (2) which caregiver and patient characteristics influence membership in the identified symptom cluster groups. Baseline cross-sectional data were collected from allogeneic HSCT caregivers participating in a randomized controlled trial at the National Institutes of Health Clinical Center. Measures included the Caregiver Reaction Assessment (CRA), Health-Promoting Lifestyle Profile II (HPLP-II), Fatigue Symptom Inventory (MFSI), Pittsburgh Sleep Quality Index (PSQI), and Patient-Reported Outcomes Measurement Information System (PROMIS). Cluster analysis was used to identify symptom clusters, and univariate analyses and multiple logistic regression were performed to identify factors that contribute to symptom clusters. The average age of caregivers (n = 44) was 45.20 ± 15.05 years; primarily white (52.3%) and female (88.6%) and often the spouse/partner of the patient (50.0%). Two symptom cluster groups were identified: low symptom burden (n = 24; 54.5%) and high symptom burden (n = 20; 45.5%). Caregivers with higher levels of loneliness (odds ratio, 1.12; 95% confidence interval, 1.04 to 1.22; P = .004) were more likely to be in the high symptom burden group. This study provides evidence that 5 symptoms commonly found in family caregivers-fatigue, sleep disturbance, depression, anxiety, and cognitive impairment-tend to occur in clusters. Therefore, clinicians should be aware that caregivers with 1 or more of these symptoms may be at higher risk for developing the others, and caregivers reporting high levels of loneliness may be at particular risk. Future research is needed to identify novel interventions that target multiple, co-occurring symptoms. Such interventions also might include components that decrease loneliness. © 2022 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

Virtual reality is a novel technology that provides users with an immersive experience in 3D virtual environments. The use of virtual reality is expanding in the medical and nursing settings to support treatment and promote wellness. Nursing has primarily used virtual reality for nursing education, but nurses might incorporate this technology into clinical practice to enhance treatment experience of patients and caregivers. Thus, it is important for nurses to understand what virtual reality and its features are, how this technology has been used in the health care field, and what future efforts are needed in practice and research for this technology to benefit nursing. In this article, we provide a brief orientation to virtual reality, describe the current application of this technology in multiple clinical scenarios, and present implications for future clinical practice and research in nursing.

UNSTRUCTURED Virtual reality is a novel technology that provides users with an immersive experience in 3D virtual environments. The use of virtual reality is expanding in the medical and nursing settings to support treatment and promote wellness. Nursing has primarily used virtual reality for nursing education, but nurses might incorporate this technology into clinical practice to enhance treatment experience of patients and caregivers. Thus, it is important for nurses to understand what virtual reality and its features are, how this technology has been used in the health care field, and what future efforts are needed in practice and research for this technology to benefit nursing. In this article, we provide a brief orientation to virtual reality, describe the current application of this technology in multiple clinical scenarios, and present implications for future clinical practice and research in nursing.

Objectives To evaluate an interactive electronic Cancer Survivorship Patient Engagement Toolkit (CaS-PET) using a single-group pre-/post-test design. Sample & setting 30 cancer survivors with a mean age of 56.5 years (SD = 13.6) were recruited from the University of Maryland Medical Center in Baltimore. Methods & variables CaS-PET was designed to deliver survivorship care plans (SCPs) with multifactorial support and comprised of SCPs, biweekly follow-up using patient portal e-messages, and online resources. Outcomes included health-related quality of life, symptom burden, impact of cancer, fear of recurrence, physical activities, dietary behavior, patient-provider communication, adherence to treatment, and e-health literacy. Results At three months, there was a significant improvement in quality of life, physical symptom burden, and total symptom burden. Implications for nursing Findings suggest an excellent potential for using CaS-PET for survivors who are in transition from treatment to survivorship.

