Experience with Sunitinib in metastatic renal cell carcinoma (mRCC) patients: pooled analysis from 3 Spanish observational prospective studies

Background: A pivotal, randomized, phase III trial demonstrated a statistically significant superiority of sunitinib over interferon-α in metastatic renal cell carcinoma (mRCC) patients.

Objective: To evaluate the effectiveness and safety of sunitinib in patients with advanced or mRCC in routine clinical practice.

Methods: Retrospective pooled analysis of clinical data from three observational and prospective studies carried out between 2007 and 2011 in 33 Spanish hospitals. Tumor response, Progression-free survival (PFS) and overall survival (OS), and main sunitinib-related toxicities were registered.

Results: 224 patients were analyzed. Median PFS 10.6 months (95% CI: 9.02–12.25), median OS 21.9 months (95% CI: 17.2–26.6). Objective response rate (ORR) 43.8% (95% CI: 36.8–50.7). Median time to PR was 3.8 months (95% CI: 3.86–5.99) and to CR 8.2 months (95% CI: 4.75–9.77). The most common ≥ grade-3 AEs were asthenia/fatigue (18.7%), hand-foot syndrome (6.2%), hypertension (5.8%) and neutropenia (4.8%). Hand-foot syndrome, diarrhea and mucositis were confirmed as independent predictors for PFS and/or OS in a multivariate analysis (p < 0.05)

Conclusions: Outcomes with sunitinib in daily clinical practice resemble those obtained in clinical trials. Long-term benefit with sunitinib is possible in advanced RCC patients but the appropriate management of toxicities is mandatory to enable patients to remain on treatment.     

Utilization of influenza and streptococcal pharyngitis point-of-care testing in the community pharmacy practice setting

Background

One way to reduce the complications and costs of influenza like illness and pharyngitis is to improve access to testing and treatment in early stages of infection. Pharmacy-based screening and treatment of group A streptococcus (GAS) infection and influenza has the potential to improve patient care and population health.

Why do we not want to recommend influenza vaccination to young children? A qualitative study of Australian parents and primary care providers

IntroductionInfluenza vaccination has been shown to be safe and effective against influenza and in the prevention of complicating secondary respiratory illnesses. However, its uptake in young children remains low. This study explored the views, attitudes and practices of parents and primary care providers (PCPs) on their knowledge and acceptance of influenza vaccination in children under 5.MethodsUsing a cross-sectional qualitative research design, we conducted 30 in-depth interviews with PCPs (i.e., general practitioners, practice nurses, maternal and child health nurses, and pharmacists) and five focus groups with parents (n = 50) between June 2014 and July 2015 in Melbourne, Australia. Data were thematically analysed.ResultsParents thought the vaccine could cause influenza, and influenza vaccination was not necessary for their children as they needed to build their own ‘immunity’. Parents said that they would consider vaccinating their children if recommended by their GP and if the influenza vaccine was part of the immunisation schedule. PCPs also expressed concerns regarding the efficacy of the vaccine as well as out-of-pocket costs incurred by families, and uncertainty regarding the mortality and morbidity of influenza in otherwise healthy children. However, they said they would recommend the vaccine to high-risk groups (e.g. children with chronic disease(s), and asthma).ConclusionDespite the established safety of influenza vaccines, barriers to uptake include concerns regarding the iatrogenic effects of vaccination, its administration schedule, and knowledge of influenza severity. Updated information on influenza and the efficacy of the vaccine, and incorporating influenza vaccination into the immunisation schedule may overcome some of these barriers to increase influenza vaccination in this vulnerable cohort.     

Incidence of all-cause adult community-acquired pneumonia in primary care settings in France

Objectives

To estimate the incidence of all-cause outpatient community-acquired pneumonia (CAP) in adults in France from a national prospective observational study of CAP management in general practice (CAPA).

SPOTS: A Model for the Creation of Sustainable,Population-Based,Occupational Therapy Fieldwork Sites

This paper describes a model for the creation of sustainable, population-based, occupational therapy fieldwork sites (SPOTS). An example of a population-based fieldwork site was created with Appalachian Mountain People in Kentucky and its outcomes are presented. Outcomes were gathered using a wide variety of evaluation feedback forms. The results indicate that all staff, student, and college feedback were extremely favorable as detailed and suggest that others may use the SPOTS Model to develop population-based occupational therapy services that address public health issues for people with disabilities identified in Healthy People 2020 and create scholarly opportunities for students and faculty.     

