Evaluation of the PROMIS pediatric global health scale (PGH-7) in children with asthma

Objective: To evaluate the reliability and validity of the PROMIS Pediatric Global Health scale, a 7-item measure of perceived physical, mental, and social health, in children with asthma. Methods: From February 2014 to February 2015, convenience samples of 8–17 year-old children (n = 182) and parents of 5–17 year-old children (n = 328) visiting an emergency department for treatment of asthma were enrolled. The Asthma Control Test was used to characterize children as controlled versus not controlled, and the PROMIS Asthma Impact Scale was used to assess asthma symptoms' impact on functional status. We conducted longitudinal analyses among 92 children and 218 parents at 3 weeks, and 74 children and 171 parents at 8 weeks after enrollment. Results: The PGH-7 reliability ranged from 0.66 to 0.81 for child-report and 0.76 to 0.82 for parent-proxy. In cross-sectional analyses, children with controlled asthma had PGH-7 scores 0.40–0.95 standard deviation units higher than those who were uncontrolled. The PGH-7 was responsive to changes in overall general health between time points, with moderate effect sizes (0.5–0.6 standard deviation units). In longitudinal analyses, PGH-7 scores were no different between those who stayed uncontrolled versus became controlled at 3 weeks of follow-up; however, by 8 weeks of follow-up, the differences between these groups were 0.7–0.8 standard deviation units, indicative of large effects. Conclusions: The PGH-7 is a reliable and valid patient-reported outcome for assessing general health among children with asthma. It is a useful complement to other asthma-specific outcome measures.     

Scaphoid fracture geometrics: an assessment of location and orientation

The location and angle of scaphoid fractures are important attributes which guide management. We used a 3 dimensional scaphoid model, generated from CT scans, to map scaphoid fracture planes. The point at which the fracture plane crossed the central axis of the scaphoid was noted. The angle of the fracture planes with regard to the central axis was also noted. This allowed calculation of the location of the fracture and the angle of the 379 fractures. The mean point of intersection for fractures with the scaphoid axis was 50% along the scaphoid. Sixty percent of all fractures were found around the central 20% of the scaphoid. The mean angle between the scaphoid axis and the fracture plane was 63 degrees). On comparing angle with location, as fractures move away from the scaphoid waist, they become less perpendicular to the scaphoid axis (p?p?p?p?=?.018). There was no link between fracture plane angles and age, sex and union status. Most fractures occur at the centre of the scaphoid. There is a link between the location and angle of scaphoid fractures. It also identifies older patients and males are more likely to have more proximal scaphoid fractures.     

Phase I dose-escalation trial of the oral AKT inhibitor uprosertib in combination with the oral MEK1/MEK2 inhibitor trametinib in patients with solid tumors

This study aimed to determine the safety, tolerability, and recommended phase II doses of trametinib plus uprosertib (GSK2141795) in patients with solid tumors likely to be sensitive to MEK and/or AKT inhibition. This was a phase I, open-label, dose-escalation, and dose-expansion study in patients with triple-negative breast cancer or BRAF-wild type advanced melanoma. The primary outcome of the expansion study was investigator-assessed response. Among 126 enrolled patients, 63 received continuous oral daily dosing of trametinib and uprosertib, 29 received various alternative dosing schedules, and 34 were enrolled into expansion cohorts. Doses tested in the expansion cohort were trametinib 1.5 mg once daily (QD) + uprosertib 50 mg QD. Adverse events (AEs) were consistent with those reported in monotherapy studies but occurred at lower doses and with greater severity. Diarrhea was the most common dose-limiting toxicity; diarrhea and rash were particularly difficult to tolerate. Overall, 59% and 6% of patients reported AEs with a maximum severity of grade 3 and 4, respectively. Poor tolerability prevented adequate delivery of uprosertib with trametinib at a concentration predicted to have clinical activity. The study was terminated early based on futility in the continuous-dosing expansion cohorts and a lack of pharmacological or therapeutic advantage with intermittent dosing. The objective response rate was < 5% (1 complete response, 5 partial responses). Continuous and intermittent dosing of trametinib in combination with uprosertib was not tolerated, and minimal clinical activity was observed in all schedules tested.     