Purpose The aim of this study was to test a modified version of the Technology Acceptance Model, which describes users' technology adoption, to examine the relations between patient portal use and potential influencing factors in adult patients who have used patient portals. The modified model posits that patient portal use can be explained by attitude and self-efficacy for using patient portals, perceived usefulness and ease of use, data privacy and security concerns, eHealth literacy, education level, and age. Design A cross-sectional anonymous online survey was conducted for adult patients who had used their patient portals in the past 12 months. Methods Participants were recruited from 20 settings selected in a large integrated health care system. Data from 743 patients were subject to structural equation modeling for model testing. Findings Sixty-eight percent were White and female, with a mean age of 53.1 years (SD = 15.34). Forty-seven percent used patient portals about monthly or more frequently. Scores for perceived usefulness and ease of use of patient portals were relatively high (as measured using the modified Perceived Health Web Site Usability Questionnaire; each item mean, 6.0-6.2; range, 1-7). The final model adequately fit the data (comparative fit index = .983, standardized root mean square residual = .064, root mean square error of approximation = .059). Patient portal self-efficacy and data privacy and security concerns had a direct impact on patient portal use. Perceived usefulness and ease of use, eHealth literacy, education level, and age indirectly influenced patient portal use. Conclusions This study contributes to expanding a theoretical understanding of adult patients' patient portal use in a real health care environment. Future studies need to include more diverse populations in various settings. Clinical relevance Knowledge gained from this study can be used by technology experts to make patient portals more user friendly and by administrators to implement patient portals more effectively.

Older adults can benefit from using patient portals. Little is known whether the perceptions and use of patient portals differ among diverse older adult populations. The aim of this study was to assess the difference in perceived usability of patient portals, self-efficacy for using patient portals, and patient portal use between two adult samples aged 65 years or older. One sample was recruited from a health care system, including hospitals and clinics (n = 174), and the other sample was recruited from nationwide communities (n = 126). Conducting a secondary data analysis using two survey datasets, this study performed a series of linear and ordinal logistic regression analyses. The health care system sample had a higher mean number of chronic diseases and proportion of recent hospitalization than the community sample. The health care system sample showed higher perceived usability, self-efficacy, and usage frequency of patient portals compared to the community sample. eHealth literacy was a significant predictor of perceived usability and self-efficacy. Perceived usability was another significant predictor of self-efficacy. Self-efficacy and health condition variables significantly predicted the more frequent use of patient portals. Compared to the health care system sample, the relationship between perceived usability and use of patient portals was stronger and significant in the community sample. These findings suggest that approaches for promoting patient portal use should consider personal characteristics and health conditions of diverse older adult populations. Future research needs to focus on assessing the impact of using patient portals on older adults’ health care outcomes.

Introduction: The high prevalence of chronic illnesses is a serious public health problem in the United States, and more than 70 million older adults have at least one chronic illness. Patient portals (PPs) have an excellent potential to assist older adults in managing chronic illnesses; however, older adults' PP adoption rates have been low. Lack of support for older adults using PPs remains a critical gap in most implementation processes. The main aim of this study was to assess the impact of an older adult friendly Theory-based Patient portal e-Learning Program (T-PeP) on PP knowledge, selected health outcomes (health decision-making self-efficacy [SE] and health communication), PP SE and use, and e-health literacy in older adults. Materials and Methods: A two-arm randomized controlled trial was conducted with older adults (N = 272) who had chronic conditions. Participants were recruited online, and data were collected at baseline, 3 weeks, and 4 months. The main intervention effects were tested using linear mixed models. Results: The average age of participants was 70.0 ± 8.5 years, and 78.3% (n = 213) were white. At 3 weeks, the intervention group showed significantly greater improvement than the control group in all outcomes except PP use. At 4 months, the intervention effects decreased, but PP SE remained significant (p = 0.015), and the intervention group showed higher frequency of PP use than the control group (p = 0.029). Conclusion: The study findings showed that the T-PeP was effective in improving selected health and PP usage outcomes. Further studies are needed to test the long-term effects of T-PeP using more diverse samples.

Patient portals can be beneficial for older adults who manage their own health. However, there is a lack of research on older adults' experience using patient portals in the community. The aim of this study was to assess older adults' perceived usability of patient portals they currently use. This was a secondary data analysis using selected baseline data from an online trial that tested the effects of a 3-week Theory-Based Patient Portal eLearning Program, and included 272 older adults recruited online. Data were analyzed using descriptive statistics and content analysis. Most participants owned patient portal accounts (n = 194 [71.3%]). Self-efficacy for using patient portals was relatively low (mean, 27.1; range, 0-40), and perceived usability of patient portals was also low (mean, 28.7; range, 6-42). The most-favored features of patient portals were review of medical information and eMessaging. The main difficulties in using patient portals were associated with login/access and specific portal functions. Managing multiple patient portals was a particular challenge for many participants. Findings from this study indicate the importance of providing proper levels of training and technical support to older adults to maximize use and improve outcomes of patient portal implementation.