Background: The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) statuses are frequently discordant between the primary tumor and metastatic lesions in metastatic breast cancer. This can have important therapeutic implications. Patients and methods: In all, 541 patients with available receptor statuses from both primary tumor and metastatic lesion treated at Heidelberg and Tuebingen University Hospitals between 1982 and 2018 were included. Results: Statistically significant discordance rates of 14% and 32% were found for ER and PR. HER2 status was statistically insignificantly discordant in 15% of patients. Gain in HER2 positivity was associated with an improved overall survival, whereas loss of HR positivity was associated with worse overall survival. Antiendocrine treatment differed in 20% of cases before and after biopsy and HER2-directed treatment in 14% of cases. Conclusions: Receptor statuses are discordant between primary tumor and metastasis in a considerable fraction of patients with metastatic breast cancer. Next to a highly presumed predictive value with respect to efficacy of endocrine and HER2-targeted therapy, discordance seems to provide prognostically relevant information. Where feasible, metastatic lesions should be biopsied in accordance with current guidelines.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Pregnant women have a high demand for fetal monitoring and reassurance. Consequently, they use a variety of health applications in pregnancy and tend to visit emergency departments for objectively non-urgent consults. However, the potential of electronic Health (eHealth) and mobile Health (mHealth) solutions is clinically hardly used to prevent non-urgent emergency consultations. To implement modern care solutions a better understanding of the attitudes, fears and hopes of health care professionals towards eHealth and mHealth is needed. Objective: The aim of this study was to investigate the attitudes of health care professionals in obstetrics towards telemedicine. Methods: A quantitative web based survey among health care professionals in Germany was conducted. The participants included nurses, midwives and physicians of all age groups and job positions working in hospitals with various level of care. The questionnaire comprised 24 questions capturing study population characteristics, views about emergency consultations in obstetrics, attitude towards telemedicine, job satisfaction and sleeping behavior. Results: 244 health care professionals participated in the online survey. In general, health care professionals are skeptical (72.9%; n=170) about the use of telemedicine in obstetrics, however, 55.8% (n=130) recognize its potential. Physicians are optimistic with 72% (n=62) considering the use of applications (apps) for pregnancy monitoring reasonable by contrast to just 36% (n=47) of non-physicians (P<.001). Significantly more non-physicians reject such developments categorically, 58% (n=75) compared to 27% (n=24) of physicians (P<.001). We also found, that obstetricians with more than ten years of work-experiences are more skeptical. 49% (n=18) of them believe that telemedicine could reduce non-urgent emergency consultations compared to 73.2% (n=106) among obstetricians with less than 5 years of experience (P=.006). Our survey revealed a high job satisfaction among health care professionals in obstetrics and a prevalence of regular sleeping problems of 46% (n=91). Surprisingly, both job satisfaction and sleeping problems were independent from the number of night shifts served per month (P=.77 and P=.99 respectively). Yet, 56.6% (n=112) of the survey participants thought they would be happier in their job if they had to work fewer night shifts per month. Conclusions: Our study reveals an ambivalent attitude towards telemedicine among health care professionals in obstetrics. Efforts to promote the use of telemedicine should concentrate on nurses and midwives since this group is most skeptical about it in Germany. By contrast, particularly young physicians recognize the potential of apps for patient care and would like to use such technology in pregnancy monitoring.

Mobile and tablet apps, ubiquitous and pervasive computing, wearable computing and domotics for health.