Five-year Long-term Outcomes of Stereotactic Body Radiation Therapy for Operable Versus Medically Inoperable Stage I Non–small-cell Lung Cancer: Analysis by Operability,Fractionation Regimen,Tumor Size,and Tumor Location

Background

Stereotactic body radiation therapy (SBRT) is standard for medically inoperable stage I non–small-cell lung cancer (NSCLC) and is emerging as a surgical alternative in operable patients. However, limited long-term outcomes data exist, particularly according to operability. We hypothesized long-term local control (LC) and cancer-specific survival (CSS) would not differ by fractionation schedule, tumor size or location, or operability status, but overall survival (OS) would be higher for operable patients.

Association of Target Volume Margins With Locoregional Control and Acute Toxicities for Non-small cell lung cancer Treated With Concurrent Chemoradiation Therapy

Purpose

This study aimed to investigate the association between target volume margins and clinical outcomes for patients with inoperable non-small cell lung cancer (NSCLC) treated with concurrent chemoradiation therapy.

Capacity to Provide Geriatric Specialty Care for Older Adults in Community Oncology Practices

BackgroundAmerican Society of Clinical Oncology guidelines recommend that patients ≥65 years of age starting chemotherapy undergo a geriatric assessment (GA) to inform and guide management; however, little is known about resources available in community oncology practices to implement these guidelines and to facilitate geriatric oncology research.Materials and MethodsOncology practices within the National Cancer Institute Community Oncology Research Program (NCORP) were electronically surveyed in 2017 regarding the availability of specialty providers, supportive services, and practice characteristics, as part of a larger survey of cancer care delivery research capacity.ResultsOf the 943 NCORP practices, 504 (54%) responded to the survey, representing 210 practice groups. The median new cancer cases per year ≥65 years of age was 457 (interquartile range 227–939). Of respondents, only 2.0% of practices had a fellowship‐trained geriatric oncologist on staff. Geriatricians were available for consultation or comanagement at 37% of sites, and of those, only 13% had availability within the oncology clinic (5% of overall). Practice size of ≥1,000 new adult cancer cases (ages ≥18) per year was associated with higher odds (1.81, confidence interval 1.02–3.23) of geriatrician availability. Other multidisciplinary care professionals that could support GA were variably available onsite: social worker (84%), nurse navigator (81%), pharmacist (77%), dietician (71%), rehabilitative medicine (57%), psychologist (42%), and psychiatrist (37%).ConclusionOnly a third of community oncology practices have access to a geriatrician within their group and only 5% of community sites have access within the oncology clinic. Use of primarily self‐administered GA tools that direct referrals to available services may be an effective implementation strategy for guideline‐based care.Implications for PracticeOnly a minority of community oncology practices in the U.S. have access to geriatric specialty care. Developing models of care that use patient‐reported measures and/or other geriatric screening tools to assess and guide interventions in older adults, rather than geriatric consultations, are likely the most practical methods to improve the care of this vulnerable population.     

Critical self-reflection for nurse educators: Now more than ever!

The dynamic healthcare world and increased demands on nurses call for a parallel shift in nursing education that is optimally geared toward effectiveness. Just as student nurses are taught to reflect on their practice to effectively meet clients’ needs, educators also need to be well versed in self-reflection to enhance their teaching methods. Self-reflection is the deliberate consideration of experiences, which when guided by the literature helps an individual gain insight and improve practice. Educators should not only opt for personal reflection but should also seek the views of their students and peers. Self-reflection becomes critical when it goes beyond mere reflection, questioning teaching assumptions, and addressing their social and political context. Given the remarked benefits of using self-reflection in education, and the current COVID-19 global repercussions which have urged faculties to try alternative methods of teaching, a concise guide to self-reflection is hereby provided for use by nurse educators.