The intersection of identities in supervision for trauma-informed practice: Challenges and strategies

ABSTRACT

This article discusses and illustrates the role and impact of the intersection of supervisors’ and supervisees’ social identities and the associated power and privilege within the context of supervision for trauma-informed practice. Based on current theoretical, empirical, and practice literature, challenges related to the supervisor’s and supervisee’s racial, ethnicity, gender, social class, and additional social affiliations are identified, as are strategies for addressing them within supervision for trauma-informed practice. A case example drawn from the authors’ experiences illustrates the importance of attending to intersectionality in trauma-informed supervision Suggestions for future research efforts are offered.     

Compassion: a concept analysis

Compassion is a quality deemed sine qua non for nursing and claimed to underpin the profession in its larger-than-life scope. Yet the meaning of the concept "compassion" (or "compassionate care") is neither clearly defined in nursing scholarship nor widely promoted in the context of contemporaneous everyday nursing practice. The term in its moral dimension has, at best, been downgraded as an optional practice in everyday nursing care and, at worst, dismissed as lofty ideals connected to other disciplines, such as religion and ethics. A concept analysis using Walker and Avant's strategic method as well as Rodgers's evolutionary paradigm was undertaken to clarify the meaning of the concept "compassion" and examine its relevance in the context of everyday nursing practice.     

Physiotherapy management of osteoarthritis of the hip: a survey of current practice in acute hospitals and private practice in the Republic of Ireland

Objective

To identify the current management of osteoarthritis of the hip by physiotherapists in private practice and acute hospital settings in the Republic of Ireland.

Design

Cross-sectional postal questionnaire survey.

Participants

Physiotherapists in 35 acute hospitals (n = 150) and a random selection of physiotherapists in private practice (n = 172) in the Republic of Ireland were surveyed.

Results

A valid response rate of 65% (n = 210) was achieved. The most common intervention used by therapists was exercise therapy (210/210, 100%), followed by education (207/210, 99%), manual therapy (202/210, 96%), thermal agents (154/210, 73%) and electrotherapy (130/210, 62%). Hydrotherapy and acupuncture were used by 29% (61/210) and 18% (38/210) of respondents, respectively. Statistical differences in these interventions between public and private settings existed only for thermal agents (P = 0.001) and acupuncture (P = 0.002). A total of 84% (177/210) of those surveyed used outcome measures, most commonly pain severity scales (163/210, 78%). Osteoarthritis-specific questionnaires (33/210, 16%) and quality of life (16/210, 8%) measures were used less frequently.

Conclusions

The importance of exercise therapy, education and manual therapy in the management of osteoarthritis of the hip was demonstrated. There was little difference overall in the physiotherapy management of osteoarthritis of the hip between public and private settings. The use of these interventions compared to known scientific evidence is discussed. Although there was high usage of outcome measures, hip osteoarthritis-specific outcomes and quality of life measures were not commonly used. This survey identified interventions most commonly used in clinical practice including exercise, education and manual therapy, and highlights a need for further research to evaluate the effectiveness of such interventions.     

Measurement of force production during concurrent performance of a memory task

Objectives

Theories from the cognitive psychology literature, such as those of dual-task interference, provide an important insight into some of the information-processing demands that are inherent in the performance of physical activities of daily living. This study aimed to quantify dual-task decrement when performing a physical task with a concurrent memory task, in order to examine the implications of dual-task performance for physiotherapy practice.

Design

A quasi-experimental design was chosen consisting of three trials. Each participant completed one set of three trials. The trials consisted of one single-task physical test, one single-task memory test and the dual-task condition.

Participants

The sample consisted of twenty-five female participants, aged 20-37 years (mean age 25.0 ± 3.9 years), who were recruited incidentally. Inclusion criteria included self-declared right-handedness with no recent upper limb neuromusculoskeletal injury or disease.

Interventions

Force data were collected for the right elbow flexors during a sustained isometric maximal voluntary contraction.

Main outcome measures

Force, recorded as Newtons using a strain gauge, and the results of a memory test.

Results

Under dual-task conditions both force production and memory recall were significantly impaired (P < 0.01). The mean force in the dual task was 91.3 N (95% confidence interval 81.1 to 101.5 N). The mean number of words recalled in the group who learnt the words in the dual task was 7.3 (95% confidence interval 6.1 to 8.4) and the mean number of words in the group who recalled the words in the dual task was 9.6 (95% confidence interval 8.1 to 11.1). The average decrement in force and number of words recalled was similar for both (∼16%). This may be a result of sharing of a limited attention capacity between the two tasks.

Conclusions

Results may have important implications for physiotherapy practice in suggesting that patients should not be subjected to an overload of cognitive information whilst trying to achieve maximal strength gains during a rehabilitation programme.