Substantial Volume Changes and Plan Adaptations During Preoperative Radiation Therapy in Extremity Soft Tissue Sarcoma Patients

Purpose

Many authors suggest that extremity soft tissue sarcomas (ESTS) do not change significantly in size during preoperative radiation therapy (RT). This cone beam computed tomography study investigates the justification to deliver the entire course with 1 initial RT plan by observing anatomic changes during RT.

Primary Care Physician Attitudes and Intentions Toward the Use of HIV Pre-exposure Prophylaxis in Adolescents in One Metropolitan Region

Purpose

Understanding the attitudes of physicians toward the use of pre-exposure prophylaxis (PrEP) for HIV prevention among youth is critical to improving access to PrEP. We examined PrEP-related attitudes among physicians who provide primary care to 13- to 21-year-old adolescents.

中药调节黏膜免疫系统用于防治COVID-19的思路探索

机体免疫功能低下患者,极易出现新型冠状病毒感染,与中医所说正气不足、邪毒侵扰一致。目前集中在抗病毒药物研发是必须的,但对于调节机体免疫系统制剂的研究也较为迫切。黏膜组织是人体免疫系统的一道重要屏障,具有独特功能和结构的独立免疫体系,是机体抵抗感染的第一道防线,与外界抗原(比如食物、共生菌、病毒等)直接接触。其在抵抗病毒、抗感染方面,黏膜免疫(如呼吸道黏膜、肠道黏膜等)起着极其重要的作用,可以消灭外来病原微生物或其他外来抗原,不至于病毒侵入机体组织而对机体造成损伤。中药通过黏膜免疫系统发挥治疗作用的研究报道日益增多,该文拟针对黏膜免疫系统与新型冠状病毒肺炎(COVID-19)的关系以及中药的干预机制展开探讨,以期为COVID-19的防治提供可借鉴的研究方法与治疗思路。     

Radiothérapie en conditions stéréotaxiques : étude prospective évaluant la fatigue et la qualité de vie

PurposeTo evaluate prospectively asthenia and the quality of life in patients treated by stereotactic body irradiation and to determine their predictive factors.Methods and materialsQuality of life was assessed by the EORTC QLQ-C30 and asthenia was evaluated with the Brief Fatigue Inventory (BFI), on the first day (T1), last day (T2) and 1–3 weeks after the end of treatment (T3).ResultsSixty-three patients were treated with stereotactic body irradiation from February 2017 to May 2017 and 41 were included in the analysis (22 patients excluded for lack of understanding, organization, psychologic disorders or refusal). The mean number of fractions was 5 (± 2). The compliance to quality of life assessment was 98%, 95% was 81% at T1, T2 and T3, respectively. An increase of asthenia and a worsened quality of life were found in 12 (29%) and 14 (34%) patients between T1 and T2. Univariate analysis demonstrated a correlation between asthenia and quality of life were correlated with performans status (P = 0.03 and 0.05 respectively), hemoglobin level (p = 0.01 and 0.004), albumin level (P = 0.01 and 0.06), distance between home and radiotherapy department (P = 0.05 and 0.02). Multivariate analysis demonstrated a correlation between female gender (P = 0.012), albumin level (P < 0.001), distance over 25 km (P < 0.001) with asthenia, and albumin level (P = 0.003), hemoglobin level (P = 0.004) and previous chemotherapy (P = 0.003) with quality of life. No influence of stereotactic body ratiotherapy parameters was seen.ConclusionDespite hypofractionation, stereotactic body radiotherapy induced asthenia and deterioration of quality of life.     

The journeys of three ASPIRE winning medical schools toward excellence in student assessment

Abstract

Introduction: ASPIRE Excellence Awards in Student Assessment are offered to medical schools with innovative and comprehensive assessment programmes adjudged by international experts, using evidence-based criteria.

The journeys of three ASPIRE-winning medical schools toward “assessment excellence” are presented. These schools include Aga Khan University Medical College (AKU-MC), Pakistan, Southern Illinois University School of Medicine (SIUSOM), USA, and University of Leeds School of Medicine, UK.

Methods: The unfolding journeys highlighting achievements, innovations, and essential components of each assessment programme were compared to identify differences and commonalities.

Results: Cultural contextual differences included developed-versus-developing country, east-west, type of regulatory bodies, and institutional-versus-national certifying/licensing examinations, which influence curricula and assessments.

In all, 12 essential commonalities were found: alignment with institutional vision; sustained assessment leadership; stakeholder engagement; communication between curriculum and assessment; assessment-for-learning and feedback; longitudinal student profiling of outcome achievement; assessment rigor and robustness; 360° feedback from-and-to assessment; continuous enrichment through rigorous quality assurance; societal sensitivity; influencing others; and a “wow factor.”

Conclusions: Although the journeys of the three medical schools were undertaken in different cultural contexts, similar core components highlight strong foundations in student assessment. The journeys continue as assessment programmes remain dynamic and measurement science expands. This article may be helpful to other institutions pursuing excellence in assessment.     

A review of interprofessional training wards: Enhancing student learning and patient outcomes

Background: In an interprofessional training ward (ITW), students from different health professions collaboratively perform patient care with the goal of improving patient care. In the past two decades, ITWs have been established world-wide and studies have investigated their benefits. We aimed to compare ITWs with respect to their logistics, interprofessional learning outcomes and patient outcomes.

Methods: We explored PubMed, CINAHL, Web of Science and EMBASE (1990–June 2017) and included articles focusing on interprofessional, in-patient training wards with student teams of medical and other health professions students. Two independent reviewers screened studies for eligibility and extracted data.

Results: Thirty-seven articles from twelve different institutions with ITWs were included. ITWs world-wide are organized similarly with groups of 2–12 students (i.e. medical, nursing, physiotherapy, occupational therapy, and pharmacy) being involved in patient care, usually for a period of two weeks. However, the type of clinical ward and the way supervisors are trained differ.

Conclusions: ITWs show promising results in short-term student learning outcomes and patient satisfaction rates. Future ITW studies should measure students’ long-term interprofessional competencies using standardized tools. Furthermore, a research focus on the impact of ITWs on patient satisfaction and relevant patient care outcomes is important.     

The role of “improv” in health professional learning: A scoping review

Background: The use of improvizational theater (“improv”) in health professional education (“medical improv”) is an emerging field. However, optimal curricular design features and learning outcomes have not yet been systematically described.

Objective: To synthesize evidence on learning outcomes and curricular design elements of improvizational theater training in health professions education.

Methods: A literature search with keywords “Improv” and “Improvisational Theatre” was undertaken in January 2016 in Ovid MEDLINE, CINHAL, EMBASE, SCOPUS, Web of Science, and ERIC, with an accompanying gray literature search. Four authors coded and achieved consensus on themes relating to curricular design elements and learning outcomes, which were mapped onto the CanMEDS framework.

Results: Seven articles met inclusion criteria. Key curricular design features included (i) facilitators with dual clinical and theater expertise; (ii) creating a low-stakes environment; and (iii) engaging in debrief to highlight clinical relevance. Improv curricula were found to impact most CanMEDS roles, including: Medical Expert (comfort with uncertainty); Leader (team management); Scholar (feedback, self-reflection); Communicator (empathy, active listening, non-verbal communication); Collaborator (culture of trust); and Professional (resiliency and confidence). Mechanisms by which improv may promote acquisition of these professional competencies, and the utility of improv in areas such as interprofessional team development, leadership, and wellness and resiliency are discussed.