Anxiety and aggression in adolescents with autism spectrum disorders attending mainstream schools

This study investigated the link between anxiety and aggression in adolescents with autism spectrum disorders (ASDs) using self-report measures of anxiety and anger and teacher ratings of behaviour. Participants were 104 high school students aged 12–18: 52 students with ASDs, without intellectual disability, and their typically developing peers matched for age and gender. Students with ASDs who attend mainstream high schools reported higher levels of anxiety and reactive anger than their peers, were reported by their teachers to engage in more aggressive behaviours, and were at higher risk of being suspended from school. The results further suggested that social anxiety is a significant moderator of the relationship between autism and physical aggression. For ASD students, but not for the control students, there was a strong, positive relationship: higher levels of anxiety were associated with higher levels of physical aggression. However, ASD students with high anger control did not display physical aggression. Our results have implications for screening students for anxiety, the provision of interventions for managing anxiety and the development of anger management skills, and for the appropriateness of suspension as a mandatory response to incidents of physical aggression in schools.     

Post-neoadjuvant strategies in breast cancer: From risk assessment to treatment escalation

The post-neoadjuvant setting in early breast cancer represents an attractive scenario for adjuvant clinical trials, offering the opportunity to test new drugs or combinations in high-risk patients who did not achieve pathologic complete response after primary treatment. No standard therapies are routinely proposed to patients with residual disease after neoadjuvant chemotherapy and few trials have explored this setting. To date, only one randomized phase III study showed the benefit of additional capecitabine after neoadjuvant chemotherapy, and international guidelines recommend at least to consider its use, particularly for triple negative breast cancer. Therefore, the management of these patients is still a clinical challenge, with limited data supporting the use of an additional adjuvant non-cross-resistant chemotherapy. Escalation strategies are currently under evaluation, with new agents proposed as supplementary post-neoadjuvant treatment (e.g. platinum salts, capecitabine, poly ADP-ribose polymerase inhibitors, immune checkpoint inhibitors, cyclin-dependent kinase 4/6 inhibitors). Based on these premises, selection criteria are critical to identify patients who may benefit from post-neoadjuvant therapies, through the validation of prognostic and predictive biomarkers for a reliable risk assessment and estimation of benefit.The present review summarizes the efforts in introducing new therapeutic options for patients with breast cancer and residual disease after neoadjuvant treatment, with a particular focus on the ongoing clinical trials and useful biomarkers for risk stratification.     

Brainstorming Our Way to Improved Quality,Safety, and Resident Wellness in a Resource-Limited Emergency Department

PurposeTo implement a more efficient standardized computed tomography (CT) protocoling system for emergency department (ED) patients in order to improve resident work satisfaction and wellness, and decrease lag time between ordering and protocoling a study.Methods and MaterialsResidents recorded lag times between time of order and time of protocol for 176 CT scans between November 2018 and January 2019. Pre- and postintervention resident surveys of 7 questions utilizing a 5-point Likert scale were used to assess the perceived efficiency and overall satisfaction with the protocolling system. CT technologists received a 2-step Standardized ED CT Protocoling Guidance Sheet for common indications and would consult the radiologist for any questions.ResultsLag time between order and protocol averaged 17.8 minutes. Postintervention surveys demonstrated that residents were more satisfied with the new system (100% vs 6.1%), had an overall higher job satisfaction in the ED (91% vs 12.1%), thought the system was more efficient for a single study (100% vs 15.2%) and for an entire shift (100% vs 6.1%), volume of studies was maximized (91% vs 6.1%), and the workflow allowed residents to focus on interpreting studies and communicating findings (91% vs 3%).ConclusionThe implementation of an auto-protocolling system at our institution's ED took a system which was disruptive, inefficient, and unreliable, and eliminated both lag time and variation in time between ordering and protocoling, improving time to final report. It simultaneously decreased interruptions, allowing residents to focus on study interpretation, which increased resident work satisfaction, wellness, and educational benefit.